Friday, January 30, 2009

Day 2 With the Navigator

Yesterday I took my Navigator for a long run to see how accurately it could predict a low. One of the main reasons I wanted a CGMS was to have a way to monitor my blood sugars during exercise without stopping, to have an alternative to finger sticks in the pouring rain (like IMLP) and to have a trend predictor of an impending low.

The plan was to run for 40 minutes yesterday at a recovery pace at then do hill repeats for 20 minutes. I knew my cumulative carbohydrate total was a bit lower than it should have been for the amount of exercise I've done over the past 2 weeks and thought there was a small chance I'd have a low, but was confident I had enough in the tank to finish the run. However, as I looked down at my Polar RS800 I noticed maintaining a 10:30 pace was WAY harder then it should have been (normally I run at an 8:40 - 9:20 pace), which is normally the first sign of a low. After struggling along for 3 or 4 minutes my navigator started vibrating, I took it out of my sleeve pocket and saw the vertical downward arrow and a blood sugar of 106 - it worked!

Yesterday, without the Navigator I would have kept running until my blood sugar was in the 60s since I normally test every 30 minutes while running. The Navigator predicted my low 4 minutes before I would have tested and allowed me to safely walk the rest of my route home - rather than having to sit down with an energy gel waiting for my blood sugar to rebound. The Navigator worked perfectly yesterday and prevented what could have been a dangerous low - exactly what I wanted the device for.

Thursday, January 29, 2009

Freestyle Navigator - First Impressions

Wow! Before writ ting about the technical details of my first calibration I wanted to immediately write about my first 24 hours with my navigator. Like I said, Wow! As annoying as the sensor is to wear, as frustrating as some of the device settings can be - this device is incredible.

As you saw from my packing for Costa Rica I'm pretty neurotic when it comes to diabetes management and want to have as complete information as possible. While sitting in class I often worry that the warmth of the room is due to a raising or falling blood sugar rather than well the actual temperature. Yesterday at any moment during class I could look down at my navigator and see that the room actually does have big temperature swings that my bs had nothing to do with.

I was able to identify a few trends in my blood sugar and identify the general time that I had some basal rate discrepancies leading to some blood sugar highs around 2pm (for the past week). And on the treadmill the thing was incredible!! I wanted to run in a controlled environment yesterday and was able to see how my effort affected my blood sugars - totally cool. But more importantly the navigator gave me the peace of mind to run as hard as I wanted.

I know that the navigator has a time lag, that the information isn't perfect and that it will never truly replace finger pricks. But only doing 5 finger pricks yesterday versus 15, seeing general trends in my blood sugars and having the extra confidence to just go about my normal day make the positives of this device far outweigh the negative characteristics.

Tuesday, January 27, 2009

It's Here! It's Here!

While up in Boston I received an e-mail from my neighbor that said "Ed I noticed a huge box outside your door, so I brought it up to my apartment, let me know when you're back in C'Ville." Once I sadly left my gorgeous girlfriend and beantown I was excited to find out if this package was my CGMS.

Once I arrived at my apartment I contacted my neighbor ASAP and was thrilled to pick up a huge box (not from Medtronic.) I quickly opened the box and was greeted by my FREESTYLE NAVIGATOR!

Unfortunately my first attempt to link the sensor to the receiver didn't work so I need to wait until I get in touch with my trainer as I don't want to waste a second sensor. But I can't wait to test this thing out and save at least a couple finger pricks a day. More to come......

Friday, January 23, 2009

JDRF Fundraiser

I recently received an e-mail informing me about a great new fundraiser for the JDRF. I've done work with the JDRF as a mentor in the past and try to support them as often as I can.

On Wednesdays Togo, a West Coast sandwich chain will make a donation to the JDRF for every $1.99 "flashback" sandwich purchased. This is an easy way to help support one of the greatest allies of a type 1 diabetic.

Have a great weekend!

Tuesday, January 20, 2009

When Insulin Goes Bad!

On my return flight from Costa Rica I had mentioned some annoying highs that were tough to get down. That pattern became more severe in the days immediately after my return to the states and continued for the better part of the week. Originally I had thought the pesky highs were from some not so stellar eating habits during a glutinous period.

Last Wednesday I went to Cheesecake factory with my sister and had to take in nearly 20 units of insulin to get my blood sugar below 200! Originally I had thought that this was due to a huge portion of nachos, bacon cheeseburger and order of fries (gotta live sometimes!) but the next day when my blood sugar sky rocketed from a turkey sandwich on whole wheat I began to think something else was up. It seemed that the only thing that would get my blood sugar down was exercise.

During my drive back down to Charlottesville my blood sugar spiked near 400 after having just a Clif Builder Bar for breakfast. Then it dawned on me, my basal rates weren't wrong, my insulin had gone bad. I guess with all the traveling the insulin molecules began to break down and became about 1/4 as effective as they should have been. Changing the vial solved my problem but gave me a great idea. Why can't pharmaceutical companies put a component in the insulin that lets us know when the molecules goes bad - a 4th grader with a chemistry set could figure out how to do it and it would save all of us alot of angst and aggravation.

Thursday, January 15, 2009

The Costa Rica - How Do You Bolus For That Game

The next edition of Ring the Bolus will have pictures from the amazing activities Kim and I did in Costa Rica. But today, I wanted to share with you some pictures of the amazing food we had and how I attempted to bolus for some incredibly good (but fattening - anyone want 5 lbs!) food.

Delicious Fish Tacos - oh how fried fish taunts me! Was conservative on my bolus and went for 110 grams of carbs - 2 hours after lunch was around 190, Kim and I were still trying to be athletes at this point so a run brought that down no problem.

A few bites of shrimp enchiladas probably didn't help that calculation!

What's better than a healthy home cooked meal in a beach house with an ocean view on vacation! Local rib eye, some ravioli and you guessed it wine out of a blender! The rental house didn't have a cork screw nor did the 3 bodegas we tried to find one at - nothing says class like Cabernet out of a blender :). Totally over calculated for this meal and wound up in the 50s before bed.

I thought Kim was going to bite my hand off when I took this one - the avocado and shrimp at Cafe de Paris was so good we were too excited to take a picture at the start; no issues on the bs with this one.

Breakfast on the day we left the beach, left over shrimp pizza, some scrambled eggs and Costa Rican coffee - a perfect brunch before the drive to the mountains.

On the road around Nueva Arenal is one of the best hidden gems I have ever eaten at. Cafe de Macadamia had one of the friendliest owners and most delicious food I've encountered. The bread was made with macadamia nuts, the coffee was to die for and the talapia sandwich was out of the water fresh. The bread has way more carbs than I would have thought - normally a sandwich has about 50 grams of carbs but this one had closer to 75, well worth the slight high after lunch!

Arenal Nayara was probably the most incredible hotel I've ever stayed at. Private bungalows, outdoor showers and damn good food. I'm not sure if it was the 3 bottles of wine or an over calculation but my blood sugar dropped below 30 that evening! Thankfully all those cliff bars and glucose tabs I brought with me saved me from a really dangerous situation. The ceviche, tortilla soup, mahi mahi and steak were all incredible though - worth a scary low, maybe not but incredible nonetheless.

Desafio Adventures is the # 1 adventure company in Costa Rica. Each excursion includes a great Tico meal, like the one seen below. You'd be amazed by how many damn carbs are in that little glass of orange tastiness.

Ahhh fajitas how I miss thee. But at this meal I was sweating bullets because my meter had a major meltdown. For some reason I kept getting Error 2, I sat down to dinner knowing that I was low and ordered a coke, but couldn't tell what my blood sugar was by the time our meal arrived. When we got back to the hotel I used my back up meter to find out my blood sugar was still in the 60s. What really got me worried was the fact that the battery in my back up meter was dead (way to check that before I left), thankfully my watch and back up meter used the same battery!

Who would have thought 2 Pina Coladas could send your blood sugar to 400! Even with a 1.5 unit bolus - man those things have some sugar in them.

Nachos and chicken fried rice with shrimp - anyone want to tell me how to bolus for that one?

Roast chicken with guacamole and tortillas, I thought I had this one bolused perfectly, this was our last meal in Costa Rica about two hours before our flight and perhaps my favorite meal. But, an hour into our flight my blood sugar spiked to 250 and stayed there for a while. Kim and I had to sprint through Newark airport to make our connecting flight to Boston, the 1/2 mile run in flip flops where I sounded like a charging rhino dropped the bs below 170.

All in all figuring out the carbs went pretty well but at times had me feeling like the guy below!

Wednesday, January 14, 2009

How To Pack For An International Trip

The Northeast has welcomed me back from Costa Rica with freezing cold and snow - how I miss the tropics already! The trip was incredible; Kim and I had an amazing time and my blood sugars were for the most part under control.

As I wait for my fingers to thaw out and collect my thoughts from the trip and repack to head back to Virginia, I thought I'd share with you how my neurotic self packs for an international trip:

Think I was prepared?

Friday, January 2, 2009

Costa Rica Here We Come!

Kim and I are headed to Costa Rica tomorrow for a week of surfing, fishing, hiking, white water rafting, zip lining and cannoyneering. I can't begin to tell you how excited I am but also have experience for the first time how stressful it can be to plan an international trip with diabetes. If we were going to a less remote locale I'd be able to hit up a CVS or call medtronic if I had any problems with my pump or diabetic supplies. However, since we'll be in pretty remote areas doing some crazy stuff I have to pack my bag like Odysseus headed to Ithaca.

I'm pretty sure the chances of finding a cliff bar in Costa Rica or a glucose tablet are nonexistent so I need to be prepared for lows, highs and everything in between. I have extra test strips packed, two meters, batteries for my pump and meter, two vials of insulin, a full box of infusion sets, and the waterproof case for my pump. This is also requiring me to scour Boston for a new back pack so I can bring this stuff with me on our outdoor adventures - don't think my awesome Timbuk2 laptop messenger bag will cut it while white water rafting!

Look forward to sharing pictures of the adventure with you when I get back - HAPPY NEW YEAR!