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?
Friday, June 8, 2012
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!
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!
Thursday, May 31, 2012
Blast From the Past
The other day when I logged into facebook I was greeted by this photo from 2008:
That was me before the Mooseman Half Iron, my first, up in New Hampshire. At the time I was like a sponge absorbing everything I could about blood sugar management during exercise. That race taught me so many things about nutrition. I remember coming out of the water with a blood sugar too low (I thought) to go out and bike. I remember my front derailleur breaking yet again on my bike during the first lap of the course and my seat post constantly slipping down. I remember the most painful cramps I had ever experienced during the run. But I also remember completing my first half ironman and thinking how awesome that was to cross the finish line.
This morning I went out for my pre-work run. A quick 4 miles at 7am; back then the idea of a quick 4 miles was not even a glimer in my eye. This morning I left the apartment with a blood sugar of 152, back then I would not have dreamed of starting a run with a blood sugar below 200. This morning I ran with no nutrition, back then I ran with a convenience store in my fuel belt. This morning after I finished my run I had a gulp of water and some eggs, back then I would have monitored my blood sugar every 15 minutes with a coke in one hand, a gel in the other and a cornucopia of carbohydrates in front of me "just in case." It's pretty obvious things have changed.
But like I said in my post back to basics, the big picture has become alot easier to manage and I have alot more confidence that I'm not going to spontaneously drop to a blood sugar of 25 or spike to a blood sugar of 500 during exercise. That confidence does not have me ignoring blood sugar management however, I simply need to test a little bit less and have a much greater base of experience to know how my body will respond to exercise. For example this morning my legs felt like lead when I started my run, in 2008 I would have tested every other stride wondering why I felt so tired. Today I knew it was because I was up a bit late last night watching the Stanley Cup and did a hard core leg workout yesterday at the gym. With each passing experience my knowledge base has grown allowing me to push a bit harder in workouts and know when my body really needs a break. Yes things have changed and seeing that picture made me realize how far my collective experience has come.
That was me before the Mooseman Half Iron, my first, up in New Hampshire. At the time I was like a sponge absorbing everything I could about blood sugar management during exercise. That race taught me so many things about nutrition. I remember coming out of the water with a blood sugar too low (I thought) to go out and bike. I remember my front derailleur breaking yet again on my bike during the first lap of the course and my seat post constantly slipping down. I remember the most painful cramps I had ever experienced during the run. But I also remember completing my first half ironman and thinking how awesome that was to cross the finish line.
This morning I went out for my pre-work run. A quick 4 miles at 7am; back then the idea of a quick 4 miles was not even a glimer in my eye. This morning I left the apartment with a blood sugar of 152, back then I would not have dreamed of starting a run with a blood sugar below 200. This morning I ran with no nutrition, back then I ran with a convenience store in my fuel belt. This morning after I finished my run I had a gulp of water and some eggs, back then I would have monitored my blood sugar every 15 minutes with a coke in one hand, a gel in the other and a cornucopia of carbohydrates in front of me "just in case." It's pretty obvious things have changed.
But like I said in my post back to basics, the big picture has become alot easier to manage and I have alot more confidence that I'm not going to spontaneously drop to a blood sugar of 25 or spike to a blood sugar of 500 during exercise. That confidence does not have me ignoring blood sugar management however, I simply need to test a little bit less and have a much greater base of experience to know how my body will respond to exercise. For example this morning my legs felt like lead when I started my run, in 2008 I would have tested every other stride wondering why I felt so tired. Today I knew it was because I was up a bit late last night watching the Stanley Cup and did a hard core leg workout yesterday at the gym. With each passing experience my knowledge base has grown allowing me to push a bit harder in workouts and know when my body really needs a break. Yes things have changed and seeing that picture made me realize how far my collective experience has come.
Thursday, May 24, 2012
Grinding Away
I received the below email from Dr. B today after he reviewed my stats from my first 5 days back on a Dexcom.
"Sensor tracings look GOOD! Strong work! I noticed a bit of a peak in am (likely post breakfast) so watch that area as you may need more insulin with that meal, otherwise if you keep this up your HbA1c will be much better by next check!"
Even though I've only recently gotten back on the blood sugar war path, the daily grind has been tough. Waking up at 6:30 to make sure I get in a 4 mile run before work, eating the same breakfast each day, counting ever carb and fighting to find the right thing when eating out has been exhausting. Last night I had a really long conversation with Katie letting her know what I'm going through. It has been a long time since I've focused this strongly on getting my blood sugars under control so alot of the mental fatigue that goes along with that had been forgotten.
Currently we're living in a craptastic studio in Park Slope. When I received my job offer from EDH I knew I wouldn't be able to stomach the 2+ hour commute each way from my parents to my office. So I hopped on Craig's List to find an inexpensive stay for the month of May. When I first went to see the apartment I think my blood sugar was slightly low because I thought the apartment was small but totally liveable. When I returned with keys in hand, I nearly had a nervous break down as the girl I'm subletting from neglected to remove any of her stuff from the closet, didn't leave me a drawer to put anything and essentially has each and every crevice of this 10 x 10 studio packed to the gills. To top things off we're both terrified to cook in the apartment and are forced to sleep seperately as there is only a full size lofted mattress and a futon in the apartment (two on the mattress is too close for comfort.)
So with the size of the apartment I'm unable to bring my bikes (besides Mr. Foldie) and am forced to eat out each night. We fear Mothra will crawl out from the wall or one of the 1,000 empty shoe boxes to eat both us and our food if we attempt to cook. Combine that with the news about my A1c and I'm living in a high stress diabetic zone. That has led to a pretty melancholy Ed.
But, the daily grind is getting easier and starting next month we move to a different place where I can both cook and store my bike; then the daily grind will become routine and my #s will continue to stabilize. For now I can just focus on turning my numbers around in a pretty difficult blood sugar management environment and know I'm doing the best I can. And right now the best I can seems to be working.
"Sensor tracings look GOOD! Strong work! I noticed a bit of a peak in am (likely post breakfast) so watch that area as you may need more insulin with that meal, otherwise if you keep this up your HbA1c will be much better by next check!"
Even though I've only recently gotten back on the blood sugar war path, the daily grind has been tough. Waking up at 6:30 to make sure I get in a 4 mile run before work, eating the same breakfast each day, counting ever carb and fighting to find the right thing when eating out has been exhausting. Last night I had a really long conversation with Katie letting her know what I'm going through. It has been a long time since I've focused this strongly on getting my blood sugars under control so alot of the mental fatigue that goes along with that had been forgotten.
Currently we're living in a craptastic studio in Park Slope. When I received my job offer from EDH I knew I wouldn't be able to stomach the 2+ hour commute each way from my parents to my office. So I hopped on Craig's List to find an inexpensive stay for the month of May. When I first went to see the apartment I think my blood sugar was slightly low because I thought the apartment was small but totally liveable. When I returned with keys in hand, I nearly had a nervous break down as the girl I'm subletting from neglected to remove any of her stuff from the closet, didn't leave me a drawer to put anything and essentially has each and every crevice of this 10 x 10 studio packed to the gills. To top things off we're both terrified to cook in the apartment and are forced to sleep seperately as there is only a full size lofted mattress and a futon in the apartment (two on the mattress is too close for comfort.)
So with the size of the apartment I'm unable to bring my bikes (besides Mr. Foldie) and am forced to eat out each night. We fear Mothra will crawl out from the wall or one of the 1,000 empty shoe boxes to eat both us and our food if we attempt to cook. Combine that with the news about my A1c and I'm living in a high stress diabetic zone. That has led to a pretty melancholy Ed.
Katie, as any reasonable person would think, assumed that I was either unhappy with my job, the move to NY or our relationship. None of those could be further from the truth, I am incredibly happy to be back home, have found what I honestly think is my dream job and am thrilled to be starting a life here with her. So for the first time she is really learning what it means to date a diabetic with all the ups and downs this disease can throw us.
What I explained to Katie last night is that the apartment has essentially taken away the tools I know how to use to manage my disease. What has always worked best for me is cooking my meals, and riding my bike - neither of which is an option right now. So that means each weekend we go away, or each day I'm forced to examine a new restaurant menu adds to the fear that my A1c will continue to rise. Maybe it's an addiction, maybe it's a phobia but I'm terrified of letting this disease impact my life so each little thing that contributes to taking away my tools has really frustrated me.
Monday, May 21, 2012
No one said this would be easy...
Tired legs, a sore back and pesky lows; how I forgot about all those things in my training hiatus. I had remained in reasonably good shape; my lab results indicate I ate healthy enough and while my weight went up a bit it's not as if I jumped 5 points on the BMI scale. But man at times I feel like a washed up old journey man fighter in my path back to fitness and blood sugar glory (if an A1c under 6.5 counts as blood sugar glory).
Last week I had an outstanding week of training. I got in 3 runs, 3 lifts, 2 bike rides to work and a solid training ride on Sunday. The sublet I currently have is too small for the lady friend, el toro and me so the bull has to sit this one out up in Mahopac. That means my rides during the week are limited to Mr. Foldie and me scrambling across the Brooklyn Bridge. Nonetheless all the rides into work, morning runs and training sessions add up to have a profound impact on my basal rate.
For the past 48 hours I've been fighting off low after low. 30 miles into my ride yesterday I had to call it a day as my blood sugar kept dropping below 70. That pattern continued throughout the night as I hit 50 three times from 6pm to 10:30 pm even though I treated with a cranberry juice and had a delicious sushi and rice dinner.
Right now my basal rate is about 16 units per day, I suspect that it will drop by at least .75 units over the next 24 hours and continue to fall to about 13 units a day over the next 45 days. Once my basal rate stabilizes I know my recovery time will decrease and my ability to push through endurance fatigue will increase. Until then though this is going to be a long, slow, up hill climb.
Last week I had an outstanding week of training. I got in 3 runs, 3 lifts, 2 bike rides to work and a solid training ride on Sunday. The sublet I currently have is too small for the lady friend, el toro and me so the bull has to sit this one out up in Mahopac. That means my rides during the week are limited to Mr. Foldie and me scrambling across the Brooklyn Bridge. Nonetheless all the rides into work, morning runs and training sessions add up to have a profound impact on my basal rate.
For the past 48 hours I've been fighting off low after low. 30 miles into my ride yesterday I had to call it a day as my blood sugar kept dropping below 70. That pattern continued throughout the night as I hit 50 three times from 6pm to 10:30 pm even though I treated with a cranberry juice and had a delicious sushi and rice dinner.
Right now my basal rate is about 16 units per day, I suspect that it will drop by at least .75 units over the next 24 hours and continue to fall to about 13 units a day over the next 45 days. Once my basal rate stabilizes I know my recovery time will decrease and my ability to push through endurance fatigue will increase. Until then though this is going to be a long, slow, up hill climb.
Thursday, May 17, 2012
Routine really matters
It's been about two weeks now since my life returned to the normal pace, flow and stresses that I had become accustomed to. During my unemployment my biggest frustration was that I had no control over what great opportunity would let me take the next step in my career. That forced me to search the internet and network for hours on end trying everything I could to take the next great leap. The same intensity I put towards that effort also got me totally out of my eating and exercise routine. Combining those factors is what I believe lead to my worst A1c yet.
However, I've seen a HUGE change in my blood sugar stability, energy levels and overall health since I've returned to work, settled into a sublet and gotten back to my hour + of exercise a day. Yesterday for example my blood sugar was never higher than 165 and I only hit one low (68) after my bike ride home post lifting. Numbers like 91, 98, 107 and 117 are visiting my meter much more frequently than numbers like 57, 237, 312 and 192. Variability is bad for business as a diabetic so the more consistent I stick to my routine the better off I am.
Thus far since I've refocused my blood sugar management efforts I've really only had one bad day of finger pricks. On a business trip to Pittsburgh earlier this week my blood sugar went haywire. I ran about 4 miles in the morning starting with a blood sugar of 210 but I finished with a blood sugar of 208; after taking in a decent amount of insulin my blood sugar had climbed to 268 and was still in the mid 200s at lunch time. I struggled for most of the day getting my bs in check and may have over corrected as I dropped to 50 right before my plane ride home. A frustrating day, but I'll take it, if I can hit my #s 9 out of 10 days I'm in a much better place than I was.
Also, I apparently decided to make my return to d-blogging on world diabetes week; pretty happy to be back.
However, I've seen a HUGE change in my blood sugar stability, energy levels and overall health since I've returned to work, settled into a sublet and gotten back to my hour + of exercise a day. Yesterday for example my blood sugar was never higher than 165 and I only hit one low (68) after my bike ride home post lifting. Numbers like 91, 98, 107 and 117 are visiting my meter much more frequently than numbers like 57, 237, 312 and 192. Variability is bad for business as a diabetic so the more consistent I stick to my routine the better off I am.
Thus far since I've refocused my blood sugar management efforts I've really only had one bad day of finger pricks. On a business trip to Pittsburgh earlier this week my blood sugar went haywire. I ran about 4 miles in the morning starting with a blood sugar of 210 but I finished with a blood sugar of 208; after taking in a decent amount of insulin my blood sugar had climbed to 268 and was still in the mid 200s at lunch time. I struggled for most of the day getting my bs in check and may have over corrected as I dropped to 50 right before my plane ride home. A frustrating day, but I'll take it, if I can hit my #s 9 out of 10 days I'm in a much better place than I was.
Also, I apparently decided to make my return to d-blogging on world diabetes week; pretty happy to be back.
Tuesday, May 15, 2012
It's different the second time around
Last evening I was writing an email to my local Animas rep to get hooked up with pump supplies when it struck me how much I've learned over the past few years. The first time I chose a pump I scoured the internet, blogs and articles for hours on end to learn anything I could about the differences between pumps. I picked other t1d's brains about the type of infusion set they were using, the ease of using the pump and even talked a couple companies into letting me try out a pump with saline. My way of coping with my diagnosis was to bury myself as deeply as I could into understanding how to manage the disease.
Fast forward six years and in my email to my Animas rep I knew exactly what to say and exactly what I needed. In a brief 2 sentence and 2 bullet point email I emailed my rep with the infusion set and reservoir that I needed. No fan fare, no worries, just a calm knowledge that I have this thing (at least the ordering of supplies under control). Now had you asked me a month ago when I was still without health insurance I would have been more frantic, but the details have become common place, it's the management that remains hard.
Fast forward six years and in my email to my Animas rep I knew exactly what to say and exactly what I needed. In a brief 2 sentence and 2 bullet point email I emailed my rep with the infusion set and reservoir that I needed. No fan fare, no worries, just a calm knowledge that I have this thing (at least the ordering of supplies under control). Now had you asked me a month ago when I was still without health insurance I would have been more frantic, but the details have become common place, it's the management that remains hard.
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