Tuesday, June 26, 2007

The Great Outdoors (Yikes)

This weekend I'm supposed to go on a camping trip and I think it's safe to say that I'm absolutely freaked out by the idea of it. Each time I've gone away since my diagnosis I've known exactly what type of food I'd be eating and at what time - a hotel or friend's house really helps with this. However, when you're out in the woods planning meals can be difficult and since I do not start my pump until July 5th, I'm stuck with lantus and novlog. Adding to my fears is the fact that I'm supposed to support Courtney in the Tinman Triathlon this weekend as well. Normally I'd eat a hearty breakfast for a day of running around cheering for someone on a triathlon course but I'm not sure the campfire is going to provide much more than a muffin. Because of all the increased activity I'm real worried that I'll be low and won't have a controlled environment to get back to healthy bs levels.

I'll be carrying a supply of clif bars, glucose tabs and apples; hopefully that does the trick. I'll also be using my trusty Frio wallet to keep my insulin cool. Does anyone have any suggestions to reduce my fears of going low?

Monday, June 25, 2007

Wedding Cake & Whiskey

Saturday presented one of the biggest challenges to blood sugar control I have faced. On June 23rd, my best friend got married - I had to brave the heat of an outdoor wedding in a tux (pictures coming soon), get buzzed enough to deliver a speech and have enough energy to dance the night away. 5 months ago none of those things would have given me a worry; however my life now is all about being prepared.

I arrived at the venue at about 3 pm with a full supply of cliff bars, power gels, glucose tabs, insulin and glucagon - I needed to be prepared for whatever I might face. Sitting in a cramped attic in a beautiful old mansion the groomsmen dressed, in the room we were treated to a few beers, some champagne and small sandwiches. I cut back on the bolus for the chicken salad wrap I had and checked my blood sugar right before we went downstairs for the big moment - holding steady at 120 and ready to go.

On a side note the bride's dressing room was WAY BETTER than the groom's room. However, when I delivered the bride her gift from the groom the intensity in her room was over the top - I felt like those girls were more amped up than I was for any of my college football games. I half expected to see them giving each other head butts and putting on eye black.

Thankfully there were no blood sugar lows when I delivered the rings and amazingly I didn't drop them or fumble them! After the ceremony I ate a bit of my cliff bar as I waited for the assistant manager to bring my man purse outside (my man purse is my diabetes survival bag). I wasn't sure if I was showing signs of going low or if it was just the heat. The rest of the night went amazingly well - I delivered my speech without a problem, continued to have bites of my cliff bar throughout the night and was able to drink and dance like everyone else. Throughout the evening I did the finger pricks and was never about 170 or below 110, which I'm more than happy with. I even remembered to check my blood sugar when I woke up with a pounding headache at 5 am! On Sunday I went for an hour and 1/2 bike ride to try and beat the hangover.

Congratulations again Steve and Merry!

Tuesday, June 19, 2007

Cliff Bar Crisis & Team Fat Bird

Yesterday Courtney and I had planned to go for a 2 hour bike ride from my apartment to Prospect Park in Brooklyn. Courtney is preparing for an ironman and I'm getting ready for the Tour De Cure on July 8th (you can also use that link to donate for this great cause). I'll be captaining Team Fat Bird for the event and if any NY riders would like to ride with us please contact me.
Just some background; Team Fat Bird was inspiried by one of my favorite artists - Ed Heck. His paintings have always made Courtney and me smile and one in particular "Love Birds" made us realize how happy people can be just enjoying themselves. My goal with the team is to show people that even with this chronic disease you can still challenge yourself athletically and have a great time doing it; so the title seemed to fit perfectly.

Now back to the cliff bar crisis. I was expecting Courtney to arrive at my apartment around 5:30 pm so I gobbeled down my cliff bar at 5:20 to raise my bs enough for the ride. At 5:30 my phone rings and because of midtown traffic Courtney couldn't make it to my apartment safely (she was run off the road by one too many cabs!). I immediatley freak out knowing that I just had 40 grams of unbolused carbohydrates and am not yet comfortable going for a ride by myself. This really was the first time a plan to control my blood sugar went completly SNAFU.

After hanging up with Courtney I realized I needed to adapt to the situation. I took 2 units of insulin and did a 1/2 hour core workout in my sweltering apartment. Although I didn't burn as many calories as I would have liked I was able to control my carbs and adjust to the situation. This made me realize no matter how much I plan I'll still be confronted by mini-challenges. When that happens I just need to remember to take a deep breath and know that my workout doesn't have to be perfect to control my blood sguar; somewhere a Fat Bird is smiling.

Monday, June 18, 2007

It's Like Christmas

The day I've been waiting for has finally arrived - I received my Minimed Pump in the mail! The box arrived at 6 pm on Friday but since my company has the worst mail room in the history of offices, I didn't receive it until about noon Monday.

I could barely contain my excitement when our mail guy approached me with this box:

Never before has a cardboard box with a logo that is the bastard child of Cirque Du Soleil and Leondardi daVinci brought me so much joy.

Opening the box filled me with excitement and anticipation:

But it was still a tease as I had to dig through 5 lbs of popcorn and countless packages of reservoirs and infusion sets to find what I was truly searching for :

Which contained my brand new purple pancreas:

My excitement is tempered by the fact that I can't get into see my diabetic educator at the Berrie Center until the 28th. However, this will give me a chance to take the online "pump school" offered by minimed and read all the instruction manuals. Once I get used to the square wave bolus I may just have to break my no Chinatown in the summer rule to have the dim sum feast I've been craving.

Friday, June 15, 2007

Back on Track!

After a tough couple weeks my blood sugar finally leveled off yesterday. Instead of using the 12:1 ratio I had calculated with for the past month and 1/2 I'm now using a 15:1 ratio. My lowest blood sugar from yesterday and through the first half of today was 81 and that was after a great lift. Hopefully I'll be able to take inspiration from the guys playing at Oakmont this weekend to just keep grinding it out.

In other exciting news, I'm scheduled to get my Minimed 522 today! I absolutley cannot wait to start pump therapy and am really looking forward to it. Sometime next week I hope to post a full side by side comparison to illustrate why I went with Minimed over Animas. As soon as I have the pump in my hands I'll be calling Leigh over at the Berrie center to st up my first of two appointments to learn how to use the thing.

Have a great weekend everyone.

Wednesday, June 13, 2007

So This Is How You're Going To Be.....

So diabetes I see you don't like to fight fair. Unlucky for you that I say give me your toughest and I'm going to come back even stronger. I thought I had this whole carb ratio thing figured out and then over the past two weeks it seems to have completely changed. I spoke about my lows last week but this week they have become even worse. Although I haven't encountered any crazy sub 40 numbers the numbers this week have been that much more frustrating.

On Monday night Courtney finally joined me at the awesome Australian seafood restaurant, Bondi Road, that opened across the street from my apartment. We shared an appetizer of breaded shrimp and small crab cake balls (both delicious), for my entree I had a great grilled Red Snapper and sauteed spinach with pine nuts and 1 Cooper Pilsner (an Australian Beer). I estimated this meal to have maybe 20 carbs and gave myself 2 units of insulin. 2 hours later my blood sugar was down to 70. The next day I had my usual turkey sandwich for lunch with a bolus of 4 units of insulin; I have this lunch every day and my body reacts pretty much the same every day. However I dipped below 80 after my lunch - aggravating! Although this gave me the opportunity to have a full Cliff Bar before my Tuesday run (very exciting when you've had to calculate how much a cliff bar would raise your bs for a couple months). I had a great run and had normal blood sugars for the rest of the day - the fun really began Wednesday.

Wednesday morning I had egg whites on toast with 6 oz of orange juice, my normal cover for the oj is 2 units of insulin so I added 1 unit to cover the slice of bread; by the time I got into work my bs dipped into the 60s. For lunch I had my turkey sandwich and added 4 peanut butter crackers (about 15 g of carbs) but only covered with 4 units of novolog - I still went low! After a frustrating day and a hellacious GMAT tutoring session I needed some comfort food so I ordered a bacon cheeseburger and a baked potato from Dallas' BBQ. I covered with 4 units of insulin but 2 hours later my blood sugar was 360! I took 4 units of insulin to bring it down, unfortunately my bs refused to budge - so I went to sleep hoping it would drop overnight.

At 7:40 am my bs was down to 320, I had an egg white omelet and 6 oz of orange juice so I took 6 units of novolog, 2 to cover and 4 to correct. By the time I got to my office my blood sugar was down to 49. Playing with a yo-yo is fun but being one is not. I've e-mailed my endo and educator to see if they can provide any insight. I still say if this is the best you can do diabetes continue to bring it because I will control you, whether I have to run more, lift more, eat less or eat more I will do what it takes to prevent you from controlling my life.

Tuesday, June 12, 2007

Adult Onset Type 1

I was recently at the kickoff party for the Young Friend's of the Naomi Berri Center; 4 of the "friends" were diabetics, each of us had been diagnosed after our 17th birthday. It seems that a diagnosis of Type 1 diabetes later in life has become more common over the past decade. This morning CNN.com ran an article about a 49 year old woman who was diagnosed with Type 1. Like the rest of us, she knows she must simply deal with the disease.

It's weird knowing that 3 or 4 months ago I was able to eat what I wanted without considering the repercussions. I didn't have to calculate the # of carbs in what I ordered at a restaurant or worry about how a beer was going to affect my blood sugar (up or down, up or down). Over the past few weeks Courtney has asked me to go for Dim Sum, Indian food or grab a burger at Shack Shake and I've had to turn each one down. Yesterday, she made a surprise visit to my office and before we grabbed an afternoon coffee she ordered an Ice Cream from Mr. Softee with sprinkles. In the past I may I have given her a look because she is training for an Ironman but yesterday for whatever reason I felt like that was insensitive. Perhaps I've been more on edge because of all the lows I've had over the past week and 1/2 but I'm definitely sensing a whole host of new struggles now facing me.

Monday, June 11, 2007

The Art of Miscalculation

After driving back to the city from my parent's house on Saturday night I decided to eat 2 stuffed peppers I had gotten from Whole Foods for dinner. Unfortunately my grander plans of a night out on the town fell through - this could have been a cruel twist of fate. The closest match to my whole foods stuffed peppers was Stoufer's Frozen Stuffed Green Peppers or Stoufer's Frozen Stuffed Peppers with Beef. Calorie King states that these peppers have 21 grams of carbs per serving or 42 grams per serving respectivley (1 pepper). I decided that the whole foods peppers were probably closer to 21 grams of carbs so I gave myself 4 units of insulin to cover the 2 peppers I would be eating. About a half hour later I was trying to move my bike into a less obtrusive corner of my apartment and felt like I was back at the Kappa Sigma house doing 15 shots of Jager in a row - my low hit me like a ton of bricks! I got out my glucometer as quickly as I could and had a blood sugar of 38 - the scariest feeling I have ever had. I quickly chugged about 15 oz of orange juice and had 3 glucose tabs; then called my girlfriend and told her to call me in 15 minutes, if I didn't pick up I told her to call 911. Thankfully in 12 minutes my blood sugar was back to 125 and I eventually needed a unit of insulin to bring my blood sugar down a bit (high of 210). This brings up an interesting problem though - if I'm estimating carbs based on Calorie King software which seems to do a better job of calculating fast food than home cooked meals how can I bolus with confidence? It's clear that the Stoufer's meals have alot more carbs than the whole foods peppers did, in the future I'll know this but how can I avoid this error with other foods in the future? At least my Saturday night provided alot more excitement than the Soprano's finale.

Thursday, June 7, 2007

Diabetes and Relationships

Up until now all the posts on this blog have been about me and how I've been dealing with the disease. But really for us with diabetes that is only half the story. We all have an amazing support network and people who care about us that see us through our everyday struggles. At times I think our bs concerns may be more of a trial for them than for us. I'm perfectly cool not eating certain foods or taking it easy on the beers but what about when that prevents your significant other from enjoying some of the things they want to do.

Last night I was on the Upper West Side to check out a desk I found on Craig's List. Since my first apartment in Manhattan in 2002 I've had this monster IKEA corner desk - it was great for my studio as I put it right under the loft I built it has done nothing but take up way too much space in my 1 bedroom since 2003. I've made excuse after excuse not to get a new desk but finally I found the perfect match - the Jay Desk from West Elm. So after my first GMAT tutoring session I headed to 75th street to check out the desk and bought it for $100.

Because of work meetings, GMAT tutoring, not getting off the express train, and looking at the desk I had gone about 4 hours without eating. I had my turkey sandwich at 12:30, a cliff bar for my 3 and 1/2 mile run at 2:45 and a small bite of a cliff bar at 5. By the time I met Court on the UWS I was starved and really irritable (bs was down to about 85). She hadn't had the best of days and certainly would have rather seen a happy Ed than the low blood sugar ogar. However, with a headache coming on and my irritability towards all the lows I had in the past few days I tried as best as I could to be myself but just couldn't shake the bad mood.

As we walked past a few places on Columbus Ave. I continued to get more irritable as I was trying to find something that I knew I could correct properly for. She suggested sushi which I quickly shot down; I just didn't feel after the roller coaster since Sunday that I could account for that much rice, the soy sauce or fill up enough on sashimi without a $300 bill. Finally we found a nice bar & grill where I calculated everything I would eat on my trusty palm pilot loaded with Calorie King software. I need to remember that as new as this disease is for me, it's even newer for those around me. As many doctor's appointments that they attend or as much research as they do I can only explain how I feel to them not get them to live it. Court has been unbelievably supportive and as soon as I get my new Paradigm pump I think I owe her a big sushi dinner and maybe even a night of dancing which she always asks me to do.

Wednesday, June 6, 2007

Pesky Lows

Since Sunday, I've been battling a nightly low every day. On Sunday I headed over to Duane Reade (Manhattan's CVS) to pick up some stuff for the week at about 8:50 pm. At DR I felt my usual warning signs - oddly my ankle which I had reconstructive surgery on as a junior in high school starts to tingle and my forehead itches (weird) - and thought I should buy some life savers. Since I didn't see any life savers readily available at the check out counter I figured I could make it home no problem. I kept feeling weirder and weirder as I made it back to my apartment and by the time I checked my bs it was down to 42 - my lowest on record. So I took some orange juice and had a small piece of bread and was fine.

On Monday night, I had a baked potato, breaded chicken patty and green beans for dinner; corrected with my normal 12 : 1 ratio but had my bs drop into the 50s again. OJ did the trick again and I was fine for the rest of the night.

Last night I had my most annoying low yet. Courtney brought me Halal from our favorite street meat guys - the cart at 53rd and 6th! I can't tell you how excited I was to have the cart again, if you're ever in the city believe me the 30 minute wait is worth it. We had our delicious street meat and some red wine; I figured the meal had about 70 grams of carbs and bolused accordingly. But less than 2 hours later I was down to a bs of 89 so I had a bite of a cliff bar, 30 minutes after that I was down to 68 and had a glass of orange juice, 20 minutes after that only up to 75 so I had a second glass of oj, 20 minutes later down again to 73! A third freaking glass of OJ!!!! Finally by 11:50 I had my bs up to 99, ate a piece of a cliff bar and went to sleep.

This morning I woke up with a bs of 164 and had egg whites on toast for breakfast with a glass of orange juice. I bolused accordingly and by 9am my bs dropped to 58! I had 3 glucose tabs and now my blood sugar is back up in the 90s. I know I might still be honeymooning but really all these lows 3 days in a row, I just can't figure out what the heck is going on. I e-mailed my endo and cde today to see if they had any suggestions. The weirdest part is my lunch bolus is still working normally, I have a turkey sandwich just about everyday and take 4 units of insulin to cover it - works perfect. So I don't know if my ratios are changing at different times of the day or if my pancreas is just waking up every now and again.

Monday, June 4, 2007

Picked a Pump!

After countless hours of research and loosing way too many minutes of sleep stressing about which pump to pick I finally came to a decision. I'm going with the Minimed Paradigm 522 pump, contrary to what I had earlier stated. After exhausting every possible shred of information I came to the conclusion that the 522 was the best pump for me.

During my trial of the 522 I absolutely loved that I could access the bolus wizard by simply hitting the "B" button on the pump - this took about 3 less steps than the Animas 2020 would have. Also, I felt the way the bolus wizard worked was more intuitive and provided better information than the Animas 2020.

After reading some awful reviews of the OneTouch meters on Six Until Me I came to the realization that Minimed puts out a better overall product than the Animas/ J&J team does. I have to base my future expectations on the past performance of the Animas family of products; the glucowatch has proven to be unreliable and OneTouch meters don't seem to be as accurate as the competition. Also, I expect a company that is just 6 years old to have been more innovative than they have been to date. While the 2020 has a better design and a great color screen I just don't think it stacks up against the functionality of the Minimed. I'm trying to live a healthy life not win a fashion contest so I went with the practical decision.

I'll have the full tale of the tape to more fully illustrate my decision but I wanted to share my excitement with the rest of the blogosphere! I can't wait to get on the pump and start experiencing some of its benefits.

Sunday, June 3, 2007

The First Bike Ride....

Since my diagnosis on April 2nd my workouts have been limited to half hour runs and hour lifts. Yesterday I was finally able to make it back onto my bike for what I hoped would be an out and back from Manhattan to Rockland Lake (about 70 miles). I started the day with a blood sugar of 110 and had half a cliff bar with no bolus shot. I felt great headed out of the city and at mile 15 my blood sugar was 100, so I took the second half of my cliff bar. I continued on the ride and went up some monstrous hills; on the third hill I felt my first crash and had a Gu to recover quickly. As the miles started to pile up in the 90 degree heat my blood sugar kept getting lower and lower. About 30 miles into the ride I started needing a Gu every 15 minutes as my blood sugar kept dropping into the 60s. Unfortunetley I just couldn't get my blood sugar high enough to finish the ride and had to call in the relief vehicle, my SUV driven by my Dad from Westchester. The whole ride was a learning experience; I now know that I need to take in alot more carbs pre bike ride than I do pre run and that the longer I ride the harder it's going to be to keep my blood sugar at healthy levels. Best of all the hard work resulted in my ability to enjoy some of my favorite foods!

Since exercise makes insulin so much more effective I was able to reward myself with some AWESOME food after the ride:

1 - Oat Bran Carrot Muffin from the Runicevle Spoon in Nyack - absolutley amazing and a great resting spot as I waited for my Dad.

2 - Gnocchetti in Gorgonzola Sauce from Da Andrea in the West Village - if you haven't had a chance to try the pasta at this cozy spot, run to it! Everything is home made and it feels like you're in an Italian Grandmother's kitchen

3 - Cannoli from Roco's Bakery in the West Village - Cannolis and Cookies are by far two of my favorite foods in the world. Since my diagnosis I haven't had the chance to enjoy either but since the insulin was so effective yesterday I knew it was my chance to indulge my vice! My god the cannoli was fantastic! Saving up my food vices for special occasions makes them that much tastier.

Although I didn't get to finish the ride I set out on, I was smart about my diabetes, got in a great workout, learned some things and got to eat some of my favorite foods. If I have to go on a 40 mile bike ride every time I want to eat a cannoli it's well worth it!

Friday, June 1, 2007

Identifying Differences - Finally!

One of the major differences between pumps is how they count insulin on board (IOB); Minimed pumps use pharmodynamics while Animas uses pharmokinetics. Currently Diabetes Mine has some more information about this. As I understand it pharmodynamics takes the cellular level of insulin present to deliver a bolus shot; this reduces the amount of IOB in the bolus wizard calculation possibly causing more lows than a pharmokinetic system. However, a pharmokinetic system may not allow the pump wearer to fully cover all additional carbs they are eating due to how it calculates IOB. I need to do some more research on studies that determine which is a more effective way of treating diabetes.

A second major difference between the 2 pumps is how they deliver the bolus insulin. The minimed pump delivers a unit of insulin every 30 seconds, so a 3 unit bolus will take a minute and 1/2 to deliver. The Animas pump delivers a unit of insulin every second in the 2020's normal mode and a unit of insulin every four seconds in the 2020's slow mode. I have yet to find any medical significance to the speed of a bolus and how the body absorbs it but I'm hopeful that I can find an article on it soon.

Lastly, the basal rate of each pump is calculated completely differently. The Minimed pump uses a mathematical formula of (units of insulin per hour) / .05 to determine how often you will receive a basal injection. Animas simply delivers basal insulin every 3 minutes. Therefore, if you receive .6 units of insulin per hour the Minimed pump will give you insulin every 5 minutes or 12 times per hour (.05 units of insulin for each injection). For the same .6 units of insulin per hour the Animas pump will give you a shot every 3 minutes or 20 injections of insulin in that hour (.03 units of insulin for each injection).

I've identified some major differences between the two pumps. My next step will be to talk to Leigh my diabetic educator to find out what/ if any the difference is between delivering insulin in the above methods. Although Minimed has received alot of goodwill I want to make sure they are using the most effective method of insulin deliver, I do not want to chose their pump simply because they were the first to introduce a CGM meter that spoke directly to their insulin pump.