Monday, September 24, 2012

Expired sensors: I'm stubborn and frugal, but...

Right after I posted about trusting my sensors enough to use them for corrections...  I went on a run of 3-4 sensors that just didn't have it. I wonder if there is something about body chemistry that throws them off. I had such good results for a long time, and the sensors were even expired... More recently I had to toss out the box I was using because they were consistently inconsistent. Yes, they were expired, but that's not always a deal breaker.

The straw that broke the camel's back... I was doing weekend work (catering) which included a lot of hustling and moving of somewhat heavy stuff. My sensor showed me going up, and showed me at 150 mg/dl. Since I've been fighting a cold and running higher BG it' didn't seem that strange to be climbing while being active. I felt more on the low side with a jittery-ness that didn't feel high at all. I tested and found that I was 44 mg/dl. By the time I tested, my sensor was reading 180 mg/dl. So, not only was it off by a lot, it was actually showing movement in the wrong direction. Times like that, you just want to turn it off because it's no help, and you are getting false alarms.

This brings me back to my theory about body chemistry. I have read that Dex sensors are made inaccurate by using acetaminophen. Could there be things in my sinus spray that enter my system and cause my interstitial fluid to less readable by the sensor?

I've also been seeing my sensor stay the same while my meter shows an upward trend for over an hour.  So, anyway, I've tossed out the box of sensors that expired in February and now I'm using a box that only expired in June. Why do I have so many expired sensors around? Because I found that I'm able to get 6-7 days on them, doubling their life. Putting them in once a week is a really good trade-off of pain and bruising to useful data. When the data is useless, you wonder...

Wednesday, September 5, 2012

Breaking the Rules

I've become a loyal CGMS user. I rarely go for 12 hours without it. I've found that the few times I've cruised around without a sensor, I have some sort of surprise that takes me out of range. I believe that being able to head off a rise when I hit 130 mg/dl makes a big difference. My body is much more nimble and able to get the correction done if I'm still close to the normal range when I correct.

I've found that my CGMS data has been really accurate from 80-160 mg/dl. Like, when I cross-check it with my meter it's wicked close. I don't know if Medtronic updated their sensors, or if my personal chemistry is just jibing with the sensors better, but over the last few months I have been rather impressed, and have grown to trust those numbers on the display.

So, what I've been doing lately is breaking the rules.

You aren't supposed to base corrections on your CGMS reading. It's usually 20 minutes behind your actual BG, and could allegedly be wrong. But, lately, when I see myself hitting a predictable post-meal 130-140 mg/dl I bolus a unit on my pump. It turns it around.

I've written blog posts about the inherent inaccuracy of my CGMS and about how it would never be smart to respond with insulin to the wacky readings you sometimes get. But, I've noticed that things have changed, and I've changed my habits. One thing that makes it work for me is that the dose is small and the correction is timely. If it's post-meal and it's predictable, I'm comfortable with the scenario.

I wouldn't recommend this to anyone else. We all do things off-label that we consider safe, like re-using lancets, and pen needles. And, this is something that I've changed recently. If my BG gets really high (160+) I do the standard meter-check and correct.

But, this has given me a taste of what it might be like when CGMs are really accurate and you or the pump can use the data directly for minute-to-minute corrections, in real time. I'm down with it.

Ironic. I wrote this post a few days ago, and now my current sensor is doing those devious things that I thought were a thing of the past. It's diving and climbing randomly, meanwhile my meter tells me things are as stable and  predictable as ever. Hmmm. I guess if you want some good thing to dissolve, you just have to blog about it.

Tuesday, September 4, 2012

August Averages, etcetera

I've downloaded my sensor and pump data and the numbers are kind of average. It seems like I've settled into a cost/benefit ratio for my d-management that works. I'm putting in a tolerable, habitual effort and getting fairly satisfactory results. Things haven't changed much in the last three summer months. I haven't been obsessing too much and haven't tweaked my routine too much.

Sensor average for August: 134 mg/dl
Standard Deviation: 42
Insulin TDD: 25.8 units

As, I looked over my numbers, graphs and charts I can see that I'm still spending more time out of range during the hours after dinner. I'll work on that. I usually consume a decent chunk of protein with dinner and I think I have some kinks to work out with how the protein effects my BG later in the evening. I normally convert protein to an equivalent number of carbs, but it doesn't always work out perfectly. I know I could get into using TAG, but I've never been an absolute engineer about it. Is that okay? Maybe.

Routine & Exercise
Going back to work this month brought some routine back into my life, and it seems that it improved my glucose control too. I stopped my twice daily walks and increased my basal from 14 units to 18 units. It seems to be the right amount for compensating for that activity. I have plantar fasciitis, likely caused by incorrect footwear, so I'm giving my feet some time to recuperate while I'm busy with the Fall schedule. When I see some improvement, I'll make an effort to get some shoes that fit correctly and start my walking again.

As I returned to work I had planned to respond to increased stress with some basal adjustments. It seems that the basal adjustment that I made for less exercise was also enough to keep things in check for any additional stress from work. Mostly I find that I have some positive adrenaline responses (exhilaration?) from work.

Symlin Update:
First, the spelling: I had previously been spelling it wrong with an extra "i".  And, apparently, so had much of the internet, if you search Symilin you will find plenty of discussion... Oops, I just noticed that most of the mispellers are me.)
  • I'm almost always taking it after a meal. It seems to work just as well if it's taken 10-15 minutes post-meal. 
  • I've also found that it helps with corrections at times. If I start a meal with BG above my ideal range, just the introduction of Symlin will cause a drop in glucose. I believe that it is because Symlin impacts the amount of glucose the liver is releasing. With a reduction in liver glucose, there is a drop in BG just from basal insulin and any insulin on board. I have seen discussion on Symlin corrections (see the section titled "how to really screw it up", in which Symlin is taken with a correction bolus and the two hormones work together to provide a rapid correction. I'm rather cautious, and normally don't use any insulin during the hour that Symlin is in my system, but it seems to work to effectively lower glucose all the same.
  • Symlin is touted to cause weight loss. I have lost about 10 lbs. since starting Symlin in April. I have dipped below my goal weight and continued to further lean out. I am now making an effort to eat plenty of calories, specifically protein, to support muscle gain. I can't really attribute the weight loss wholly to the Symlin, but, it is one of several factors.
  • One bummer is that the last couple times I have purchased Symiln I have paid the same co-pay and gotten 2/3-1/2 the quantity that I'm supposed to get. This was due to insurance schedule limits or pharmacy stock. The co-pay isn't small, so I'm hoping that this will get straightened out. If I'm paying $45 for only 10 days of Symlin, I might start to question how necessary it is.
I did have one episode recently with a-fib. It lasted over 12 hours which was starting to bother me. I worked a weekend evening, catering a wedding, and didn't take my evening dose of beta-blocker till I got home late. I was in a-fib all night and the next AM till about 10am, in church it finally subsided. It was uncomfortable. I felt like my whole torso was being jarred by my jumpy heart. The only trigger that I can point to is the exertion of lots of work and dehydration, and a couple bites of a cookie, which is not on my normal list of foods. I have noticed symptoms after small amounts of gluten containing foods in the past, and I think that cookie might have been enough. I'm willing to do pretty much anything to avoid those drawn out episodes.

Endo time
I think the next time I see my primary physician I will ask for a referral to an endocrinologist. I think my doc has done a great job with me, but I'd love to get a bit closer to the cutting edge studies and see what types of tests they might run to be more proactive with me. I don't want to offend my doctor that's been treating me and calling me his model patient for 12 years, but, you have to do what you have to do...