Wednesday, August 6, 2014

Catching up!

I have a train ride to Chicago, and I thought it would be a good time to get caught up on some diabetes blogging. 

I've had a few observations that I've wanted to write about for a while. 

Sleep and blood sugar levels
My previous  experience of blood sugar problems while sleeping was mostly focused on waking up sweaty and hypo. I felt like sleeping with high BG was just poor, unrestful sleep, but not the end of the world. 

Lately, I've been finding that I've had a reversal. If my blood sugar rises to over 170 mg/dL while sleeping it will wake me up, and I can tell my body temp is higher and I will begin to sweat. I usually won't be able to sleep fitfully again till my BG is headed downward. Often I find myself up at 2:30am waiting for a correction to take effect. 

On the other hand, I've also discovered that my best sleep is often when my glucose levels are 60-70 mg/dL. I know it sounds crazy to sleep while teetering on the edge of hypo, but it's really the best sleep ever.

So, I think it's really interesting that my symptoms and sensitivities seem to have changed. I'm curious if any other diabetics have experienced this. How do you rate your sleep at different ends of the BG spectrum?

Sunday, November 17, 2013

Enlite! Oh... wait.


Ever since I heard about Medtronics new CGM Enlite sensor I was excited to get it. It's reportedly tiny, painless, more accurate, with an intended 7 day use. Despite the Dexcom being the favorite choice for long-wear and comfort, I've been waiting for a sensor that has all that, but continues to integrate with my pump. The FDA had been SUPER slow in getting it approved. So, finally a couple weeks ago we got the news that it is approved and immediately available! I called them to get it sent to me, but found out that you have to also have the latest pump with low threshold suspend. So, I have to wait until my warranty period is over (May 2014), before I can get the newest pump and the Enlite sensors. I guess patience is all part of the game. But, I have to say... this timeline is nothing compared to what my sister has experienced in the UK with national healthcare. She was told a couple years ago that she was on a waiting list for a pump, and then hasn't heard a peep since.

In the meantime, I'm using expired sensors because I get much more wear on one than is recommended. I get 7-10 days on a 3 day sensor. They are working just fine. I had to ask M-tronic to stop shipping me sensors (and a bunch of other stuff) till I could get caught up. I probably won't have to get anymore before the Enlites come. The good news is, I'm on a winning streak with the Sofsensors no bleeding or bruising, just moderately painful harpooning. I can live with it till at least May.

Monday, October 21, 2013

Blood sugar mysteries,the good kind...

Back in September, I believe it was 9/9-9/10 or somewhere around there, I got spooked by my glucose levels. For about 36 hours my levels stayed incredibly stable! It was an almost un-diabetic experience. I kept looking at my CGM graph and felt fairly incredulous when I saw that I was still cruising steady at 80 mg/dl. I kept double-checking with my meter because I thought my sensor was going bad. It wasn't, I was literally teetering on the edge of perfect blood sugars no matter what I did. It wasn't just that I was running lower than usual, it was that I was neither rising nor dropping the normal amounts that you expect in the course of a day. I checked my data on the CGM and it showed that I was averaging 76 mg/dl and, (with the 24 hour high being 83 and low being 60) the standard deviation was something insane like 7.

Theories went through my head:
-was my infusion set in a vein, giving me super efficient insulin delivery?
-had my body figured out how to moderate my blood sugar (both high and low) just a tiny bit better?
-was I getting beta cell function back?

I still have no idea what was going on. On the third day or so my I think I sabotaged it and had dessert or something. It was almost like I wanted to make sure everything was still volatile. Party over!

Here's something I can say for sure, the more I aim for good control, I notice that my body becomes accustomed to that regularity, and it becomes easier to achieve it. When things are erratic, they seem to stay that way until I really settle things down with some simple living. It seems like there is some inertia to it, and it goes in cycles. Additionally, one of the major variables that seems to have the most consistent affect on my control is my infusion sites. When they are working well, it's a dream... when they lose their magic, it's obvious, and my blood sugars rise and react sluggishly to insulin.

Thursday, September 12, 2013

Untethered For a Day

When I woke up yesterday with no more Novolog in my pump, I did what any sensible insulin addict would do and took some expired Lantus. How much? To be safe I took 50% of my total daily dose, 18 units. Immediately my levels returned to normal and I felt that twinge in my gut that signals glucose dropping quickly. It was such a distinct sensation that I wondered if Lantus loses it's time-release function and acts quickly when it's old? It leveled off in a comfortable range and I relaxed.

I disconnected my pump, but carried it around all day since it could receive data from my CGM and help me keep tabs on my levels. During the day I had to do corrections of expired Novolog from a pen. They sort of worked... I was able to keep my glucose at or below 200 all day. Due to a busy day and subbing for a colleague, I didn't have lunch, so I was able to skip the mealtime bolus drama. The corrections throughout the day were already keeping me pretty busy. (Meanwhile, in the pharmacy, it was taking them all day to get a hold of my doctor and get me some emergency insulin. Good thing I didn't throw that expired insulin away. )

I picked up some legit Novolog pens, but didn't want to start the pump back up until the Lantus was out of my system. I did have a low after dinner and had to do some snacking to keep things in check. I had been a bit aggressive with corrections since I suspected the Lantus would eventually start to taper off. Of course, overnight my levels started to rise and I was awakened by high blood sugar at 2:30am. I couldn't sleep so I got up, loaded the pump, took a Symlin aided correction and have been up since. I probably will regret not sleeping, but the week is winding down and after lying in bed for an hour, there's no point in staying horizontal.

It was an adventure. I kind of liked being free from tubing for the day, but correcting with Novolog every couple of hours was similar to being tethered to something. I didn't relax about it too much.

I have some blogging to do...

I've been storing up some thoughts, observations and data that I would like to document here. I'm going to make a list to remind myself of the writing I'd like to do.

  • Blood Sugars Mysteries, the good kind... (why do we have a day or two of unbudgeable perfect glucose control?)
  • Off label uses for Symlin
  • My LDL Cholsterol went down (a lot) for the first time in 7 years. Why?
  • My other data from the recent months, not as bad as I thought. 
  • iBGstar Meter on sale, is it worth anything?

Wednesday, September 11, 2013

It might be an interesting day for glucose...

Every time I fill my pump reservoir I hold the wee cylinder of insulin up to the light and say to myself, "I can't believe this tiny little amount of clear liquid is going to keep me alive for the next few days". It's always kind of awesome to realize.

And then, today, I ran out... Like, really ran out! What's going to keep me alive?

I'm feeling a little irresponsible, but I'm also a victim of the random whimsy that is mail order prescription drug service. Usually they ship overnight, and usually they auto-ship. Neither of those happened, and when I got down to about a week of insulin left, I manually ordered my prescriptions. I got a confirmation that my shipment had been shipped and was relieved. Then yesterday, I came across this sad little package on the counter that had some pills in it that I didn't need. "Where's the insulin?" I checked the website and see that all the diabetes related stuff was hung up (no doctor refill response?), and not yet shipped.

Hmmm. In the fridge I have Lantus and Novolog pens, but they expired a year ago (it probably IS irresponsible to not know the status of those). I took some anyway (and Symlin). I know that when stuff expires it often still works, maybe just not as well. I could fill my pump from the Novolog pen, but I don't really want to commit quite yet. What works better 12 months expired Lantus, or 9 months expired Novolog?

I called Walgreens at 5:30 this morning and explained my situation. They are going to try getting in touch with my doctor, and then try to get the insurance to override the insurance limitations and get me some fresh Novolog. Sounds complicated, but I think they've done this before. I'm glad they are 24 hours.

I'm sure I'll learn a lesson from this, I usually do. 

Sunday, June 23, 2013

New meter, again.


I use pretty much whichever meter is integrated with my Medtronic insulin pump. It keeps things simple. First they gave me a B-D Link Meter, then about two years later they switched to One-Touch Ultra Link, and now they are paired up with Bayer. A few months ago they shipped me a Contour USB Next Link. Yep, next is right.

The Next Link is supposed to be more accurate, and it has a USB connector right on it, and works to upload your pump data. So, you don't need another device to upload your stats to the Medtronic CareLink reports website. It's pretty small too.

All that said, I'm not totally flipped over it. There are definitely some things I like about it, but unfortunately the things I don't like about it pop up every time I use it.

Operation:
My old Linked meters used to just send the test results directly to the pump and initiate a conversation about a correction, if needed. This one asks me every time if I want the results to be sent to the pump. Every time... I have to decide. It also asks me upon each test whether this is a before meal test or an after meal test, I always push "no mark" because... I really don't care... (my pump already has all the meal times programmed so I can look at that data later). So, before I can see my darn numbers I have to answer questions, and then I have to tell it to send the results to my pump. I'd love to skip the questions and just get on with it. This is a major weakness with this meter, for me... I've thought that maybe it can be programmed to skip this stuff, but I haven't investigated. (I just did and found that you can either "never send results", or "ask me".)

Okay, other factors... 
  • Despite the meter being small, the case is just as big as other meters have been. This is okay for me, because I always try to keep my Symlin pen with my meter, and it barely fits in the case. 
  • The elastic strap that holds the meter in place is flimsy and cuts right across the middle of the screen. This is weird. 
  • The zipper on the case opens in an unintuitive way so that whenever I unzip it, my meter is upside down. It's like you have to forget all you've ever known about books, left to right, and top to bottom.
Some good things...
  • I like the color screen.
  • The results are quick, once you answer the requisite questions and finish getting annoyed. 
  • The test strip container is big enough for you to get your finger into the container and drag a strip out. I've had a few meters where you had to shake them out.
  • The meter has a rechargeable battery that you can recharge less than once a month by attaching the USB connector to your computer. My other meters only needed batteries about once a year, so this isn't necessarily an upgrade.
  • Accuracy? I tested this meter against my One Touch Ultra Link a few times and didn't find  much of a discrepancy. I think it may just be a reason to get users on board with the change, but in the end it probably isn't that significant, considering that the accuracy standards for meters are rather soft (+/- 10%). The change probably had more to do with business relationships and money than accuracy. Maybe I'm just jaded?
That's what I have on this. I'd be interested in hearing from anyone who has thoughts on this change. And if you know how to make it more convenient to operate, let me know...

Update: After messing around with the settings a bit, I was able to turn off the "before meal/ aftermeal" questions. Now I just have to test and send reading to my pump. It's not as annoying, but still kind of unnecesary.