My in-laws took the boys overnight last night, and we decided to go out to dinner. It was a spur-of-the-moment thing; we didn’t have much in the way of leftovers and were both frazzled from the long week at work.
I wasn’t worried; I had changed my site the day before, had a ton of insulin in my pump, had my meter and juice and all in my purse. Decided, in the light of recent news, to go eat something with chili peppers in it as a sort of salute to capsaicin.
I had been running in the low 200s all afternoon despite corrections, but wasn’t too concerned. This was just my thyroid getting jealous since the pancreas was getting all the attention. I’ve noticed before I work backwards to most “typical” Type 1’s – this apparently includes being hyper- not hypo- thyroid. So when things act up, it just randomly spits out some extra hormones and keeps my around 250 for 4 or 5 hours. My 4 hours was just about up, the latest correction would work, and I’d be back to normal by the time our food arrived.
Alas, wrong again. Still 250 when we sat down. Ordered a Pilsner Urquels on tap and nibbled a bit of bread, bolused 4 units and doubled my basal for 4 hours. Dinner arrives: 300. Eat the Cajun fish and a few tablespoons of spicy risotto. Despite the menu, this is an Irish pub; my beer comes in a pint, about 4 times as much as I normally have at one sitting, and I’m pleasantly buzzed. Maybe my site’s clogged. No problem, we’ll just finish eating and head home and I’ll take care of it there. Bolus another 5 units.
I check my Dexcom. 390. Yeah, like it climbed that fast in ten minutes. Restaurant is pretty tight quarters; I’ll just nip into the ladies’ room and swap out my site with the spare from my purse. Once in the ladies’ I test again. 390. Damn! OK, lets swap out that…site…Damn again. I’d transferred the spare infusion set to my evening bag for last weekend’s Xmas party, and hadn’t put it back. OK, another 6 units, and I’ll just ask for a doggie bag for that lobster risotto.
We head home. I run upstairs to check. 372. OK, forget the stupid site, let’s just inject 5 units and then change. Rip out the old set and inspect it carefully. No kinks or bends, nothing to show why it didn’t work. Which means I may actually have like 15 units of insulin on board. Probably not though. I check Dexcom; it shows me dropping. Sharply.
Oh, shit.
“Honey, you remember how to use the glucagon, don’t you? Just in case?” We’d done a practice with an expired set last year and he’d been nervous just injecting an orange – but since then I’d made him do my site change or Symlin a few times so he’d be used to sticking me (I’m snickering here) just in case he ever had to.
I dig out the glucagon kit from the bedside table. It expired in June. But wait, I know I picked up a new one; must be downstairs. We take out both kits, set the good one aside and take the expired kit and a Clementine from the fruitbowl. Practice time again.
“All right, you need to figure out what to do. I’m not going to be telling you if you really need to use it.” He flips over the kit and begins studying the label on the bottom. “The instructions are inside.”
He opens it up, takes out the folded glucagon-for-dummies sheet and starts reading.
“Um, honey? I don’t think you need to shake the bottle until you add the liquid – it’s just a tablet in there now.”
He growls just a bit and returns to reading the sheet. Needle in the bottle, squirt and shake, draw it up into the syringe.
OK, that takes a few tries, he keeps sticking the needle too far in and sucking up air. My tipsy self is finding this incredibly humorous.
Finally, the moment of truth. He pins the orange firmly against the counter with one hand, needle in the other.
“Throw it in like a dart, don’t hang on to the plunger. Great. Now just wait ten seconds or so, you don’t want to let it dribble out if you pull out too soon…” Yeah, I know I said I wouldn’t help him. I also promise not to back seat drive.
He waits, then pulls out the syringe. The orange erupts like a mini geyser, like a garden fountain with its single perfect arc three inches into the air. Our own personal “Citrusken Pis”, taking a leak on the kitchen counter.
I lose it. We laugh so hard we can barely stand up. We can’t even look at the real kit without giggling.
“Okay, honey, if my BG keeps dropping, just dial 911 tonight, all right?”
But we don’t need to. It levels out at a great 150, stays that way most of the night.
Saturday, December 16, 2006
Thursday, November 09, 2006
On driving a junker
(This really is a D-related post, so be patient..)
I grew up in a family that bought only cheap used cars. So I’ve seen my share of real clunkers: the rewired toggle-switch ignition, the horn under the dash, the rusted out gas tank that could never be filled more than half full (well, it could be filled more, it would just run out until it was half full), the speedometer that always read 0 mph. When I was in grade school my dad even had a car that, if he stopped at a traffic light, he often had to open the driver’s door, duck under the side of the car, and hit something with a wrench before he could start moving again (don’t ask me what he did, I think it was something involving the clutch).
So when we were first married, our first car was a true junker given to us for free by my older brother. To be fair, he really thought we would just use it for a weekly trip to the grocery store, not 3 ½ hours of daily commuting in Boston (Callahan Tunnel or Tobin Bridge in a rusted out 1979 Chevy Monza is not for the faint of heart) and for trips back and forth between Boston and Albany at least once a month. That car lasted almost two years, helped out that every time we came home, another brother would rebuild the carburator or something to keep it running. I used to be proud of the fact that I “paid” less for my car than for subway fare; that, by God, it was ugly and clunky but had four wheels and ran (most of the time); and that when you were trying to merge on Storrow Drive you could just look over at the Alfa Romeo next to you and laugh - a car full of holes is a great intimidation factor - and they would always move out of the way.
But there was a downside to the seventiesmobile, as we affectionately called it. We had to get the AAA-plus package, the one with the 100-mile free towing (and actually used a 96.2 mile tow once when we broke down in the middle of the pike); we had to carry at least 2 gallons of water for the leaky radiator at all times; we had to drive with the heat on full blast and the windows open in the middle of July; we had to fill one tire with air every two weeks, and we had to budget a lot for repairs for the times we broke down when we weren’t near family. I could call the local tow company and say “Jim, it’s Val.” and they would ask “are you at home or at work?” not “who are you?”. We had to plan trips around how flaky the car was being, what the temperature was, and how far to the nearest rest stop. And on mornings it wouldn’t start, we had to call in to work, because none of the rental places in town would rent to someone under 25.
Finally the repairs were more than a car payment would be (and the seventiesmobile died with a boing, as the snapped alternator belt richocheted through the radiator leaving nothing but a pile of metal shavings behind). We decided to break with my family tradition and get a real car. It was a life-changing experience. Not only did we not need to run the heater in the summer, it had A/C! We no longer had to say “We’ll be there sometime between 2 and 7” or check that our supply of antifreeze and fix-a-flat was okay before we went anywhere. We could just get in the car and start it up and go.
After a week of having a “grownup” car there was no way we could ever go back. A whole layer of stress I wasn’t even aware of evaporated once I realized that I no longer had to keep track of where the nearest pullover was or how long a walk back to the emergency telephone.
Fast forward fifteen years or so to my diagnosis with Type 1. I feel I’ve got a pretty good handle on things, I’m doing okay with carb counting, and there isn’t a heck of a lot that I want to do that diabetes really gets in the way of. But, it’s like driving a junker. It’s always that background level of stress, that constant vigilance, that keeping track of stuff that nobody else needs to. I want automatic transmission, cruise control, and a stereo system. I want my grownup car.
I grew up in a family that bought only cheap used cars. So I’ve seen my share of real clunkers: the rewired toggle-switch ignition, the horn under the dash, the rusted out gas tank that could never be filled more than half full (well, it could be filled more, it would just run out until it was half full), the speedometer that always read 0 mph. When I was in grade school my dad even had a car that, if he stopped at a traffic light, he often had to open the driver’s door, duck under the side of the car, and hit something with a wrench before he could start moving again (don’t ask me what he did, I think it was something involving the clutch).
So when we were first married, our first car was a true junker given to us for free by my older brother. To be fair, he really thought we would just use it for a weekly trip to the grocery store, not 3 ½ hours of daily commuting in Boston (Callahan Tunnel or Tobin Bridge in a rusted out 1979 Chevy Monza is not for the faint of heart) and for trips back and forth between Boston and Albany at least once a month. That car lasted almost two years, helped out that every time we came home, another brother would rebuild the carburator or something to keep it running. I used to be proud of the fact that I “paid” less for my car than for subway fare; that, by God, it was ugly and clunky but had four wheels and ran (most of the time); and that when you were trying to merge on Storrow Drive you could just look over at the Alfa Romeo next to you and laugh - a car full of holes is a great intimidation factor - and they would always move out of the way.
But there was a downside to the seventiesmobile, as we affectionately called it. We had to get the AAA-plus package, the one with the 100-mile free towing (and actually used a 96.2 mile tow once when we broke down in the middle of the pike); we had to carry at least 2 gallons of water for the leaky radiator at all times; we had to drive with the heat on full blast and the windows open in the middle of July; we had to fill one tire with air every two weeks, and we had to budget a lot for repairs for the times we broke down when we weren’t near family. I could call the local tow company and say “Jim, it’s Val.” and they would ask “are you at home or at work?” not “who are you?”. We had to plan trips around how flaky the car was being, what the temperature was, and how far to the nearest rest stop. And on mornings it wouldn’t start, we had to call in to work, because none of the rental places in town would rent to someone under 25.
Finally the repairs were more than a car payment would be (and the seventiesmobile died with a boing, as the snapped alternator belt richocheted through the radiator leaving nothing but a pile of metal shavings behind). We decided to break with my family tradition and get a real car. It was a life-changing experience. Not only did we not need to run the heater in the summer, it had A/C! We no longer had to say “We’ll be there sometime between 2 and 7” or check that our supply of antifreeze and fix-a-flat was okay before we went anywhere. We could just get in the car and start it up and go.
After a week of having a “grownup” car there was no way we could ever go back. A whole layer of stress I wasn’t even aware of evaporated once I realized that I no longer had to keep track of where the nearest pullover was or how long a walk back to the emergency telephone.
Fast forward fifteen years or so to my diagnosis with Type 1. I feel I’ve got a pretty good handle on things, I’m doing okay with carb counting, and there isn’t a heck of a lot that I want to do that diabetes really gets in the way of. But, it’s like driving a junker. It’s always that background level of stress, that constant vigilance, that keeping track of stuff that nobody else needs to. I want automatic transmission, cruise control, and a stereo system. I want my grownup car.
Sunday, July 16, 2006
DexCom versus The Other Guys: Twelve Thoughts
I am in a fairly unique position with regards to the new continuous glucose monitors. I partcipated in a study with an integrated pump and monitor (you know the one) where I got to use it for six months, and then went out and bought a DexCom, which I have been using for two weeks now. So I thought I’d give you the lowdown on them. Remember, this is only my opinion, your mileage may vary, etc, etc, etc.
So, here’s my notes on who beats who for various categories:
1. Size of transmitter: DexCom wins. You get a little rectangular plastic doohickey on a large white pad that’s the size of the other transmitter. Plus, DexCom has no wires, while The Other Guys (hereafter TOG) have a little 3-inch wire tether between the sensor and transmitter, which I wound up having to over with a second piece of IV-3000 so the wire didn’t catch. That brings me to the next item:
2. Sensor and water: this is a toss-up. DexCom says not to cover your sensor, except for short periods of time like a shower. I’m not going to pay $ for the big cover-up every time I shower, so I just shower with the transmitter/sensor still uncovered on my leg. Sometimes it’s a bit off for an hour or so after, other times it stays dead-on. However, when I have covered the sensor, about half the time my improvised multi-IV-3000 patch leaks, and I walk out of the shower with the sensor in a little bag of water taped to my leg, and it’s off for much longer. With TOG I never had to worry about the sensor, happy under it’s IV-3000 blanket. However, read number 4 below:
3. Accuracy in the 200-400 range: Hey, am I supposed to admit I still go this high with a continous monitor? Well, I do, and I would say both seem pretty good in this range.
4. Accuracy in the 30-100 range: DexCom wins, big time. If I look over my six months of records with TOG, it claims I’ve been below 70 maybe a handful of times. Not True. My favorite was a gardening low where I felt low even tho sensor said I was 160. Tested in at 30. I hit 30 while on vacation last week, and DexCom read 36. Much, much better. The times when the DexCom sensor is off are when it’s still drying out from one of my bad shower patch jobs. In fact, that’s when it acts like TOG – maybe theirs is affected by the humidity under that patch and they just haven’t figured it out yet?
5. Size of receiver: TOG definitely win on this. DexCom’s receiver is way too big, and awkward to stuff in your pocket. I like the size of the screen on the DexCom, but maybe in version 2.0 they could move the buttons to the top and slim it down a bit. I mean, TOG has all the same kind of stuff in there, plus a full insulin pump in almost half of the space.
6. Flexibility: TOG lets you program in a lot more choices: alarm volume, etc – DexCom pretty much lets you set the high and low alarm numbers (it also has a built-in non changeable low alarm at 45). TOG would let you specify when to re-alarm if you are still low x minutes after the first alarm. Plus, DexCom’s picture driven menu is just a pain in the butt to use. Either use that extra CPU space to do something useful, or let me have the option of a single menu with “start sensor/stop sensor/set alarms/set date”. I don’t need the cute little animated transmitter. Really.
7. Accessories: TOG wins here too. Because it’s a pump, it has the standard belt clip plus all those companies making pump cases, etc. DexCom comes with a psuedo-leather, black plastic case with an annoying cell phone clip on it. You know, the ones that stick out like a little flat-topped mushroom on the top and hook into a too-small clip that keeps falling off your pants? Plus, it clicks whenever you bump it: CLICK…CLICK…CLICK. Yuck.
8. Packaging: I have to say, I know it doesn’t matter in the long run, but my DexCom came in a plastic case, that looked like I bought it off the shelf at Target. Much nicer than the standard cardboard-box-with-label. I felt more like a consumer of geeky electronics than a medical patient.
9. Battery usage: For both, the transmitter battery is understandably sealed. TOG’s pump-and-reciever works on a AAA battery, while the DexCom needs to be recharged every 3-4 days. It would be convienient to keep the charger at work, because that’s where I sit still the longest, but then I might forget it on the weekend. The don’t recommend charging it in bed, because the range may be a bit less while it’s charging, but that’s what I have been doing anyway. Come on, guys, drop a double-A into it, please.
10. Receiver range: Seems about the same on both. Both occasionally flake out in bed. I can live with that, I suppose, but I don’t like it. Maybe Navigator will fix this.
11. Sensor insertion: Once they’re in, I never felt either sensor, though TOG's transmitter would sometimes catch on somthing and feel like a pinch. DexCom has a thinner sensor wire, but TOG has a reusable inserter that is spring-loaded. With DexCom, I can’t help feeling that part of the $35 cost is the big plastic inserter I have to throw out with every use. Plus, I really can’t bring myself to do thumb-on-the-plunger insertion with something that big – I wind up holding it in place with one hand, and slapping the plunger down a la whack-a-mole with the other.
12. Software: I’m not sure if the software I used for the study is available to those who buy TOG, nevertheless they win because DexCom doesn’t have any yet. I know, it’s in the works and I’m waiting for it, but I really miss being able to print out my single-day summaries.
Well, I’ll probably have more to say later but that’s it for now. For me #4 is the only real point. That’s what I want the thing for, the rest is just fluff. I’m sure as these products mature, they’ll move a lot closer together – especially if insurance would start paying for them, a lot more people would use them.
So, here’s my notes on who beats who for various categories:
1. Size of transmitter: DexCom wins. You get a little rectangular plastic doohickey on a large white pad that’s the size of the other transmitter. Plus, DexCom has no wires, while The Other Guys (hereafter TOG) have a little 3-inch wire tether between the sensor and transmitter, which I wound up having to over with a second piece of IV-3000 so the wire didn’t catch. That brings me to the next item:
2. Sensor and water: this is a toss-up. DexCom says not to cover your sensor, except for short periods of time like a shower. I’m not going to pay $ for the big cover-up every time I shower, so I just shower with the transmitter/sensor still uncovered on my leg. Sometimes it’s a bit off for an hour or so after, other times it stays dead-on. However, when I have covered the sensor, about half the time my improvised multi-IV-3000 patch leaks, and I walk out of the shower with the sensor in a little bag of water taped to my leg, and it’s off for much longer. With TOG I never had to worry about the sensor, happy under it’s IV-3000 blanket. However, read number 4 below:
3. Accuracy in the 200-400 range: Hey, am I supposed to admit I still go this high with a continous monitor? Well, I do, and I would say both seem pretty good in this range.
4. Accuracy in the 30-100 range: DexCom wins, big time. If I look over my six months of records with TOG, it claims I’ve been below 70 maybe a handful of times. Not True. My favorite was a gardening low where I felt low even tho sensor said I was 160. Tested in at 30. I hit 30 while on vacation last week, and DexCom read 36. Much, much better. The times when the DexCom sensor is off are when it’s still drying out from one of my bad shower patch jobs. In fact, that’s when it acts like TOG – maybe theirs is affected by the humidity under that patch and they just haven’t figured it out yet?
5. Size of receiver: TOG definitely win on this. DexCom’s receiver is way too big, and awkward to stuff in your pocket. I like the size of the screen on the DexCom, but maybe in version 2.0 they could move the buttons to the top and slim it down a bit. I mean, TOG has all the same kind of stuff in there, plus a full insulin pump in almost half of the space.
6. Flexibility: TOG lets you program in a lot more choices: alarm volume, etc – DexCom pretty much lets you set the high and low alarm numbers (it also has a built-in non changeable low alarm at 45). TOG would let you specify when to re-alarm if you are still low x minutes after the first alarm. Plus, DexCom’s picture driven menu is just a pain in the butt to use. Either use that extra CPU space to do something useful, or let me have the option of a single menu with “start sensor/stop sensor/set alarms/set date”. I don’t need the cute little animated transmitter. Really.
7. Accessories: TOG wins here too. Because it’s a pump, it has the standard belt clip plus all those companies making pump cases, etc. DexCom comes with a psuedo-leather, black plastic case with an annoying cell phone clip on it. You know, the ones that stick out like a little flat-topped mushroom on the top and hook into a too-small clip that keeps falling off your pants? Plus, it clicks whenever you bump it: CLICK…CLICK…CLICK. Yuck.
8. Packaging: I have to say, I know it doesn’t matter in the long run, but my DexCom came in a plastic case, that looked like I bought it off the shelf at Target. Much nicer than the standard cardboard-box-with-label. I felt more like a consumer of geeky electronics than a medical patient.
9. Battery usage: For both, the transmitter battery is understandably sealed. TOG’s pump-and-reciever works on a AAA battery, while the DexCom needs to be recharged every 3-4 days. It would be convienient to keep the charger at work, because that’s where I sit still the longest, but then I might forget it on the weekend. The don’t recommend charging it in bed, because the range may be a bit less while it’s charging, but that’s what I have been doing anyway. Come on, guys, drop a double-A into it, please.
10. Receiver range: Seems about the same on both. Both occasionally flake out in bed. I can live with that, I suppose, but I don’t like it. Maybe Navigator will fix this.
11. Sensor insertion: Once they’re in, I never felt either sensor, though TOG's transmitter would sometimes catch on somthing and feel like a pinch. DexCom has a thinner sensor wire, but TOG has a reusable inserter that is spring-loaded. With DexCom, I can’t help feeling that part of the $35 cost is the big plastic inserter I have to throw out with every use. Plus, I really can’t bring myself to do thumb-on-the-plunger insertion with something that big – I wind up holding it in place with one hand, and slapping the plunger down a la whack-a-mole with the other.
12. Software: I’m not sure if the software I used for the study is available to those who buy TOG, nevertheless they win because DexCom doesn’t have any yet. I know, it’s in the works and I’m waiting for it, but I really miss being able to print out my single-day summaries.
Well, I’ll probably have more to say later but that’s it for now. For me #4 is the only real point. That’s what I want the thing for, the rest is just fluff. I’m sure as these products mature, they’ll move a lot closer together – especially if insurance would start paying for them, a lot more people would use them.
Friday, June 30, 2006
Ch-ch-ch-changes….
OK, this week I turned in my study pump-and-continuous-monitor, started using my new DexCom, started Symlin, went back to my old pump, had it break two days later, and am now using Lantus and a Novolog Jr pen until my replacement pump shows up on Saturday (right before the big family party at my house…) Busy, busy, busy.
I was going to jot down some of my first impresssions/pleas for improvements on the various hardware I’ve been using, but I left my notes at work, and I’m not going to be back in there until Wednesday, when I can hopefully come up with a more in-depth analysis of my pros/cons of the two continuous monitors I have used…
So instead, for today I’ll jump onto the Symlin-starters bandwagon and add my comments. Let me say that having a continuous monitor does a lot for my piece of mind, from trying the new drugs to guestimating the seldom-used back-up plan…
1. My dr’s office started me out on 2.5 units of Symlin with half my regular insulin dose. Believe it or not, for dinner this was perfect. I watched my BG on the DexCom arch gracefully up about 40 points and then back down, over the course of three hours or so. We still want to increase the Symlin, but I’ll have to cut the dinner insulin back to a quarter my regular dose.
2. Lunch seems to be better right now with about 80% of my insulin bolus plus the 2.5 units of Symlin.
3. Breakfast still sucks, even with 80% of the bolus dose. Tomorrow we try 100%, then scale it back on Sunday when I up the Symlin to 5 units.
4. I wish Symlin came in a pen – or that I could use it to fill some Novolog Jr cartridges. Symlin people – are you listening?
5. Even better, any plans to test out Symlin mixed with insulin? Maybe for people who’ve already done the ramp-up to a standard dose…
6. I haven’t experienced any nausea, or appetite issues. The theory is by starting out on a really low dose and ramping up gradually, your body will be less shocked into nausea. I hope so. Haven’t noticed any changes in my feeling full or snacking, either. Which is fine by me.
7. Symlin makes my continuous monitor graphs look more like a “typical” T1 reaction, instead of the near-vertical ups and downs. Or at least it did when I still had access to a combo bolus, which is pretty damn hard to do with a syringe (you push it veerrry slowly…) It seems to smooth stuff out overall, even at the lowest dose. We’ll see what happens when I’ve worked up to 10 units….
I was going to jot down some of my first impresssions/pleas for improvements on the various hardware I’ve been using, but I left my notes at work, and I’m not going to be back in there until Wednesday, when I can hopefully come up with a more in-depth analysis of my pros/cons of the two continuous monitors I have used…
So instead, for today I’ll jump onto the Symlin-starters bandwagon and add my comments. Let me say that having a continuous monitor does a lot for my piece of mind, from trying the new drugs to guestimating the seldom-used back-up plan…
1. My dr’s office started me out on 2.5 units of Symlin with half my regular insulin dose. Believe it or not, for dinner this was perfect. I watched my BG on the DexCom arch gracefully up about 40 points and then back down, over the course of three hours or so. We still want to increase the Symlin, but I’ll have to cut the dinner insulin back to a quarter my regular dose.
2. Lunch seems to be better right now with about 80% of my insulin bolus plus the 2.5 units of Symlin.
3. Breakfast still sucks, even with 80% of the bolus dose. Tomorrow we try 100%, then scale it back on Sunday when I up the Symlin to 5 units.
4. I wish Symlin came in a pen – or that I could use it to fill some Novolog Jr cartridges. Symlin people – are you listening?
5. Even better, any plans to test out Symlin mixed with insulin? Maybe for people who’ve already done the ramp-up to a standard dose…
6. I haven’t experienced any nausea, or appetite issues. The theory is by starting out on a really low dose and ramping up gradually, your body will be less shocked into nausea. I hope so. Haven’t noticed any changes in my feeling full or snacking, either. Which is fine by me.
7. Symlin makes my continuous monitor graphs look more like a “typical” T1 reaction, instead of the near-vertical ups and downs. Or at least it did when I still had access to a combo bolus, which is pretty damn hard to do with a syringe (you push it veerrry slowly…) It seems to smooth stuff out overall, even at the lowest dose. We’ll see what happens when I’ve worked up to 10 units….
Friday, June 23, 2006
24 hours of being me
Thursday 10:48 am (this "day" is not starting when I wake up because I'm pretty much a zombie then). I'm sitting in front of the computer at work. My pump beeps to remind me it's been 2 hours since my last bolus. I was 277 after breakfast for no discernable reason so I took 1.6 units the pump said I didn't need [3.1 to correct, 3.9 still active]. Sensor says 192 with a single down arrow. Study meter says 145. Val 1, diabetes 0.
10:55 am. Bathroom trip. Check pump tubing from where it enters my leg back to pump, looking for air bubbles. Thought I'd seen a half-unit sized bubble last night near the pump, but now it's nowhere to be found. Maybe that explains the breakfast high, or at least part of it.
11 am Meeting. Bring meter and juice.
11:30 Discretely reach down and hit button on pump to display sensor reading. Glance down. 136. That's 60 points lower than last time I tested, where sensor was about 50 points higher than fingerstick. Even if it's still 50 points off (not likely as things should have slowed down), that would put me at 86, still ok.
11:40 Repeat push and check. 132. OK, we're fine, not moving much at all.
11:55 Meeting ends. Get lunch from cafeteria, whole wheat sandwich (26), salad (0), cookie (16?), and water. Sensor says I'm 120, UltraSmart says 98. Pump bolus estimate is 4.2 units. I usually eat an extra 15g carbs or so and still go low if I'm doing my standard 3-mile walk at lunch, but today I'm running errands. Go for 4.4 units, split half now, half over 30 minutes.
12:15 Heading out to store. Check sensor - 106. But, it hasn't caught up with my food yet. I'm fine.
12:30-1pm During errands, periodically check sensor using same technique as in meeting. 140 with 2 up arrows, 138 level 10 minutes later; 126. Hmm, maybe I should have taken less insulin. Decide I'm OK to drive back to work without testing.
1:55 - my post lunch reminder. Sensor: 114, UltraSmart: 119. Yes! Now, I should be OK for most of the afternoon.
2:15 - cup of tea with milk. No bolus.
2:30 Sensor 120. I typically (but not in the last 2 days) drop between 50-175 points on the way home. Better keep an eye on numbers, since I may have to eat at 3:30 to be able to leave at 4.
2:50 Sensor 128. Great, we're level.
3:09 Sensor 138. Still good.
3:30 I've got my "turnaround" feeling, like I'm in an elevator that's gone down unexpectedly. Sensor: 132. UltraSmart: 101. I don't want to eat too much, but I don't want to go low on the way home either. Break off two squares of my emergency dark chocolate bar, figuring 7 grams of carbs with fat should digest slowly just over the time I normally drop.
3:45 Sensor: 124. Uh, oh. Let's wait a few minutes and use meter.
3:51 Sensor: 116. Nuts! UltraSmart: 101. Still. Decide to drive home without further snacks. School ended today, and my mother in law is watching the kids, so I don't have to pick them up, making my drive less than 25 minutes instead of 90.
4-4:30 Periodic checks of sensor on the drive home show me steady around 120. Val 2, diabetes 0. Go chocolate!
5:20 Supper is ready. Sensor: 114, UltraSmart: 80. Perfect. My mother in law has made us a batch of pasta fagiole, with directions to add the pasta to the beans and sauce at the last minute. I nuke up leftover brown rice instead of pasta for me, and have sauce over that, with a small glass of red wine. Yum. My guess is 48 g carbs, I take pump's recommended 4.0 units, 50/50 split over a half hour.
5:40 Sensor alarms low, 84 with one arrow down (I set it to 100 to catch lows). Ultra smart says 90. I've just finished eating, so I should be fine. Dig up the flyer for the summer camp orientation tonight and discover it starts at 6 and serves food. So I guess we didn't really need that supper, except it was better than hot dogs. For everyone. Pile kids into car and head out. My husband drives, as he usually does when we both go out together, even before diabetes.
6:15 - 7. I have a plate of salad, two oreos, and a cup of diet pepsi at the picnic. Bolus 0.7 units for 16 grams without testing or checking the sensor.
7 pm Back in the car. Sensor says 146. We drive to supermarket with kids.
7:50 In checkout line, better look at sensor. 194, just on the slope down. Fine, no problems. Get kids ready for bed.
8:41 post-bolus alarm. Sensor : 136, StudyMeter: 141. Great!
9:12 Sensor is level at 138. I usually drop at some point before midnight. Let's try 15g dark chocolate again, no bolus. Check tubing for bubbles now because I won't remember in the morning.
11pm. Sensor still level at 140. StudyMeter: 136. Perfect. Go to sleep. Val 3, diabetes 0.
5am Friday. Alarm clock goes off, waking me from a dream that I'm low and can't find any food. Not a good sign. I'm also bathed in sweat, and we have central air: Not a good sign, either. Hit the snooze and reach for the UltraSmart. Pop the cap off in the dark and try to slide a test strip into the little notch in the meter. Can't get it in. Try using the backlight on the pump. Still can't get it in. This, too, is Not A Good Sign. Give up and flip on the bedside lamp, discovering the reason I can't get the strip in is that there's still an old one in there. Sensor says I'm 106. UltraSmart: 119. Did I bounce? Dirty finger? Stress of trying to get the frigging strip in? Or is that the real reading, and dreams of being low were just that, dreams? The cat has curled up on top of my pump. Pull the sheet up and shut off alarm clock.
5:30 am pump low alarm (cat has moved): 96. UltraSmart: 97. Get up, decide to unplug for the shower. Feed cat. Usually I wrap the pump in a ziploc freezer bag and take it in with me, but usually I'm a lot higher than 97 too. Val 4, diabetes 0. Shampoo, removing AUTS (another used test strip) that has somehow entangled in my hair.
5:50 shower over, hook pump back on and get dressed. Sensor did not lose signal when I showered, says I'm 90.
6am sensor low alarm. Turn it off but don't check.
6:15 make breakfast. Sensor: 98, StudyMeter: 121, UltraSmart: 114. We're all in sync, good. Have a Thomas' mini-bagel (24), milk(13), and cream cheese (let's try 5). Take pump's recommended 7.0 units, split 50/50 over half an hour as usual. Feed dog and kids, or at least perky, cheerful Number 3 Son, who wakes up at 6 with no alarm. Definitely not my genes there. Make decaf coffee to take with me.
6:30 ready to leave for work. Sensor: 122 with an up arrow. Fine.
7:05 am Arrive at work. I have my "turnaround" feeling. Sensor: 166, one up arrow.
8am. Bathroom, tubing check, look at sensor. 164. No arrows. Perfect. This was the same breakfast that took me to 277 yesterday, by the way.
8:10. Feeling a little sweaty. Could be the a/c. Low? After breakfast? Not likely. Check sensor: 170. It's the a/c then.
8:15 pump reminder. Sensor: 168. StudyMeter: 171. For breakfast, this is success.
8:40 Walk to cafeteria with my office mate. They do not have apple turnovers, my real weakness, so I just refill my decaf coffee and head back. Sensor: level at 170.
9:15 Sensor 134, two down arrows. Huh? I'll check with meter later..
9:30 Sensor 120. No more arrows. Probably fine, check later.
10am Sensor 102. Hmm. UltraSmart: 90. An hour and a half until lunchtime. Snack, or wait? I'll wait a bit and see what happens.
10:15 Sensor low alarm 94. So that's what happens. Don't bother with the meter, just eat a bit of lunch early. Except, didn't make a lunch today. Break into the pack of PB crackers, eat 2 (7g). Should be OK until lunch.
10:30 Sensor 90.
10:45am Sensor low alarm 78. Huh? UltraSmart 96. Crackers worked after all. I'm OK until lunch. Low successfully averted; Val 5, diabetes 0.
This was a good day. In fact, this was an extremely good day, the kind of day I only have every couple of weeks. The sensor and meters were in agreement, unlike last week, when the sensor said 160 and a finger stick said 30 (sensor never went below 85 that day). Or the night before last, when my BG wouldn't go below 350 for four hours, despite all the corrections.
This was the kind of day I hope I have more of. And that I probably will have more of, because although I hope and pray for a cure, realistically I know that when and if it comes, it will probably be for people who've just been diagnosed, who still have some beta cells left. That I may go the rest of my life like this, hoping for days when I "only" have to think about diabetes 46 times in 24 hours. Because I can deal with that, I really can.
But no little kid should have to.
10:55 am. Bathroom trip. Check pump tubing from where it enters my leg back to pump, looking for air bubbles. Thought I'd seen a half-unit sized bubble last night near the pump, but now it's nowhere to be found. Maybe that explains the breakfast high, or at least part of it.
11 am Meeting. Bring meter and juice.
11:30 Discretely reach down and hit button on pump to display sensor reading. Glance down. 136. That's 60 points lower than last time I tested, where sensor was about 50 points higher than fingerstick. Even if it's still 50 points off (not likely as things should have slowed down), that would put me at 86, still ok.
11:40 Repeat push and check. 132. OK, we're fine, not moving much at all.
11:55 Meeting ends. Get lunch from cafeteria, whole wheat sandwich (26), salad (0), cookie (16?), and water. Sensor says I'm 120, UltraSmart says 98. Pump bolus estimate is 4.2 units. I usually eat an extra 15g carbs or so and still go low if I'm doing my standard 3-mile walk at lunch, but today I'm running errands. Go for 4.4 units, split half now, half over 30 minutes.
12:15 Heading out to store. Check sensor - 106. But, it hasn't caught up with my food yet. I'm fine.
12:30-1pm During errands, periodically check sensor using same technique as in meeting. 140 with 2 up arrows, 138 level 10 minutes later; 126. Hmm, maybe I should have taken less insulin. Decide I'm OK to drive back to work without testing.
1:55 - my post lunch reminder. Sensor: 114, UltraSmart: 119. Yes! Now, I should be OK for most of the afternoon.
2:15 - cup of tea with milk. No bolus.
2:30 Sensor 120. I typically (but not in the last 2 days) drop between 50-175 points on the way home. Better keep an eye on numbers, since I may have to eat at 3:30 to be able to leave at 4.
2:50 Sensor 128. Great, we're level.
3:09 Sensor 138. Still good.
3:30 I've got my "turnaround" feeling, like I'm in an elevator that's gone down unexpectedly. Sensor: 132. UltraSmart: 101. I don't want to eat too much, but I don't want to go low on the way home either. Break off two squares of my emergency dark chocolate bar, figuring 7 grams of carbs with fat should digest slowly just over the time I normally drop.
3:45 Sensor: 124. Uh, oh. Let's wait a few minutes and use meter.
3:51 Sensor: 116. Nuts! UltraSmart: 101. Still. Decide to drive home without further snacks. School ended today, and my mother in law is watching the kids, so I don't have to pick them up, making my drive less than 25 minutes instead of 90.
4-4:30 Periodic checks of sensor on the drive home show me steady around 120. Val 2, diabetes 0. Go chocolate!
5:20 Supper is ready. Sensor: 114, UltraSmart: 80. Perfect. My mother in law has made us a batch of pasta fagiole, with directions to add the pasta to the beans and sauce at the last minute. I nuke up leftover brown rice instead of pasta for me, and have sauce over that, with a small glass of red wine. Yum. My guess is 48 g carbs, I take pump's recommended 4.0 units, 50/50 split over a half hour.
5:40 Sensor alarms low, 84 with one arrow down (I set it to 100 to catch lows). Ultra smart says 90. I've just finished eating, so I should be fine. Dig up the flyer for the summer camp orientation tonight and discover it starts at 6 and serves food. So I guess we didn't really need that supper, except it was better than hot dogs. For everyone. Pile kids into car and head out. My husband drives, as he usually does when we both go out together, even before diabetes.
6:15 - 7. I have a plate of salad, two oreos, and a cup of diet pepsi at the picnic. Bolus 0.7 units for 16 grams without testing or checking the sensor.
7 pm Back in the car. Sensor says 146. We drive to supermarket with kids.
7:50 In checkout line, better look at sensor. 194, just on the slope down. Fine, no problems. Get kids ready for bed.
8:41 post-bolus alarm. Sensor : 136, StudyMeter: 141. Great!
9:12 Sensor is level at 138. I usually drop at some point before midnight. Let's try 15g dark chocolate again, no bolus. Check tubing for bubbles now because I won't remember in the morning.
11pm. Sensor still level at 140. StudyMeter: 136. Perfect. Go to sleep. Val 3, diabetes 0.
5am Friday. Alarm clock goes off, waking me from a dream that I'm low and can't find any food. Not a good sign. I'm also bathed in sweat, and we have central air: Not a good sign, either. Hit the snooze and reach for the UltraSmart. Pop the cap off in the dark and try to slide a test strip into the little notch in the meter. Can't get it in. Try using the backlight on the pump. Still can't get it in. This, too, is Not A Good Sign. Give up and flip on the bedside lamp, discovering the reason I can't get the strip in is that there's still an old one in there. Sensor says I'm 106. UltraSmart: 119. Did I bounce? Dirty finger? Stress of trying to get the frigging strip in? Or is that the real reading, and dreams of being low were just that, dreams? The cat has curled up on top of my pump. Pull the sheet up and shut off alarm clock.
5:30 am pump low alarm (cat has moved): 96. UltraSmart: 97. Get up, decide to unplug for the shower. Feed cat. Usually I wrap the pump in a ziploc freezer bag and take it in with me, but usually I'm a lot higher than 97 too. Val 4, diabetes 0. Shampoo, removing AUTS (another used test strip) that has somehow entangled in my hair.
5:50 shower over, hook pump back on and get dressed. Sensor did not lose signal when I showered, says I'm 90.
6am sensor low alarm. Turn it off but don't check.
6:15 make breakfast. Sensor: 98, StudyMeter: 121, UltraSmart: 114. We're all in sync, good. Have a Thomas' mini-bagel (24), milk(13), and cream cheese (let's try 5). Take pump's recommended 7.0 units, split 50/50 over half an hour as usual. Feed dog and kids, or at least perky, cheerful Number 3 Son, who wakes up at 6 with no alarm. Definitely not my genes there. Make decaf coffee to take with me.
6:30 ready to leave for work. Sensor: 122 with an up arrow. Fine.
7:05 am Arrive at work. I have my "turnaround" feeling. Sensor: 166, one up arrow.
8am. Bathroom, tubing check, look at sensor. 164. No arrows. Perfect. This was the same breakfast that took me to 277 yesterday, by the way.
8:10. Feeling a little sweaty. Could be the a/c. Low? After breakfast? Not likely. Check sensor: 170. It's the a/c then.
8:15 pump reminder. Sensor: 168. StudyMeter: 171. For breakfast, this is success.
8:40 Walk to cafeteria with my office mate. They do not have apple turnovers, my real weakness, so I just refill my decaf coffee and head back. Sensor: level at 170.
9:15 Sensor 134, two down arrows. Huh? I'll check with meter later..
9:30 Sensor 120. No more arrows. Probably fine, check later.
10am Sensor 102. Hmm. UltraSmart: 90. An hour and a half until lunchtime. Snack, or wait? I'll wait a bit and see what happens.
10:15 Sensor low alarm 94. So that's what happens. Don't bother with the meter, just eat a bit of lunch early. Except, didn't make a lunch today. Break into the pack of PB crackers, eat 2 (7g). Should be OK until lunch.
10:30 Sensor 90.
10:45am Sensor low alarm 78. Huh? UltraSmart 96. Crackers worked after all. I'm OK until lunch. Low successfully averted; Val 5, diabetes 0.
This was a good day. In fact, this was an extremely good day, the kind of day I only have every couple of weeks. The sensor and meters were in agreement, unlike last week, when the sensor said 160 and a finger stick said 30 (sensor never went below 85 that day). Or the night before last, when my BG wouldn't go below 350 for four hours, despite all the corrections.
This was the kind of day I hope I have more of. And that I probably will have more of, because although I hope and pray for a cure, realistically I know that when and if it comes, it will probably be for people who've just been diagnosed, who still have some beta cells left. That I may go the rest of my life like this, hoping for days when I "only" have to think about diabetes 46 times in 24 hours. Because I can deal with that, I really can.
But no little kid should have to.
Wednesday, June 14, 2006
Continuous Monitoring, Part 2
I have to turn in my pump-and-CGMS setup in two weeks. Which means I am back to my regular pump then. I can't go back to guessing, though. With all its problems, having the sensor still sucks less than not having it.
I have ordered a DexCom. I should be able to seamlessly jump from one to the other on the 27th.
Stay tuned for my comparison.
I have ordered a DexCom. I should be able to seamlessly jump from one to the other on the 27th.
Stay tuned for my comparison.
Thursday, June 01, 2006
The Hike from Hell
Sunday of Memorial Day weekend. Wanting to do something outdoors. Decide on a hike with kids and dog, including a picnic lunch on the trailhead before we start. The kids are good hikers, completing a 6 mile hike last fall with more energy than we had. So we decide on Hadley Mountain, a nice two-hours-each-way hike with a fire tower at the top for the boys to climb, roughly 90 minutes from home.
My husband goes out for a quick shopping trip for hiking goodies and breakfast while I pack. My waking BG was 123 and was still flat around 2 hours later when he arrived with the breakfast. I ate half a cheese danish and half a glazed donut, figuring my best guestimate for the carbs minus a bit, as we’ll be exercising. We eat and get in the car.
I’m wearing my commando-dork outfit, an LL Bean fly fishing vest with every pocket stuffed: meter, extra strips, new infusion set, four juice boxes, pb crackers, gorp, spare pump battery, sunflower seeds, etc, etc. Plus a fanny pack with the digital camera, dog treats, and two water bottles, one for me and one for the dog. Number One Son (age 11) and Number Two Son (9) carry their own backpacks with water and snacks, and my husband has another with the rest of the snacks, binoculars, bug spray, sunscreen and water for him and Number Three Son (age 6). It’s surprising we even manage to get out of the house.
As we’re driving my sensor high alarm goes off. I ignore it for a bit because I just had the danish, which I know is going to shoot up there. Within 15 minutes it changes its estimate from 220 to 300. Uh-oh, better test. 358. Ugh. Well, still got over an hour before the hike. Three units should do it.
11:30 am - arrive at the trailhead, unpack the picnic, test again. 302. WTF? OK, just half a unit more. No lunch for me, just that diet ginger ale. We coat the kids and us with sunscreen and bug repellent and hit the trail. We see a bunch of tent caterpillars crawling around. The dog amuses herself by eating them and then coming to me for water.
12:15 pm – Damn, it’s hot. Wishing I brought my hat just to keep the sweat from running down my face. Hmm, sweat: let’s test, just to be safe. 47. Oh, shit. Down 3 juice boxes, suspend the pump, wait ten minutes, eat a pack of pb crackers. 12:45 – gotta be better now. 60. All right, another juice box, a handful of dried apricots. Maybe two. Put the pump back on a low temp basal. Keep going, as Numbers One and Two Sons are way ahead now.
1pm. We reach the fire tower. The kids and husband go up. I hang out with the dog, drinking water. The sensor has me at 175. Test : 111. OK, I eat a few more snacks, make the temp basal even lower, and just hang out, relaxing. The kids get a certificate from the ranger in the tower. Number Two Son (the outdoorsman) goes up and down the tower five or six times, then starts exploring the summit with his brothers. I even climb up the fire tower (trying not to focus beyond the metal ladder as I’m afraid of heights).
2pm – shortly after starting back down, I start getting stomach cramps. Well, I’ve drank four juice boxes and a bottle of water. Time to find a little girl’s tree and let some of it out.
2:30 – it didn’t help. Still got bad stomach cramps. Keep walking. Only as we get to the wet, shady section of the trail, they move in. The tent caterpillars, having lured us into a false sense of security by crawling harmlessly along the path on our way in, attack. They rappel down from the trees by the hundreds, aiming for our faces. Number Three Son wants to hold my hand, but I can’t – I’m clutching my stomach with both of them, and besides if we’re two abreast, there’s no way to avoid the dangling critters. Even the dog won’t eat them now.
The cramps increase in intensity. I almost never have stomach problems, and the last time I felt like this, it was right before getting an epidural. Why the hell did I eat all those dried apricots?
The kids look upward and flip out. Literally thousands of the caterpillars are moving in for the kill. Looks like something from an Indiana Jones movie. I fully expect to see a few hikers dangling from the trees, caught by some caterpiller Shelob. Number Two
Son takes one in the face and screams. Husband tries to calm the kids by speaking calmly, and eats one. Twice.
They’re all walking way too fast. I check my BG again, 170, so the cramps are only indirectly diabetes-related. Damned juice boxes.
Number One Son grabs Two by the shoulders and propels him forward as a human shield. Two is shreiking, One is laughing – and suddenly it’s reversed, as a kamikaze ‘pillar hits One’s open mouth and he does some impromptu break-dancing. Lord, I wonder how this will look in their autobiographies. Our kids are never leaving the house again.
3:30 – kids are ahead with the dog, trying to find the end of the trail and our caterpillar-free car. Husband is walking with me, holding my elbow as I’m bent almost double. I brush three caterpillars from my hair, find one on each shoulder of the vest like some epaulets from a goddamn caterpillar army.
The stomach cramps reach their logical conclusion and I dash for the trees, ignoring the bugs, only hoping I don’t squat in poison ivy.
We make it to the car, climb in, and pass out the cookies, ice tea, etc, we’d left in the cooler. I eat one, then reach for my meter. 245. Correct and add in that cookie. Laugh each time a caterpillar splatters on the windshield.
It’s fifteen minutes to the nearest fast-food joint. While my husband goes in for a coffee, I dash for the ladies room and stay there. Then I make it all the way home, where I lock myself in the bathroom for two hours, and don’t even attempt to eat anything until some toast about nine pm.
The next day, two of the boys broke out in a rash that looked like the start of poison ivy. Luckily it faded after a day, only a reaction to the bug spray. The kids have developed a fear of caterpillars. The dog won’t even try to get in the car anymore. And me? Tomorrow Number Two Son and I leave for a weekend camping trip at Lake George.
We’re bringing hats.
My husband goes out for a quick shopping trip for hiking goodies and breakfast while I pack. My waking BG was 123 and was still flat around 2 hours later when he arrived with the breakfast. I ate half a cheese danish and half a glazed donut, figuring my best guestimate for the carbs minus a bit, as we’ll be exercising. We eat and get in the car.
I’m wearing my commando-dork outfit, an LL Bean fly fishing vest with every pocket stuffed: meter, extra strips, new infusion set, four juice boxes, pb crackers, gorp, spare pump battery, sunflower seeds, etc, etc. Plus a fanny pack with the digital camera, dog treats, and two water bottles, one for me and one for the dog. Number One Son (age 11) and Number Two Son (9) carry their own backpacks with water and snacks, and my husband has another with the rest of the snacks, binoculars, bug spray, sunscreen and water for him and Number Three Son (age 6). It’s surprising we even manage to get out of the house.
As we’re driving my sensor high alarm goes off. I ignore it for a bit because I just had the danish, which I know is going to shoot up there. Within 15 minutes it changes its estimate from 220 to 300. Uh-oh, better test. 358. Ugh. Well, still got over an hour before the hike. Three units should do it.
11:30 am - arrive at the trailhead, unpack the picnic, test again. 302. WTF? OK, just half a unit more. No lunch for me, just that diet ginger ale. We coat the kids and us with sunscreen and bug repellent and hit the trail. We see a bunch of tent caterpillars crawling around. The dog amuses herself by eating them and then coming to me for water.
12:15 pm – Damn, it’s hot. Wishing I brought my hat just to keep the sweat from running down my face. Hmm, sweat: let’s test, just to be safe. 47. Oh, shit. Down 3 juice boxes, suspend the pump, wait ten minutes, eat a pack of pb crackers. 12:45 – gotta be better now. 60. All right, another juice box, a handful of dried apricots. Maybe two. Put the pump back on a low temp basal. Keep going, as Numbers One and Two Sons are way ahead now.
1pm. We reach the fire tower. The kids and husband go up. I hang out with the dog, drinking water. The sensor has me at 175. Test : 111. OK, I eat a few more snacks, make the temp basal even lower, and just hang out, relaxing. The kids get a certificate from the ranger in the tower. Number Two Son (the outdoorsman) goes up and down the tower five or six times, then starts exploring the summit with his brothers. I even climb up the fire tower (trying not to focus beyond the metal ladder as I’m afraid of heights).
2pm – shortly after starting back down, I start getting stomach cramps. Well, I’ve drank four juice boxes and a bottle of water. Time to find a little girl’s tree and let some of it out.
2:30 – it didn’t help. Still got bad stomach cramps. Keep walking. Only as we get to the wet, shady section of the trail, they move in. The tent caterpillars, having lured us into a false sense of security by crawling harmlessly along the path on our way in, attack. They rappel down from the trees by the hundreds, aiming for our faces. Number Three Son wants to hold my hand, but I can’t – I’m clutching my stomach with both of them, and besides if we’re two abreast, there’s no way to avoid the dangling critters. Even the dog won’t eat them now.
The cramps increase in intensity. I almost never have stomach problems, and the last time I felt like this, it was right before getting an epidural. Why the hell did I eat all those dried apricots?
The kids look upward and flip out. Literally thousands of the caterpillars are moving in for the kill. Looks like something from an Indiana Jones movie. I fully expect to see a few hikers dangling from the trees, caught by some caterpiller Shelob. Number Two
Son takes one in the face and screams. Husband tries to calm the kids by speaking calmly, and eats one. Twice.
They’re all walking way too fast. I check my BG again, 170, so the cramps are only indirectly diabetes-related. Damned juice boxes.
Number One Son grabs Two by the shoulders and propels him forward as a human shield. Two is shreiking, One is laughing – and suddenly it’s reversed, as a kamikaze ‘pillar hits One’s open mouth and he does some impromptu break-dancing. Lord, I wonder how this will look in their autobiographies. Our kids are never leaving the house again.
3:30 – kids are ahead with the dog, trying to find the end of the trail and our caterpillar-free car. Husband is walking with me, holding my elbow as I’m bent almost double. I brush three caterpillars from my hair, find one on each shoulder of the vest like some epaulets from a goddamn caterpillar army.
The stomach cramps reach their logical conclusion and I dash for the trees, ignoring the bugs, only hoping I don’t squat in poison ivy.
We make it to the car, climb in, and pass out the cookies, ice tea, etc, we’d left in the cooler. I eat one, then reach for my meter. 245. Correct and add in that cookie. Laugh each time a caterpillar splatters on the windshield.
It’s fifteen minutes to the nearest fast-food joint. While my husband goes in for a coffee, I dash for the ladies room and stay there. Then I make it all the way home, where I lock myself in the bathroom for two hours, and don’t even attempt to eat anything until some toast about nine pm.
The next day, two of the boys broke out in a rash that looked like the start of poison ivy. Luckily it faded after a day, only a reaction to the bug spray. The kids have developed a fear of caterpillars. The dog won’t even try to get in the car anymore. And me? Tomorrow Number Two Son and I leave for a weekend camping trip at Lake George.
We’re bringing hats.
Sunday, May 21, 2006
Sensor Redux
I feel that after all the rants I’ve posted about this sensor study, I ought to post an update on how I feel now. Two major things have changed. Number one was, I decided since the BG meter they wanted us to use wasn’t accurate at normal-to-low BG, that anytime I thought my BG was in the normal-to-low range, I would use my regular meter and manually enter the BG into the sensor. That has helped a lot with its accuracy. It’s still off, but now it says I’m 95 when I’m 65, not 40.
The second thing is, they’ve come out with a 2.0 transmitter and pump software. I had to go trade in what I’ve been using since Christmas, and start the new ones. This is to help with the long warm-up time, where you start a new sensor and it’s 120 points off for 12 hours. Now it does seem to reach its typical accuracy after about 3 hours.
So is it now at the point where I would use it? Yeah, I’d say so. The catch? My Animas pump is only 2 years old, so even if I wanted this, my insurance wouldn’t pay for it. On the other hand, I’ve gotten really used to being able to see the trends of what my BG is doing. The solution? The day I have to turn this in, I’m buying a DexCom. And keeping my fingers crossed my insurance will pick up at least some of the sensors. We’ve got six months of data to show how volatile my BG is, how I don’t have a hope of controlling it without continuous monitoring. So maybe they’ll pay for it. If not, well, starting in September we’ll be done with daycare, except the elementary before-school care, which is $500 less a month than we’re paying now. We’ll use that. Of course, it would be nicer if we could actually have a savings account, and we’ll have 3 kids to send to college starting in 6 years. But when you think of the possible expense of not having it…
So, for anyone who is planning on getting this integrated pump and sensor, here’s my top 5 tips/tricks/cheats. Disclaimer: I am not a doctor, blah, blah, blah, but here’s what I would do were I to keep this thing:
1. Never use a BD logic meter.
2. Be aware – this pump eats batteries.
3. When it claims to have a calibration error, don’t give it another BG value for at least an hour.
4. Unless you’re actually low when you calibrate, check the sensor isig value first. If it’s under about a 9.5, it’s not ready yet. Wait a bit.
5. If it says the sensor is bad, leave the sensor in, and tell the pump you’ve just put in a new sensor. Nine times out of ten that works and the sensor initializes happily and has no problems.
6. That same strategy also seems to work when your sensor has hit the end of its 36-hour life span. Tell the pump it’s a new one, and leave it in. The FDA says not to do it, but they aren’t paying for the damned things.
At the same time I start the DexCom, I am also going to start trying Symlin for the spikes at breakfast. We’ll see how that goes….
The second thing is, they’ve come out with a 2.0 transmitter and pump software. I had to go trade in what I’ve been using since Christmas, and start the new ones. This is to help with the long warm-up time, where you start a new sensor and it’s 120 points off for 12 hours. Now it does seem to reach its typical accuracy after about 3 hours.
So is it now at the point where I would use it? Yeah, I’d say so. The catch? My Animas pump is only 2 years old, so even if I wanted this, my insurance wouldn’t pay for it. On the other hand, I’ve gotten really used to being able to see the trends of what my BG is doing. The solution? The day I have to turn this in, I’m buying a DexCom. And keeping my fingers crossed my insurance will pick up at least some of the sensors. We’ve got six months of data to show how volatile my BG is, how I don’t have a hope of controlling it without continuous monitoring. So maybe they’ll pay for it. If not, well, starting in September we’ll be done with daycare, except the elementary before-school care, which is $500 less a month than we’re paying now. We’ll use that. Of course, it would be nicer if we could actually have a savings account, and we’ll have 3 kids to send to college starting in 6 years. But when you think of the possible expense of not having it…
So, for anyone who is planning on getting this integrated pump and sensor, here’s my top 5 tips/tricks/cheats. Disclaimer: I am not a doctor, blah, blah, blah, but here’s what I would do were I to keep this thing:
At the same time I start the DexCom, I am also going to start trying Symlin for the spikes at breakfast. We’ll see how that goes….
Friday, May 19, 2006
At what point does it become OK to blame the victim?
Last week a “friend-of-a-friend” (type 2, diet controlled) was hospitalized in diabetic coma. She’s doing OK now, still in the hospital, but my friend was asking me questions like “Is 1200 a high blood sugar?” (you bet!). The doctor said she will need to be on insulin from now on, so I was explaining about how sometimes with type 2 the beta cells burn out and just can’t produce any more. In the course of the conversation it turned out the the woman in the hospital has not been to a doctor or tested her BG in more than ten years!
Made me want to hop into a time machine, go back ten years, and slap her when it might still do some good. I didn’t want to upset my friend, but lord knows what kinds of complications Hospital Woman has set herself up for. Or what kind of success she’ll have now that she has to pay attention to her disease.
I can understand getting burned out with a tight regimen. I personally think it’s worse to have to constantly refuse food you love than to just bolus for what you’re eating. But I can’t understand someone being told you have a serious disease, and just never bothering to do anything other than decide you’ll only have cake on special occasions.
I guess I just can't help feeling a bit pissed off at Hospital Woman. If someone had told me there was something I could have done to avoid taking insulin for the rest of my life, believe me, I would have done it. She has a niece or something with Type 1. Doesn't she know how much this sucks? Doesn't she realize she just threw away what I wish I still had, a body that works on automatic?
Made me want to hop into a time machine, go back ten years, and slap her when it might still do some good. I didn’t want to upset my friend, but lord knows what kinds of complications Hospital Woman has set herself up for. Or what kind of success she’ll have now that she has to pay attention to her disease.
I can understand getting burned out with a tight regimen. I personally think it’s worse to have to constantly refuse food you love than to just bolus for what you’re eating. But I can’t understand someone being told you have a serious disease, and just never bothering to do anything other than decide you’ll only have cake on special occasions.
I guess I just can't help feeling a bit pissed off at Hospital Woman. If someone had told me there was something I could have done to avoid taking insulin for the rest of my life, believe me, I would have done it. She has a niece or something with Type 1. Doesn't she know how much this sucks? Doesn't she realize she just threw away what I wish I still had, a body that works on automatic?
Saturday, April 22, 2006
The Game
Congratulations! You have been randomly selected to play. Here’s your first question:
Predict the amount of insulin you need for breakfast today.
To make it easy, we’ll show you a graph using the latest technology for the exact same breakfast at the exact same time with the exact same insulin dose for the past two days:
Take your best guess….You’re wrong! You’re always wrong! But, you do receive a consolation prize: blurred vision, irritability, nausea, rapid heartbeat, shakiness, confusion, fainting, etc, etc. Plus, at no extra cost, you’re automatically entered into our grand prize drawing for blindness, amputations, kidney failure, and a host of other disorders.
By the way, there’s an admission fee for this game. Depending on your insurance coverage, anywhere from several hundred to several thousand dollars per year.
What’s that? You don’t wan’t to play? That’s too bad, because according to our rules, you have to. You will never win, you will never break even, and you can never, ever, quit.
Time to proceed to the next round: correction or lunch. Again to help you out, here’s your last week of BG numbers:
Have fun!
Predict the amount of insulin you need for breakfast today.
To make it easy, we’ll show you a graph using the latest technology for the exact same breakfast at the exact same time with the exact same insulin dose for the past two days:
Take your best guess….You’re wrong! You’re always wrong! But, you do receive a consolation prize: blurred vision, irritability, nausea, rapid heartbeat, shakiness, confusion, fainting, etc, etc. Plus, at no extra cost, you’re automatically entered into our grand prize drawing for blindness, amputations, kidney failure, and a host of other disorders.
By the way, there’s an admission fee for this game. Depending on your insurance coverage, anywhere from several hundred to several thousand dollars per year.
What’s that? You don’t wan’t to play? That’s too bad, because according to our rules, you have to. You will never win, you will never break even, and you can never, ever, quit.
Time to proceed to the next round: correction or lunch. Again to help you out, here’s your last week of BG numbers:
Have fun!
Friday, April 14, 2006
Diabetes Hall of Shame, Vol 1 -- and the book meme
I was surfing the OC at lunch yesterday and found this link on DiabetesMine
Amy’s comment on it was “Forbes reports: better treatments available, but the health care system falls short.” That sounded interesting, so I went to the page and read the article. As I did, I got more and more angry. The post is about Type 2 diabetes, although it never mentions there are two types nor that genetics play a role, and ended with the asinine quote "If you stay lean and fit throughout your life, you have a 95 percent chance of never getting diabetes," he said. "It's almost entirely preventable." From Dr. Robert Rizza, a professor of medicine at the Mayo Clinic and president of the American Diabetes Association, of all people. [emphasis mine]
I assumed that his quote was taken out of context, but still wrote out the following comment and sent it via their “comments” link:
"Diabetes" is not preventable
As a "lean and fit" person with Type 1 (formerly called juvenile) diabetes I found your article ignorant to the point of insult. Type 1 diabetes is an autoimmune disease having nothing to with weight, eating habits, or exercise. People with Type 1 must inject themselves with insulin daily to stay alive. There is absolutely nothing that can be done to prevent or alleviate Type 1 diabetes. Your article was about Type 2 diabetes, but you did not make any mention of this. And even though weight and inactivity are contributing factors to Type 2 diabetes, the are not the sole cause of it, and there are fit, active people with Type 2 because they have a genetic predisposition for it. [asswipe]
OK, so the grammar isn’t the greatest, but I was mad. And, of course, I didn’t add the “asswipe” but you can bet I thought it. I have gotten increasingly impatient with the blame-the-victim attitude found in almost all news reports, and this one didn’t even do the token “There are two types of diabetes…” sentence. I’m normally a fairly quiet person and don’t really enjoy calling attention to myself but now I am urging anyone who reads this to please follow the link and add your own comments to the editor….
And now for something completely different – Julia’s book meme. A disclaimer – I am a compulsive reader who has been know to read the toothpaste tube every morning if I can find no other reading material in the bathroom….
Instructions: Bold the ones you've read. Italicize the ones you've been wanting/might like to read. ??Place question marks by any titles/authors you've never heard of?? Plus I'm adding this, as Turtlebella noted that the choice of books by each author is a mite idiosyncratic: put an asterisk if you've read something else by the same author.
*Allcott, Louisa May Little Women
*Allende, Isabel The House of Spirits (also about half in Spanish)
*Angelou, Maya I Know Why the Caged Bird Sings
*Atwood, Margaret Cat's Eye
Austen, Jane Emma
??Bambara, Toni Cade Salt Eaters??
??Barnes, Djuna Nightwoodde??
Beauvoir, Simone The Second Sex
*Blume, Judy Are You There God? It's Me Margaret
*Burnett, Frances The Secret Garden
Bronte, Charlotte Jane Eyre
Bronte, Emily Wuthering Heights
Buck, Pearl S. The Good Earth
Byatt, A.S. Possession
Cather, Willa My Antonia
Chopin, Kate The Awakening
*Christie, Agatha Murder on the Orient Express
??Cisneros, Sandra The House on Mango Street??
Clinton, Hillary Rodham Living History
??Cooper, Anna Julia A Voice From the South??
??Danticat, Edwidge Breath, Eyes, Memory??
??Davis, Angela Women, Culture, and Politics??
??Desai, Anita Clear Light of Day??
*Dickinson, Emily Collected Poems
*Duncan, Lois I Know What You Did Last Summer
DuMaurier, Daphne Rebecca
Eliot, George Middlemarch
??Emecheta, Buchi Second Class Citizen??
*Erdrich, Louise Tracks
Esquivel, Laura Like Water for Chocolate
Flagg, Fannie Fried Green Tomatoes at the Whistle Stop Cafe
Friedan, Betty The Feminine Mystique
Frank, Anne Diary of a Young Girl
??Gilman, Charlotte Perkins The Yellow Wallpaper??
??Gordimer, Nadine July's People??
*Grafton, Sue S is for Silence
Hamilton, Edith Mythology
Highsmith, Patricia The Talented Mr. Ripley
??hooks, bell Bone Black??
*Hurston, Zora Neale ust Tracks on the Road
??Jacobs, Harriet Incidents in the Life of a Slave Girl??
*Jackson, Helen Hunt Ramona
*Jackson, Shirley The Haunting of Hill House
Jong, Erica Fear of Flying
Keene, Carolyn The Nancy Drew Mysteries
Kidd, Sue Monk The Secret Life of Bees
Kincaid, Jamaic “Lucy
*Kingsolver, Barbara The Poisonwood Bible*
??Kingston, Maxine Hong The Woman Warrior??
??Larsen, Nella–Passing??
*L'Engle, Madeleine “A Wrinkle in Time
*Le Guin, Ursula K. The Left Hand of Darkness
Lee, Harper To Kill a Mockingbird
*Lessing, Doris The Golden Notebook
??Lively, Penelope Moon Tiger??
??Lorde, Audre The Cancer Journals??
Martin, Ann M. The Babysitters Club Series
*McCullers, Carson The Member of the Wedding
McMillan, Terry Disappearing Acts
??Markandaya, Kamala Nectar in a Sieve??
??Marshall, Paule Brown Girl, Brownstones??
Mitchell, Margaret Gone with the Wind
Montgomery, Lucy Maude Anne of Green Gables
??Morgan, Joan When Chickenheads Come Home to Roost??
*Morrison, Toni Song of Solomon
??Murasaki, Lady Shikibu The Tale of Genji??
*Munro, Alice Lives of Girls and Women
Murdoch, Iris Severed Head
??Naylor, Gloria Mama Day??
??Niffenegger, Audrey The Time Traveller's Wife??
*Oates, Joyce CaroleWe Were the Mulvaneys
*O'Connor, Flannery A Good Man is Hard to Find
??Piercy, Marge Woman on the Edge of Time??
??Picoult, Jodi My Sister's Keeper??
Plath, Sylvia The Bell Jar
Porter, Katharine Anne Ship of Fools
Proulx, E. Annie The Shipping News
Rand, Ayn The Fountainhead
Ray, Rachel 365: No Repeats
Rhys, Jean Wide Sargasso Sea
??Robinson, Marilynne Housekeeping??
??Rocha, Sharon For Laci??
Sebold, Alice The Lovely Bones
Shelley, Mary Frankenstein
Smith, Betty A Tree Grows in Brooklyn
Smith, Zadie White Teeth
Spark, Muriel The Prime of Miss Jean Brodie
Spyri, Johanna Heidi
Strout, Elizabeth Amy and Isabelle
*Steel, Danielle The House
*Tan, Amy The Joy Luck Club
??Tannen, Deborah You're Wearing That??
Ulrich, Laurel A Midwife's Tale
??Urquhart, Jane Away??
*Walker, Alice The Temple of My Familiar
*Welty, Eudora One Writer's Beginnings
Wharton, Edith Age of Innocence
*Wilder, Laura Ingalls Little House in the Big Woods
*Wollstonecraft, Mary A Vindication of the Rights of Women (is this a trick question – isn’t this Mary W Shelley above?)
Woolf, Virginia A Room of One's Own
Amy’s comment on it was “Forbes reports: better treatments available, but the health care system falls short.” That sounded interesting, so I went to the page and read the article. As I did, I got more and more angry. The post is about Type 2 diabetes, although it never mentions there are two types nor that genetics play a role, and ended with the asinine quote "If you stay lean and fit throughout your life, you have a 95 percent chance of never getting diabetes," he said. "It's almost entirely preventable." From Dr. Robert Rizza, a professor of medicine at the Mayo Clinic and president of the American Diabetes Association, of all people. [emphasis mine]
I assumed that his quote was taken out of context, but still wrote out the following comment and sent it via their “comments” link:
"Diabetes" is not preventable
As a "lean and fit" person with Type 1 (formerly called juvenile) diabetes I found your article ignorant to the point of insult. Type 1 diabetes is an autoimmune disease having nothing to with weight, eating habits, or exercise. People with Type 1 must inject themselves with insulin daily to stay alive. There is absolutely nothing that can be done to prevent or alleviate Type 1 diabetes. Your article was about Type 2 diabetes, but you did not make any mention of this. And even though weight and inactivity are contributing factors to Type 2 diabetes, the are not the sole cause of it, and there are fit, active people with Type 2 because they have a genetic predisposition for it. [asswipe]
OK, so the grammar isn’t the greatest, but I was mad. And, of course, I didn’t add the “asswipe” but you can bet I thought it. I have gotten increasingly impatient with the blame-the-victim attitude found in almost all news reports, and this one didn’t even do the token “There are two types of diabetes…” sentence. I’m normally a fairly quiet person and don’t really enjoy calling attention to myself but now I am urging anyone who reads this to please follow the link and add your own comments to the editor….
And now for something completely different – Julia’s book meme. A disclaimer – I am a compulsive reader who has been know to read the toothpaste tube every morning if I can find no other reading material in the bathroom….
Instructions: Bold the ones you've read. Italicize the ones you've been wanting/might like to read. ??Place question marks by any titles/authors you've never heard of?? Plus I'm adding this, as Turtlebella noted that the choice of books by each author is a mite idiosyncratic: put an asterisk if you've read something else by the same author.
*Allcott, Louisa May Little Women
*Allende, Isabel The House of Spirits (also about half in Spanish)
*Angelou, Maya I Know Why the Caged Bird Sings
*Atwood, Margaret Cat's Eye
Austen, Jane Emma
??Bambara, Toni Cade Salt Eaters??
??Barnes, Djuna Nightwoodde??
Beauvoir, Simone The Second Sex
*Blume, Judy Are You There God? It's Me Margaret
*Burnett, Frances The Secret Garden
Bronte, Charlotte Jane Eyre
Bronte, Emily Wuthering Heights
Buck, Pearl S. The Good Earth
Byatt, A.S. Possession
Cather, Willa My Antonia
Chopin, Kate The Awakening
*Christie, Agatha Murder on the Orient Express
??Cisneros, Sandra The House on Mango Street??
Clinton, Hillary Rodham Living History
??Cooper, Anna Julia A Voice From the South??
??Danticat, Edwidge Breath, Eyes, Memory??
??Davis, Angela Women, Culture, and Politics??
??Desai, Anita Clear Light of Day??
*Dickinson, Emily Collected Poems
*Duncan, Lois I Know What You Did Last Summer
DuMaurier, Daphne Rebecca
Eliot, George Middlemarch
??Emecheta, Buchi Second Class Citizen??
*Erdrich, Louise Tracks
Esquivel, Laura Like Water for Chocolate
Flagg, Fannie Fried Green Tomatoes at the Whistle Stop Cafe
Friedan, Betty The Feminine Mystique
Frank, Anne Diary of a Young Girl
??Gilman, Charlotte Perkins The Yellow Wallpaper??
??Gordimer, Nadine July's People??
*Grafton, Sue S is for Silence
Hamilton, Edith Mythology
Highsmith, Patricia The Talented Mr. Ripley
??hooks, bell Bone Black??
*Hurston, Zora Neale ust Tracks on the Road
??Jacobs, Harriet Incidents in the Life of a Slave Girl??
*Jackson, Helen Hunt Ramona
*Jackson, Shirley The Haunting of Hill House
Jong, Erica Fear of Flying
Keene, Carolyn The Nancy Drew Mysteries
Kidd, Sue Monk The Secret Life of Bees
Kincaid, Jamaic “Lucy
*Kingsolver, Barbara The Poisonwood Bible*
??Kingston, Maxine Hong The Woman Warrior??
??Larsen, Nella–Passing??
*L'Engle, Madeleine “A Wrinkle in Time
*Le Guin, Ursula K. The Left Hand of Darkness
Lee, Harper To Kill a Mockingbird
*Lessing, Doris The Golden Notebook
??Lively, Penelope Moon Tiger??
??Lorde, Audre The Cancer Journals??
Martin, Ann M. The Babysitters Club Series
*McCullers, Carson The Member of the Wedding
McMillan, Terry Disappearing Acts
??Markandaya, Kamala Nectar in a Sieve??
??Marshall, Paule Brown Girl, Brownstones??
Mitchell, Margaret Gone with the Wind
Montgomery, Lucy Maude Anne of Green Gables
??Morgan, Joan When Chickenheads Come Home to Roost??
*Morrison, Toni Song of Solomon
??Murasaki, Lady Shikibu The Tale of Genji??
*Munro, Alice Lives of Girls and Women
Murdoch, Iris Severed Head
??Naylor, Gloria Mama Day??
??Niffenegger, Audrey The Time Traveller's Wife??
*Oates, Joyce CaroleWe Were the Mulvaneys
*O'Connor, Flannery A Good Man is Hard to Find
??Piercy, Marge Woman on the Edge of Time??
??Picoult, Jodi My Sister's Keeper??
Plath, Sylvia The Bell Jar
Porter, Katharine Anne Ship of Fools
Proulx, E. Annie The Shipping News
Rand, Ayn The Fountainhead
Ray, Rachel 365: No Repeats
Rhys, Jean Wide Sargasso Sea
??Robinson, Marilynne Housekeeping??
??Rocha, Sharon For Laci??
Sebold, Alice The Lovely Bones
Shelley, Mary Frankenstein
Smith, Betty A Tree Grows in Brooklyn
Smith, Zadie White Teeth
Spark, Muriel The Prime of Miss Jean Brodie
Spyri, Johanna Heidi
Strout, Elizabeth Amy and Isabelle
*Steel, Danielle The House
*Tan, Amy The Joy Luck Club
??Tannen, Deborah You're Wearing That??
Ulrich, Laurel A Midwife's Tale
??Urquhart, Jane Away??
*Walker, Alice The Temple of My Familiar
*Welty, Eudora One Writer's Beginnings
Wharton, Edith Age of Innocence
*Wilder, Laura Ingalls Little House in the Big Woods
*Wollstonecraft, Mary A Vindication of the Rights of Women (is this a trick question – isn’t this Mary W Shelley above?)
Woolf, Virginia A Room of One's Own
Tuesday, March 21, 2006
Things I have learned from using a continuous monitor
1. The type of food I eat makes no difference whatsoever. Wheat bread is not better for my BG than white bread (it just tastes better).
2. Using the elliptical makes my BG go up for 4-5 hours three hours after I stop. It does lower it while I’m exercising, though. (this is the opposite of everything I have ever read on exercise).
3. The BG spike from two ounces of amaretto is negligible.
4. Orange juice used to treat a low wears off 20 minutes later and I’m low again. Whole milk works better.
5. Combo/extended boluses really work. I usually set mine for 50% now, 50% over the next half hour.
6. If I eat breakfast, my BG will go over 230. Always. If I take a lot of extra insulin, I will first go over 230, then go low. Skipping breakfast shows my basal is fine.
7. Stress does not seem to affect my BG at all. Or, my BG is so sensitive to stress that it is constantly affected by the stress of waking up, the stress of driving, the stress of working, the stress of not working….
8. The low BG alarm on the monitor is embarrassingly loud during the day, but will not wake me at night (possibly because by the time it thinks I’m below 100 I’m really below 50). It doesn’t wake my husband either.
9. The best week I have ever seen for BG was during Christmas, when I ate tons of baked goodies, drank lots of sweet booze, was under a lot of stress both at work and home, and did no exercise. Go figure.
10. Even having a continuous readout, doing ten or more fingersticks a day, and going over everything with my CDE once a week does not get me to an a1c of 7.0.
11. Some days, my BG numbers are just completely random. I have not yet tried seeing if there is a correlation to the Dow (Val’s BG went up after hearing news of the dollar’s weak showing against the yen). Don’t laugh, I’ve tried everything else.
12. I work backwards. I can pretty much read what is supposed to happen for the “typical” diabetic and know I’ll be the opposite. This includes exercising (higher not lower), junk food (spikes less than health food), menses (high for 2 weeks after, low the week before), and being sick (runs lower when I’m sick).
13. Decaf coffee raises my BG. A large decaf coffee with ½ cup milk I have to treat like 20g of carbs. Don’t ask my why, that’s just how it works.
14. Just because I can see my BG is high, doesn't mean I can do anything about it.
2. Using the elliptical makes my BG go up for 4-5 hours three hours after I stop. It does lower it while I’m exercising, though. (this is the opposite of everything I have ever read on exercise).
3. The BG spike from two ounces of amaretto is negligible.
4. Orange juice used to treat a low wears off 20 minutes later and I’m low again. Whole milk works better.
5. Combo/extended boluses really work. I usually set mine for 50% now, 50% over the next half hour.
6. If I eat breakfast, my BG will go over 230. Always. If I take a lot of extra insulin, I will first go over 230, then go low. Skipping breakfast shows my basal is fine.
7. Stress does not seem to affect my BG at all. Or, my BG is so sensitive to stress that it is constantly affected by the stress of waking up, the stress of driving, the stress of working, the stress of not working….
8. The low BG alarm on the monitor is embarrassingly loud during the day, but will not wake me at night (possibly because by the time it thinks I’m below 100 I’m really below 50). It doesn’t wake my husband either.
9. The best week I have ever seen for BG was during Christmas, when I ate tons of baked goodies, drank lots of sweet booze, was under a lot of stress both at work and home, and did no exercise. Go figure.
10. Even having a continuous readout, doing ten or more fingersticks a day, and going over everything with my CDE once a week does not get me to an a1c of 7.0.
11. Some days, my BG numbers are just completely random. I have not yet tried seeing if there is a correlation to the Dow (Val’s BG went up after hearing news of the dollar’s weak showing against the yen). Don’t laugh, I’ve tried everything else.
12. I work backwards. I can pretty much read what is supposed to happen for the “typical” diabetic and know I’ll be the opposite. This includes exercising (higher not lower), junk food (spikes less than health food), menses (high for 2 weeks after, low the week before), and being sick (runs lower when I’m sick).
13. Decaf coffee raises my BG. A large decaf coffee with ½ cup milk I have to treat like 20g of carbs. Don’t ask my why, that’s just how it works.
14. Just because I can see my BG is high, doesn't mean I can do anything about it.
Sunday, February 19, 2006
Don't pull out that checkbook just yet
I haven’t been updating very often. I kept hoping the initial issues would be straightened out and I’d be able to tell you how wonderful the integrated pump and continuous BG monitor was. I knew it wouldn’t be perfect, but I had hoped it would at least be useful. I’m not so sure it is. Here’s my opinions, in bullet form:
What they got right
The display. One click on the pump and I see a graph of the previous 3 hours, plus my current BG reading, plus an indicator if things are changing “rapidly”: one arrow for rising/dropping a point a minute for the last 20, 2 arrows if two points a minute. This screen is probably the most useful thing about the whole setup.
The display part 2. There is a second screen which shows you the previous 24 hours, same extra info, which is really great when you wake up and want to see what the heck happened overnight, or is my bizarre overreaction to breakfast today as bad as it was yesterday, etc.
The software. As part of the study, you download the pump to a website, where you can create various reports of the data. My favorite is the one where you can overlay the past X days of sensor readings, to allow you to look for patterns. Sure, there are improvements that could be made to the interface for this, and more flexibility would be nice, but in general it’s a useful tool the way it is. Which brings us to –
What needs more work
Accuracy. It’s hard to decide where to start on this list, but I guess this is the biggest issue. I mean, we all know that the BG reading you see on your meter is pretty much an imaginary number. Try it twice in a row, or the same drop of blood and strips in your meter and back up meter, and you’ll see ten to fifteen points difference most of the time. Plus, sensor is measuring BG in interstitial fluid, not blood. So I know I shouldn’t be upset if the sensor and the meter disagree by 20 points or so. The problem is, they differ by much more than that an awful lot of the time. You pretty much have to ignore the first twelve hours or more, where I’ve seen the sensor and the meter as much as 100 points apart. (See warm-up time, below). But even when you’re on day 2 or 3 of the sensor, sometimes the readings are just out to lunch. Like 190 versus 286 as a post meal reading.
The BG meter. OK, this is a study thing, but maybe it’s contributing to the accuracy mentioned above. The deal is, all us study participants must use the same meter and strips. Makes sense, doesn’t it? Except, there’s a problem with the meter we’re using. It’s not great below 100. %$#@&! Hello? Below 100 is when you NEED the meter to be accurate. Here’s the deal. I tend not to feel a low until I’m about 55 or so. I’ve been working at avoiding them (I averaged one a day below 55 before the study started) and now only seem to get shaky every other day or so. But, when I check with the meter, I was seeing things like 94, or 78. Hmm, guess I was wrong. Well, then I get a call from our study coordinator saying that they think there is a problem with this meter in the normal-to-low range, so if you feel low, treat it anyway, or double-check on your old meter. So the next day I felt weird; the sensor showed me happily buzzing along at 110 or so, and I decided to do a comparison. Big drop of blood, half on old meter (fresh bottle of strips), half on the meter for the study, the one the sensor calibrates against. The result? Study meter says I’m 78. Old meter says 53. I feel 53. Making the sensor exactly DOUBLE my best guess as to my actual BG.
Sensitivity. I try to look at the picture more than the number. Hey, the numbers may be off, but at least it shows you whether you’re climbing or falling. Except when it doesn’t. Take this morning for instance. When I went to bed, sensor thought I was 156; meter said I was 136. No big deal – in the ballpark, if slightly lower than I like to be at bedtime. I decided to leave it alone and see how I did overnight. I woke up, and the display screen showed me relatively flat all night and currently 142. I checked with the meter and got 85. WTF? I dropped 51 points overnight, not 14. There’s a big difference there. To be fair, I realize this is a complex thing to measure, the sensor degrades as your body tries to “coat” the thing under your skin, which is why you have to keep re-calibrating it with the meter. BUT, as a consumer I’m just saying that I don’t like it.
Warm up time. You have to change the sensor every three days. I do it with my site change. After you put the sensor in, you tell the pump about it, and it goes into a countdown for 3 hours, and then beeps to ask you for its first calibration reading. About 15 minutes after the calibration your first reading shows up on the pump. So far, so good. The problem is, that it takes a lot longer than that to actually be accurate – or as accurate as it gets. Some times it seems ok in the afternoon after my morning site change, some times it’s not synched up until the following morning. Some times it never syncs up. Then, at 36 hours exactly, it beeps and shuts off. The reasoning (I assume) is, that it degrades over time (hah!) and they don’t want you using the meter values as gospel when they know it’s off. As opposed to the rest of the time, when the inaccurate values are apparently OK. It would be better if at 36 hours it gave you a warning (like a low reservoir warning) and then shut down in another 6 or so.
Quality control. The first box of sensors I got, half of them went bad. Most of those were during the warm-up period, before I ever got a reading from them. My study coordinator actually replaced the little transmitter too, in the thought that it might be that rather than the sensors going bad. Afterward, in the second box, I’ve only had one go bad. BUT, keep in mind in the real world, I’d be paying for these. Let’s assume these sensors sell for the same price Wil pays, about $40 a pop. I’m ignoring the cost of the transmitter and the pump itself here. That means I tossed about $200 without ever getting any benefit from them. Add to that the warm-up day, the accuracy problems, etc, and it comes out to about $40 a day when you actually get useful readings from them. Would I use it if my insurance paid for it? Yeah, in a heartbeat, because it’s at least better than what’s out there right now. Would I use it if I had to pay $15 a day on my own? Probably. We can afford that, if we’re careful. Would I use it as it stands now, where I average 1 day in 3 of useful information – $40 a day for the days that it works? No way in hell.
Transmitter. The transmitter which sends the readings to the pump is not small. It’s an oval shape, the length and thickness of my pinky. You stick it to your skin with an adhesive pad that starts to itch after about two days and leaves behind a sticky residue That you have to really scrub at it to get off. A lot of times, it doesn’t deal with the fact that while I’m sleeping the pump might be on the other side of my body. It beeps politely to let me know there’s a weak signal, which I sleep through, and eventually shuts off sensor communication. At this point the pump beeps again, and again, until it finally goes into beep and vibrate mode and wakes me up. I turn on the light, clear the alarm, and re-start the sensor, which means that in 15 minutes it beeps again wanting a calibration, so I can’t go back to sleep until that happens. Now on its own this wouldn’t be a big deal. In fact, if this was the only problem with the whole setup I wouldn’t even mention it, but it is an irritation. And the fact that it is this thing that wakes me up, rather than a low alarm when I’ve obviously gone low overnight, this just pisses me off. I’ve had to reset the low threshold to alarm if I dip below 100 to have a chance of catching it before the real BG hits 50. What I think the issue is here is that they are using the technology because it’s cool, not because it’s useful. Yes, it’s really cool that the sensor/transmitter broadcasts a (random) BG reading to the pump, and that the pump displays them for you. It’s great that you can do this without wires. BUT, what the developers seemed to have forgotten, is that we’re already hooked up to the frigging pump. Why not just run a wire along the infusion set tubing, with say 12-18 inches of free wire at the end so you can position the sensor away from your infusion site. That way, you’d definitely change it with your site, AND you wouldn’t have to worry about this lost sensor crap. Plus I wouldn’t find the damn thing alarming every time I step out of the shower, because it would KNOW I was disconnected.
OK, I’m not going to go into the minor annoyances at all, because if the major ones were fixed I could deal with the minor ones. My husband is amazed I’ve stuck with the study, but I want them to see what’s wrong, so they know what they should do before they make this a commercial product. I mean, it COULD be so damn good, if it only worked. In the meantime... Do you remember all the hype before Windows 95 came out? How great it looked, how much it did? And then when you actually used the real product, before the service packs came out? This is worse. This is Microsoft Bob (or the Paper Clip Guy, for those of you fortunate enought to have never seen Bob). It’s something that in theory could be really useful, even indispensable, but in reality it’s just a giant pain in the butt. I really hope they can get this to work – or someone else can – but I don’t think I’m going to be the first to jump on the boat to start throwing money at a 1.0 product.
What they got right
The display. One click on the pump and I see a graph of the previous 3 hours, plus my current BG reading, plus an indicator if things are changing “rapidly”: one arrow for rising/dropping a point a minute for the last 20, 2 arrows if two points a minute. This screen is probably the most useful thing about the whole setup.
The display part 2. There is a second screen which shows you the previous 24 hours, same extra info, which is really great when you wake up and want to see what the heck happened overnight, or is my bizarre overreaction to breakfast today as bad as it was yesterday, etc.
The software. As part of the study, you download the pump to a website, where you can create various reports of the data. My favorite is the one where you can overlay the past X days of sensor readings, to allow you to look for patterns. Sure, there are improvements that could be made to the interface for this, and more flexibility would be nice, but in general it’s a useful tool the way it is. Which brings us to –
What needs more work
Accuracy. It’s hard to decide where to start on this list, but I guess this is the biggest issue. I mean, we all know that the BG reading you see on your meter is pretty much an imaginary number. Try it twice in a row, or the same drop of blood and strips in your meter and back up meter, and you’ll see ten to fifteen points difference most of the time. Plus, sensor is measuring BG in interstitial fluid, not blood. So I know I shouldn’t be upset if the sensor and the meter disagree by 20 points or so. The problem is, they differ by much more than that an awful lot of the time. You pretty much have to ignore the first twelve hours or more, where I’ve seen the sensor and the meter as much as 100 points apart. (See warm-up time, below). But even when you’re on day 2 or 3 of the sensor, sometimes the readings are just out to lunch. Like 190 versus 286 as a post meal reading.
The BG meter. OK, this is a study thing, but maybe it’s contributing to the accuracy mentioned above. The deal is, all us study participants must use the same meter and strips. Makes sense, doesn’t it? Except, there’s a problem with the meter we’re using. It’s not great below 100. %$#@&! Hello? Below 100 is when you NEED the meter to be accurate. Here’s the deal. I tend not to feel a low until I’m about 55 or so. I’ve been working at avoiding them (I averaged one a day below 55 before the study started) and now only seem to get shaky every other day or so. But, when I check with the meter, I was seeing things like 94, or 78. Hmm, guess I was wrong. Well, then I get a call from our study coordinator saying that they think there is a problem with this meter in the normal-to-low range, so if you feel low, treat it anyway, or double-check on your old meter. So the next day I felt weird; the sensor showed me happily buzzing along at 110 or so, and I decided to do a comparison. Big drop of blood, half on old meter (fresh bottle of strips), half on the meter for the study, the one the sensor calibrates against. The result? Study meter says I’m 78. Old meter says 53. I feel 53. Making the sensor exactly DOUBLE my best guess as to my actual BG.
Sensitivity. I try to look at the picture more than the number. Hey, the numbers may be off, but at least it shows you whether you’re climbing or falling. Except when it doesn’t. Take this morning for instance. When I went to bed, sensor thought I was 156; meter said I was 136. No big deal – in the ballpark, if slightly lower than I like to be at bedtime. I decided to leave it alone and see how I did overnight. I woke up, and the display screen showed me relatively flat all night and currently 142. I checked with the meter and got 85. WTF? I dropped 51 points overnight, not 14. There’s a big difference there. To be fair, I realize this is a complex thing to measure, the sensor degrades as your body tries to “coat” the thing under your skin, which is why you have to keep re-calibrating it with the meter. BUT, as a consumer I’m just saying that I don’t like it.
Warm up time. You have to change the sensor every three days. I do it with my site change. After you put the sensor in, you tell the pump about it, and it goes into a countdown for 3 hours, and then beeps to ask you for its first calibration reading. About 15 minutes after the calibration your first reading shows up on the pump. So far, so good. The problem is, that it takes a lot longer than that to actually be accurate – or as accurate as it gets. Some times it seems ok in the afternoon after my morning site change, some times it’s not synched up until the following morning. Some times it never syncs up. Then, at 36 hours exactly, it beeps and shuts off. The reasoning (I assume) is, that it degrades over time (hah!) and they don’t want you using the meter values as gospel when they know it’s off. As opposed to the rest of the time, when the inaccurate values are apparently OK. It would be better if at 36 hours it gave you a warning (like a low reservoir warning) and then shut down in another 6 or so.
Quality control. The first box of sensors I got, half of them went bad. Most of those were during the warm-up period, before I ever got a reading from them. My study coordinator actually replaced the little transmitter too, in the thought that it might be that rather than the sensors going bad. Afterward, in the second box, I’ve only had one go bad. BUT, keep in mind in the real world, I’d be paying for these. Let’s assume these sensors sell for the same price Wil pays, about $40 a pop. I’m ignoring the cost of the transmitter and the pump itself here. That means I tossed about $200 without ever getting any benefit from them. Add to that the warm-up day, the accuracy problems, etc, and it comes out to about $40 a day when you actually get useful readings from them. Would I use it if my insurance paid for it? Yeah, in a heartbeat, because it’s at least better than what’s out there right now. Would I use it if I had to pay $15 a day on my own? Probably. We can afford that, if we’re careful. Would I use it as it stands now, where I average 1 day in 3 of useful information – $40 a day for the days that it works? No way in hell.
Transmitter. The transmitter which sends the readings to the pump is not small. It’s an oval shape, the length and thickness of my pinky. You stick it to your skin with an adhesive pad that starts to itch after about two days and leaves behind a sticky residue That you have to really scrub at it to get off. A lot of times, it doesn’t deal with the fact that while I’m sleeping the pump might be on the other side of my body. It beeps politely to let me know there’s a weak signal, which I sleep through, and eventually shuts off sensor communication. At this point the pump beeps again, and again, until it finally goes into beep and vibrate mode and wakes me up. I turn on the light, clear the alarm, and re-start the sensor, which means that in 15 minutes it beeps again wanting a calibration, so I can’t go back to sleep until that happens. Now on its own this wouldn’t be a big deal. In fact, if this was the only problem with the whole setup I wouldn’t even mention it, but it is an irritation. And the fact that it is this thing that wakes me up, rather than a low alarm when I’ve obviously gone low overnight, this just pisses me off. I’ve had to reset the low threshold to alarm if I dip below 100 to have a chance of catching it before the real BG hits 50. What I think the issue is here is that they are using the technology because it’s cool, not because it’s useful. Yes, it’s really cool that the sensor/transmitter broadcasts a (random) BG reading to the pump, and that the pump displays them for you. It’s great that you can do this without wires. BUT, what the developers seemed to have forgotten, is that we’re already hooked up to the frigging pump. Why not just run a wire along the infusion set tubing, with say 12-18 inches of free wire at the end so you can position the sensor away from your infusion site. That way, you’d definitely change it with your site, AND you wouldn’t have to worry about this lost sensor crap. Plus I wouldn’t find the damn thing alarming every time I step out of the shower, because it would KNOW I was disconnected.
OK, I’m not going to go into the minor annoyances at all, because if the major ones were fixed I could deal with the minor ones. My husband is amazed I’ve stuck with the study, but I want them to see what’s wrong, so they know what they should do before they make this a commercial product. I mean, it COULD be so damn good, if it only worked. In the meantime... Do you remember all the hype before Windows 95 came out? How great it looked, how much it did? And then when you actually used the real product, before the service packs came out? This is worse. This is Microsoft Bob (or the Paper Clip Guy, for those of you fortunate enought to have never seen Bob). It’s something that in theory could be really useful, even indispensable, but in reality it’s just a giant pain in the butt. I really hope they can get this to work – or someone else can – but I don’t think I’m going to be the first to jump on the boat to start throwing money at a 1.0 product.
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