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Posts from the ‘Robot Life’ Category

Binge-Watching Causes Low Blood Sugars.

Dead Poet’s Society.  It might be a film from 1989, but it remains one of my favorites largely in part to Josh Charles as Knox Overstreet.

(He doesn’t care that Chris is with Chet.  Carpe diem!  And there’s a point to this – stick with me.)

Chris and I don’t watch a lot of television, but we have been swept up in the whole binge-watching phenomenon afforded by outlets like iTunes, Netflix, and Amazon Prime.  Even though we were late in getting into Breaking Bad, we caught up last year in a hurry just in time to immerse ourselves into the broadcast of the second half of season five (technology, bitch!)  We didn’t watch The Wire when it was originally broadcasted, but we did rip through five seasons of that show in a hurry.  And we finished True Detective last night (even though I will admit that I didn’t catch everything everyone was saying because the mumbling was oh my).  Binge!!

But we don’t watch every show together. The Good Wife, which I’ve just recently started watching while doing longer, steady cardio workouts at the gym, is my go-to show to watch solo.  Which brings us back to Knox Overstreet, because he’s a lead character in The Good Wife.  And for at least 40 minutes every day, for the last two weeks or so, good ol’ Knox has been helping me earn my steps for the day.

Last week, though, I made the mistake of trying to binge-watch at the gym and mistakenly lost track of time and blood sugars.  Instead of taking a peek at my Dexcom every ten minutes or so, I totally spaced.  Which meant that I did an hour of walking/running “blinded.”  I should have checked my blood sugar.  Instead, I walked to the car in a staggered pattern, not unlike Billy from Family Circus, unlocking the car door and haphazardly throwing all my junk onto the passenger seat while simultaneously fumbling for my glucose meter.

“Yes, I’m sure you’re right,” in response to the triple BEEP BEEP BEEP! of my Dexcom receiver, throwing rage from inside my gym bag.  My glucose meter confirmed the tri-beep with a blood sugar of 33 mg/dL.

It’s funny (not really) how the symptoms are dammed up until I see the number, and then once I am aware of my actual blood sugar, the dam gives and hot damn, panic hits.  My car, for a brief moment, looked like I let a glucose tab dust genie loose from its lamp as I worked through five glucose tabs.  I sat and waited until the feeling came back to my lips and my hands stopped shaking, then checked my blood sugar again to make sure I was okay enough to drive home.

The lesson learned?  If I’m going to spend more than my fair share of time watching Knox Overstreet woo Nurse Carol Hathaway, I need to watch my Dexcom graph closely.  Binge-watching is apparently the leading cause of Sparling low blood sugars.

 

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!!

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.

Hypo Unawareness.

There are times when I think that maybe my hypoglycemia unawareness is made up, or all in my mind, or that it’s overblown and exaggerated.  “Pfffft, you can go without a Dexcom for a few hours, because you’ll totally feel any lows that crop up,” is the mantra that runs through my head when I pull a sensor off and see scaly skin, knowing I should wait before even going near the skin with another sensor.  (The Dexcom adhesive/sensor rash isn’t entirely better, but mostly better. The Toughpad underneath the sensor holds it for at least seven days, and more often than not, I’m able to go approximately ten days per sensor.)

But the thing is, I shouldn’t let things go that long.  I should be pulling the sensors at the seven day mark, to avoid mangling my skin and forcing myself into brief CGM hiatuses.

I tend to wear my sensors in the same region of my body (outer thigh), where there is enough real estate to work with, but not enough to work with exclusively.  The time between sensor reapplications, whether it’s a week or more, isn’t enough time for my skin to fully heal.  Sometimes a skin reaction doesn’t occur and the skin that was trapped underneath the Toughpad for a week is still unmarked and supple, so I can stick another sensor in whenever I’m ready.  Usually, regardless of how the skin looks when I pull off a sensor, I rotate to the other thigh and try to pick a different insertion spot, just to keep things on the up and up.  And sometimes, even when the skin looks good after I pull a site, it sometimes turns red, prickly, bumpy, and scaly a day or two afterwards, and remains scaly for several days.  (I apply this Curel lotion to my scaly skin and it helps quite a bit.)


I have trouble – lots of it – pulling a sensor off simply because it’s hit the seven day mark.  If that sensor is stuck, and the results are good, I want to leave it on as long as possible.  I feel like the longer a sensor is on, the more accurate and precise it becomes.  Days 8, 9, and 10 are always spot-on and I feel confident in the results because they not only match up with my meter for spot-checks, but they consistently match up.  Seeing more than a 15 point spread between my Dexcom number and my blood sugar meter check is a rarity in those date ranges.

Frustrating, to say the least, to pull of a sensor that seems to be working just effing fine, thank you very much.

I need to take better care of my sites, because for every long sensor shelf (leg?) life, I’m paying for it on the other side with scaly, un-useable skin.  Which equals out to needing to let the sites breathe for even 18 hours or so every few weeks.

Which ends up resulting in moments like this today:  Sitting in the parking lot at the bank, chewing and swallowing glucose tabs as fast as I can because the blood sugar of 41 mg/dL came out of no where and the only reason I even tested my blood sugar before driving home was because Birdy asked me if she could have a snack and I wanted to have a snack, too.  I had no idea my blood sugar was tanking.  Even in retrospect, the only symptom I had was a clumsy fumble for my meter in my purse, but I initially blamed the fumbles on cold hands.

I chomped the hell out of those glucose tabs – not out of shaky, panicky hypoglycemic symptoms, but the lack thereof.

 

Airplane Mode.

When it comes to traveling by airplane, I follow all of the rules (if you don’t turn off your cell phone when it’s time to take off, I’m the one shooting you panicked looks, which is how my face remains for the duration of the flight).  Until we’re up in the air, I leave my Dexcom receiver fully shut down and when I was using the Ping meter, I kept the RF (radio frequency, aka the automagic shuttling of blood sugars from my meter to my pump) shut off.

imagine my delight when I finally figured out that pressing the button on the side of my Verio Sync twice in rapid succession would put my meter into airplane mode!  (IMAGINE IT!!!)

(But did I test in my seat on the airplane?  I’ll never tell.  ;) )

Close, but(t) not close enough.

“My mom?  She has brown hair and a red shirt,” said my daughter’s playgroup friend, climbing up the jungle gym.

“My mom is over there.  She has a pump in her butt,” my daughter pointed towards me and waved, causing me to quickly answer the look of surprise on the other parents’ faces with a brief, panicked explanation of the insulin pump connected to the top of my left hip.

 

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