It's The Little Things (Like a finger prick)

For months I have agonized over my finger pricks. I assumed that each lancet device was the same and that no matter which one I used I'd have to deal with black dots at the tips of each finger and looking like I had deformed fingers each time I got out of the pool. I thought each lancet device would be as uncomfortable as the one that came with my freestyle flash and take as many tries to draw blood as that one. Oh how I hated this evil little gray device of torture:

The grey device of torture once decided to break apart as the pharmasist was seeing what type of lancets I used just to bring the pain to someone else. I can't count the number of times the protective plastic fell off leaving the prick of death to be exposed giving me an unexpected jab when I went to test!

After 4 months of discomfort I decided to try a new lancet device and I can't be thankful enough that I went with the Accu-Check Softclix:

For the past week I have lived in finger prick bliss. During sweaty workouts I don't have to worry about my hand pulling off the only protection I have from the lancet of death, I've only had to reprick myself once out of 50 tries, the holes are healing and the black dots are gone! Maybe I'm turning soft in my old age but I'm glad to say good bye to the grey finger prick of death and hello to blue buddy.

Sleep & Blood Sugar

From Saturday through Tuesday I woke up each day at 5am. Saturday I woke up early due to the birds chirping in Lake Placid, Sunday to get to the Ironman to volunteer, Monday to sign up for the 2008 Ironman and Tuesday for a flight up to Boston for business. While I would have been much happier staying in bed and waking up at 7 the early days let me learn alot about how my body reacts to environmental changes and made me aware that I experience some dawn phenomenon.

Each night I went to bed with my bs around 100 (give or take a few points) but at 5 am each morning my blood sugar had raised to about 140. Without a correction my blood sugar would drop below 120 by 7:30 am. Had I not had such a crazy schedule I never would have learned that I did encounter a spike in those early morning hours and wouldn't have been able to discuss the necessary pump adjustments with my endo.

By Wednesday I was absolutely exhausted. I had my finance class Tuesday evening and didn't get home until about 9:30 pm; my bs was a mess on Wednesday. I had a reading of 197 after my turkey sandwich for lunch and really had incredible swings. After getting to the gym and returning to my regular sleep pattern my bs has returned to the 90 - 110 range. Have others of you noticed the dramatic effects a chaotic change to your normal routine can have on your bs?

Time to Ring The Bolus!

I had an incredible past few days. On Friday Courtney and I drove up to Lake Placid to volunteer at Ironman USA. Although we both got a bit sick from the 40 degree temperatures at night and didn't get nearly enough sleep the whole weekend was a blast. I never thought that handing out water to so many sweat soaked athletes could be so much fun. The smiles on someone's face during the marathon portion of an ironman when you call out their name and tell them they look strong is just an amazing feeling - I was in complete awe of these athletes and have tremendous respect for each of them.

Since my college football days ended I have been looking for a new athletic challenge. I have been seeking a way to perform in front of crowds and test my body's limits. Diabetes has given me the opportunity to make endurance sports even more challenging than what they already were and lets me "fight" something during them. I was so inspired by what I witnessed on Sunday that I woke up at 5:20 am on Monday to get in line to sign up for the 2008 Lake Placid Ironman! On July 20th, 2008 I will swim 2.4 mile, bike 114 miles and run 26.2 miles.

I can't wait for my training to start and I'm really looking forward to sharing my blood sugar challenges with each of you. During the race we saw 2 people with insulin pumps and 2 people wearing Tour De Cure bike jerseys. Last week I did my due diligence to make sure it was an ok decision to sign up for this race and spoke with some amazing Type 1s who have successfully completed ironmans or other triathlons in the past. Jay Handy of the JDRF and Tom Kingery of the future Team Running on Insulin both spoke to me at length about the training requirements of the race but more importantly helped me embrace my enthusiasm for this challenge. Through this event I hope to show all those diabetic kids or adults that we can challenge our physical limits and can compete in insane athletic events. Now it's time for me to live up to my blog name and Ring The Bolus; this next year will have more sweat, more pain, and more commitment than any athletic endeavor I've tackled in the past and I can't wait!

So that's why you change the infusion set!

I've been on the pump for a couple weeks now, up until Tuesday I hadn't had a problem with it. I had planned on changing my infusion site that evening when I got home from work - however, during a pretty tough speed workout at the gym the tape adhesion started to peel away from the skin a bit - no big deal I thought it will stay there until I get home. After I finish my run I notice that the adhesionison is half off so I hustle over to Duane Reade to pick up some athletic tape. As I walk up Broad St - I feel a pinch at my side and then realized that the damn thing fell out! Luckily I kept some extra infusion sets at my office but didn't have the minimed inserter - so for the first time I had to jam that big needle into my gut; not fun, I like the inserter much better!

I wanted to see how long 1.4 mg of insulin would last in my pump for so I didn't change the reservoir after the infusion site change - last night at the Yankee game I was greeted by a low reservoir warning - no big deal, I had enough left for the basal during the game and 1 bolus. But I learned two valuable lessons from this - change your infusion site every 3 days (not 4) and 1.4 mg of insulin will last me 5 days, I'll just keep learning this stuff as I go.

Endo Follow Up

This morning I had my first "true" follow up with my Endo. I've read other blogers accounts of their 3 month visit but I had yet to feel the anticipation of a new A1c. I entered the office, sat down in the testing room and anxiously waited until Dr. Goland called me into her office. Upon meeting me in the waiting room she had a huge smile on her face and pointed at a number in my chart.... 5.6!!!!!!!!!! Back on April 2nd my A1c was above 16 and during one of my early visits about the pump (mid May) my A1c was 7.8 - having a "normal" A1c let me know that all the hard work and sacrifices that I've been making since my diagnosis are paying off and that I am handing diabetes a "defeat" each day. The challenge to maintain this healthy level will continue to motivate me to run, lift, bike, swim and challenge myself athletically in whatever way possible. I may eventually have to find something besides chicken sausage and artichokes to eat but for now that's working too!

What made the office visit even better was getting to meet about 25 kids who go to the Naomi Berrie Center's summer camp. Each one of the campers is a patient at the center and about 2/3 wear pumps. I had no idea that the center ran such a program and was thrilled to meet all of them. Kerri who is working with me on the "Friends of the Berrie Center" fund raising effort saw me sign in and said I have something to show you... she took me to one of the back offices where I saw 25 of the happiest kids I've ever seen with bright yellow t-shirts on. Today they were all going to play tennis and earlier in the week they went to the zoo. The Berrie Center takes a family oriented holistic approach to diabetic care and seeing the smile on those kids faces really drove that point home. The office is more than a medical center it is a place of support, hope and confidence for all of us who struggle with the disease.

Pumping It Up!

Although I'm less than a week into my pumping life, I couldn't feel more liberated or be happier about the results. In addition to having awesome bs control during the ride on Sunday I was able to eat a delicious lobster roll with fries on Saturday night and eat POPCORN AT THE MOVIES following dinner!!!! When I was first diagnosed with diabetes I guess I shed away from putting myself in a situation that would be hard to control, like eating movie popcorn, having some french fries or sleeping in a bit. Now that I'm starting to understand how to use a square wave or dual wave bolus and how to adjust my basal rate I feel like I can once again eat all those foods I love, in moderation. I'm not sure if it is the confidence of knowing that my insulin can be constantly adjusted or that I don't have to stab myself to be able to eat but I feel as if the pump has lifted 1,000 of pounds off my shoulders.

One of my biggest frustrations with diabetes was going to the gym and being really worried about getting a low from lifting or running. Last week I had some problems adjusting my basal rate prior to working out and encountered a low while on the treadmill and another low after a secondary muscle group lift. I guess I didn't reduce my basal rate enough prior to exercise or bolused too much for my Clif Bar.

For me, lifting is a way to reduce stress and lets me clear my mind of all the things that are bothering me so any disruption to that routine is tremendously frustrating. Pre lift I like to have a Clif Builder Bar so I have enough energy to work my butt off for an hour and 15 minutes. While on lantus/ novolog I would eat my Clif Bar without a bolus and then have to bolus after my lift to account for any sugars I didn't work off. However, yesterday by reducing my basal rate to 50% 45 minutes before my workout and bolusing .5 units for the Clif Bar I ended my lift with a blood sugar of 89! I can't tell you how much a regulated blood sugar aids in recovery.

NYC Tour De Cure & Life on The Pump

Yesterday Team Fat Bird completed the NYC 62 Mile Tour De Cure. Unfortunately Team Fat Bird was reduced from a team of 5 to just Courtney and me but we represented well nonetheless. I woke up at 5:45 am, had a protein shake and reduced my basal rate to 30% for the next 7 hours. Nothing gets you ready for a ride like Cyndi Lauper at 6:30 in the morning! The ADA really needs to work on their music choices, the last song I heard before starting the ride was Foreigner's "Waiting for a Girl Like You" - now I'm about as big of a fan of 80s rock as you can find but seriously if you're going to play Foreigner can we at least get Juke Box Hero????

Although most of the about 40 people who did the 62 mile ride missed the turn at 54th Street the ride was amazing. I've ridden the GW Bridge to 9W North route 3 or 4 times this year but doing the ride with so many people who are raising money for our cause was great. The best part was riding out onto the pier in Piermont to have this gorgeous view of the Tapanzee Bridge (that's Courtney in the picture with me):

Best of all - I DIDN'T HAVE A LOW THE ENTIRE RIDE!!!!! Pre-ride I had a protein shake and a 1/2 a bagel; about 10 miles in I had a Cliff Bar and followed that up with 3 carb booms throughout the ride. I can't believe how much easier life is on the pump! My purple pancreas is just amazing - just a complete difference in endurance compared to multiple daily injections.

I think the ADA could have organized the ride better, and marked the course much better. One big frustration was we couldn't find the rest stop in Piermont and the rest stop on 9W had run out of water! Additionally, Battery Park has tremendous foot traffic on Sundays. The only people who came into the Tour De Cure area were ones trying to buy a water - alot of awareness could have been raised yesterday but they would have needed a more organized effort to fully take advantage of that opportunity.

My Purple Pancreas

Yesterday I promised I would disclose the reason why a 28 year old male chose a purple Minimed pump over a more subdued color. But first I have to praise my pump to no end. The worst part of my day, every day, for the past few months has been that stinging shot of lantus. Having the lantus at room temperature took a bit of the sting out but I was still never comfortable with it and to never have to do that again brings a huge smile to my face. After 24 hours I feel so much freer, I don't have to rush to the bathroom at work to bolus before lunch, I don't have to worry about having some chips and salsa while playing Wii with a friend and am comforted by the fact that I now have even better control of my diabetes. Best of all I know that the chemical that is keeping me alive is constantly attached to me and can be altered to better fit my activity alot of weight was lifted off my shoulders yesterday and I can't express how happy I am to be pumping.

Why purple, you ask (not that anyone asked). My life is greatly defined by my past and my past includes three amazing years at Hobart College. As the starting center on the Hobart College football team for the 1999 and 2000 seasons I gained amazing friends, tremendous leadership experience and learned alot about myself. I've been able to take the dedication and commitment that it took to succeed as a college athlete and apply it to almost every facet of my life. Most importantly the adversity that I faced on the field, countless hours of preparation and sacrifices I had to make have allowed me to deal with diabetes running head first and taking it on. When it came time to choosing a pump and I saw that purple was available I had to go with it. Hobart's colors are purple and orange - I raise those colors high whenever I can; be it on my golf bag or shirt, a hat and now my insulin pump. Now each time I face a challenge with diabetes I can look down at my pump, remind myself of the dedication it took to succeed in a sport I loved and apply that same intensity to controlling this illness.

Pumping Away!

The morning of PUMP DAY has finally arrived and I'm happily basaling away!!! Last night I laid out the pump paraphernalia that I would need with me:

And took my last shot of Lantus for the foreseeable future:

I won't miss the Lantus a bit - every time I injected it burnt and I was getting sick of drawing blood every now and again - you are going to be much easier to break up with than my Novolog Pen.

I arrived at the Naomi Berrie center on 168th street at about 8am and was starving. Having taken only 5 units of lantus last night had my blood sugar running a bit high but that was to be expected. I met with Leigh and we set my settings and inserted the infusion set! Since I had done the earlier trial with the Minimed pump I only needed 1 appointment to set up. Right now I only have 2 basal rates, .35 from midnight to 4am and .4 for all other times. This process really is fascinating and I'm excited to see how my body reacts to different types of activities. It will be alot easier to do long periods of strenuous exercise now since I won't have to devour countless Carb Booms and Cliff Bars to maintain my bs.

At 9am my bs was 140 - I bought a blueberry muffin and a large coffee at the corner coffee truck and headed back up to the office. I delivered my first bolus with the purple pancreas and did GMAT problems for the next hour and 1/2 at the center. At 10:30 my bs was 170 - I always have a problem covering for muffins (note to calorie king - you need more muffin examples in the database!). Leigh said she'd rather have me high to start than low so I was free to leave and go to work. I just checked my blood sugar at 1pm and had a bs of 69 (guess it wasn't the lasting effects of my cold that made me feel shaky). Perhaps I need to lower my basal rate during midday but that will be shown over time. I did miss having to go into the bathroom to shoot myself in the stomach with my trusty novlog pen but I think I just might be able to get used to sitting in my chair, hitting a button and eating without having to retuck my shirt pretty easily. This is going to be alot of fun!

Tomorrow I will finally reveal why I decided to have a purple pancrease.

Attack Of The Summer Cold

I have to thank all of you for such great advice for my canceled camping trip this past weekend. Unfortunately I came down with an awful cold on Thursday and had to cancel the trip; since I was going through a box of tissues an hour and my head felt as if it was going to explode in the a/c I couldn't imagine how I would have felt tramping through the woods. However, I'll hopefully be able to get in a camping trip at some point this summer and will be sure to report in when I do.

A cold with diabetes provides a whole host of new problems that I never knew about. I hadn't a clue that insulin would react in a completely different way because I was a bit sick. My normal bolus ratios seemed to work ok for some meals but for other meals I'd still go pretty high. I'm not sure if the insulin just takes longer to get through your system when sick or if it's less effective, I did go low after a few corrections - nothing to be too concerned about. My biggest disappointment was the Chinese food I ordered for the first time in 3 months! Normally when I have a cold I get the spiciest food possible to clear out my sinuses; it seems that my favorite local delivery places went out of business in the past month or so and I had to try a new place - it was awful; I wound up having to eat some bread to have enough carbs since I barely ate half of my meal.

Thankfully, I was feeling well enough by mid-day Sunday to go on a Bike Ride and prepare for the Tour de Cure. Unlike my ride a few weeks ago I really prepared for this one and took some advice from commentors. I reduced my bolus by one unit on Sunday morning, had a full Cliff Bar before my ride, had one water bottle with water and another with half water and half Gatorade and had Carb Booms throughout the ride. For all the effort I was rewarded with this view:

The ride was insane - I rode through 41 miles of hills in the Hudson Valley - for those of you familiar with the area I started at the intersection of route 100 and 35 in Somers, traveled south on 100 to 129, took a left on Quaker Ridge Rd. Then found Quaker Bridge Rd where that gorgeous view was snapped from an iron bridge in the middle of the woods - from there I found my way back to 134 and closed the loop with 100. I've never done a ride with that many hills before and man my quads were burning by the end - when I started on 100 I was averaging about 22 mph, on the same stretch back I could muster only enough energy for an average of 14 mph! The Carb Booms prevented any lows and for endurance sports I highly suggest them over the other energy gels - they taste better and seem to be much more effective - I was using bannana.

Have a great 4th of July! The next time you'll hear from me I'll be an official Insulin Pumper!!!