CGM

SWD - Sara & Martin - May 2012

Bullets: Rat-a-tat Tat

I’ve been traveling a lot lately. And working. And traveling some more. If my counting is correct, this past weekend was my 8th trip somewhere out of town in the last two months, after weeks of prepping for said travel, and I still have one more trip to go.

8 Fingers

I’ve forgotten what weekends at home are, but if those mythical creatures still exist, I’m certainly looking forward to one someday soon. I’ve got a lot of catching up to do, and so much that I want to share with all of you that still read my blog and haven’t given up on me while I’ve been M.I.A. the past few months.

Overall, the past several months have been a success, made up of both work and diabetes, and including a lot of reading, thinking, meetings, planning, traveling, juggling, tightrope walking, backward and forward somersaults, and as much fun as there has been time for in the three ring circus that is my life these days. Here are just a few highlights:

  • I took a trip to Seattle, Washington for the Medical Library Association conference. I had never been that far west or north before, and it was a mind-boggling and delightful experience. Jet lag sucks though.
  • I attended the inaugural Students With Diabetes National Conference in May, and it was one of the most incredible three days with diabetes that I’ve had in my entire life. Ever. I’m still processing my thoughts on it, but what is being done with Students With Diabetes and Bringing Science Home is nothing less than life altering.
  • After working every day (and night) since the end of February to plan a statewide meeting of medical librarians, I was elected President of the Florida Health Sciences Library Association. I’m extremely proud of and excited to lead this group to some grand things for medical libraries in Florida over the next year.
  • I’ve finally decided that I’m all in for D-Ink. I just have to find someone who has the skill to draw what I want. Will share my thoughts on that process, which may appeal to some of you who are also considering D-Ink.
  • New diabetes technology is out and about, and I’m drooling over it. However, with every new invention to improve the lives of people with diabetes, there comes a list of challenges.
  • Traveling and eating out so much has left me still struggling with my weight…again. It’s a recurring theme, really. I wanted to be lean by Friends For Life this year, but alas, that’s next week, and I don’t see myself losing the equivalent of a toddler between now and then. I’m exploring some options of what to do about it, and trying to figure out how I can get into a routine that isn’t so detrimental to my bottom line, so to speak.
  • Through everything, I’m still working to stay on top of my world with diabetes. 60% of the time it works every time. Wearing my Continuous Glucose Monitor (CGM) on a constant basis is still probably my biggest diabetes challenge, for a host of different reasons.
  • Also, I’ve spent some time recently shepherding someone near and dear to me who is newly diagnosed with Type 1 diabetes. It has left me with a lot of thoughts about how we, both as patients and parents of children with diabetes, react to change and the news that our transmission has decided that it wants to be a “stick shift” rather than an “automatic.”

More to come on all of this, but I’m just excited to get back to writing and sharing and communicating with everyone again.

Here’s a picture of me and Sara at the Students With Diabetes National Conference. See also: Poster children for Type 1 diabetes. (You read it here first.)

SWD - Sara & Martin - May 2012

Level Foods

Level Up

A recurring theme in my diabetes world is running low. I can function normally with a blood sugar down to the mid-40’s most of the time, and not even realize it. That’s called blood sugar unawareness. It’s also dangerous.

Low blood sugars have a way of sneaking up on me. I finally figure out something is wrong when all of a sudden I’m unable to focus, or my mouth is running 90mph but the words aren’t making sense anymore, or I’m trying to communicate but can’t get any words out at all, or my mood swings from normal to highly agitated and upset for no reason, or I’ve sweat through my clothes and am a shaky mess.

Most days I wear a Continuous Glucose Monitor (CGM), which alarms when my BG drops too low. Most days, it even catches it in time. However, there are days that I go without my CGM, which is dangerous, stupid, and quite honestly, a total waste of money. Those CGM sensors are not cheap…at all!

When I was a kid, I was stupid and I guess I thought I was invincible, because I would run off to play or with friends and never carry anything to treat a low with me. It’s a wonder that I survived, as active as I am and as busy as I’ve always been, from childhood to adult. I don’t even want to know what my A1C must have been when I was flying by the seat of my pants like that.

After 31 years of Type 1 diabetes, and a lot of lessons learned, I don’t go anywhere without something to treat a low. I’ve got glucose tabs on my car keys. I’ve got juice boxes in my refrigerator. I have a stash of low blood sugar remedies in my nightstand drawer. In fact, I’ve probably got something to treat a low in every room of my house, every bag I carry, in my car, and in every drawer of my desk at work.

There’s a new product that I carry with me everywhere now. It comes in a pouch, and it fits in my pocket, in my BG kit case, in the easy access velcro pocket on the outside of my messenger bag, in my gym bag, in the back of my cycling jersey, in my car, and I’ve even managed to stuff one in my shaving kit for when I’m traveling.

Level Foods

I’m talking about Level. Level is a pouch of glucose gel, 15 grams of carbohydrates in each, that are perfect for me to treat a low blood sugar with…anywhere. I can swallow it easy when my mouth won’t cooperate, it opens easy so that I can rip it open with my teeth if necessary when my hands are being clumsy, and it’s delicious, unlike most other glucose products I’ve choked down in a moment of low blood sugar desperation. Level is available in four flavors: Mandarin Orange, Caramel, Strawberry-Banana, and Vanilla.

One thing that most people with diabetes (PWD’s) who run low can appreciate is that, when we are low, it’s a lot more fun to treat that low blood sugar with something delicious than it is to force feed ourselves with something that nobody would eat on a normal day. That is one thing I like about Level pouches. Treating a low with something that tastes like mandarin-orange, strawberry-banana, caramel or vanilla really isn’t so bad.

My advice: Try it. It’s worth a shot to not have to eat a handful of glucose tabs, at least for one low. Tell the folks at Level that you read about it on Diabetically Speaking, and they’ll throw in a bonus! Just enter diabeticallyspeaking at checkout on their web site, LevelFoods.com, and get 20% off any purchase of $25 or more. Pretty sweet! (Pun kind of intended.)


Now, this is the disclaimer part. I am in cahoots with the company that makes Level. They really didn’t have to push me very hard to get me to say good things about their product. I really wanted to share with those of you that read Diabetically Speaking because it works for me, it doesn’t taste like I’m eating chalk, and I can actually get into it when I’m having a shaky, clumsy, can’t quite get my body to do what it’s supposed to kind of low. It’s pretty much a life saver in Martin’s diabetes world, but in the effort of honesty and integrity, I’m divulging that not only am I a Level fan, I’m also a customer. So there. Remember, enter diabeticallyspeaking at checkout at LevelFoods.com, and get 20% off orders of $25 or more.

Why You So Stubborn, Diabetes?

I think of myself as a typically optimistic person, especially when it comes to my diabetes, because really my life with diabetes is better when I’m able to cast it in a positive light. Even so, that doesn’t mean that I don’t spend a few days in the trough of a wave every once in awhile.

Today was one of those days. I didn’t sleep much over the weekend, so this morning I got up early and fed the dogs and then decided I would try to sleep a little bit longer, considering it was Sunday and all and I didn’t have to go to work or anything. About the time I got comfortable, some masochist with a lawnmower decided that 8:00am was a fine time to mow the grass next door. Seriously, how do you get up so early on a Sunday and think, “I’ll go mow the grass this morning.” Read the paper and have a cup of coffee for Pete’s sake. Have a whole pot if it tickles you. Just don’t go outside and crank up the mower and wake up the neighborhood! </rant>

I like to make a big breakfast at least one morning on the weekend. I’m doing good to get dressed and get to work on the weekdays, so Sunday mornings are my time to pause and enjoy the thrills of a pot (or two) of coffee, eggs, sausage or bacon, and Meet the Press with A-Flizzle. If you ordered that meal at Denny’s, it would be a Grand Slam Nerdy, and could you leave a carafe of coffee on the table please?

I found a little bit of Bisquick left in the fridge, which is weird because most people put that in the pantry, but I decided to use it up and make a couple of pancakes. I limited myself to just one pancake, the one that came out looking like it had been put in somebody’s pocket instead of in the skillet, because I didn’t want my blood sugar to go through the roof or anything crazy. And it didn’t. It just hovered around the stinkin’ penthouse suite all day long, making me real frustrated because it wouldn’t come back down to the lobby where all the normal BG’s hang out.

That was the only starch that I had on the day, and I hovered around 200 mg/dl all day long. Being used to running a BG of around 100 lately, I felt that 200 in full effect. I even resorted to rage bolusing, just throwing a max amount of insulin at it to try and get it to budge. We went to see Hunger Games with some friends, and I barely touched the popcorn. Then we went to dinner afterward, and I couldn’t even eat because I was so nauseous and thirsty from the stubborn high BG. Finally, after I got home and gave up, I started to sink back down to normal again.

Stubborn CGM

I ended up having to take over 100 units of insulin today to combat diabetes. That really, REALLY frustrates me, considering how a normal day for me (with carbs) is closer to 60 or 70. In hindsight, I shouldn’t have eaten that pancake, but there was no way of knowing that it would have been so stubborn all day long. The beauty of the conundrum is that it might not have even been the pancake. It could have been that my insulin lost its potency, or that I’m fighting off a virus of some kind, or that I was wearing green today instead of blue and my diabetes was offended. In other words, who knows?

Some of you may be reading this and thinking, “Wow, he’s got the diabetes real bad.” You may be thinking, “He really isn’t taking care of himself having to dose that much to get his blood sugars to cooperate.” You might even be thinking, “I would have been pissed too if that guy had woken me up with that damn lawnmower!” Or you might just be thinking, “Yup, been there, done that.” I’m convinced that some days diabetes has a mind of its own and does whatever it damn well pleases, regardless of what we try to do to “control” it.

Fighting back the tears, I was telling A-Flizzle about how frustrated it makes me when I feel like I have no control over what my body and diabetes has decided it wants to do. I hate feeling like I’m just strapped in and along for the ride, wherever it may take me. That is why I have the CGM, why I check my blood sugar on average 6-8 times a day, and why I try and count everything that goes in my mouth so that when I do make a mistake, hopefully it isn’t a complete disaster.

This situation is a good reminder to myself that we can do seemingly everything right in our lives with diabetes, from correct carb counting, insulin dosing, BG checking, and everything else, and yet we can still have those days where all of the pieces just refuse to fit together.

Tomorrow is a new day, with a new inset, and a fresh reservoir of insulin in my pump. So bring it beetus! I’ll be your Huckleberry.

I Break For Coffee

Hangry

It’s hard to describe, and even differentiate sometimes, the difference between having a low blood sugar and just running on pure empty from not eating all day.

All week, since Daylight Savings Time kicked in, I have been trying to outrun the clock and get to work on time. I love DST, don’t get me wrong, but it’s really hard to get up in the morning when it’s still dark outside.

Okay, who am I kidding? It’s hard for me to get up in the morning whether it’s dark outside or not.

Yesterday morning was no different. Running late, I brushed my teeth, grabbed my work gear, made certain that I wasn’t walking out of the house with flip flops and pajama pants on, and hit the road.

I realized when I grabbed my messenger bag out of my car that it was lighter than usual. Turns out I had left my lunch (leftover white bean chicken chili from dinner the night before) at home. It happens, right?

This wouldn’t normally be a problem, but I have a habit (a good habit, if you’re viewing things from my employer’s perspective) of getting to work and throwing myself into things and not stopping. I’m notorious for working through lunch, skipping breaks, and looking at the clock to surprisingly discover that it’s mid-afternoon and I haven’t seen the outside of my office all day. The only thing that I will consistently break for is coffee.

I Break For Coffee

After my second cup of coffee…okay, third cup…maybe fourth cup…I realized that I was pretty much plowing through my day of meetings, emails, phone calls, and one-armed library dragon training. Once I was done, and those dragons were tamed well enough to stamp due dates in library books like they were born with that one lonely arm to do just that instead of burn villages and terrorize innocent monks (Trogdor!!!), I called it a day and headed home.

Now, I knew I had been moderately low all day. I’m back to wearing my Continuous Glucose Monitor (CGM) again, after a slight hiatus from all the beeping and bonking and wee-ooo-wee-ooo-wee-ooo alarms waking me up in the middle of the night, and it had warned me off and on all day that I was hovering around 75 mg/dl. Still, I didn’t stop to treat it or deal with it. I just kept working.

When I got home, A-Flizzle and our pal EriCAH were there, so I started preparing dinner. Yay, food!

I kept noticing that I was agitated with everything, but I didn’t have the sense to question why. Cutting the chicken and vegetables, I was seething. Trying to figure out how to make the chicken stock thicker, I was fuming. When I realized that we only had a single serving of rice, I was mulling over what it would be like to throw the refrigerator off a cliff. It was so ridiculous that I was getting on my own nerves. I must have been driving A-Flizzle and EriCAH crazy.

That was when I realized I had reached my limit. I was low. I was hungry. I was angry. I was HANGRY! And I was making dinner and the food was too raw to eat immediately. Oh, the agony! The horribleness! The tragedy!

Eventually dinner finished, and we all got to experience my chicken thai curry science project of a meal, but it was a great example of how normal for some people isn’t normal for those of us with diabetes. There are times that we absolutely MUST stop and eat. Going all day long without eating is dangerous, and in hindsight, I’m probably lucky that I didn’t have a sneaky low that left me sitting in my office in a pile of sweaty, shaky, confused nonsense with a co-worker telling me, “Drink your juice Shelby!”

I’ll probably do it again though. Because I’m stubborn like that.

Cake or Death?

If you have diabetes, regardless of type, it is inevitable that at some point you have encountered some form of THE question…

“Can you eat that?”

Sometimes it takes on the shape of “Should you be eating that?” or “Is that good for your diabetes?” or “I’m eating for two, even though I’m a dude, so why are you eating that when I was counting on eating your share?!”

When I’m asked this question, sometimes I will respond with some well-deserved diabetes education. “Yes, I can eat this. I just have to know how many carbs (carbohydrates) are in it, and what my blood sugar is, so that I can give myself the correct amount of insulin to keep my blood sugar from spiking too high due to not enough insulin, or going too low because I dosed too much.”

That is usually enough to get either understanding or slightly confused looks of acceptance. Math and science, for the win! And truthfully, I’m typically happy to educate. I like it when people learn about real life with diabetes.

If I’m in a mood though, or if I’m having a low BG (low blood sugar) and don’t have the patience for a diabetes learnin’ session, I might just respond with a snotty little question of my own, such as, “Should YOU be eating that?” That’s always a show stopper, as the guilty party takes that last bite of chocolate cake and shamefully makes their way back to the other room while I feel only slightly guilty with my shaky, moody, slightly confused, sweat-drenched self. Cake or death? Whatever, I’ll apologize later…GIVE ME CAKE!

Since I got my CGM (continuous glucose monitor), even more questions have been introduced to my world with diabetes. A-Flizzle is getting good at recognizing the different tones of the CGM alarms, but most people around me and my beeps and bonks aren’t able to decipher if I’m low, high, have a low reservoir, a low battery, or if I just forgot to hit “OK” after my last BG (blood glucose) check. Still, I’m glad when it beeps and they stop to ask, “What does that alarm mean?” It doesn’t matter to me if they were able to define the alarm or not. What matters was that they heard it, and recognized that it was diabetes related, so that if I need something, I have their attention. Diabetes win!

Another diabetes win happened this past weekend when A-Flizzle was supervising, I mean, helping me organize my diabetes supplies. While sifting through test strips, glucose gels, infusion sets, and alcohol swabs, we came across this little gem when I got my paws on a fresh box of CGM sensors.

Cake and CGM Sensors

Do you see it? Look a little closer.

Cake (forget the CGM sensors)

Cake! On a diabetes supply container! For a device that helps monitor glucose levels!

Cake or death, you ask? CAKE! Definitely, cake.

Snow - 12-28-2011

2012 Goals & Resolutions

Last year I put together a post of some of the things that I wanted to accomplish in 2011. My first goal was to get my A1C under 6.2. At my last three endo visits, my A1C was 5.6, 5.7, and 5.6. Goal achieved, sort of, but with that low A1C came a couple of dangerous lows. Those A1C’s don’t make me a “good diabetic” anymore than those dangerous lows make me a “bad diabetic.” It’s just proof that an ideal number goal that signifies that diabetes is in good control is also very close to the edge of a low blood sugar disaster.

I made a resolution last year to wear my CGM more regularly. I did mostly, yet those two aforementioned lows both outran my CGM’s ability to predict the low blood sugar in time for me to fix the problem myself. During the first low, my CGM started beeping while A-Flizzle was feeding me glucose tabs. (See also: This CGM technology stuff has got to improve if we ever hope to see a closed-loop artificial pancreas in reality.) Unfortunately, due to expired sensors, supply refill woes, and now a CGM transmitter that is no longer transmitting, I’ve been without my CGM for 2-3 months, and I can definitely tell because my BG’s are all over the place. Like that sweaty 35 this morning, followed by a headache inducing 237 at dinner tonight. I’m concerned about my next A1C, but I know that it is just data, and I know that I’m struggling, and I’m just going to put my faith in my endo, my CDE, and myself to work together and turn this beat around. Diabetes is hard enough. Why beat myself up about it?

My #2 and #3 goals were really all about exercise, and if I look at them explicitly, I failed them both. I did not run a 5K, nor did I find a group to start cycling with on a regular basis. I did, however, discover the joys of spin class, so I’m chalking those up as a sort of win.

One goal I had that I’m extremely disappointed about not achieving is to get down to a stable 165 lbs. The first half of this year I did phenomenal at losing some weight, eating low carb, getting some exercise in, and really feeling like I was on my way to a more fit me. Then I had that low BG seizure at the beginning of July, where I chewed up my tongue and could only eat really soft, bland, room temperature foods for about 2-3 weeks, and that sunk my battleship. I was traveling at the time, so I resorted to eating total garbage like macaroni and cheese, soft cookies, potatoes, and starchy things that I had done so well at resisting in the first half of 2011. Now, here at the beginning of 2012, I’m right back to where I started, maybe even a little heavier. I have some new weight-related goals in mind though, so rather than throwing myself a pity party, I’m going to try a healthy helping of encouragement instead.

Another resolution I had was to go to the ophthalmologist. I’ve written about this experience, but suffice it to say that I did indeed go, and I got my card the other day reminding me to make a new appointment, and it isn’t something I’m as afraid of as much as I once was. I’m calling that an accomplishment.

Other goals and resolutions involved having adventures, paying off some bills, getting diabetes stuff that I needed (like a new medical ID bracelet), and remembering that even though diabetes is ever present, it isn’t the only thing that is important in life. All of those things I can mostly say I succeeded at, and am not opposed to carrying those ideals forward in the new year.

So without further ado, I present my 2012 goals and resolutions.

Goals
1. A1C <= 6.2. Less would be good.
2. Pay off at least two debts.
3. Have an adventure…regularly. Take pictures. (I really can’t emphasize this one enough. It’s a MUST!)
4. NEW for 2012: Drop some heft. Goal weight, 175 lbs. I will re-evaluate once this goal is achieved.
5. NEW for 2012: Complete an urban disturbance/warrior 5K, where you climb walls, jump fire, wade through mud, etc. I don’t know the exact name of these types of races. I just know I want to do one.
6. NEW for 2012: I will have a pool nearby this year, so I’m going to start swimming again. I miss it bunches. Plus, I need to get my bikini body ready for…*cough*…nevermind. Nothing to see here. Move along people.
7. NEW for 2012: Be successful with at least one big thing for diabetes advocacy. Measure of success to be determined based on specifics of the diabetes advocacy activity. That should leave me plenty of room to cause trouble.

Resolutions
1. Wear CGM consistently.
2. NEW for 2012: Find and go to the dentist, in addition to endo and ophthalmologist.
3. NEW for 2012: Exercise at least 3 days a week, even if work, blogging, and rest have to be sacrificed in order to do so. This will help my strength, energy level, blood sugar stability, and entertainment value while strutting around without clothes on.
4. NEW for 2012: Blog consistently, but only if it meets self-imposed quality standards. Or includes a good laugh. Or both.
5. NEW for 2012: Stop letting other people dictate my emotions. Their Jedi mind tricks are no good here.

Yeah…that’s a good start.

Snow - 12-28-2011

Gummy Bears

Twas A Gummy Bear Night

Twas a night before Christmas, when all through the house
Not a CGM was beeping, all sensors were out.
The transmitter was stashed amongst the pump supplies with care
In hopes that my insurance company soon would say, “Clear!”

The gummy bears were nestled all snug in their bag,
Patiently awaiting for diabetes to attack.
The cat under covers, the dog taking a nap,
It was only a matter of time before diabetes would snap.

When just down the hall there arose such a clatter,
I sprang from my bed in a soaking wet lather.
Panicked and stricken, I searched for my glasses,
Hoping to high heavens my feet weren’t molasses.

The moon in the window lighting my way
Leading me to the kitchen where the gummies await.
Like a chorus of Hungry Hippos my teeth were a chatter,
Am I low? Or just cold? Truthfully, it doesn’t matter.

Flicking on the lightswitch in a soaking wet fury,
“Get in my belly you gummies!” I said, a bit slurry.
More delicious than glucose tabs and easier to swallow,
The red ones are best, and what makes the clear ones so hollow?

The clock ticks, the minutes pass, waiting for a fixin’
It doesn’t seem to be working, my brain says as I listen.
I think, “Let’s chase the gummies with a bottle of soda!”
“Diet, that’s not,” a voice says, kind of like Yoda.

As the bottle is emptied I start to stop shaking,
This all will have consequences in the morning upon waking.
Tired and worn out, I drag my carcass to bed,
Where visions of semi-coherent boluses dance in my head.

And then, in a moment, the sun starts to shine.
Morning already?! It was only just five!
As I sit up in bed, and try to shake off the fog,
I realize I feel like a rotting old log.

Time to get dressed, from my head to my foot,
“I think I wore these clothes yesterday,” I think as I look.
A bundle of sweaty clothes, a shower is needed.
What happened last night, and why am I still seated?

I make it down the hallway, shuffling feet in my slippers,
When all of a sudden I spot movement that’s chipper!
When, what to my sleepy-filled eyes should appear,
Those gummies are partying, and one of them has a beer!

I shake, and I tremble, and rub my eyes in disbelief.
A gummy bear palooza, in MY kitchen sink?!
I grab my pump quickly, and notice the last,
A bolus, SWAG-worthy, taken blindly and fast.

I reach for my meter, and check without fear,
Hoping that some sense in those numbers will appear.
Double-digits, that figures, at least now I know
Those gummy bear phantoms were all because I was low.

Gummy Bears

Photo by Pato Garza (CC license)