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.