Monday, June 25, 2012

5x 40 Club

The 5x 40 club is not a club you want to be a card carrying member for.  Yesterday my blood sugar crashed into the 40s 5 times, probably the most frustrating  day of blood sugar management I had ever had. 

The day started off perfectly, I woke up with a blood sugar of 93, had some cereal and a clif bar then went for my Sunday run.  Back in full training mode my run was awesome, 8 perfect miles in a high zone 2, low zone 3 heart rate, non-stop running between 8:20 and 8:45 minute miles.  Total time for the run was 1:08 and it marked my longest contiguous run since 2011.  To top it off when I finished the run my blood sugar was a gorgeous 108.

Post run I took in some chocolate milk and then had to conduct an hour long phone interview for work.  Post the call I tested and was frustrated to see 301 on my meter.  That could have been the excess carbs I had on board from my sports nutrition but it aggravated me just a bit.  I then made an egg sandwich on a pumpernickel wrap and bolused up for the 25 - 30 grams of carbs.  About 2 hours later I hit my first 40 of the day, I took in some OJ and went back to the power point I was working on.

Around 3 pm (2 hours after my first low) I tested again and 40 came up yet again, more OJ.  I then took a short walk to the store to buy some stuff for lunch for the week and coffee for the morning, when I returned 30 minutes later I was in the 40s again (now 3 times for the day).  I took in more OJ and at 6pm Katie and I headed out for dinner.

The wait for the restaurant (2+ hours) we wanted to go to caused us to dinner in reverse last night.  I was craving frozen yogurt in a big way so we hit up 16 handles pre-dinner and I bolused for the 30g of low fat deliciousness I was about to eat.  Yet my blood sugar decided to pop into the mid 200s post fro yo but finally started to come back down once we got to Lucali (rated as NY's top pizza place).

I combo bolused for what I assumed to be the 100g of carbohydrates I was about to inhale.  By 11:30 pm my blood sugar had tumbled back into the 40s for the fourth time that day.  Instead of OJ I opted for 24g of carbohydrates from yogurt and decided to go to sleep.  At 2 am my CGM started beeping with my fifth blood sugar in the 40s for the day which brought me to the fridge to pound some OJ.

This is the frustrating part of blood sugar management.  I have been testing my basal rates non-stop all week, and I thought I had them dialed in.  Then a day like yesterday will pop up and it throws everything out of whack.  I have a greater ability to deal with extremely low blood sugars than most diabetics I have met.   Whether it was the 38 I encountered at IMLP, the countless times I have gone low during a business meeting, or combating 40 after 40 on a day like yesterday I have not really run into a low that has fully shut down my thought process or coordination.  I'm terrified however that I tempt fate 1 too many times and eventually this will catch up with me.  The 5x 40 club just isn't a fun place to be.

Wednesday, June 20, 2012

A lecture on the rain from Animas customer service

About a year into my switch from Medtronic to Animas and I'm really starting to regret the decision.  Today's incident may have finally pushed me over the top.  Previously it took me 4 days to reach someone to find out how to connect with my new endo to fill my pump supply order, no one ever replied to my questions about patient assistance when I was unemployed and overall the entire experience with them hasn't been all that stellar.

I've been having some blood sugar issues lately; since I've refocused my management efforts most of the time my blood sugar is really spot on but there are times where my blood sugar simply doesn't make sense.  Those occurrences seem to be happening more frequently so I've seriously begun to doubt the quality of my pump.  Most recently I went out to see the Avengers on Monday night.  Prior to dinner my blood sugar was an awesome and stable 105.  I had organic coos coos for dinner with vegetables and then had a small popcorn during the movie.  All in I took in 5 units of insulin for dinner and another 4 units of insluin for the small popcorn (which I split with Katie).  By the end of the movie my blood sugar was a shocking 451!

Today I woke up with a blood sugar of 303, I took in 2 units of insulin to correct, had a very light breakfast and went for a 4 mile run.  Post run I was down to 150 and then took the 5 mile ride into work.  After being at work for an hour and having no additional food my bs had climbed to 195.  2 units of insulin later my blood sugar was sticking around 175.  For lunch I had a romanie hearts salad with a small amount of cheese, a ton of veggies, balsamic vinaigrette dressing and a small piece of whole wheat bread took in 4.55 units of insulin for the meal and had climbed to 353 an hour and 1/2 after lunch!  I did 2 corrections for that 2 hours apart and finally my blood sugar has come below 250.

So with that final bit I decided to give Animas a call to see if we could go through a diagnostic test on my pump.  But first the tech rep asked me some pretty standard questions, but kept interjecting how many fabulous self corrections and tests the pump does (which began to annoy me).  Then she asked "how frequently do you change your infusion set?"  My response, "um I don't keep total track of it but usually every 3 - 4 days."  Well good God you could have thought I just told her I'm drowning myself in a cocktail of drugs and booze every night while playing Russian Roulette and clubbing baby seals.  The tech rep then went on a 10 minute lecture about how insulin is like rain and when it rains too much and the ground can't absorb anymore the ground floods.  After she went on her rant for 10 minutes I politely said, "thanks for that but I don't really need a lecture right now can we just do the pump diagnositc?"  To which she replied something else about the GD rain so then I said "ya know what why don't you just pass me along to a supervisor."  Sadly a supervisor was not available so I have to wait for Animas to call me back but when she offered to go through the diagnostic with me I told her I'd rather just wait for the supervisor.  Sorry lady I'd rather deal with high blood sugars and feeling like sh*t than get a lecture from you again.

So yeah right now I'm kind of thinking Animas sucks and I really miss Medtronic.

Wednesday, June 13, 2012

I won the Flywheel battle but they won the war...

The other night Katie convinced me to hit up Fly Wheel a new style spinning class that has become all the rage.  There are actually dedicated arguments on the interwebs about which version of the new spinning class is better - Fly Wheel or Soul Cycle (so its honestly become kind of cult like). Katie wanted to check out Fly Wheel first and after her first class she was hooked; so we decided on a Fly Wheel date earlier this week.

The format of the class is pretty interesting, Fly Wheel supplies water, spin shoes and a spin bike that can be fully adjusted.  The spin bikes are arranged in a "stadium style" arena with the instructor at the lowest point on the floor facing the rest of the class.  At the front of the room there is what Fly Wheel calls the "torque board" which is a leaderboard that is calculated by some formula which compares the tension on your spin bike and cadence - the board is split by gender. 

The class uses top 40/ high energy rock type music to keep the class motivated and the cadence ranges from 50 - 115 and three positions (seated, standing on the hoods, standing leaning forward).  The class also incorporates some weird minor muscle group upper body lifts using body bars at some point during the class.

So for my thoughts, the class was pretty interesting for spinning but not really my thing.  I "won" the class sitting atop the leaderboard with 50 or 60 more points than the next closest person and I felt like I got a great aerobic workout in but not really training in, if that makes sense.  I'm also pretty sure I won the competition for most sweat all time in a spin class; damn that room was hot!  But winning the sweating battle also led to a major problem for me.

After the class Katie and I went to a local sports bar to check out the Devils Stanley Cup Game (we won't go into the details of game 6...) and I was pretty surprised to see my blood sugar had climbed to the 200s by the time we got there.  I took in insulin and checked my blood sugar about 45 minutes into our visit and my blood sugar had climbed to about 280ish even though I had taken in a good bit of insulin.  By the time we decided to leave mid way through the 3rd period my blood sugar was up in the 300s so I went to the bathroom and in the low light it seemed like my infusion set had come out but I couldn't tell.

Once home under the bright lights of our bathroom I was able to confirm that the infusion set had popped out due to the sweat but the damage was done.  By this point my blood sugar was 500 or higher and I felt like I was going to throw up all over the place.  For the next couple of hours I took on bolus after bolus trying to bring my blood sugar down.  I started with 4 units to be on the safe side and then took another 4 units of insulin 2 hours later when I was still at 450 at 1 am.  By the time I woke up after the 8+ units of insulin my blood sugar was down to 80; but I felt pretty crappy the entire day.

The past week has not been fun for me and my pump.  I now see why so many people choose to use injections vs relying on technology and non-certain delivery.  I still love the freedom my pump provides but really trusting this is becoming hard.

Friday, June 8, 2012

Trust Your Pump?

Monday morning I changed my reservoir and infusion site, Wednesday mid-day I changed my infusion site again and by Thursday I made a last ditch effort and sucked the insulin out of the current reservoir into a new one - let me explain.

After the cheesecake debacle on Sunday evening my blood sugars only climbed higher.  I was able to correct for the huge portion of fat I had that evening but I couldn't figure out why my blood sugar was continuously + 250 from mid-day Monday to late yesterday.  I was exercising, I was eating incredibly healthy and I was getting a pretty good amount of sleep.  It simply didn't add up; either my insulin needs had increased 10x in a 24 hour period or something was up with my pump.

The magnitude of the blood sugar snafu struck me on Tuesday morning.  I woke up at 6:20 am to go for a run before work, my blood sugar was a shockingly high 248.  Thinking it was because I had adjusted my basal rate a bit too low pre-run I had my pre-run breakfast (ezekuiel cereal and strawberries) and took in 2 units of insulin.  Post run my blood sugar was 202 - normally my blood sugar drops 100 - 150 points during a 5 mile run, especially after eating something as low glycemic as that cereal.

I took in 2 units of insulin post run, showered and hopped on Mr. Foldie to get to work.  By the time I finished the 5ish mile ride into work my blood sugar was a hellacious 350!  Rage bolusing did little to bring my insulin in line as my blood sugar was above the pixie stick line for most of the day.  About 15 units of insulin later my blood sugar finally started to fall and post bike ride home my bs was around 185.  However, after a light dinner of chicken sausage and arugula salad my blood sugar was back in the 250 range!

Wednesday morning I woke again with a blood sugar near 300 and the pattern from Tuesday was mirrored.  At that point I decided to change my infusion set to see if there was some blockage going on that my pump wasn't reporting but to no avail.  I continued to rage bolus for most of the day but by 10 pm I was fighting off a ton of lows although no where near how low I should have been based on the amount of insulin I was taking on.  Thursday morning the pattern became much worse and I was in the mid 300s the entire day. 

With an awful headache, an upset stomach and blurry vision I ran to Google and searched "how do I know if my animas pump is broken."  I came across this fantastic blog post from back in July 2011.  The symptoms the post speaks about seemed to be pretty close to what I was dealing with.  So by the time I got to the end of the post and read about a strong smell of insulin inside the pump from a leaky reservoir I just had to investigate.  Sure enough when I checked the reservoir cavity I was overwhelmed with the smell of burning rubber (what I think insulin smells like) and the bottom of the reservoir totally smelt like it too. 

That's when I took the extra reservoir I had in my back pack to suck the insulin from the current reservoir into a new one.  I wanted to make sure that my insulin didn't go bad so was trying to keep things consistent.  An hour after I changed reservoirs my blood sugar began coming back into line.  This morning with no changes and a very similar routine I woke with a blood sugar of 125, having my customary breakfast I rode to work and got in with a blood sugar of 89.  It's nice being back to normal, now if I could just shake the cob webs of the past couple days of highs.

The bigger question is, how do I start to trust my pump again?

Tuesday, June 5, 2012

Avoid The Cheesecake!

Workouts and my blood sugar had been going so well that I decided to splurge on a piece of Cheesecake this past Sunday night.  Katie and I left the shoe box of a sublet we were originally staying in out near Prospect Park for new luxurious digs on the Columbia Waterfront.  At the original apartment we were terrified to cook so had to eat out every meal, thus were overly excited to finally be able to cook again on Sunday.  For the past week my blood sugars had been rock solid, I got in over 20 miles of running last week, some seriously solid lifts and a few bike commutes so was feeling I could binge a bit on dessert.

For dinner Katie and I cooked whole wheat pappardelle, turkey meatballs and an awesome arugula salad.  Having run 7 miles earlier that day and 6 miles the day prior I thought that entitled me to a bit of extra carbohydrates.  Union Market had a single serving cheesecake honestly the circumference of a small juice glass; so Katie and I figured it couldn't be that bad for you.  Once we got home we flipped it over and realized this miniscule portion of desert had 17g of fat and 22g of carbohydrates!  Throwing caution to the wind I decided to have 3 spoon fulls of the desert (about 1/4 of the serving) and call it a night.

Shortly after that I lost any thoughts of romance as I began to recall the feeling of my pre-diagnosed days.  Looking at my CGM I saw my blood sugar had climbed from 145 at the end of dinner to 197 about an hour later and took in another unit and 1/2 of insulin.  A half hour later Katie came to the bedroom and I was all but dead to the world sprawled out on the bed somewhere between sleep and a diabetic haze.  I woke up at about 5:30 am to go to the bathroom and still felt incredibly warm and pretty out of it, when I tested my blood sugar was a shocking 338! 

Still with the shock fresh in my mind I quickly looked at my CGM and saw that I had been in the 350 - 400+ range all night!  I had turned off the high alarm on my unit as I continue to get my blood sugars back under control but really could have used them the other night.  But I also realize what an advantage it is to live with a type 3 (those who love those who have diabetes) as I told Katie the next time I suddenly seem totally out of it to check my CGM.  But most importantly I learned to avoid Junior's Cheesecake at all costs!