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Posts from the ‘Pumping Insulin’ Category

So Maybe Don’t ALWAYS Pre-Bolus.

I like to pre-bolus.  It helps keep my post-meal blood sugar spikes from rocketing out of range and taking a sizable bite out of my overall diabetes control.  (… I’m sorry.  I laugh every time I type the word “control.”  It’s not a word I toss around lightly when it comes to diabetes.  I’m not Janet Jackson.)

The art of pre-bolusing has been instrumental in keeping diabetes shit in line.

But it only works when it works.

Last night, we ordered pizza to go along with our birthday cake for Birdzone (we rounded out the meal by eating a stick of butter each and guzzling soda – healthy! – only the butter part is a lie) and the promise was “delivery in 30 minutes.”  Since pizza can be insulin’s kryptonite, I thought it wise to pre-bolus so that the initial carb influx of the pizza would be headed off by the first bolus, and then I’d chase my meal with more insulin to grab the fat-induced-blood-sugar-bump that hits about two hours later.  (I don’t have a #DIYPS, so when my food choices edge towards pizza party, I have to improvise a touch.)

Basic gist?  I took my insulin way too freaking early because the pizza arrived an hour later.

My Dexcom was freaking out by the time the pizza delivery man left – “Kerri, your Dexcom is vibrating like crazy over here, and says you’re low.”  “Like how low?”  “Like spelled out as LOW low.” – so the first piece of pizza was inhaled in a matter of seconds.  The second piece went just as quickly, and then I chased my dinner with a handful of glucose tabs.  (Wildberry – the perfect palette cleanser.)  Pre-bolusing doesn’t always work – its success leans on timing.  My pre-bolus was working right on schedule … if the pizza had arrived on time.  But due to tardy carb arrival, my blood sugar was in the trenches and covered in pepperoni.

“Mawm, is this good pizza?”

“The best!”  I answered her, through a mouthful of glucose tabs.

Think Like a Pancreas: The Blog.

I’ve known Gary for several years, and most of my interactions with him have been silly (confessing that my daughter busts out dance moves to the Philadelphia 76er’s theme song), so I leaned on his website to pull a formal bio description.  “An award-winning Certified Diabetes Educator, Masters-level Exercise Physiologist and person with type-1 diabetes since 1985, Gary Scheiner has dedicated his professional life to improving the lives of people with insulin-dependent diabetes. He was recently named 2014 Diabetes Educator of the year by the American Association of Diabetes Educators.”

Pretty awesome.  And now Gary is bringing his personal experience as a PWD and professional expertise as a CDE into the blogging space, with the Think Like a Pancreas blog.  I wanted to catch up with him about the how, and the why, of making the decision to join the online conversation:

Kerri:  For the few who don’t know your story, what’s your connection to diabetes?

Gary:  I was diagnosed with type-1 diabetes back in the summer of 1985 in a town just outside of Houston, Texas named “Sugarland”.  A coincidence?  I don’t think so.

Kerri:  Makes for a good story, though.  When did you start becoming aware of/involved in the DOC?  What sites were you frequenting back in the day?

Gary:  I was first “introduced” to the DOC by Allison Nimlos (nee Blass) (love that word, nee.  reminds me of the Knights of the Black Forest in Monty Python and the Holy Grail).  I’ve also been friends with Scott Johnson for many years, and anyone who knows Scott has to become connected with diabetes social media.  The first sites I can recall visiting were David Mendosa’s Living With Diabetes, Kelly Close’s diaTribe, Amy Tenderich’s Diabetes Mine, and the Children With Diabetes site (since I’m on their faculty).

Kerri:  So what made you decide to take the leap into social media?  

Gary:  Our national/international clientele are increasingly active on the web.  It seems like the best way to communicate.  Our practice has been publishing a newsletter for nearly 20 years.  It started out as a printed publication called “Control Solutions” which then morphed into an e-publication called “Diabetes Bites”.  However, putting them together was quite labor intensive.  Blogging allows me and all of our Integrated Diabetes Services clinicians to get the word out in a timely and simple manner (better known as “fast” and “cheap”).

Kerri:  What’s weirder:  Blogging or Twitter?

Gary:  It’s hard to get really weird in less than 140 characters.  But both have their place:  Twitter is great for sharing minor snippets of news and experiences.  Like today, I couldn’t believe that TSA at Seattle’s airport was merging people in the pre-check line with people who had no background checks whatsoever, and sending them all through the same minimal security process.  Talk about a major flight risk!  It also makes the pre-screen process a complete waste of time.  Anyway, I was able to share that on twitter – gave me a chance to vent and perhaps raise the ire of people who can do something about it.

Blogging allows us to delve more deeply into items of interest to the diabetes community.  We can offer up a mix of key facts, experiences and personal opinions in a concise and lighthearted way.  My “Sensor vs. Sensor” blog comparing the various CGM systems, for example, has become been a topic of online and live conversation worldwide since it came out last month.

Kerri:  In your blog announcement, you said you wanted to “keep it fresh, informative and unbiased, yet opinionated and entertaining.”  In a pleasantly-saturated market, how do you plan to do that with your site?    

Gary:  You have to remember, our blog team is very unique.  The information is coming from recognized experts – nurses, dietitians, exercise physiologists and mental health professionals who are certified diabetes educators.  There aren’t many bloggers with those kinds of credentials.  All of our clinicians have type 1 diabetes themselves and extensive personal and professional experience with virtually every diabetes medication, product, and form of technology on the market.  And we are not formally affiliated with any pharma company or device manufacturer.  That allows us to KEEP IT REAL and remain UNBIASED and CREDIBLE.  You won’t find that in too many places.

Kerri:  So what are your social media goals?  Looking to change the web? The WORLD?

Gary:  Just want to entertain and inform our little corner of the diabetes world.  Our focus is truly on the type 1 diabetes community, as well as type 2s on intensive insulin therapy who take their diabetes every bit as seriously as those with type 1.  I’ll be very happy if each post can make one person smile, learn something they can apply, or just nod and say “Hey! Now I get it!”

Kerri:  And how can people connect with you? 

Gary:  First off, I have to make a living.  That comes from helping clients meet their diabetes management goals.  Our practice offers individual consulting services all over the world via phone and the internet.  Details are at our website, or people can call our office for more info:  toll-free in North America. 877-735-3648.  Outside North America +1 (610) 642-6055.

We also offer webinars on advanced topics in diabetes self-management at Type 1 University.

Our blog is called “Thinking Like A Pancreas, “named after my favorite diabetes book  – guy who wrote that must be some kind of genius) [Editor's note:  Clever, Gary.  Clever.]  , and it is located right on our website.

Our twitter handle is @Integ_Diabetes

Our facebook page is simply Integrated Diabetes Services

Kerri:  Anything else you’d like to add?

Gary:  When I’m in need of a good laugh, if The Simpsons aren’t on, I can always turn to the Kelly & Kerri shows (@diabetesalish and @sixuntilme).

Kerri:  Thanks, Gary!  Welcome to the blogosphere, and I’m looking forward to seeing how many Simpsons references you can cram into one post.  And if you have trouble adding links to your blog posts, don’t blame me:  I voted for Kodos.

Inset/Outset.

Most of the time (read: every other time except this one), the cannula is laced through the insertion needle on the insets for my insulin pump infusion sets.  But this infusion set was attacked by diabetes gremlins, because the cannula made a run for it before I even opened the spaceship pod:

Insulin pump inset ... er, outset.

Insulin pump inset … er, outset.

Scott, on Facebook, quipped it best:  “It appears that instead of an Inset, they gave you an Outset.”

UPDATED:  I opened the set this morning.  No tubing, either.  Gremlins!!

Insulin Pump Refill: In a Pinch.

Usually, I am a thorough diabetes packer. Extra test strips? Yep. Back-up insulin pen? Yes, again. Glucose tabs? I have a WHOLE JAR and will share them with the plane.

But today, I effed up my routine.

I’m currently en route to Seattle for work and there are 59 units left in my insulin pump.  To last me until Saturday night.  This may not be quite enough.

In my carry-on bag (no checked luggage because I tie my clothes into intricate, teeny pretzel-esque knots before shoving them into my suitcase), I have all of the aforementioned diabetes supplies but I forgot my vial of insulin.

HOW?  I’m usually so fastidious!  Ish!

Normally, I open a bottle of insulin and work my way through it over the course of however many weeks. While I’m using it, it sits in a makeup bag in my bathroom, along with some infusion sets and insulin cartridges.  (One stop shopping – just reach my hand in and I come out with everything I need to do a site change.  Convenient, especially if Birdzone is waiting [im]patiently for me.)  Once the bottle is kicked, I throw it away and crack open a new one.  (Not literally, though it has happened.)

Whoops on that last part because I forgot to grab a new bottle and add it to the bag when I last filled up my pump. And in the wee early morning hours today as I left for the airport, I totally forgot to get a new bottle.

So now I’m flying across the country with a half-filled insulin pump and only an insulin pen in my bag.  Stupid forgetting things brain.

insulin pump refill

Thankfully, there are some MacGyver‘ing options available to me.  I do have a bottle of Levemir and a few syringes that I could use, alongside the pen of Humalog, and I could go off-pumping until I get back home.  But I can also refill the insulin reservoir by pushing the refill needle into the top of the insulin pen, dialing back a bunch of units, and pushing the insulin into the cartridge.  My preference is to remain pumping, so I’ll be knocking out air bubbles aplenty when I do this to refill before flying home.

It’s a messy, make-shift refill, but when you’re far from home and it’s the only option, it’ll do.

Guest Post: A Do-It-Yourself Pancreas System.

Necessity is the mother of invention, and in some cases, that necessity comes with a side of love. My dear friend Dana Lewis (who threatens to wash my mouth out with soap every time I curse) and her amazing boyfriend, Scott Leibrand, have created a “Do It Yourself Pancreas System” that is revolutionizing not only Dana’s diabetes confidence, but potentially changing the landscape of diabetes management for us all.  Does that seem like too-big of a statement?  Read for yourself and see what patient-led innovation can really accomplish.

*   *   *

I took a deep breath, intentionally pulled out my pump, and bolused. He asked if it was a pager and we continued our conversation.

That was our first date, and his first introduction to my diabetes. It wasn’t the big deal that I thought it would be.

On our second date, I hated to drink the toddler sized juicy juice from my coat pocket when walking on the beach before dinner, but that wasn’t a big deal, either. He only asked if it was for low blood sugar.

On our fourth date, when he opened his trunk to grab roller blades, I noticed a Costco-sized box of juice boxes. “I thought they might be good to keep in the car in case you run out of them in your purse,” he said.

The next few months were filled with other surprising moments as Scott started learning about diabetes, not only from me, but also from the DOC. I loved when he started following some of my d-friends on Twitter and saw other perspectives on life with diabetes.

I wasn’t sure what to think about all of this, though – especially because I was falling in love with someone for the first time, and it was with someone who was not only interested in understanding diabetes, but also in helping me find ways to make it easier. 

I joke about using Twitter partially so my family knows I’m alive, but it’s actually pretty true. I had shared with Scott what it was like living by myself and dealing with diabetes at night. I will sleep through any type of CGM alarm, even if I place it in a glass to amplify the audio of the alerts. I talked about wanting someone to be able to look remotely and see if I was alive based on CGM numbers. Scott and I started talking about other things we’d like to do, if only we could get the data off of my CGM in real time.

Then late last year, I stumbled across John Costik on Twitter. He was talking about viewing his son’s CGM data remotely. I emailed Scott saying we should talk to John and build upon what he was doing … and Scott tweeted John before he even responded to my email!

Thanks to John, we were able to upload my CGM data in real time. We created a system that would trigger custom CGM alerts to send to both me and Scott. If I wasn’t responding to CGM alarms and “snoozing” them in the system, Scott could see what my BG was and decide if he needed to call and check on me. If I was responding to alarms, he didn’t need to do anything except send e-hugs for lows.

We added a feature to the system to plug in how much insulin was in my body and how many carbs I had eaten. This enables me to track my BGs after a meal more accurately, and project if I am likely to go high or low. When my BGs come in higher or lower than estimated (for any reason), it shows me how far out of range I am projected to go and what I need to do to fix it (with an additional bolus for a projected high or using temp basals or carbs for an impending low). It also tell me how long I have before I drop below 80, to figure out if I have time to do a temp basal or if carbs are the best option to prevent a low.

We started calling it the “do it yourself pancreas system”, or #DIYPS.

Before #DIYPS, it took more guessing to try to prevent or fix a low without causing a rebound. #DIYPS’s calculations help me reduce the extra carbs I use for lows by allowing me to more precisely use temp basals. It’s also brought my average blood sugar down and reduced total time spent high or low. You can see the difference from before I started using the system, and after, by looking at my 30-day trailing estimated average glucose (eAG).

#DIYPS is especially helpful during those “oh no” (or something that involves soaping your mouth afterward) moments – like when you put in a new pump site and two hours later you get a “no delivery” alarm. I had this happen last week; my BGs were rising suddenly, I supposedly had insulin on board, but in reality my pump hadn’t been able to deliver my basal insulin for the last two hours, and the corrections hadn’t really gone into my body either. I didn’t know if any of the insulin had gone in or how high I was going to rise.

Previously, I would have guessed and hoped for the best. With #DIYPS, I was able to use the system’s constant re-calculation of my data to safely give a big correction bolus to replace the un-delivered basals & boluses from the past two hours, and use it to come down to a safe level. In this case, I managed to level off flat in the mid-90s for the next few hours. Of course, this all had happened after midnight – so the other great benefit of #DIYPS in this situation was feeling like I could go to sleep safely. Even with a lot of insulin on board to correct this who-knows-how-high BG, I could trust #DIYPS to alarm and wake me up if I was projected to go out of range.

You can read more about how #DIYPS works here (and why it’s not an artificial pancreas), and Scott’s perspective on it here. We’re not done, and we’re hoping to partner with folks who are interested in helping us build on the system. But we are not waiting until an artificial pancreas is out on the market to make the quality of life with diabetes better. Right now, the #DIYPS user interface is pretty simple. But, my biased opinion is that it’s incredible – how can it not be when it gives me the peace of mind of being able to sleep safely at night?

#DIYPS – and Scott – have also taught me that just because I can do something myself, doesn’t mean I have to. Yes, I can do all the calculations #DIYPS does, but I don’t have to spend as much time thinking about it now over the course of the day (although I do validate any action I take with my own assessment of my CGM data or BG reading). Reducing the cognitive load of diabetes means I have more time and energy to spend living my life. That’s something else to fall in love with.

*   *   *

Following Dana and Scott’s journey on Twitter via the #DIYPS hashtag, or through Scott’s blog.  (Because Dana does not blog.  She changes the world via Twitter. Although she can be gently asked to guest post, which is why I’m so happy she bit the blogging bullet and shared her story here today.  Thanks, Dana!!  And look – I didn’t curse at ALL through this whole write-up!)

Bloody Cannula. (A Grost.)

This one’s a gross [read: gross post], so viewer beware:

Blood sugars inexplicably in the high 200′s?  Burning sensation when I bolus?  Site uncomfortable to lay on?

Shoulda known.  Sneaky little vampire cannula.

Boop Beep Boop!

BOOP BEEP BOOP!

I lifted the corner of my shirt and inspected my pump, looking for the “low battery” or “low reservoir” alarm splashed across the screen.  Nothing.

I went back to working, throwing my focus back onto the words escaping my hands but then …

BOOP BEEP BOOP!

“The gosh darn?!” I said (or a version of that), lifting my shirt again to steal a glance at my pump screen.  No alarms, no surprises.  Nothing.

Maybe I was losing my mind.  I mean, my Animas pump doesn’t even make the boop beep boop sound  – that was the tune of its predecessor, which had been sitting dormant in my bathroom closet for four years.  And the battery isn’t even in that pump, so how could it possibly be …

BOOP BEEP BOOP!

Again!  I made a cup of coffee and as the water filtered through the grounds, the smell of fresh coffee filled the kitchen and I breathed in deeply, trying to find my mind again and get my brain back to writing mode but …

BOOP BEEP BOOP!

“Chris!  Do you hear that noise?”  I called out.

“What noise?”

“That boop beep booping noise. I keep thinking it’s my pump but it’s not my pump because my pump doesn’t even make that noise but I keep hearing it …” I said, interrupted by the BOOP BEEP BOOP! again.

I went upstairs to my bathroom and foraged through the shelves until I found the box where my old Medtronic pump was hiding out.  No battery in it – its “vulture eye” closed – so no chance of it throwing the boop beep boop but then I heard it again – BOOP BEEP BOOP! – from downstairs.  But why was I hearing the exact same sound?  Had this old pump come back to life somehow?  I was ready to go full-Poe and tear up the planks to find the source of the boop beep booping.

“Chris?  Do you hear that sound coming from downstairs?  Or is it coming from up here?”

“No, I hear it, too!  It’s not your pump?”

“Nope,” I yelled down to him.  “Not my Dexcom, either.  Nothing on my body right now is boop beep booping.  But I keep hearing the – ”

BOOP BEEP BOOP!

“I heard it!”  he yelled.  “It’s coming from down here, in the kitchen!”

Turns out that our new dishwasher, if you open it mid-cycle and forget to restart it, makes the exact same BOOP BEEP BOOP! as my old Medtronic insulin pump.

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