Aha! Manual Mode was more effective on 11/1

 Yesterday I tried manual mode during the day again, and it gave me quite good results. It was a busy day with quite a bit of activity cooking and doing yardwork. I found I had to eat some pumpkin pie a few times, because the basal rate for manual mode was too much for an active weekend day. However, all said and done... I was in range all day, used less insulin than usual, and didn't have any problems keeping my blood sugars close to normal.

Here are the stats for the day: 

90% in target range, 7% below range (pumpkin pie time), 0% above range, TDD 47.3, Basal 34 units 73%, Bolus 12 units 27%, Total Carbs bolused for 65grams, Correction boluses 2.5 in 3 corrections, Sensor average 124 mg/dL, Standard Deviation 0

See, to me it's interesting that to achieve a real average of 124 mg/dL you have to do something totally different than have a pump trying to keep you at 120 mg/dL. If I had my basal right adjusted for the activity, I probably could have used 40 units of insulin instead of eating pie. But, the pie was delicious, and I rarely eat it when I should, so it worked out well. I also had 2 slices of pizza with dinner, bolused correctly for them and took a walk to help my insulin match up. That was successful as well. I think a day with less carbs could run 37 units, and have me a lot closer to the amount of insulin I was using 10 years ago. 

I have found that switching between Auto Mode and Manual mode is pretty easy. All I have to do is put in a BG reading right when I switch back to AM. At night before I go to bed, I calibrate my sensor and put the pump back into AM. 

Today, I will see if the manual mode basal rate will be right for a day at work. If I bounce along the bottom of the low range, I'll definitely adjust it. Being lowish at work is a little panicky. I'll keep some sweet tarts on hand (just adjusted my manual mode basal rate to 30 units from 34). Right now my basal rate is a flat rate all day. So, there could also be some tweaking of that as well.

Experimenting with Manual Mode during the day

 Almost as quickly as I had pondered the idea, I started trying it. 

Yesterday I took the pump out of auto-mode in the morning and I started correcting toward 90 mg/dL throughout the day. It worked pretty well. My basal was still pretty aggressive and was probably doing most of the work. I stayed in the 90-110 mg/dL range most of the day and things were pretty uneventful. At dinner I had some beer,  soup with pinto beans in it, and then some pumpkin pie, and it was really hard to take enough insulin to keep me in range. I chased it with boluses, and took a walk, and when I went to bed I was at 197 mg/dL and I popped back into AM for bed. During the night my BG came down to 130 mg/dL by 1am. During the night I had a request for calibration or BG (I can't remember) and I entered the last reading it had as a BG and went back to sleep. It's cheating, but being woken up is worse than cheating. 😳 I'm always looking for ways to win against the alerts and alarms on this pump.

Some stats from yesterday: 

Sensor average: 135,  Standard Deviation 49, 6 corrections totaling 7 units, TDD 47.3 units

Questions I have... by not using AM during the day, am I depriving the pump of data that helps it keep me in range better? Or, does it know me well enough by now that it can jump in at any time? The warm-up period for AM is MM with sensor, so maybe I'm just warming it up all day?

Wow... Almost 10 years...

 I'm really glad I have this blog because it gives me metrics to compare as I track my health. I am really interested in seeing how things change over time, and to read back through the 137 posts that I wrote over the course of 3 years, it makes me realize how much attention I was paying to my physical health and my diabetes management. I hadn't realized that I have been using CGMs for over 10 years... I didn't realize that I've been using a pump even longer. I'm not even sure how I found the time to write that much... but, I did. 

I'm going to compare some data from then and now and use it to create some goals for myself. 

October of 2012                                     October 2020

Total cholesterol: 250                            220
HDL: 72                                                53
Triglycerides: 56                                    108
LDL: 167                                                145
CHOL/HDLC ratio: 3.5                           4.1
NON-HDL Cholesterol: 178

A1C: 6.4                                                 7.4

We  can see that my lipids are pretty similar, but the triglycerides are higher. I want to get those lower to support my desire to stay off statins. I think getting better glucose control and eating lower carb will help lower inflammation and also get the triglycerides down. It seems that my total cholesterol and HDL/LDL are about the same, but more exercise might help me raise the HDL for a healthier ratio. 

My current A1C is higher than I'd like, but it's been this way for a while. I noticed that when I started using the 670g pump in auto-mode, my average glucose levels have been higher and my TDD (total daily dose) for insulin also went up. My weight has stuck at 170-180 lbs, and I haven't been able to make much impact on it no matter what I do with diet and exercise.

The 670g pump shoots for a glucose level of 120 mg/dl, and it rarely gets you below that. That being said, my average blood sugars range from 120-180 on a daily basis. This jibes well with my current A1C which is 7.4, or an average BG of 164. I'm wondering if I used manual mode during the day and was more aggressive about correcting to 90 mg/dl if I could get my average down. I would have to get my basal really dialed in to make that work. I think another factor for this current A1C is that I have a transmitter that is on it's way out... and for a few months prior to my AC1 check it was throwing errors and requiring a BG randomly. This would bump me out of auto-mode overnight, etc. I wasn't able to stay in AM for long stretches of time. 

Here are some numbers from the last 14 days: 

82% time in auto-mode, 65% time in target range, 0% below range, 18% above range, TDD 53.8 units, Basal 36.7, Bolus 17, 91 grams of carb bolused for daily,  Sensor Average 149 mg/dL, standard deviation 18.6

The new pump that I'm hoping to get in 2021 is supposed to allow for a target BG of 100 mg/dl. If that works, I think I could improve my glucose control, especially since it also gives auto-boluses to correct when you get really far out of range.

Really catching up...

I just found this blog again. I have been missing long-form writing and having ways to journal about many things in life. 

Since I've lapsed into paying much less attention to my diabetes, I'm thinking it might be a good idea to return to dia-blogging. I don't know if anyone is still reading... but, I plan to try to document my journey again, if only for myself. 

 I'm going to summarize my current situation- before I get started with regular posts. 

I'm still using a Medtronic insulin pump. Currently it is a 670g model with the Guardian sensor. I've been using it for about 2 years, and it has made life a bit easier. I wouldn't say my control is better, but I'm spending less time thinking about my glucose levels. At release, this pump was touted as the closest thing to an artificial pancreas on the market. It is pretty smart, but it's pretty slow to make changes to your blood sugar. It's very safe... I have my eyes on the next generation coming up. 

I stopped using Symlin. I wasn't getting a huge benefit from it, and it was very expensive for my insurance to pay for. Right as I was choosing to discontinue it, my insurance took it off their list of approved drugs. So, all's well that ends well. 

I'm walking for exercise. Over the past several years I have had some foot and back pain that has put a damper on exercise, but I've tried to stay consistent with walking daily. 

I'm re-reading Dr. Bernstein's Diabetes Solution book. I'm trying to get my self psyched up to care more... The fact is, we need a pep-talk once in a while. I've gotten pretty lax about carbs, while still trying to keep my levels pretty good. 

My A1Cs have been in the 7s all along, but I think I could do better. I've recently re-doubled my efforts with low-carb eating. Most days I don't eat significant carbs till dinner, and I'm trying to keep that down to a minimum. I think my real carb downfall might be the pints of homebrewed beer that I like to sip at night. 

 Ok, I have to stop there... this doesn't have to be comprehensive, and I think it's just more important that I get something re-started. Anyone still reading? Anyone still have an RSS feed?

Catching up!

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

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

Sleep and blood sugar levels

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

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

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

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

Enlite! Oh... wait.

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

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

Blood sugar mysteries,the good kind...

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

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

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

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