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.
Tuesday, June 12, 2007
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.
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.
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.
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!
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.
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.
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