Gadgets!

This list of new diabetes care products for 2012 was interesting to me.

I have often wondered how long it would take till my iPhone will act as a pump remote and also slurp data from my CGMS. It's not on the list, but I'm hoping that there will be a way that smart phones and apps can be added to the list of diabetic tools. I know there are probably more FDA/ FCC hoops to jump through when you are talking about universal communication devices being able to communicate with live-saving devices. For convenience, it would be great to reduce the number of devices that you carry around. Right now, my pockets are full.

I'm glad that Medtronic has updated their sensors to be closer to Dexcom in sensor life. I've been getting 6 days out of my 3 day sensors, so it will be a welcome thing to do it legitimately. I hope they are truly more accurate as well.

As long as I'm making a hope list:

1) I hope Medtronic updates their screen and interface on their pumps. I like all the integration of the various devices, but the LCD display seems a bit 1990s.

2) Getting CGMS report info right on the device would be a no-brainer. They need to make it so that you can run averages and reports right on the pump, and see what's been going on. Right now I have to connect to a website via a USB device, and then after several steps, I can see a report that I have to download as a PDF. It's a procedure, for sure.

3) I might like to ditch the tubing and try a patch-style pump. But if that means removing the whole patch and starting over, when something goes wrong... I'm not so sure. Right now, I can change the set without changing the insulin cartridge, and vice-versa. It makes for quick-easy maintenance, as needed. Plus, it seems like the patch-style pumps are best on the abdomen, and I've been preferring hip sites lately.

Testing, testing, 1,2,3... maybe 4?

So, I'm on holiday break from teaching and it seems like a good time to follow up with the heart arrhythmia tests. Today I'll get my Holter monitor for 24 hours. When I give it back tomorrow they'll put me on a treadmill and do a sonogram of my heart thumping away (also known as a stress test). Then, later tomorrow night, I'll show up at the local sleep clinic to do a sleep study. And finally, the order has been put in for me to get a CT scan of my sinuses... my ongoing headaches and and erratic glucose control are pointing to some sort of infection continuing on in my head. If that doesn't turn up anything, I'm headed to the dentist. By the time I return to work I will have run the doctor/testing gauntlet and hopefully will come out more enlightened and feeling better...

And what's the worst of it? Yeah, only the unpredictable blood sugars... that's one thing that helps me feel like I understand what's going on. It's also the thing that tells me something is wrong. It's been off for so long, I almost forget what it was like, back in August-October when everything was smooth and predictable. Right now my average glucose is 162, which has steadily risen in the past months. If I didn't have a CGMS I could not have navigated these past months, my results would have been much worse.

I'm re-reading Dr. Bernstein's Diabetes Solution and it clearly says that when you experience something like I have been (totally erratic glucose), even without the headaches, you should head straight to the dentist. I'm pretty sure that he's right. I'll find out soon.

Glucagon more important than insulin?

http://www.diabetesincontrol.com/index.php?option=com_content&view=article&id=10462

I found this article interesting. It seems as if our insulin needs are dictated partly by the secretion of glucagon. If glucagon is taken out of the equation, insulin becomes much less necessary? Yes, let's try this on some humans and see if it holds true. They are calling it a possible cure for Type 1 diabetes.

It's tricky because right now glucagon helps to protect us from severe hypoglycemia. I don't know if I would want to give mine up... it could change the way all the mechanics are understood.

interview with my kids about diabetes

I wrote about my first experiences with diabetes and growing up with a diabetic dad. I started to wonder about how my children understood diabetes through living with me. I knew there would be some gaps in their information. We haven't really ever talked about it directly, just in the day-to-day activities.

I started eating low-carb in 2003, so that's all they remember, and it's the most tangible thing that they are aware of in my daily treatment. I thought it was interesting that they are barely aware of my use of insulin, and the younger kids weren't sure what you do to get high blood sugar down. I guess they think when I'm tired that's what's going on. I'm resting it down.

Well, it was fun to work with them. I enjoyed creating the video. Sometime I'll interview Carol... I know she has some opinions about getting awakened in the night by my glucose sensor alarms.

matters of the heart- (part 2) cold drinks

On Thursday I had to stay late at work. I forgot that by the time I got home I'd be 5 hours past the time I usually take my beta-blocker. I didn't really think about it was because I thought it was a precautionary med and hoped I wasn't actually depending on it in my daily routine. Well, when I got home at 11pm, I took my medicine and while I swallowed it, I thought I'd get rehydrated. I guzzled 2 glasses of cold water and my heart started pounding. What the heck! Yep, I was in a-fib again.

I felt a bit discouraged when I realized that I might have to take the medicine religiously to prevent arrhythmia in the future. Sheesh, five hours without medicine and I'm back in the rapid heart rate scenario? So, that night I felt pretty sober and headed to bed with my heart thumping away. It wasn't the best night of sleep, but when I woke up my heart rate was back to normal.

Today, while I was eating lunch with the kids, I was drinking ice water and I felt my heart jump and crank out about 5-6 rapid beats and then it was back to normal. It made me wonder if the cold water could be a trigger for atrial fibrillation. So, this evening I searched the web, "atrial fibrillation cold drink" and found that it's a known trigger. I love taking my questions to the web. The more you know, the more you know, right?

So, I might not be as dependent on the medicine as I assumed. And, I'll take it easy on the cold water chugging...

I am glad it's ice water and not black tea that's giving me trouble.

2 problem ones, and I'm taking one now...

Ever since I started caring a lot about my glucose levels, I've also cared about taking medications that might mess things up. Even though there's a warning on many cold medicines, etc. I haven't noticed much impact from using them. However, I can confidently say I know of 2 medicines that messed up my levels and I have tried hard to never use them since.

1) Prednisone- I had an eye injury in 2003 that caused a lot of swelling in my retina. I had to take prednisone to help control the inflammation and swelling. It made my blood sugars unmanageable for the entire time I took it. I basically couldn't take enough insulin. They didn't go dangerously high, but they could hardly be brought below 180 the whole time. I couldn't wait to get off of it.

2) Levaquin- When I had to take it for a serious sinus infection I noticed that I had to take a lot more insulin. When I looked it up online, I found confirmation that it was on the list of medications that can effect insulin and blood glucose. I have avoided it successfully most times. When the doctor would prescribe it I'd ask for something else and it usually worked out. This time, I had already tried the something else so I pretty much had to go with it. My doctor said I should keep an eye on my glucose levels... Yeah, that's why I don't want it in me. So, I'm on day 6 with it... Yes, my control has been iffy. And, yes, the drug comes with a formidable list of possible side-effects. For the first couple days I felt like I had the flu. I take it with dinner, and my blood sugars shoot up to 200 even with no carbohydrates consumed.

I will take it 4 more times, and then, maybe, I'll leave my string of headaches and this subtle poison behind me. My big plans for the winter break: hang out with the family, and get healthy!

An interview with me.

Some time ago I received a request to do an interview for Diabetes Resource Page. I did. And they recently published it. It looks to me like the site has a commercial focus and was in need of some "personal" content. Well, if you are interested in more information about me, it's there. I enjoyed pulling together my thoughts about my comprehensive experience as a diabetic.

One little clarification: In the intro they stated that I "neglected" (their word) my diabetes in my adolescence. It's all relative, but I wouldn't call it that. I used the information and tools I had at that time, and felt that it was a good as it could get, even though it wasn't very good. As I became aware of better methods, I was happy to embrace them.

matters of the heart (part 1) - snoring?

So... last week at this time I was waking up in the hospital, with hardly any decent sleep.

I was diagnosed with a condition called atrial fibrillation, which is where the top chambers of your heart beat erratically compared to the lower chambers. It results in an irregular and faster heart rate. I felt like my heart was pounding all the time, and it was. I was doing about double time.  I was told that it is not related to diabetes.

My doctor had me drop in (no appointment, just walk-in whenever) on Thursday to check my stats and see how I was. While I was there he called and got me an appointment to see a cardiologist, because I had never seen one while in the hospital. The next day I was in the office and having a chat with a young doctor. He listened to my story, asked some questions, and put in requests for further tests. I will be doing a day on a heart monitor, a stress test, and a sleep study. He wants to get more information and rule some things out. He said it may have been a one time episode, and I might not even need the beta blockers I'm taking right now.

I was intrigued by the idea that it might have been caused by sleep apnea. I have started snoring this year, and Carol has influenced (!!) me to start sleeping on my side to stop it. I have been doing some reading about it and am realizing that it's a very common problem and a lot of health issues are caused by sleep disorders. I would like it if it were that simple. Just fix the sleep, and everything else will fall into place. I don't have the impression that my snoring is the type that stops my breathing, but that's what they all say...

Anyway, in the next month or so I'll have those tests done and get a bit closer to understanding what's going on.

I had to reduce my dose of beta blockers this week because my heart rate had eventually dropped over the weekend, into the 40s. I'm no olympic athlete, so that was a bit too slow. I felt woozy and lethargic at that uber-chill pace. Barely awake.

One more thing... I like both my primary doctor and this new cardiologist, a lot. A new generation of doctors is emerging. They are young, and they know how to work with people. They listen and go out of their way to make things work for you. It's great.

thanks for the low

Last night I woke up with low blood sugar, 58 at 1:30am. I'm pretty happy about it. Why?

1) It means I still have hypoglycemia awareness, which is your body's safety catch for the dangers of low blood glucose levels. It woke me up, with the characteristic fluttery stomach, quickened heart rate, and a touch of adrenaline. (I found some leftover Halloween candy. Did I over-do it? Probably.) Since, it's been some time since I have had an overnight low, I wasn't sure if it would wake me up.

2) It means my insulin is working. Despite fighting an infection and taking a medication that can causes insulin resistance (Levaquin), things came around during the night and I ended up with too much insulin in my system. As long as insulin works I'll be the post-Banting miracle called thriving diabetics.

Downsides?
Yes, there are also two of those.

1) It means I may have a headache today from it. But, based on recent history for me, it's par for the course. Feeling great otherwise.

2) It means my glucose levels today will run 180-200 for about 6-8 hours and not respond normally to insulin. I have to keep calm and not over-correct. You can stack insulin and have it all come into play at the wrong time, and cause the situation all over again. Just stay chill and wait until you see yourself coming out of it. I would say about 3pm I'll start seeing if I'm responsive to insulin.

I have quite a few things to write about, so be ready for some activity in the next few days.

One more thing... what about my glucose sensor? Did it warn me? No, it was 30 minutes behind the game and was still showing 70 when I woke up. That's fine. I might just change my warning setting to 80, just to catch dips like that. Infrequent as they are, I'm not too worried. 

Glad I wrote it down

 I was reading back at how I started this blog in September. I wanted to make sure that I didn't duplicate information too much. I read that in September I was taking 38 units of Novolog a day. And, at the time,  I was feeling rather efficient. I think the stress of starting a new school year and functioning throughout the day on adrenaline was definitely having an impact. Now that I've settled into the routine and am not feeling stress or anxiety from managing new situations, I think things are working better.

For the past 10 days my average insulin usage has been 27 units/ day. This 30% decrease has taken place very slowly and I was totally unaware of how much it was. I'll have to remember that when I transition from different periods of more or less stress. It seems to be one of the largest factors that I can recognize.

When I was having issues with my heart last week I was asked by many people if I was stressed out. I was pretty adamant that I've been feeling very little anxiety, and that my heart was totally out of sync with my mental state. In fact, when I was in the hospital, I had to reduce my basal rate because I couldn't eat most of the food that they offered to cardiac patients. It was maybe a bit stressful to be hospitalized because it was my first stay in the hospital, that I can remember.  I was kind of fasting in there. I plan to write about it sometime.

Star of the cardiac breakfast, decaf coffee.

Diabetes: First impressions...

Growing up, my dad was the only Type 1 diabetic I knew. By the time I noticed him taking injections, he had been insulin dependent for more than 15 years. He was athletic, hard-working, family-oriented, and smart. Diabetes was a quirky aspect of his personality. Sometimes, in the middle of the night, he'd eat the piece of cake we brought home from a birthday party. "Low blood sugar" was the explanation for strange things like that. It was similar to his use of contact lenses. Sometimes one fell out and everyone tried to help find it, usually when he was doing a handstand or something fun like that. He liked adventurous things like wilderness backpacking, riding motorcycles, and we talked about going skydiving someday. He was my first introduction to diabetes, and he didn't hate it or fear it. Overall, I didn't see diabetes as something to fear. The idea of becoming like him, in any way, seemed just fine.


When I was diagnosed, as a 12 year old, it was something that Dad and I had in common. It was a pain, but at least I wasn't in it alone, and it wasn't unfamiliar. We learned how to use a glucometer together in the 80s. Now, we were both responsible for cookies that went missing during the night. I suppose that seeing my dad as a fit, rather normal diabetic made it never seem like diabetes was trying to kill us. It was part of who we are. It's us. It's how we are uniquely created.


I think of my diabetes as a physical attribute that makes me different, stronger, and interesting. When I look at it that way, I'm always ready to hone my understanding of myself (and diabetes) further. It's not just so I can live longer (although that's a great motivator), but because it's part of me that I want/ need to understand even better. It's something to be mastered.


If I were ever 'cured' of diabetes, I think I would spend the rest of my life in awe of how precisely, and with what perfect control, the normal metabolism performs its functions. 


I would have a hard time giving up that part of myself, that has defined me in positive ways for the past 26 years. It has taught me that:

1. discipline pays off, 
2. progress can be slow, 
3. results speak for themselves, 
4. and that you can always learn more. 

And, for that, diabetes has become a strange friend, and mentor.

Seasonal affective insulin consumption

I have more updates on the "mysteries of my heart" series, but I thought I'd take the blog discussion back to it's sugary roots for a post or two. 

I have been adjusting my basal rate to get the most stable glucose levels I can. But this time of year things always get a bit more interesting with basal levels. The change of seasons from warm weather to cold weather somehow affect my insulin needs. It's strange, but it's a documented thing.  For me it has been about 5-10% difference. I might notice 1-2 units/day up or down when the weather becomes consistently hot or cold.
Right now I'm on 19 units basal. I reduced it from 22 after my stealth (sinus?) infection got under control. Outside of that exception, normally I'd be adding some basal to the winter season to keep things steady. Warm temperatures usually have me backing it off a bit, after I find myself going hypo during a normally stable time of the day.

I'm curious how many of my diabetic readers notice seasonal changes in how much insulin they use.

Did I mention that I love the information that I can slurp out of my infusion device (pump)... I'm pretty sure I did.

probably back on track... at least today

I started all the investigation on Monday and it's only Thursday. Maybe one of the longer weeks that I can remember?
So, yesterday was pretty rough because I went back to work and had already been out of rhythm for 10 hours or so when I woke up in the AM. As the day went on I was getting more tired from it and maybe just a bit unnerved. Also, I picked up a BP and heart monitor at the pharmacy on my way to work so I could check it throughout the day. The results always showed irregular heart beat, but the BP and heart rate read normal. It doesn't pick up the whacky artrial beats, so it it looks normal, even when it's off. However, it does pick up the funky rhythm, so it's pulls it's weight.

I got in touch of my doctor, who was off for the day, but on call. He said I should double my dose of beta blockers and stop by his office anytime during the day to run the numbers.

Right when I had had enough and was really doggedly heading home I noticed that I felt pretty relaxed in my chest. I walked out to my car thinking that maybe it was back to normal. When I got home I checked my rhythm and it was back in line. So, 3 hours before I got a chance to take my new dosage, things improved on their own. I got home and took a fantastic nap.

I stayed normal all evening, felt great. Slept normally, slept well.
This AM I'm feeling well rested and my heart is beating in a normal sinus. I'll go see my doctor today, and hopefully this hiatus from the arrhythmia will continue. When I feel like this, things look really rosy.

Moving along...

I did, indeed, stay for 24 hours and was released from the hospital at almost exactly 3pm. By the time they let me out. I had been off the IV for 12 hours with a regular heart rhythm. They gave me a wheel chair ride to the front door (come on, really?)

I went home, happy to get out of there. However, it was strange to not be able to look at a screen and be satisfied with my pulse being normal. I took a long nap where I was super knocked out, nothing woke me up. I was really comfortable and very tired.

After dinner I picked up my medication from the pharmacy and took my first dose of beta blocker, which is blood pressure medicine that also helps control atrial fibrillation. When I went to bed I was aware that my heart rate seemed faster again, but I figured that it was just a matter of the medicine getting rolling. When I woke up during the night and this AM I have felt that I have A-fib going on again. I don't feel too bad, just rather aware of my heart thumping away.

I was prepared to feel light-headed or dizzy from the beta-blocker lowering my blood pressure, but it didn't do that. I am going to go to work and have a day where I take it easy. I'll probably call my doctor and let him know that I feel like I'm still having an irregular heartbeat. I think based on the info from the hospital tests, etc., he may be able to adjust dosage to help get it back to normal. I'm not planning to do more hospital time if I don't have to.

If medicine doesn't do the trick, they'll do electrical cardioversion, which is an electrical shock to reset the heart's electrical impulses. As you might imagine, I'm not crazy about the idea.

More info...

Before

After

When I got here a few nurses commented that I didn't look like their next patient. I think being poked, prodded, and awakened every hour might get you there.

They put me on a heart monitor at 3:30pm or so. You could see that my heart was beating pretty fast, between 140-170 bpm. It took a while for them to get my medicine started via IV, but they got my IV set up and drew blood for labs from it. I would guess that I was given Cardizem about 5:30 or 6:00. By 7:00 by heart rate was going under 100, which was our target.

Dad Sidebotham visited and while he was here we chatted and noticed that my heart rate was settling in the 80s. I felt way better.

Overnight I was on the IV and my heart rate continued to drop into 70s. I was wearing a cuff for automatic test of BP because the medication can also cause BP to go too low. Sometime during the night my BP got a bit on the low side and they took me off of the drip. So far, I've been off the medicine for a few hours and things are normal. My pulse pattern on the EKG has a normal sinus, which means the spikes are all regular and the right shape and frequency.

Today I have to have an echocardiogram and hear from the cardiologist (I haven't seen one yet). The nurses seem to be able to handle this type of situation pretty well, kind of routine, maybe. I asked if I'd be going home later today and the nurse was not totally sure, but thought I would be sent home with oral medication and be done.

I don't like having my blood taken that much, and since I've been here they have taken my blood 3 times in addition to having me on an IV. They said they are checking my blood for heart enzymes every six hours. I'm guessing they'll be taking more too.You can get used to anything?

Oh, yes, diabetes... it's pretty bland. My glucose levels have been normal the whole time. The nurses come in and ask me what my BGs are every six hours and I tell them. The lab ran an a1C and they said it was 6.8. Still room for improvement, but I just had a month+ of mysterious rises every PM. I think with the antibiotics I'm taking, that's all taken care of.

Images are worth a thousand...

This image was found on everyone's favorite online encylopedia. The top shows the chaotic action of the atrial fibrillant's heart pumping Notice the skipped spikes... also the extra underarm perspiration. Is it hot in here or is my heart beating double time?

I think it visually shows how my heart felt, kinda out of control, but still keeping me going. It was an exhausting, anxious feeling, which for me, is just wrong. I shoot for calm enthusiasm. Now for a nap?

Just sitting around posting on my blog when I should be working...

My doctor ran an EKG and confirmed that my heart was running at high speed for no reason. My heart rate was 143 bpm while I was lying on a table. That's my normal workout target.

So it' looks like I have A-Fib. Atrial Fibrillation. My doctor said it was a manageable condition, and not caused by any of my other health factors. I'm doing some reading about it right now. I'm not really sure what to think about having a heart condition, I kind of like being active...

I've been kind of faking good health by achieving close to normal blood sugar, but I can't fake this one. My heart is cranking.

Anyway, I'm headed to the hospital for a 24 hour stay. A cardiologist will do some further tests and try to sort out a medication to slow down my heart to normal speed. I'm all for that.

I'll bring my laptop just in case I have time to waste.

Hmmm.

Well, this is a blog about my health.
For the past week or so I've been free of headaches... But, I've been noticing heart palpitations, and they have been more and more frequent over the past few days.
I have checked my pulse quite a bit and was very hard to tell if it was normal because there were stronger and weaker beats.
At school today I popped into the nurses office to use their digital finger pulse reader. It was 80, but I could feel my heart beating rather hard. The nurses both heard an irregular heartbeat and my BP was elevated.
I'm at my doctors office right now. He's going to do an EKG and see what kind of issues I have. I'm a bit uncomfortable. My heart has been pounding since I woke up this am.
Hopefully we will figure something out.

Serial headaches update

Well, over the Thanksgiving week I was barely in my classroom and I didn't have the headaches. Upon returning to work on Monday and Tuesday, I immediately had two wicked PM headaches for both days. It was painfully clear that it was more about that place than anything else. I began to feel that it was more obviously centered in my sinuses and jaw bone, and I called my doctor to see if I could get in to see him.

Instead of seeing him, I was able to talk to his nurse briefly, and they thought it was either a sinus infection or TMJ. His nurse was on the sinitus diagnosis and I went along with it. I'm taking antibiotics for 10 days. If that doesn't help, we will look at taking valium at bedtime to see if it will change things about my jaw movements while sleeping. I don't have any reason to agree with either of these diagnosis. I think this is the product of a short, incomplete telephone conversation. I wasn't able to describe the absence of the headaches while on holiday, and I wasn't able to talk about how the time of day is so clearly a factor. At this point it's probably just a good idea to be ruling things out...

I felt like while I was back at work I had some burning in my upper nasal region which might indicate an irritant or allergy. I used to take something called Flonase (fluticasone) all the time to keep my sinuses and nasal passages from getting inflamed and leading to infections. It was an allergy-infection preventative. I think maybe it would be good to get back on that. I think the feedback I received from my blog readers was more thoughtful and on targe than what my doctor gave me, because it was in response to my 4 weeks of research, not just the simple complaint of chronic headaches.

As a side-note, I always ask which anti-biotic is being prescribed. I have taken a few strong ones that had an impact on my glucose levels. Off the top of my head, I think Levequin was one of them. I won't take it.

Headaches Hiatus

Well, almost as quickly as I made my list of possible causes, my headaches faded away. The few things that I changed: 1) got back on Alpha Lipoic Acid and 2) adjusting my basal insulin. I'm still seeing some unpredictable things happening with my daily BG, but it's not as consistent and not accompanied by a headache every day.

I am happy to say that I've been having tea and cider every day and it seems to be a non-factor. This week my time spent in the school building was limited, but even the days I was in all day, I didn't have headaches. It's only been about a week of good fortune, but it seems like it's going to continue.

one big headache!

I have a conundrum. I have had daily headaches for the past 5 weeks or so. They are significant headaches, not nagging, more like harassing. I don't remember when they started exactly, but I do remember being surprised when I didn't have a headache on Oct. 22nd. I would guess that it had gone on consistently for about 7-10 days prior to that. They start in the early afternoon and ramp up to their worst before dinner. After dinner they usually seem to fade away.

Additionally, around 2pm I have been developing insulin resistance and my glucose rises to about 200 and stays there until 12midnight. During the night it slowly eases back to normal and is always 100-120 normal when I wake up. According to my sensor, it never goes hypo.

One theory to consider is that the headache and the glucose rise are related, and that they are triggered by the Somiyogi Effect.  I have had periods when my basal insulin wasn't right overnight and I would go low and then bounce back on a "rebound" for about 6 hours of BG at 180-250 (AND a regrettable headache usually hangs around for several hours).

The only reason it doesn't fit in this situation is that I am using a sensor and have records on where I've been on the glucose spectrum. I don't see many readings under 100 during the day. During the middle of the day I might get to 85 on the sensor (which means the actual real time BG might be lower). It's not an adrenaline event, like serious hypos tend to be. The times in the past that I have suffered the Somiyogi Effect it has included a signature headache that was unshakeable for about a day. It was the kind of headache that no pain-reliever could put a dent in.

So... I have considered a few factors and done a few experiments to see if I could stop them.

1) Food: I wondered if intermittent fasting was causing some sort of hormonal event that triggered cortisone or something that might bring a headache and insulin resistance along. I tried eating breakfast, more carbs, more protein, etc. and nothing has seemed to help. The headaches have been the most consistent thing lately...

2) Hydration: I am guilty of neglecting my hydration on days that I am busy at work. I am certain that there have been days that I've given myself a headache from dehydration. However, I have made an effort to drink plenty of water throughout the day many days in the past 2 weeks, and haven't seen a difference.

3) Tea: I noticed that the routine headache was also synchronized with my 2nd cup of strong tea for the day.  Some research on the web showed that some people are sensitive to black tea and get the achey neck and head that I was having. I stopped drinking tea altogether for a week, and I still had headaches (maybe a different type?). However, when I drank tea, they seemed to get worse, or be compounded. Inconclusive... I really love my black tea.

4) Supplements: A while ago, (maybe a month?) I ran out of Alpha Lipoic Acid, and have been living without it. It is a insulin mimetic that reduces my insulin requirements. I expected to increase my basal, but didn't really notice anything change, except this insulin resistance in the PM hours. I have gotten another shipment of ALA and am taking as I had before. I'm looking to see if my BG levels out and stays constant all day, as it did from Aug-Oct.
I have heard that low-Magnesium can cause headaches. So I added Magnesium to my list of supplements. I also added vitamin D and A.

5) Workplace: On Oct. 22nd I realized that I hadn't had a headache that day. It was a day we had a field trip, and I hadn't spent the day in the building where I normally am. I also didn't have tea that afternoon. Maybe something is wrong with my school building? *This weekend, I was waiting for the headaches to hit at their normal time, and they didn't. My BG did rise, as it has lately, but I didn't have the headaches. Right now this seems to be the most likely cause of the headaches... but, unfortunately, it's the issue I have the least ability to solve. I am wondering what types of factors in my school building could cause the headaches. During the weekend I did consume tea and cider with no ill-effects. 

6) Eyes: I had my vision checked this summer and didn't have a significant change in my prescription. When I wear my contacts all day they start to bother me, but I've been off the contacts for a while.

7) Cider: I have been having a nightly pint (or two) of home-brewed hard cider for roughly the same amount of time that this has been going on. It didn't occur to me to consider it as a suspect until I was working through this list. I may have to take a few days off to see if it's a possible culprit. Last winter it was also my beverage of choice and I don't remember anything strange during that time... then again, my BG control wasn't amazing then either.

So, that's my list. I am wondering what I'm missing. If I am a typical T1 diabetic, I have a tendency toward autoimmune problems. I wonder if I could be doing something to aggravate my immune system and create some sort of domino-effect. Could I be a migraine person, sensitive to dark chocolate, coffee and red wine?

Book Review: The Book of Better: life with diabetes can't be perfect....

I received a review copy of the Book of Better by Chuck Eichten, published by Three Rivers Press. I read it in a weekend and it was an easy and interesting read.The illustrations are humorous, the graphic design is offbeat and contemporary. Just the design alone kept me turning pages.

Chuck Eichten is a diabetic, writing from 30 years of experience as with Type 1. He claims to have made many mistakes and wants to share what he has learned with the literate world.  He writes in a light, colloquial style, using words simply and well. Chuck is a creative director at Nike, and has the experience and access to make this book a much more interesting design than most books about health topics.

The overall focus of the book seems to be to encourage those with diabetes to strive for small improvements in their health, and feel good about it. In the process, Eichten, discusses how to deal with frustrations, treatments, and hope for the future of the disease.

I have been diabetic for almost as long as the author, and have come to a similar perspective about striving for the best, while not beating myself up over things I can't control. I was on board with his perspective on that. The first chapter spent quite a bit of time on dealing with that perspective, and I found myself getting antsy to move on with facts or ideas that were new to me. I'm a voracious consumer of factual information about things, so I was anxious to hear some new stuff.

He did get onto some information that I connected with. He discussed how to deal with treatments, food, fitness, family members, the proverbial cure, and even diabetic eating disorders. He is realistic about how difficult the diabetic life can be, but he has a positive approach to dealing with various aspects of it.

My personal response to Chuck's ideas. 
So, the opinion and info that I found most interesting was his emphasis on the importance of the insulin pump for best treatment of diabetes. I was slow on the uptake for getting one, and it has taken me 3-4 years to become a full believer in the device. The summer before last, I even took a break from the pump and did multiple daily injections all summer. I just wanted to get away from it for a while. Sadly, I never got close to the control that I had with the pump, even after 3 months of trying pretty diligently. Now, with my continuous glucose monitoring system, I feel like I am happily dependent on them in my pursuit of best results. I agree (with Chuck), it's the best treatment we have right now. It gives flexibility to make your life better. And..., I definitely agree with him, that the word "pump" is a lousy word for something we might have to love and rely upon.

Another thing that Eichten emphasized in The Book of Better is the need to exercise consistently daily. He doesn't use the word exercise, though... he refers to it as moving. He advocates the need for consistent movement, every day. This is an area that I have found difficult since I started trying to do what's best for me. While I enjoy the reduced need for insulin when I exercise, the consistency is always lacking for me. Also, when I do live more actively, I find that it introduces a new variable for me to keep tabs on. I think this is one of the things that I feel the need to take to heart and add to my daily regimen. If it's daily, it won't be a variable anymore, it will be routine. A BETTER routine...

Toward the end of the book Chuck discussed the future of diabetes treatment and it was was a surprisingly comprehensive summary of the latest developments in a short number of pages. I liked that way he summed it up with graphics and minimal verbiage. I learned about the gradual movement toward a "closed loop" system, starting with an overnight-only system. Also, the development of insulin that only works when blood glucose is above the normal range sounds fascinating too.

Overall, I found the Book of Better to be a great book. I'd recommend it to any diabetic or loved ones of diabetics. The slow, therapeutic start eventually paid off with good doses of experience-based fact and opinion throughout. Positivity and hope was a clear thread that pulled the book together. Something we can all use a shot of once in a while.

Probably Nothing to Celebrate...

I went to take my "at home" A1C test and realized that I threw away the essential electronic testing portion, and only had the chemical receptor part. I bought another test and thought I'd trick it into doing 3 tests for me and use the chemical receptor part from my defunct test. Well, I did and the results were kind of hard to believe. It showed me at 5.6. I think it was an error because of the fact that I was using parts that weren't calibrated for each other.
I mean, I expected to see improvement, but that's just too much. I was hoping for some action in the 6s. I am headed for non-diabetic numbers, but I don't think I'd be getting it yet. I was tempted to repeat the test, but I think I'll just let this number ride for a while maybe the positive vibe will impact my habits for the better.

National Diabetes Day?

I just found out today, that today is National Diabetes Day. It's very cool that there is a day devoted to our situation, but I wish I had more notice... so I could work a profound post or something. Anyway, I still have diabetes and I just finished reading a book that came in the mail on Friday. I'm going to review it as soon as I can. I've already finished it.

Insulin Mimicking Supplements

I've been wanting to write about a couple of things, but have been more busy than usual. I'm half way done writing an interview for Diabetes Resource Page, and I'm putting together an employment resume for the first time in about 10 years. I am going to see if I might do some additional teaching at the local community college.
I thought I'd just quickly discuss something that's been going on. I've had a strange pattern going on with my sugar levels lately. I have been seeing my numbers start going up at about 3pm and get up to 250 before leveling off and then responding to insulin overnight. I have a theory that it's caused by the fact that I ran out of Alpha Lipoic Acid Sustained Release. I normally take it on a daily basis. When I ran out it took about 2 days for it to totally wear off and I started seeing this happen. I think if I were to stop using it altogether, I would need to sort out a new basal rate to fix it. But, I'm going to order it and keep using it. I think it's a very useful supplement. In the meantime, it's a pretty bizarre thing to have happening. I had gotten so used to seeing my levels stay under 150 after meals.
I will report back if getting back on ALA fixes it.
There are a list of supplements that are supposed to make your body use insulin more efficiently, and process sugar better. Here is a list:
Alpha Lipoic Acid
Evening Primrose Oil (enhances of the effect of ALA)
Vanadyl Sulfate
Gymnena Sylvestre
Chromium Picolinate

So far I have only been using ALA and EPO (recommended by Dr. Bernstein), and they definitely seem to work to reduce my insulin requirements. I plan to try the others as well.

Sensor life

 I use Minimed's Revel Pump with the CGMS system that comes with it. I had to wait for about 2 years for insurance approval, but now it is included with my necessary pump supplies.

I have learned from another diabetic blogger, JonahDiabetic, that glucose sensors can be used for longer amounts of time than expected (Dexcom can go 10+ days). I have normally discarded them after their time was up (3 days). Sometimes if I was too busy to change them, I'd cheat an extra day out of one by resetting the sensor link and get some extra time out of it. I was on board with the 3 day time limit because I was worried about tissue damage associated with having it in place longer. Last year, I would notice inaccurate readings or discomfort at the sensor at about the 3rd day.

I have found that since I have been achieving much better control, my sensors last longer and my skin at the site is not irritated as much as it used to be. I have a theory that getting lower average glucose numbers has improved my body's ability to deal with foreign intrusions into my skin.

I have also been able to extend the time on my infusion sites without seeing any decrease in it's effectiveness. In times past, I had noticed that sometime between 2 and 4 days the site would stop working well and I'd have to change the infusion site in order to get my insulin to fully work again. Lately, I have been keeping the site working until I refill the reservoir, which is about 5-6 days. All told, I can go a whole work week on one sensor and infusion set, and then the weekend I either go without a sensor, or start a new one.

I'm not sure it's all glucose control that's giving me more time. I'm eating a diet high in quality fat, and believe that my level of systemic inflammation has been lowered by improved glucose control. I'll be curious if this trend tracks this way long term. Right now I'm pretty happy about not needing to puncture myself as often. I'm not a big fan of sensor changes, and the first day of calibration readings.

Freebies?

I forget what they call those promotional items (swag?) that get sent to visible people on the web... but, anyway, I'm getting something for free.
It is a newly published book on the diabetic life. I was contacted by the publisher and am going to receive a copy of the book soon. I hardly consider myself a high-powered blogger... but, of course, I'll read it and report out here.
Here is a companion website for the book. I like that he is a T1 diabetic writing from 30 years of experience and that he's a creative director. 

As long as I'm at it, I think I'll also offer some thoughts on other books related to diabetic issues that I have read. That will give me something to chew on for a while.

Using the data

Since I discovered that Minimed added Mac compatibility to the Carelink website, I've been pretty religious about downloading my pump/ sensor data and looking at it carefully. I don't really think I'm too great at analyzing data, but it's pretty interesting to see patterns, etc.

The first time I had my graphs and charts I adjusted my overnight to AM basal and it immediately flattened out my levels and improved my morning blood glucose. It was a small tweak, but it made a noticeable difference. I think getting the basal correct is one of those major things that has a positive rippple effect. In reality, I didn't really add basal insulin, I just moved it from the afternoons to the morning and I fixed both a high trend in the AM and a regular dip into the hypos in the early afternoon. My overall basal actually went from 24 to 22.

Some stats:
Right now my average BG for the past month has been 136-139. I'm hoping to see that reflected in an at home A1C test in mid-November.

I'm currently taking 29 units of Novolog a day, with 22 units being basal and 7 in corrections and boluses.

Hungry vs. Empty

As I have been doing intermittent fasting daily, I have realized a few things that were surprising to me.

1) I can function well on less food, in fact I feel better if I'm never actually full.
2) The feeling that I used to consider "full" or satisfied was really just the sensation of my body digesting a meal. When my digestive system finished with that task, I always assumed I was hungry. I wasn't, I was just no longer digesting the last meal. That light, unburdened feeling is one that I am learning to love.
3) Hunger is a different sensation, when the body needs nutrients and goes looking for them. I'm able to tell the difference now that I've experienced both. I'm more likely to be comfortable throughout the day now that I'm not in a cycle of feeding to stay full.

Bad days make the good days look really good...

On Tuesday I woke 10 up with normal blood sugar levels. Throughout the first few hours of the day, however, my levels climbed to 200 despite the fact that I didn't eat breakfast. I bolused a few times and didn't see any change. I wondered if my site needed to be changed, even though it was rather new.
We had dinner plans with extended family, so instead of sitting at home trying to sort it out, I just went along with the plan, and went to dinner with hopes that things would level out. By 6pm I had been over 200 for 10 hours. I felt a lot worse than I usually do on a short excursion into hyperglycemia. I was tired, had a headache, and feeling pretty blah. Not hungry, pretty sick. During dinner I ate a bit of protein, salad, and some wine and my blood sugar made it to 325. I checked my pump tubing and discovered that the quick release was loose and clicked it back together. I bolused again, just in case I hadn't been getting insulin all day for that reason. I could tell I was in DKA and it was lousy. I drank a lot of water. When I got home I changed my infusion site, and my reservoir (which was close to it's end). Within an hour I started to see it come down. I think when I went to bed it was 260 and dropping. In the AM it was 125 and I felt normal. Off to work I went, but it left me with a clear sense that I hated being out of range, and that I will immediately change infusion sites if something is mysteriously off.

As I have tightened my control my expectations have gotten a lot higher for the way I feel. I'd say a lot of days when I was younger, that was a normal day... to run 200-300 all day. Yep, I felt bad, but it was a normal bad feeling that I was used to. I'm really happy that my new normal day is one where I look at my sensor graph and it's flat somewhere between 100-150.

Dawn Phenomenon and Intermittent Fasting

I always have tricky blood sugars in the AM and I usually think of it as the time when my numbers are off, and insulin doesn't work well.

The Dawn Phenomenon is created by your liver doing some cleanup work over night and releasing glucagon in the wee hours of the morning before you wake up. When you wake the glucagon makes you more insulin resistant and you have a harder time with bolusing for food as well as correcting AM highs.

A surprising solution to my DP effect has been to skip breakfast. I never thought I could be a breakfast skipper, even though for years my breakfast has been only eggs. Even having protein in my system seems to be complicated by DP.

I became interested in the possible benefits of intermittent fasting this summer and started to go from dinner (7pm) to lunch (1pm) as a short fast. I had read that it might help me to reset my metabolism and help me to lose some weight. In the end, I found that increased energy levels and better blood sugar control have been the real payoff.

First of all, it was hard for me to imagine that I'd feel comfortable going that long without eating anything. I was pretty sure that I'd feel fuzzy in the head and not be able to function. Well, for a day or two I did feel strange (jittery and wired, not tired) and then my body switched over and was able to do the extended overnight fast. I even exercised in the morning and it didn't make me uncomfortably ravenous.

I was doing these experiments on myself in the summer, but I wondered if it would work when I went back to work teaching high school art, thinking on my feet all morning. It still works for me. I am still functioning in a mostly fasted state for my whole work day, and having good energy and attention. Mid-morning I have tea, some nuts, and a piece of chocolate. Those are my only calories before I have lunch at 1:30 or 2:00pm. 

I think part of the reason this is working for me is because I'm eating a ketogenic diet, getting most of my energy from fat. My body is burning my body fat and it is used to burning fat for energy as well. My brain responds well to this, and I've found that I am more attentive, decisive, and mentally nimble since I've been eating this way. Our brains need fat to function.

My body also likes having glucose in a normal range, and once I got my basal insulin nailed down with my pump, I have cruised through my fasting period keeping my sugars at 90-120 the whole day. When I break my fast I take a square bolus that is spread over an hour and works slowly with the fat, protein and carbs that I eat for lunch. Right now my basal is doing most of the work because I don't have much of a spike from meals. My diabetes educator doesn't really know what to do with my numbers because they usually insist that your basal:bolus ratio should be 50:50 or something like that. I'm at about 80:20. My total insulin for the day is averaging 38 units of Novolog.

Needless to say, I'm planning to keep things this way. I feel great and am very slowly losing some of the extra weight that I have gained over the past couple years of higher insulin doses.

Some background details...

I am starting this blog about my diabetic experience because I think it's important to share information with other diabetics. I blog on other topics, but don't feel comfortable getting into deep medical details on general purpose blogs. It is not an interest that everyone shares.

A few things about me: I've been diabetic since I was 12 and am now 38. My dad and sister are also Type 1 diabetics. I have six siblings, so genetically, it only passed on to two of the seven children in my family. All three of us Type 1s in my family continue to maintain good overall health, despite the disease. We enjoy comparing notes on our control when we get together.

I am an art teacher. I have been teaching high school art for 16 years. I have three children, all of whom we will be watching for Type 1 diabetes as they grow older. So far, none of them have shown any signs of immune system malfunctions. 

I have moderately good control. I have followed some form of low-carb lifestyle since 2003, and it has been my best tool for good control, depending on how disciplined I am. I am currently achieving success by focusing on fat as one of my main energy sources. I began following a low carb eating regimen from information that I got from Dr. Bernstein's book Diabetes Solution. I don't necessarily agree with every single thing that he prescribes (he doesn't like insulin pumps), but for the most part, he's a genius.

I use a Minimed Revel insulin pump with a glucose sensor. I don't like using external devices much, but tolerate them because my control is so much better with them. This year, I have become much more disciplined (again), and having a glucose monitor has made it much easier to keep track of my progress.

My A1C levels have been coming down. In years past I have gotten as low as 6.2, but in recent years it has been in the 7-8 range. It is usually directly proportional to how often I test and how much fast acting carbs I allow into my diet. My most recent A1C test have been 7.9 (in July '11) and 7.3 (in Sept. '11).

That's it for now. I'm looking forward to writing about my experiences.