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.
Tuesday, January 20, 2009
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!
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?
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!
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!
Tuesday, December 23, 2008
How Sensitive Are Basal Rates To Diet?
Since I've been home on break my basal rates have bounced around a bit. After a few days of experiencing lows I reduced my basal rates and then encountered some 200 plus days. Two weeks ago when I finally made it back to NY my basal total was 13.5 units of insulin per day. Today my daily total basal is 16.25 units per day, more than double my basal totals at the time of my Ironman.
My diet has not been as healthy or consistent as it was when I was down in Virginia. Staying at my parents house, seeing friends and spending time in Boston all has added to a bit higher carb, higher fat diet than normal. My workouts haven't been as consistent as I would like and my sleep patterns probably haven't been as regulated. However, a 3 unit jump in basal rates in just over a 2 week period seems high.
I suppose it is now time to buckle down, return to nothing but egg whites, turkey sandwiches and chicken sausage until I get this thing back under control. I'm going to try and get my weight back under 190 by the time I return to school to see if the 7 to 10 lbs I gained after the Ironman have increased my insulin requirements. I also really need to find my software for my quick link so I can load my blood sugar information to my computer for analysis - in other words I need to become a good diabetic again.
My diet has not been as healthy or consistent as it was when I was down in Virginia. Staying at my parents house, seeing friends and spending time in Boston all has added to a bit higher carb, higher fat diet than normal. My workouts haven't been as consistent as I would like and my sleep patterns probably haven't been as regulated. However, a 3 unit jump in basal rates in just over a 2 week period seems high.
I suppose it is now time to buckle down, return to nothing but egg whites, turkey sandwiches and chicken sausage until I get this thing back under control. I'm going to try and get my weight back under 190 by the time I return to school to see if the 7 to 10 lbs I gained after the Ironman have increased my insulin requirements. I also really need to find my software for my quick link so I can load my blood sugar information to my computer for analysis - in other words I need to become a good diabetic again.
Monday, December 15, 2008
Is The Honeymoon Over?
My first semester at Darden is finally over so now I have a chance to focus on my internship search, marathon training and diabetes. Last week was hell with 5 consecutive days of 5 hour exams; not a good time by anyone's calculations but thankfully the stress didn't throw my blood sugars out of whack as they were kept pretty steady over those 5 days. However, in general I've been having a much harder time locking in my basal rates.
Over the past three months I've been playing with my basal rates on a near weekly basis; while getting my blood sugars to spike prior to a workout has been much easier. I'm pretty sure the honeymoon is over and the fight in my last islet cell has been won by diabetes. In a way that will make life easier in terms of knowing how my body will react to exercise, food and basal rates. But in another way that kind of sucks since there was a time period when I could eat pizza with just a moderate bolus.
I've been working out consistently for the past two and 1/2 weeks but have not had the reduction in basal rates that I expected. I have encountered more lows over that period than I had when exercise was less consistent due to class work but I still haven't had the blood sugar reactions I expected. Although it does seem like the overall trend in my basal rates is changing; at night I've had to increase my basal rate by a huge amount as I woke up a few nights it a row with blood sugars above 300 at 4 am; but then I would hit consistent lows around 11 am. To get all this corrected I'm going to have to keep detailed notes over the next few weeks to identify the trend and figure out exactly when my basal rate errors are occurring - consistency is the key and I just need to get back to that.
Over the past three months I've been playing with my basal rates on a near weekly basis; while getting my blood sugars to spike prior to a workout has been much easier. I'm pretty sure the honeymoon is over and the fight in my last islet cell has been won by diabetes. In a way that will make life easier in terms of knowing how my body will react to exercise, food and basal rates. But in another way that kind of sucks since there was a time period when I could eat pizza with just a moderate bolus.
I've been working out consistently for the past two and 1/2 weeks but have not had the reduction in basal rates that I expected. I have encountered more lows over that period than I had when exercise was less consistent due to class work but I still haven't had the blood sugar reactions I expected. Although it does seem like the overall trend in my basal rates is changing; at night I've had to increase my basal rate by a huge amount as I woke up a few nights it a row with blood sugars above 300 at 4 am; but then I would hit consistent lows around 11 am. To get all this corrected I'm going to have to keep detailed notes over the next few weeks to identify the trend and figure out exactly when my basal rate errors are occurring - consistency is the key and I just need to get back to that.
Tuesday, December 2, 2008
You Know You're An MBA Dork When....
You are sitting there in your second quarter operations class learning how to use six-sigma models and realize you have been using that methodology nearly everyday since you've been diagnosed with diabetes!
We were learning that under six sigma models you set an upper error limit and a lower error limit. The data points on the graph are filled in by point in time quality spot checks - quality outside this range is deemed in error. There are then a host of equations that spit out some graphs that indicate if your system is out of control and if a change needs to be made to prevent errors.
This is the exact way I manage my blood sugars. When I upload my blood sugar readings to my computer I have an upper limit of 140 and a lower limit of 75. Anything outside that band is considered in error. Overtime I determine if there is a trend for the blood sugars in error and make a change accordingly.
Just like a firm doesn't want to chase their tail to fix errors, we don't want to constantly chase blood sugars. Making a basal rate change too soon will cause the blood sugars to be in error more often. It's essential for us to keep our blood sugars "in control" - who knew I was just using six sigma to do it!
Can you tell I'm a week away from finals!?
We were learning that under six sigma models you set an upper error limit and a lower error limit. The data points on the graph are filled in by point in time quality spot checks - quality outside this range is deemed in error. There are then a host of equations that spit out some graphs that indicate if your system is out of control and if a change needs to be made to prevent errors.
This is the exact way I manage my blood sugars. When I upload my blood sugar readings to my computer I have an upper limit of 140 and a lower limit of 75. Anything outside that band is considered in error. Overtime I determine if there is a trend for the blood sugars in error and make a change accordingly.
Just like a firm doesn't want to chase their tail to fix errors, we don't want to constantly chase blood sugars. Making a basal rate change too soon will cause the blood sugars to be in error more often. It's essential for us to keep our blood sugars "in control" - who knew I was just using six sigma to do it!
Can you tell I'm a week away from finals!?
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