Something to blog about...

Yesterday around 9am my blood sugar started to climb. It wasn't that unusual, being morning and all. But, when it reached the 200s I started taking aggressive correction boluses, and I kept going with it till I got home from work. By this time it was 418 md/dL and I was feeling pretty lousy. So, I drank a lot of water, skipped dinner, replaced my reservoir, and changed my set.

While changing my set I realized what went wrong. The needle had broken off and insulin was no longer making it into the inside. And the needle? Yep, still inside. I'm going to see if it causes discomfort. I searched online and it doesn't seem like this is a very common problem. I have used these sets for years now and never had any problems with them.

Well, I'm happy to say by 9pm (12 hour tour) I was back to 123 mg/dL and was feeling pretty normal. The unresolved part is that needle that just became part of me. It made me considering taking a break from the pump for the first time in a while...

An unpleasant break in the routine...

On Monday I missed work, and I'm pretty sure it was the first time I've called in sick because of something remotely diabetes related.

During the night on Sunday my glucose level climbed to 350 mg/dL and I was awakened at 3:15am feeling overheated and clammy, and wasn't able to get back to sleep. I tested and took one of the largest boluses I've taken in a while. An hour later I was still in the 300s. Another bolus... and an hour later, with no real progress, I swapped out my infusion set and reservoir. By 5:45 AM I had been over 200 for several hours and was feeling truly lousy. In addition to the normal hyperglycemia symptoms, I was feeling nauseous and had no appetite. I felt like I had the flu. My stomach was gurgling and churning. I called in sick and started crafting my sub plans.
By 7:00am my glucose levels were under 200 mg/dL and I fell asleep. I slept for three hours and woke up feeling much better, with my blood sugar reading 130 mg/dL.

I'm not sure if a stomach bug caused me to go high, or if my infusion set wasn't working properly, but either way my symptoms were both gastrointestinal and high blood sugar. It was unpleasant and I hope to avoid it in the future. It made me realize that I am lucky that these type of complications don't arise more often.

CGM life

I use my continuous glucose monitor ALL the time.

I've found that, when I'm using it, I am more likely to head off rises before they get too high. When I hit 130 mg/dL I bolus and I'm able to turn it around. The days that I have taken a day off are almost always days that I spend more time out of range. All that to say, it's become one of my essential tools for keeping me where I need to be throughout the day. (Notice I didn't say night?)

However... it has caused me some problems too. It wakes up my wife at night. And, it's not to save my life. There are many unnecessary alarms at night, and they don't wake me up. The sound it makes is too high-pitched for me to hear. Carol hears it, and it completely interrupts her sleep. When I say unnecessary alarms, I'm not kidding... Normally the alarms that are waking her/us up are for calibration, low-reservoir, or low battery. It's the kind of stuff that can wait a few hours till morning.

Since these types of alarms are not "live-savers", I've chosen fitful sleep for both of us. A few months ago I discovered the setting called "silence all alerts". It's perfect. I set it for a duration of 8 hours and the thing shuts up completely till I get up in the morning. It's basically saved our co-sleeping marriage. But... I have to remember to do this every night before going to bed, and I  resent it. I feel like I already have enough pre-slumber tasks that I have to remember... take the dog out, lock the doors, turn out the lights, test blood sugar, calibrate the sensor... silence the alerts.

Here's what I think Medtronic should do to get this right:
I need a louder, lower frequency alarm, so that people with high-frequency hearing loss can hear it. The alarm is like a mosquito ring-tone that my kids can hear from the next room, and I can't hear from 2 ft. away. My students can hear it and I can't. If I'm in a noisy environment I don't hear it. To be honest, because it also vibrates, I don't really need to hear it. Most of the time, I've gotten the vibration alert, read the screen and then ignored it... and then it starts freaking out...

We should be able to choose time periods when we want certain alarms to be active. During sleep, I don't want petty calibration alerts to wake me. The data collected is not more important than sleep. I am glad I have the option to "silence all alerts" while sleeping, but I have to do it every darn night... and if I forget, I'm in trouble with my beloved.

The "new sensor" warm-up period is poorly timed. It requires a 3 hour warm up before calibration, and then asks for a second calibration in 3 hours. This means that if you start a new sensor, or re-start an old sensor, within 6 hours of going to bed (so for me, after 3pm) I will be awakened by another calibration request in the middle of the night. The only way I can get by this is by turning the sensor off until the morning, or silencing the alerts.

Oh, and also... I'm looking forward to not hitting large blood vessels with the sensor harpoon and dribbling blood for 10 minutes. It doesn't happen that often, but once every 6 weeks is often enough. I hear that the recent developments make this an outdated practice. I can't wait to get with the times. I'm patiently waiting for Enlite.

January- first 30 days of 2013

I'm going to report my summary numbers. I have gotten in to a routine with my diabetic management, and there haven't been too many surprises or discoveries lately. Well, maybe a few minor ones...

Average sensor glucose: 144 mg/dL.
Standard Deviation: 55
TDD Insulin: 30.8
Basal: 18.9

I stopped taking Alpha Lipoic Acid and Evening Primrose Oil. They are insulin mimetics which I have been taking for some time. I decided to stop taking them for a while because they are a bit expensive. I found that when I stopped taking them my insulin demands went up for about 4 days, and then settled back close to normal. I know there may be some other benefits to the supplements, but, for now, I'm going to see how I fare without them. I am taking very little beyond insulin and Symlin now.

I am a little shocked that I made it this far into a flu season without getting a cold or flu. At work I've seen kids out for a series of days quite regularly, so I know there are certainly some bugs going around. It's been over a year since I've had any viral stuff.

As I look at my sensor data I'm seeing some trends that show that I may need to look at my basal rates and make some adjustments. I think my higher trends are at the same times of day, normally around dinner time and afterwards. I'm noticing a dawn phenomenon trend as well.

At work they are offering health screening blood panels for free. I will probably participate because it will give me another metric to look at for a1c and whatnot.

My cardiologist recommended that I see his colleague for my recent six-month "check-up". It was like starting over again... he was looking at my condition like it was a brand-new mystery. He wants to confirm my diagnosis and has requested that I wear a monitor for 30 days. I'm fine with experiments and information gathering... but, if it's just for kicks? I think it's a bit inconvenient to wear a 12 lead monitor for a month just to confirm my diagnosis from a year ago, with no changes in treatment. So, I'm going in to get the monitor today... Also, how do you take a shower?

The medication they have had me on for the last year has been working well lately. It's a super low-dose and doesn't have any side-effects. I'm finding that when I don't have gluten in my life, I don't have any a-fib episodes. I'm pretty happy with the current program.

Getting Caught Up on 2012

I like to journal my data and numbers for my own benefit, but it looks like I haven't reported any monthly summaries since September. I know I have printed out data from my sensor/pump every month, but I just didn't realize that it had been 4 months since I compiled and reported.

I will report averages and simple data here, to get it done efficiently.

September
Average BG- 139 mg/dL
Standard Deviation- 49
Insulin: Average Daily Total- 28.2 units

October
Average BG- 138 mg/dL
Standard Deviation- 57
Insulin: Average Daily Total- 28.1 units
At Home A1c- 6.7 (10/1/12)
Lab A1c- 6.4 (10/19/12)
Post-bloodwork post from Oct. 2012

November
Average BG- 136 mg/dL
Standard Deviation- 48
Insulin: Average Daily Total- 30.8 units

December
Average BG- 144 mg/dL
Standard Deviation-52
Insulin: Average Daily Total-29.1 units
At Home A1c- 6.5 (12/18/12)

It looks like when you get a long view of the data it doesn't change as much as you would think. Sometimes during this period I crunched numbers and saw different short term trends, but by the time you get a month's data compiled all the upward or downward trends are leveled out. In the end, it appears that not a lot of change happened during these 4 months.

Other factors: 
Exercise- After returning to work in the Fall I have continued to go for a 20 minute walk after dinner. It has been helpful in countering an after dinner rise in glucose. During the past 4 months I have also done AM walks at the beginning of my day if my glucose levels were higher than 120 mg/dL.

Diet- I have found that between using Symlin and taking my evening walk I have been able to incorporate some starch into my dinner. If we have had potatoes or white rice I have had small portions  without seeing a significant rise in BG. Usually my bolus is for 30 grams of carbohydrate. For all practical purposes I'm still eating a very low carbohydrate diet.

Big Blue Test

I don't always pay attention... Without looking into details, and peripheral exposure, I thought the Big Blue Test was just a way to get more people to test their blood sugar. I know there are a few people with diabetes out there who are in denial and don't test their blood sugar, it might help them snap out of it and get more pro-active... but, when I realized that it was an "effects of exercise" experiment I became much more interested. I do this everyday and since I use a CGM I am seeing the impact immediately. It's no small thing. I'd encourage you to do it if you haven't.

When I take a brisk 20 minute walk I will usually see my insulin sensitivity kick in and my blood sugar will normally drop 30-40 points. It can make a correction work about 3x faster. For me, it's great to take a walk in the morning, and I don't have to bolus for my protein breakfast. I also take our dog for a walk after dinner and keep my post-dinner numbers in check.

Health Data from October Blood Panel

I didn't receive any info from the lab before I saw my doctor, so I went in eager to see my numbers, just like the "good old days".

Thyroid
The measurement that was unresolved last time was my thyroid levels. I had a TSH of 5.5. My doctor wanted to let it ride and see what it would do over time. This time it was 5.62, which is a tad higher. This time we also tested my free T4, which is the actual thyroid hormone produced by the thyroid gland, and it showed to be 1.1, which is in the normal range. So does that mean that everything is normal? I don't know. Reverse T3 is sometimes the real problem indicator for type 1 diabetics, but that wasn't tested. My doctor is satisfied with the results. Since I haven't had any complaints about my energy levels for the past few months, I guess I'm satisfied too.

Thyroid & Lipids
I brought up the connection between lipids and thyroid and he said that it is more of a story if the thyroid is really out of whack. He said since I don't have any signs of CHD, he's not going to try to figure out my borderline lipids via thyroid tweaks. I agree with that. The markers are fuzzy, and it's made even more murky because of the medical establishment's tendency to get everyone on a pharmaceutical when lifestyle solutions might be safer.

So, yes... lipids.
Total cholesterol: 250
HDL: 72
Triglycerides: 56
LDL: 167
CHOL/HDLC ratio: 3.5
NON-HDL Cholesterol: 178

The non-HDL Cholesterol was one I hadn't seen before. The target range is listed as 30 mg/dL higher than the LDL cholesterol target. Perhaps this measurement takes into account the fact that LDL isn't actually measured, but rather calculated... and it's, sometimes incorrectly, assumed that you have a certain number of lipoproteins, regardless of size. I'll have to find out more about this measurement and target.

Glucose Control
My A1c was 6.4, which goes along with what my average sensor numbers have indicated. Right now I'm hanging out in the 6.1-6.4 "higher risk of diabetes" range. I'd love to get into the "decreased risk of diabetes" range at <5.7, but based on my efforts I don't know if that's ever going to happen. Plus, I am positive that I already have diabetes.

My blood glucose at the time of test was 79 mg/dL. I tested on my meter before and after my blood draw and got readings of 79 and then 85, and my sensor was reading 80. I guess everything was pretty accurate at that point in time. Good to know...

To be honest, I think i have settled into a routine with glucose control and it hasn't been too variable over the last 6 months. I wish I had more to report, but things are getting pretty quiet and I'm not really experimenting too much. Sometimes it's hard to know what to blog about because most days are pretty simliar. 

I've been geeking out on looking at data across time lately, and I think I'll make some graphs that show trends throughout the past year.

Vitamin D
I made an effort to get daily doses of sun this summer, and I'm currently supplementing with liquid D3. I asked to have my levels checked and make sure I was on the right track. My levels were measured at 74 ng/mL. So, I'm in the top third of that range. My doctor said he's never seen anyone measure over the 100 ng/mL upper limit.

More Doctors...
I was planning to ask my doctor (an internist) for a referral to an endocrinologist. I thought maybe I'd get more aggressive treatment and relevant testing. I've started to realize that m doctor will probably go along with any additional tests that I feel are necessary, and he's always advocated for any devices that my insurance will cover. My long term relationship with him is good and we have mutual respect for each other. I feel pretty lucky to have him as my doctor. I decided to ask for a referral to a podiatrist for my plantar fasciitis, but held off on the endo request.