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Diabetically Speaking

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December 2010

My CGMS Struggle

My girlfriend and I went over to my hometown, about 90 miles away, and spent Christmas day playing with babies, laughing with family, and preparing and eating all kinds of delicious food, including pork chops, chicken & dumplings, baked potatoes, sweet potatoes, salad, and more desserts than a PWD can shake a vial of insulin at.

I’m a big dummy though. I ran off for Christmas festivities and forgot to put a new Continuous Glucose Monitor Sensor (CGMS) in before I left. So there I was, eating whatever I pleased, trying a little bit of this and that, SWAG bolusing like crazy, and running all over creation making my rounds. It was kind of like being Santa Claus…in a Scion. We finally made it back home that evening, and as soon as I got out of the car and inside the house I felt a headache coming on at full speed, including a feeling of just all around weird.

Fortunately, I still maintained enough lucidity to dash back out to my car and grab my kit.

5…
4…
3…
2…
1…

BG was 63.

Now, I knew from the sudden headache and overall weirdness that my blood sugar was dropping, but at that moment I felt I should have cashed a $20 bill into quarters and backed up to the ass kicking machine. Why did I run off traveling without my CGMS? After fighting and longing for this amazing near real-time blood glucose monitoring technology for so long, I still struggle with wearing yet another device on me, attached to my skin. This isn’t the first time I’ve been cavalier about wearing it, just the first time I’m willing to admit it.

I can’t explain it. I feel stupid for not wearing it all the time, but sometimes it is just too much. Or is that just what I tell myself? I know that as PWD’s we rely on data above all else to help us manage and keep the tiger on the other end of the diabetes leash tamed. So why am I so reluctant, stubborn, or just down right stupid to not wear my CGMS 24/7/365?

I love how I can see the trends of my BG’s when I’m wearing my CGMS. I feel like I am in much better control when I wear it as well, seeing which direction my BG’s are going, and being able to correct quickly. It also encourages me to test more frequently, keeping a close eye on where my BG’s are at any given moment. I like that I can catch a low before it becomes headache inducing, or worse. I also am making adjustments so that I can catch the high BG’s as well, when they happen. So it isn’t that I don’t like using the CGM. I actually find it quite fascinating.

I truly think my biggest hurdle with CGM, after having it the past three months, is that it is still another infusion site. It’s still something else that is poking through my skin. It’s still something else that I lose sleep over, not because of the beeping (that’s saved me more than once already with severe night time lows), but because I’m still not used to it being there. I’m so aware of it and don’t want to roll over on it and feel that agitating pinch, especially when I wear it on my arms.

I wish I could just put the CGMS on my forehead. I don’t really sleep on that. Of course, that might prove problematic on days like Christmas when I want to smack myself in the head for being selfish and just flying by the seat of my pants, instead of giving diabetes its proper respect. After all, each of us has had experiences with diabetes putting us in our place and reminding us that it will not be ignored.

Doh!

For those of you with CGM, do you wear your CGMS all the time?
What is your strategy for when to where your sensor and when not to?
Have you experienced any challenges in adding CGM to your diabetes arsenal?

Inquiring CGM-ers want to know.

Holidays with the BG’s

You know what’s fun?

Christmas shopping. Finding that perfect gift for a family member, loved one, friend, boss, or frenemy that you’ve been waiting since last year to get back at during the White Elephant party. Yup, somebody is getting an angry-faced pig cookie jar this year, and it’s not going to be me.

You know what’s not fun?

My CGM alarming and saying my BG is 91 with two double arrows pointing down while I’m Christmas shopping. That does explain my lack of focus though, and why it was taking me an abnormal amount of time to evaluate the power tools when I originally went to the store to look for a flashlight. Go figure.

Holidays are treacherous times for us PWD’s, and I know I’m not the only one dealing with it. We have a sleigh load of food available at work, home, at parties, and it’s really hard to guesstimate exactly what is in all that “stuff” we’re shoveling in our mouths by the handful taste testing. I have a habit of overestimating, and then finding myself battling a Larry Low two or three hours after indulging.

Part of that is because I despise the feeling of a high BG. It feels like my blood has turned into molasses, I’m cranky because I don’t feel good, and I get impatient watching my numbers not drop back to normal at a rate that meets my expectations. A 200+ reading on my meter or CGM leads to me being irritated if it is anything more than a very temporary thing.

At my endo visit a couple weeks ago my A1C had bounced up a bit from 6.1 to 6.7, while I’ve been trying to prevent severe low BG’s that were plaguing me before. Now, I know that many people would jump for joy over a 6.7, and I realize that it isn’t a bad A1C necessarily. However, it makes me feel like a failure. For those of us waging war on a day-to-day basis with diabetes, we are harder on ourselves more than anybody else is. I hold myself to a high standard when it comes to my diabetes. Whether or not it’s the reality of diabetes, I need to feel like I have some control of it, besides just telling it where it can go with a colorful description of the hand basket it can go there in. I feel I can do better than a 6.7, and get it back closer to 6.0. This is just my goal, and YDMV.

For the longest I was pumping with a single steady basal rate, 24 hours a day. I know that isn’t how the body works, but I was bolusing and temp basaling all around it, basically manually adjusting my rate of insulin as necessary. Then I got my CGM and a Certified Diabetes Educator (CDE) and Medtronic rep who is really knowledgeable about how BG’s ebb and flow, the dawn phenomenon, effects of activity, and many of the intricacies of living with diabetes. Presently, I am working hard with my CDE to get my basal rates optimized, examining trends, analyzing BG’s, and getting a better grip on preventing my BG’s from dropping too low and spiking too high. Perhaps I could have chosen a better time than December to attempt this, but meh…pressure makes diamonds, and I’m determined to ace this.

Ace of Diamonds

Since I met with my CDE and adjusted my basal rates, and then made a few more adjustments on my own after finding times of the day that my BG’s would spike inexplicably, things seem to be getting better. My average BG in the last week is down to 157 mg/dl, from a pre-adjustment average that was closer to 200.

I’ll take that kind of progress any day, and even more so with the holidays.

Sitting On My Desk For Breakfast

This morning I got to work and went through my usual routine. Laptop was running slow, scouring the internet for every update it could find. Had a hot pot of Colombian coffee brewing. Had a blueberry muffin sitting on my desk for breakfast.

I checked my blood sugar, coming in at 161 mg/dl. Not horrible, a little higher than my target, but I’ll take it. Went ahead and combo bolused for the correction and for the blueberry muffin for breakfast. Trying to get better at bolusing 15-30 minutes before eating, so I took a few minutes to check the news and weather from my iPad. Weather said today would see a high in the 40-50 degrees Fahrenheit range. Chilly for north Florida, but it beats the snow. Coffee was done brewing, so I went and got me a cup, and chatted with my coworkers. Blueberry muffin still sitting on my desk for breakfast.

Got back to my office and saw that I had new voicemail on my work phone. I had two messages from eager vendors wanting me to buy stuff from them that I’m not yet convinced that I need. Laptop was still doing its update thing, so I couldn’t get into my files yet to figure out what my next steps were going to be with the vendors. Instead, I cleared off a spot on my desk to set up my new keyboard dock and charger for my iPad. Makes a great backup, and much easier to produce content from my iPad when I have a keyboard than without it. Coffee was hot and delicious as I got everything situated where it was supposed to be. Blueberry muffin was unassuming, sitting on my desk for breakfast.

I’m a sticky note person, and I think they breed like rabbits in my office when I’m not looking. There are sticky notes everywhere. It’s colorful chaos. To make room for my iPad keyboard dock and put it in a place on my desk where I can actually use it, I had to go through probably 40 sticky notes that had accumulated on my desk. I kept about five, just to be safe, and threw the rest away…I mean, recycled them. Blueberry muffin was being resilient, sitting on my desk for breakfast.

Finally my laptop decided it would show up for work and stop with the updates, and I was able to get into my email folders and files and start looking into the vendor proposals. One of them contained a list of a few hundred titles that needed reviewing before I could make a decision as to whether I needed them or not. Usually I know what I need better than the vendors do, but the offer includes one of those end of the year sales, and I love a good deal. Meanwhile, as I’m crunching numbers and having a good ol’ time in my spreadsheets, blueberry muffin was sitting on my desk for breakfast.

It got to be mid-morning or a little later, and I was cranky. Why didn’t my coffee work this morning? I’m going to upgrade to Italian Dark Roast if this Colombian good stuff doesn’t get its caffeinated act together. Why can’t I think clearly? How come I’m fighting the urge to bite someone’s (anyone’s) head off?

…wait a tick…

Blueberry muffin sitting on my desk for breakfast…great. I bolused and forgot to eat. Stupid. BG was 45 mg/dl. CGMS finally bit the dust after six days this morning, so it couldn’t tell me what was happening. And I was just working away, dum-dee-dum, completely oblivious.

I will get better at pre-bolusing, and that is just one aspect of my diabetes that I want to get better at. My BG’s have been all over the board lately, and I have been on the glucoaster way too much. I’m a perfectionist, and I have a strict idea of what “control” is for my diabetes, but even so I fear my A1C is going to be horrific tomorrow morning when I have my endo appointment. But, that’s diabetes, and that’s life. I can’t carry the blame all the time. I shouldn’t have gotten carried away with work, but I love my work, and it happens.

But I tell you this, the next blueberry muffin I get will be getting a stern talking to if it decides to remain quiet after 30 minutes of sitting on my desk for breakfast!

Blueberry Muffin (photo by Minimalist Photography on Flickr)

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