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Posts tagged ‘blood sugars’

The No Good (Sort of Good) Food Diary.

It was easy to avoid food logging because, on the whole, my blood sugars aren’t a disaster.  I bolus for the foods I’m eating, and I don’t graze much so stacking insulin doses isn’t as much of a problem as it has been in the past.  But the other night, when 9 pm rolled around and I was asking Birdy for the fifth time why she isn’t ever tired ever, I realized I’d had six cups of coffee that day.  Technically, it may have been seven cups of coffee, because one of them was an iced coffee and those don’t follow any rational serving size.  And I couldn’t remember if I had eaten more than a handful of almonds as a snack earlier in the day, and did I end up actually sharing a doughnut with Birdy at the coffee shop, and I know I had a wrap sandwich at some point but some grapes ended up in the mix somewhere and where the hell did that glass of wine come from??

My schedule throughout the day doesn’t afford for much consistency.  Each day is pretty different from the previous one, and sticking with a set schedule is challenging on the days when I’m both working and playing with Birdzone.  Not that it can’t be done, but it isn’t usually done.  I’m becoming more scatterbrained as time goes on, to the point where I am actively forcing myself to take certain actions in order to reclaim and make sense of my days.

Which is why I decided to start logging food for a week or two, because it’s clear that I have absolutely no frigging idea what’s actually happening each day.  (I’m using MyFitnessPal for the time being, until it frustrates me and I revert back to keeping a list in my bottomless basin of a purse.)

I don’t like it, though.  It’s a level of accountability I don’t joyously embrace.  (“YAY!!  Writing down everything I’m eating?  So that I’m now tracking blood sugars and exercise AND food intake so that I can feel both powerfully informed and terribly guilty about every single choice I’m making all day long?  OH YAY!!!”)  I don’t like having to be honest and log that, yes, I ate chicken and green beans for dinner but yes, I also went berserk and had a big, fat slice of banana bread for no reason.  I don’t like looking at the food log and noting that less-than-healthy food choices really toss the calorie count for the day up into the air and then out the window.  I don’t like logging anything (read: blood sugars), and keeping a food diary is no exception to my pre-established log loathing.

But … big, reluctant sigh … it’s useful.  (bah.)

After only a day of logging foods, I realized that my coffee intake is abysmal.  Way too much.  Blood sugars don’t seem to care, but the caffeine influx makes for trouble sleeping, and I’m in no position to sacrifice sleep.  After three days of logging foods, I realized that my willpower and organizational skills are top notch in the morning and afternoon, but around 7 pm at night, I lose control over what I’m thinking/doing/eating and I consume most of my unneeded calories at night.  And while I don’t like writing down every healthy (and otherwise) decision I make during the day, the food diary does hold me accountable for my actions.

Fine. I’ll curmudgeonly accept that logging foods for a week or two is useful.

I’m already looking forward to stopping the food logging in a few days, but I know it’s a good way to realign my brain, and my schedule … and my stomach. I have already seen for myself that there are choices I can improve and decisions I can pat myself on the back for. And it’s confirmed, officially, that I drink way too much effing coffee.

Guest Post: How the MiniMed 530G Changed My Diabetes Management (Without Ever Even Seeing it in Person)

SUM is being borrowed today by Christopher Angell, fellow PWD and creator of GlucoLift, so that he can share his thoughts on the Minimed 530G … without having ever seen or used the system.  What is he on about?  Find out …

*   *   *

Leading up to the launch of the Medtronic 530G (and what a long lead-up it was) I kept asking myself “What’s the big deal?” It seemed like, apart from a new sensor (which some data had already shown to be a minimal improvement over their previous sensor, and a far cry from the already-extant Dexcom G4 Platinum) the only real innovation was the introduction of the low glucose suspend (LGS) feature, which shuts off insulin delivery after a series of alarms alerting the user about low blood sugar are ignored. “How useful could that possibly be?” I wondered.

We’re constantly told that, because of the action curve of our rapid acting insulins, changes in pump basal delivery should be calculated for events 30-60 minutes in the future. So how does shutting off my basal drip help me if I’m crashing NOW?

Still, my curiosity got the better of me.

Now, I don’t use a Medtronic pump (Tandem t:slim), or a Medtronic CGM (Dexcom G4), and I don’t even get all of my basal insulin from my pump (my current split is about 57% from my pump and 43% from a single bedtime Lantus injection). So my experience is probably in no way directly comparable to what someone using the Medtronic system would experience. Nonetheless, I started experimenting with what I’ll call MLGS (manual low glucose suspend). I didn’t use it for all of my lows, but there are a couple situations where I’ve found it to be rather useful.

The first is where my bolus and my food may be correctly matched, but are out of step. For example, say I bolused for a meal that’s mostly protein, fat, and some slower carbs, like a steak with sides of spinach and broccoli. Then after the meal, I notice a slow dip on my Dexcom, but I KNOW that once the meal starts digesting, there will be plenty of food to give the insulin I have on board something to do.

Previously, I would have eaten one or two proactive glucose tablets to keep the insulin busy while the steak and veggies get over their stage fright. Now, I’ll just unhook my pump, or set a temp rate of 0 units for 15-30 minutes. And as long as I didn’t way over-bolus, that dip tends to reverse on its own, and I’ve managed to avoid unwanted, unnecessary carbs (delicious though they may be). This is especially useful if I’ve eaten a late dinner, and don’t notice the dip until after I’ve brushed my teeth. I can still get into bed, unhook, and read until I see the CGM line flatten out, then hook back up, without re-fouling my pristine pearly whites.

The other situation where I find myself implementing MLGS is with my serious, all-hands-on-deck lows. You know, the ones where every second spared from their depths means less of a hangover, and more of my day returned to my control. There are two caveats to using MLGS with this type of low. The first is that, since I’m not at my most functional when these lows hit, I’m more likely to use the “unhook the pump” method than the “very responsibly set a temp rate” method. This means that it’s very important to remember to re-attach my pump after I turn the corner on the low. The second is that since disconnecting, even for a little while, leaves me more vulnerable to a rebound high, I always treat these lows with glucose tablets, as opposed to my fridge-clearing binges of yore. I know when I’ve eaten enough glucose to right the ship, but I have to be disciplined enough to trust it and not pile another 50g of future disaster carbs on top.

When I do those two things successfully, my bad lows feel less bad, and I seem to recover from them faster. Can I measure/prove this? No. Do I care? Not really. If it feels to me like it’s working, and I believe it’s an improvement, then it kind of is, even without hard data to verify or explain it.

So even though I’ve never used the new Medtronic MiniMed 530G, or even seen one in person (as far as I know), it has nonetheless made a positive contribution to my diabetes management toolkit, which, when you think about it, is pretty impressive.

*   *   *

Christopher Angell is the founder of GlucoLift glucose tabs (I have a stash of them in my cabinet, and they are so much better than your average glucose tab) and a good friend, diagnosed with type 1 diabetes at the age of 30.  He’s contributed here before, exploring the t:slim insulin pump and both travel and dental woes.  For more from Chris, you can check out the GlucoLift company blog.  To taste test GlucoLift glucose tabs for yourself, you can purchase them from their online store, or write to caring@glucolift.com for samples.  Tell ‘em Loopy sent you.

Endless Lows.

I do not know what makes them stick like this, the lows that creep in and stay creepy for hours at a time.

“Is this thing serious?” I asked.  Then I’d prick my finger to confirm that, indeed the Dexcom was serious, and I was in fact still low.

There are times when high blood sugars are stubborn and refuse to come down, even when I rage bolus and exercise.  But I can tolerate a sticky high because, even though it’s not comfortable, I can still function properly-ish.

The endless lows, though, work me over in a way that’s entirely different.  Last night, I came home from the gym with a downward drop in my Dexcom, and it lasted for two and a half hours.  Which meant that, for two and a half hours, I had a combination of numb lips/tongue, shaky hands, mental fogginess, and that urge to cry without reason.  I had to constantly tell my daughter, “I just need a few more minutes, because my blood sugar is low.”  I was thankful that Chris was home to help me negotiate parenting stuff/reminding me to eat something else.

What makes this happen?  How can I chomp down ten glucose tabs and a banana and some applesauce over the course of three hours and barely see a blood sugar budge?  It took over a 150 carbs to make a dent (And that dent peaked up to 200 and then promptly fell again.  What the eff?).

“What are you now?” Chris asked before bed.

“202.  And I’m fine with that,” I replied with finally-not-numb-lips-and-a-shirt-collar-dusted-with-glucose-tabs.

If I Knew Then: Continuous Glucose Monitoring – Dexcom.

I tried my first CGM system back in 2006 (this post outlines the very first awkward sensor application) and have spent the last seven years or so being thankful that this technology exists.  If I knew then what I know now … actually, I started on a CGM as quickly as I could, and stayed on it.  Why I wanted a CGM is an easy question to answer, but there are a few things I wish I had known before starting out:

I wish I had known that some of the sensors would hurt.  So many diabetes devices are branded with “pain-free!” and “barely feel it!” advertising taglines, which I think is crap.  We’re talking about a needle that pierces your skin and leaves a wire behind, underneath your skin, for a week at a time.  To think that every sensor will glide under your skin with barely a whisper is bullshit.  Some of the sensors hurt like hell when they go through my skin, and sometimes it takes an hour, or a day, for the site to settle down and not feel so tender.  But most often, it is a reasonably quick pinch and then reasonably painless for the duration of the wear.  Your mileage may vary with each and every sensor.

I wish I had known the data would be addictive at first.  The first time I wore a Dexcom sensor, it was back in 2006 and was one of the first marketed versions of the system.  But I was hooked on the data.  I looked at the receiver every five minutes and went bonkers trying to make sense of the trends.  The trouble was that the readings were far less accurate back on the Dexcom STS, but I took them as seriously as the numbers on my glucose meter.  For the first few weeks of wearing the Dexcom, I drowned in data, obsessively checking it and chasing slight blood sugar climbs with aggressive correction boluses.  I needed to learn to let the data flow into my management, not change the flow of my management.

I wish I had known I would go through a data burnout – and that’s okay.  After I gave birth to my daughter, I went through some post-pregnancy burnout (adjusting to motherhood put my diabetes on the back burner for a few months) and for several weeks, the Dexcom was used to monitor my overnights (watching for lows), but not much else.  I wasn’t in a mental state to micro-manage my numbers, and instead I needed the Dexcom graph to confirm that I was at a stable enough blood sugar to take care of my kid.  The data was too much at times, and I frequently turned off the high alarm because it BEEP!ed relentlessly.

I wish I had known that thresholds were individual choices.  Everyone manages their diabetes in a different way, and even one, single person can have varying styles and preferences.  For a few years, I wanted to see my blood sugars between 60 – 220 mg/dL.  When I needed/wanted tighter management (pre-pregnancy and pregnancy), my thresholds were between  60 – 140 mg/dL.  And now, I keep my high alarm set at 140 mg/dL.  I like knowing when my blood sugars go over 140 mg/dL because that gives me a chance to head them off at the pass and keep them from climbing into the 180′s and 200′s.  Some people roll their eyes at wide thresholds, while others judge for not having the lines “tight enough.”  Where you set your CGM alarms is a personal decision and one that needs to work for you and your medical team.

I wish I had known, and had been ready to accept, the fact that wearing a second device was going to be a pain in the ass.  I wear my sensor on my outer thigh and the bulge is pretty obvious at times.  When I go running, you can clearly see the outline of the sensor through my running pants (and you can almost read the word “Dexcom” through running tights).  In a more fitted dress, the lump on my thigh is unmistakable.  And sometimes if the sensor is a tough too high or too low, it’s right underneath where the pocket of my jeans sits, making it feel particularly lumpy and awkward.  Of course, there are plenty of times when it’s barely noticeable, if at all.  (And it’s always fun, and a bit cheeky, to talk about “the bulge in my pants.”)

I wish I had known that I would eventually learn to trust the algorithm.  At first, I had to learn how to use my CGM, and I had to let the transmitter “learn” me.  The numbers I saw, when compared to my meter back in 2006, weren’t close, but I needed to understand that the CGM provides trends, not exact blood sugar results.  (The thing doesn’t even test blood sugar, but instead interstitial fluid.  Knowing that, however, still doesn’t make me want to throw all technologies across the room when the meter and the CGM are 100 points apart.)  And even now, using the most recent iteration of the Dexcom system (the G4 Platinum), the results are almost spot-on with my meter, but I need to remind myself to test my blood sugar to confirm how accurate the CGM is now.

I wish I had known that there could be an allergic reaction to the Dexcom sensors, but that it could be managed with someone as simple as a high-tech bandaid.  After spending months dealing with a very volatile rash caused by my skin reacting to the Dexcom sensor adhesive, a reader suggested that I use a Johnson & Johnson Toughpad underneath my sensor.  This simple solution worked to cure my Dexcom rash.

I wish I had known that the information I (hunt and) gather from my Dexcom data has made my diabetes easier to wrangle in.  Sure, the thing alarms all the time and yes, wearing a device isn’t ideal.  But when it wakes me up in the middle of the night because my blood sugar has dipped below 60 mg/dL, or when I can check it before driving and see, with confidence, that my blood sugars are stable before getting behind the wheel?  For me, that makes any and all of the inconveniences worth it.

What did you wish you had known, before trying out a CGM?

Taste Test.

Since it’s December now, I hope it’s okay to revisit a video that includes a festive ol’ tree in the background.  This video is about how awesome coffee is … and why it matters that the order is RIGHT.

(See also:  Now I put my own fake sugar in the cup, instead of playing coffee roulette.)

 

 

Ketchup and Mustard.

Blood sugar excursions are one thing (little trips to the grocery store, short flights to Canada … those sorts of excursions are fine) but the long-haul ones are not okay (BOS -> MEL).  I can deal with a sticky high of 180 or 200 mg/dL without getting fired up, and lows are less frequent these days, so I’m not as irritated by them.  Issues seem weekly rather than daily, which is a lovely change of pace.

Except for yesterday.

Holy shit, Yesterday.  You sucked.

The day began with a low alarm in the morning – not a deep one, but a shallow low, easily managed by turning down my basal rate for 45 minutes and popping one glucose tab.  Before breakfast I was 107 mg/dL.  After breakfast, I was 302 mg/dL.  The eff?  I have a breakfast bolus recorded in my pump, but it clearly didn’t make a dent (either that, or the stress of the morning sent me cruising up into orbit).  My goal of bringing my blood sugar down within a few hours was thwarted by a thorough combination of a bloody infusion set (was that why my breakfast bolus didn’t register?), insulin that may have been borked (my pump cartridge was a potluck of dregs from older bottles), the regular stress of work coupled with exacerbated stress of having a high blood sugar … it was gross.

It wasn’t until about 2 pm that I was back down to the 200′s, and that was after pulling the infusion site and taking an injection.  And it wasn’t until about 3 pm that I saw a number under 100 mg/dL.  Which started the second half of my day, spent trying to bring up a low blood sugar that wanted its own bedroom.  I bounced between highs and lows for hours, not able to properly correct at either end of the spectrum due to a magical combination of user error and pancreas error.

When I looked at my Dexcom graph last night, it was way too much ketchup and mustard (aka “highs and lows”) and not nearly enough time spent in range.

“Damn hamburger Dexcom,” I muttered.

A normal day with diabetes doesn’t wring me out, but yesterday did.  Concentrating on work was really difficult, because my high-brain was too sluggish and too thick to let synapses fire.   Writing was impossible.  Sitting at my desk for more than twenty minutes was impossible because I kept having to take breaks to get more water and then to pee.  (I went for a run and a mile and a half into it, made the wise decision to turn around.  A good idea since, by the time I got back to my car, the need to pee was amazingly all-consuming.  Oh hydration!)  My whole body felt like it was submerged in Jell-O, and I tried to swim through it for the majority of the morning.  Instead of making beds/doing laundry/cleaning dishes/writing/answering emails/phone calls, I wanted to climb into bed and sleep off the blood sugar hangover, but that wasn’t an option.  Life doesn’t wait for diabetes.

I made lots of mistakes yesterday – should have pulled the site/taken an injection earlier, should have assumed my blood sugar would rise more after turning down the basal, should have checked an hour after eating instead of two.  So many things I should have done, or done differently.  But my brain isn’t very clever when it’s on the glucose roller coaster.

Oh yeah, and diabetes.

This morning, my fasting blood sugar was 104 mg/dL, a welcomed change after yesterday’s 398 mg/dL, 42 mg/dL, and all the numbers in between.

“Don’t mock me, you little jerkface,” I said to my meter.

If the frigging thing had a tongue to stick out, it would have.

 

Totally Looks Like: Shark Attack.

I don’t know how to write out the theme for JAWS, but mentally insert that [here] because apparently there was a shark sighting in the wee early morning hours of my basal profile.

Totally looks like we’re gonna need a bigger boat.

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