Wednesday Wackiness - Business Lunches

One of the things that causes me some anxiety is testing for the first time with business colleagues.  I'm not embarrassed or nervous to test at all, its more the anxiety that in some way testing and bolusing will become a distraction.  After a business colleague knows "my deal," testing becomes routine as my office mates and peers will see me test and bolus multiple times per day.  But that dynamic changes when its a one off sales meeting, interview or other business meeting.

I think my anxiety stems in part from two issues:

• In a business meeting when time is a scarce resource I don't want to take 5 minutes away from the task at hand to explain what I'm doing
• And this is probably the bigger one - perception

The 5 minutes (if that) taken away from the meeting is easily over come; as long as the conversation doesn't rat tail into the difference between type 1 and type 2 diabetes (perhaps adding to my anxiety).  If that happens then 5 minutes could quickly turn into 10 if not 15 and greatly detract from anything I'm trying to accomplish in that hour.

But the bigger issue, perception.  In business meetings I want to be focused, viewed as attention oriented, determined and strong.  Although its a necessity for me to test and bolus prior to eating I never want to seem "distracted" during a business meeting.  Due to that I feel the need to explain what I'm doing (circling back to issue 1) which in itself is a distraction from the meeting.

So there in lies the challenge - excuse myself to the bathroom, test and bolus before the meeting (taking the chance I'll eat within 20 minutes) or roll the dice and deal with the anxiety...

Monday Metrics - More Stabalization

Averages

Basal - 13.9
Bolus - 23.4
TDD - 37.3
Daily High - 41.74
Ratio Bolus:Basal - 1.68

Last week my blood sugars continued to stabilize as I get used to working out a bit more and am in my third month of operating the new pump.  I'm going to start tracking a ratio of avg bolus rate to avg basal rate.  I have a hypothesis that I may be using my boluses to compensate for a basal rate that isn't exactly perfect.  That may be why when I eat with less consistent patterns my blood sugar tends to either go high or low.

Also, the weekly high of 42 total units of insulin taken was in part due (at least I believe) to an infusion site that started to come out a bit.  While I really like the interface of the Animas pump the infusion sites I'm using are god awful.  I can't get the needle to bend the same way I could with the medtronic infusion set-up I was using and the insertion device was designing by a 3 year old on construction paper.  Who ever designed this insertion device seriously did no user experience testing.  I'm going to try and figure out a better option in the near future.

That's about it for Monday metrics, talk to you soon!

Wednesday Wackiness - When You Can't Figure It Out

Some days I realize how little I or the medical community at large understands about an individuals metabolism.  Sure, the mechanics of a metabolism are well understood but the exogenous variables that impact the system at large are much less easy to define.  That's my nerd way of saying sometimes its impossible to figure out what the hell is going on with blood sugars.

I assume my fellow Type 1 readers have been there, after a string of great blood sugars I'll encounter a day where my blood sugars simply refuse to drop below 300.  In the past this occurred alot after 100 mile bike rides as I trained for an Ironman.  I understood that, my body was releasing a ton of cortisol to repair my sore and fatigue muscles but now that my long bike rides are closer to 40 miles than 100 I no longer have that explanation.  Is it a change in seasons, daylight savings time or perhaps the salad I ate went on an all night carb bender?

On days where I have 1 egg on whole wheat toast, some quinoa and chicken sausage for lunch and a salad for dinner yet have to take in 3x the amount of bolus I normally would to get my bs into a safe zone I just don't get it.  I know those days will pop up time and again and I know I'll probably never have an explanation for those days but that doesn't make those days any less frustrating.

Monday Metrics - Some Ups & Downs

Daily Basal - 14.13 units
Daily Avg Total - 33.32
Daily Avg Bolus - 19.88
Weight - I think still 190 (I still didn't get a scale)

Was a very up and down week for my blood sugars.  I started the week on a nice streak of consistent blood sugars never going much above 150 or much below 90, but by Tuesday evening things started to change.  I was faced with a blood sugar that just refused to go below 300 that evening!  Made all the more frustrating by my dinner choice of chicken sausage and wild rice.  Normally my blood sugar would barely move after a meal like that.

Wednesday was much the same with my blood sugars hovering around 225.  Even a 25 mile bike ride done at an average speed of 22 mph couldn't get those pesky blood sugars down.  After a salad for lunch which saw my blood sugars spike above 400 I had, had enough and opted for a new infusion set.  After the switch my blood sugars became much more managable but I encountered some viscous lows.

The highs forced me to play with my basal rate a bit; the reason why my basal rate is about .5 units higher per day this Monday than last.  However, some further tweaking is necessary to really get it right as I'm trending low in the evenings and need to figure out where the extra IOB is coming from.  Further, I think my butt might be done as an infusion site location for a while.  I've noticed for a bit that my left cheek has been a bit less receptive to insulin than my right.  Now it seems my right is not a fan of novolog either so I'm going to have to use the side of my stomach for a bit.  Not a huge fan of using my stomach for a site but its better than high blood sugars!

Friday X Factors - Cross Fit

Each Friday I'll post a new story about something that has made me rethink how I have to manage my blood sugars.  The impact everything from eating out to exercise has on bs management can make this disease really variable.  This will be what I've learned from those scenarios.

Back in August I was itching for a new athletic challenge.  Due to life I didn't really have time to train as hard as I wanted for triathlon anymore and trying to fit in a century every weekend on the bike really just wasn't possible.  I still wanted to bike and run as frequently as my schedule would allow but I was dying to find something new.

One of the things I really missed over the past few years was a new challenge in the weight room.  From the time I was 8 years old until November of my 21st year I was a football player.  I lived in the weight room and got excited to push myself to lift heavier, faster and better.  To me nothing releases more stress than a good hard lift that leaves your muscles shaking.  But due to two shoulder surgeries, and some other joint issues I had to greatly reduce the amount of time I spent in the gym.  After 3 or 4 years away from heavy lifting I was ready to see what my body had left.  This would also mark the first time since my T1 diagnosis that I'd focus on high intesnisity exercise.

I had been hearing about Cross Fit for a while; CX sessions focus on a workout of the day which includes high repetitions of an Olympic lift, a body control movement like pull ups and some anaerobic activity like air squats.  The "box," as CF gyms are referred to, that I go to is LaLanne Fitness; founded by the nephew of legendary Jack LaLanne, the father of modern fitness.  The big issue for me was I had no idea how my blood sugar would react to a high intensity fast twitch focused session.

My first session was quite a learning experience; I did something like 75 push presses and 50 burpees; I couldn't lift my arms for a week, literally!  The blood sugars trended somewhat high during that workout but I just attributed that to nerves.  The second time I went to CX the workout of the day incorporated some more short sprints and a few other cortisol producing exercises.  Prior to the workout I had some muscle milk and had set my pump down to 60% of normal basal.  About 1/2 way into the WOD my blood sugar had spiked to 375!!!!!  I then realized this type of exercise would require a totally different protocol than long bike rides and runs.

I'm now three months into my CX experiment and while I still haven't mastered the kipping pull up my blood sugars are alot more consistent during classes.  As opposed to endurance training I try and start a CX class with my blood sugar around 120 (just in case).  About 25 minutes before class I'll have some muscle milk with non-fat milk and about a unit of insulin.  When class starts I'll reduce my basal rate to 80% of normal as the start of class trends towards aerobic versus anaerobic.  Then immediately after the workout of the day I take in 1.5 units of insulin (after checking my blood sugar) to make sure the extra cortisol in my system doesn't have any negative effects.  CX takes a totally different approach to managing blood sugars than what I was used to but its a blast!

Wednesday Wackiness - The New Pump

Each Wednesday I plan to share a story about those moments where I think I have T1 totally under control until I encounter a new experience that makes me realize there's still more to learn.

For a T1 a new pump is a super exciting experience.  For more than 4 years every 3 days I had stuck my body with a large needle supplied by Medtronic, primed my purple pump and clipped the tubing into my infusion site.  For 4+ years I relied on Medtronic to essentially keep me alive.  I was able to put those infusion sites in drunk, hung over, in a rush, in the dark or when I wasn't feeling well.  But I had grown a bit frustrated with my Medtronic pump, I lost trust in the machinery working properly and since I do depend so much on the pump to keep me healthy I simply had to move on.

I flirted with Animas when I first got my Medtronic pump but my first Endo whom I had an awful relationship with strong armed me away from the company.  I had kept up on Animas' development, I liked the partnership with J&J, I liked that Animas integrated with Dexcom and I loved that the pump offered more flexibility in basal rates than Medtronic.  But.... what I did not realize was the small things can add up, when comfort with a system turns into habit its really hard to change.

Inserting my Minimed Silhouette infusion set had become second nature to me.  Much like knowing how to tie your shoes I had become so accustumed to the Silhoutte I could insert it in just about any situation.  Over the 4+ years with Minimed I had inserted this set at least 400 times.  I figured the Animas infusion set would be like driving a car; different make, different model but the gas is still on the right and brake on the left.  I was ummm.... WRONG.

The first time I inserted my Animas set it took me 30 minutes to figure out where all the pieces went.  I then went through 3 infusion sets before I figured out how to insert it properly.  The second time I inserted the infusion set I couldn't figure out how to prime the pump and the god awful Animas alarm went off at least 25 times letting me know there was no insulin delivery.  And the third time.... that's when the s*it hit the fan.

I was in San Diego for a wedding, after a one or two drinks too many and hours of dancing the gf and I were a bit hungry when we returned to the hotel.  I had enough insulin to last me through the night but not enough to cover a meal of Wendys.  I had brought 3 infusion sets with me, "just in case," knowing I hadn't had alot of success inserting the sites properly.  Thank God I brought 3!

On my first attempt the infusion set fell off when I removed the needle making the set useless to me.  On my second attempt the canula popped out of my skin after I inserted the infsuion set and bled kind of alot.  And the third attempt that's when it really got to me.

On my third attempt I was extra careful, In inserted the infusion set and began to pull the needle out of the canula but my hand slipped and the set did not stay in place.  At that moment I got pretty nervous knowing I would need insulin for the next 24 hours and knowing that I wouldn't return to my apartment until 9pm the following night.  with a half used infusion set in my hand I had to thread the needle back through the canula and attempt to insert it again. With sweaty palms, a racing heartbeat and a girlfriend nervous as heck in the corner I was finally able to get the infusion set into my body.

I'm now used to inserting the Animas set; but it took a while.  A seemingly easy and brainless task caused huge frustrations.  Each time I had to insert a site I was nervous for the first month or two of using my new pump.  The big change - I had to take the front level of tape off of the infusion site at a different step of the process than with the Minimed.  A 5 second task caused all my frustrations but that's what habit causes.  Sometimes you think you have this disease totally under control and then a 5 second task puts it all back in perspective.

Monday Metrics - Back in the groove

Daily Basal Total - 13.92 u
Weight - 195 lbs (total guess, I need to buy a scale)

Over the past month I've successfully reduced my basal rate by about 2.5 units per day.  September was a bit of a crazy month for me where I spent maybe a total of 5 days in San Francisco.  3 time zones, 3 weddings and a trip to Vegas took its toll.  Once the travel was over I had a 3 day string where my blood sugar barely came below 300; you can imagine how great I felt over those 3 days.  But that string of awful blood sugars was exactly what I needed to get back on track.

Upon the final return to San Francisco (post Vegas) I knew my weight was creeping ever closer to 205, that my basal rate was disgustingly high and that my aerobic fitness was a far cry from what my status quo is.  I frankly had, had enough and although my A1c was an ok 6.7 I wanted to be better.  With my general health as motivation I got back on the bike, upped going to Crossfit to twice a week and started running again.

My diet returned to focusing on vegetables and organic foods, I decreased my alcohol intake and upped the amount of water I was drinking. My blood sugars slowly returned to the 90 - 130 band that I like to see pre-meal and my absorption rate for boluses went way up.  Having a significant other makes it a bit more difficult to go hard core diabetic diet than it was when I was a simple Ironman Bachelor.  That difficulty also expands my food choices, who knew I was the only person alive willing to eat ground bison and quinoa everyday!

The goal is to get my daily basal rate back in the 12 - 13 units per day range.  Historically that is when I've felt my healthiest, I'd also like to get my weight consistently below 185.  Each Monday we'll see how I do with that!

Back in Silver & Black!

Hello friends, miss me? My past few months away from blogging have seen me go through some tremendous life changes both diabetic and non-diabetic. I've switched pumps, left Keas, moved in with quite possibly the world's most perfect woman, got back into training and attended my sister's story book wedding. Not a bad 4 month stint!

The big diabetic news: I'm now an Animas pumper! I began to grow frustrated with the quality issues I had with my Minimed pump and simply lost trust in the machinery. When you depend on a battery and screw to stay healthy trust is a pretty important thing. Once my third pump of the year started acting funky I had had enough and made the switch. I'll have more on the transition in a future post but lets just say after 4+ years with one device the transition was anything but smooth. But I'm up the learning curve and my fancy shiny, silver & black, pump and I are getting along just fine.

The future of Ring the Bolus: My time away gave me some great perspective on what I want this blog to become. The first 2ish years of blogging was great, I felt like I shared some really relevant information with all of you and you all gave me some great feedback. The business school came, the job at Keas started and the quality of my blogging fell way off. I care deeply about the diabetic community and want to share my successes and failures with you all. So some simple ways I'm going to do that:

• Mondays - I will list my weight and current daily basal amount and highlight any big trends
• Wednesdays - Stories of frustration, not a week goes by without a D Event that drives me bonkers; I have more than enough to keep Wednesdays entertaining.
• Fridays - Training reports; I've started doing a bunch of different training stuff and the ways my blood sugars have reacted has been crazy.  Time to share the learning on all this!

Look forward to getting this conversation going again!