NovoPen Cartridge Hardiness

I was foolish enough to leave my diabetes kit unattended for a few minutes while in my synagogue's childcare area, and a kid got ahold of my NovoPen Jr and dialed up and pressed until the insulin bubbled through the sides of the opening with no needle on. You know, at the top where the orange part meets the silver? Maybe this isn't a great description. I got it from him, and unscrewed it to relieve the pressure on the cartridge. Wasn't sure if I should keep using it. Decided to take insulin out of it by syringe, did that for a couple of shots, and then decided to see if it would work with a pen needle- and it does!

:-/

I've turned 21 since I last wrote. Didn't do anything special. Did decide to give out candy to my 7th graders if they could draw an obtuse triangle... less than a third could, and my diabetic student wasn't one of them. I had thought she knew that I'm diabetic too, but it turned out she didn't.
I had had a bad tremor in class that my students had commented on in the class before lunch, and she'd seen it. When she'd asked (while I shook) to go to the office to check her blood sugar, I said yes and joked that I should be the one checking my blood sugar. Ten minutes later at lunch as she walked by, I held up my meter to show her my blood sugar. "I didn't know you had diabetes too!" she said. "Now you do," I answered. My blood sugar was 66, which she said was "really low". I guess that tells me about how low she goes (or doesn't).

I've been having a variety of health problems that don't seem to be blood sugar related, including a sometimes tremor with normal and low blood sugars, but not really with high blood sugars. I'm wondering what that could be. I don't feel like I did in the spring, but am still wondering if it could be thyroid related.

I got my H1N1 vaccination (injected) on October 23rd and went and scheduled my next endo visit for November 23rd.

Diabetes In School

If I had progressed through school at a normal rate for people in Illinois, then I would have been diagnosed with diabetes going into my senior year of high school. But I started first grade at age 5, and then started college after three years of high school, meaning that I was at the beginning of my sophomore year in college by the time I was diagnosed with diabetes at the age of 17. So, lucky me, I never had to deal with diabetes as a student in a school setting where anybody might expect to be able to forbid me to carry around medication, etc.

So although I've talked to a lot of others about diabetes in school, I don't have first hand, as a student experience with having diabetes in school.

I started student teaching five weeks ago, and got a list of my students (I've got about 140 of them) who have 504s (medical plans) and IEPs (special ed). There were 2 504ed students. Neither diabetic. My teachers told me that the last student with diabetes in the school had been six or so years previous.
Four weeks later, I'm giving my first test to the students, and one of them raises her hand and asks to go to the office. I ask what for. She says to check her blood sugar. I say, "You have diabetes too?! Go!"

Now I have a million zillion questions. I had candy I was about to try giving as rewards to the students who answer questions, and I'd gotten in peanut free and everything for my student with a peanut allergy, but of course I didn't get carb free candy. And while this particular student is not a quick student, there's no way I'm giving a reward that I can't give to every student. I would like to figure out if I can still give out candy. Should I simply make her an exception to the "candy given by teachers must be eaten in that class period" rule? Should I contact the parents and ask?
And just knowing that there's a diabetic in front of me, I want to be able to ask her a zillion questions, diabetic to diabetic. What insulins do you use? How long ago were you diagnosed? What do your hypos feel like? How often does diabetes make it difficult for you to concentrate in school? Is your diabetes managed more by yourself, your mother, or your doctor?
But I'm a teacher, and she's a student. Not my homeroom student either. There is no way to ask her just casually. So so far, I ask nothing. I notice now that she is first in the lunchroom, and that she eats school lunches; I test my blood sugar in the lunchroom, but she sees the nurse. We have a full time nurse.

I teach in a school with seventh and eighth grades only. I teach all seventh graders, five periods of them. I have the classes at different times each day. So this student has me fifth period on Mondays, fourth period Tuesdays, third period Wednesdays, second period Thursdays, and first period Fridays.

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And on another note, teaching with diabetes. I don't set the school rules, which say that students can't eat in class. I try not to eat in class. It's hard, trying to find the time to check my blood sugar. No time to use the bathroom. Fingers getting covered in marker and chalk.
At lunchtime, I take my lunch and my insulin and needles down to the lunchroom, where I eat with the students. I check my blood sugar, and about half of the time inject. I inject my calves since that requires the least amount of undressing. Most of the students don't pay any attention, as far as I can tell. A few have made comments, all of them fairly positive. One of them told me about "this guy, he has type 1, he's famous and he's my boyfriend" and was surprised that I knew she meant Nick Jonas. I have not mentioned diabetes in class, only when students at lunch have asked me what I was doing or what that little case is.

My blood sugar was running high a lot, but I finally got it down (mostly) this week. That meant more hypos while teaching, yuck yuck. I just raised the Lantus 20% and then backed it down a half unit at a time. Looking at my records for September, it looks to me like student teaching was challenging my blood sugar in each of the following ways:
depriving me of sleep, and making me less willing to wake up and check during the night
depriving me of time to check blood sugar
putting stress on me
reducing the amount of exercise I get
reducing the amount I eat (I eat when I'm hungry, and apparently I wasn't hungry in September)

Yom Kippur Log (written after Yom Kippur)

September 27, 2009

1704 hours -bg 153 Injected 20 units for the before fast feast. Started stuffing my face.

1814 hours- bg 103 20 minutes until the fast. Decided to eat another 30 carbs of fig newtons. Was absolutely full, vomitted a bit. Stayed home from services.

2011 hours- bg 213 Ignored it, read.

2035 hours- took 10 units Lantus. Ketones negative.

2116 hours- bg 246 Two units Novolog. Hoped it wasn't too much.

2249 hours- bg 217 Went to bed.

September 28

0628 hours- bg 252 Took two units of Novolog, went back to sleep.

0909 hours- bg 147 Ketones negative. Walked to the synagogue (about a mile and a half)

1030 hours- bg 121 no action

1205 hours- bg 156 no action

1426 hours- bg 163 morning services ended, I decided to stay in the synagogue rather than risk lowering my blood sugar by walking someplace

1655 hours- bg 149 evening services started

1942 hours- bg 128 evening services ended

2000 hours- took 6 units Novolog, broke my fast with 2 cups chili plus half cup granola, a little (I mean a little) melon, three slices cucumber, one slice tomato, one cup water

2119 hours- bg 331 took another 6 units Novolog, 14 units Lantus.


So, all in all, it went well. I should have been more aggressive with the post fast feast.

A No Good Rotten Cold

I started showing symptoms of a cold at exactly 1:40 PM on Monday. It was unusual mostly in its suddenness. I got a runny nose, sore throat, sore eyes. On Tuesday I woke up feeling horrible in the middle of the night covered in sweat (bg 142). I went back to sleep after an hour, woke up again at 6 AM feeling better by a bit, even more coated in sweat (it is not hot in my place). I made it through the day with nothing worse than a persistant runny nose and a sore feeling in my throat.
On Wednesday, my students heard it. Mr. B, are you coming down with something? Mr. B, I have a question. Are you sick? I know you feel, Mr. B, my baby sister is sick, too.
On Thursday, I started losing my voice, throughout the day, my voice fading in and out. I developed a hot feeling all over my body, and felt very sore when anything touched me.
On Friday, more of the same.
Saturday (today, really), I stayed home and did nothing much all day. I've only had two or three times when my voice didn't come out and I don't feel too bad.

Thing is, the insulin resistance is driving me insane.
I had 0 readings above 300 from August 2- September 14 inclusive. I had an explainable reading of 300 on September 15. But then, what happens with a cold? Two readings in the last week above 300. And insulin resistance unpredictable.

Here's a story. Today, I finish lunch (and its insulin) by half past noon. At 3:20 PM I check my blood sugar: 221. Nothing too unusual about that, I'm sorry to say. I would usually correct that with an injection of 2.5 units Novolog (at an ISF between 40 and 45), but I decide that I'll inject 9 units of Novolog, wait an hour, and then eat for the extra 6.5 units. Brilliant, right?
So an hour comes and goes, I check my blood sugar again. 246! No drop at all, in fact a rise!
So instead of having a lovely 45 carb meal, I go have some tea (peppermint papaya, no carbs or caffeine) with some celery and lettuce (that was my mother's idea). After another two hours, when the Novolog has done it's job, I am down to 132. Not a bad number- but it took 9 units to get there?!
So I had some more to eat at that point, took what should have been enough insulin too. A couple hours later I'm at 123, looks good. Took a bit more Lantus than usual. Shabbes ends, I go on the computer.

Three more hours later (right before writing this post, in fact), I check my blood sugar just because and SURPRISE! 340. Now what? I haven't seen a number that high since August 1. I'm not at all sure what my insulin sensitivity is. What to do? I took 9 units. I'll check again after an hour, I suppose.

And the worst part of this story? Yom Kippur is on Monday! It's hard enough fasting on Yom Kippur with my body's usual shenanigans- now I have to add a cold into the mix?! Oy vey!
What Lantus dose will I take next? Will I be able to fast on that holiest day of the year? Stay tuned to find out...

New Meters

On Friday, I changed the code chip in my meter, and had a hard time putting the new chip in because the plastic was loose where the chip goes in and was blocking the place where the chip goes in. So, although my meter was well out of warrantee, I called Accu-Chek. When the woman on the phone (named Eilene) found out that my back up Accu-Chek Aviva meter, also out of warrantee, also didn't totally work (the forward button is broke), she said she'd send me two new meters.

The new meters came today. I took out my usual meter, and both of the new ones. I drew a large drop of blood from my right big toe. I applied it to my usual meter on a test strip. Then I took the code chip out, put in one of the new meters, put a strip in that meter, and put blood from the same drop there. I repeated that for the third meter.
And a minor miracle occurred, for lo and behold! My meters were not 50 points aparts, not 10 points apart, no! Not even by one mg/dl did they differ. So I decided to capture the moment. Look!

Ketosis

This morning I woke up with a blood sugar of 300. It was the highest reading I'd had in, oh, 44 days :rolleyes: However, I'm no stranger to blood sugar readings that high, and I did the correction and went about with my morning routine. Just as a matter of habit, I checked urine ketones- something I always do with readings over 300. I was SHOCKED to see that my urine ketones were small, because that is the first time I've had ketones since the month of dx that weren't within a few hours of throwing up. I rechecked and they were small again. In the past, I have even forgotten bedtime Lantus, woken up with a blood sugar in the upper 400s- no ketones.

So now I'm wondering if this is a sign of things to come: am I going to be more ketone prone than I have been in the past?


And as a post script to my previous post, I took off the demo pod today, almost exactly 72 hours after putting it on. The site under where the pod had been was red and in some places purple, and there was some lumpiness under the site. This is with no cannula, nothing. The wearing of the demo pump was tolerable, but the fact that my stomache is looking this irritated after nothing but the adhesive and the weight of the solo, suggests that pumping with the solo would probably not be a great option for me.

Dummy Solo

I ordered a dummy pump from Solo a few weeks ago and it came in the mail today. I put it on my stomach, because I've been curious about what it would be like to wear soemthing there, on account of it not being smooth at all. Would the adhesive stick to a surface so hilly? Would the adhesive hurt? Etc. So far, better than expected. Of course, there's no needle or canula with the dummy, so it's not the same as it would be, and it's not entirely comfortable, but better than expected. I'm a little disappointed that the dummy can't be taken apart, because I wonder if that would be painful if I was actually wearing a Solo pump, but that's okay.

Insurance Question

So, I'm going to be all certified and ready to get a job in December, and will be starting to look for jobs in October. The thing I am looking forward to the most is getting an insurance plan that will cover a CGMS.

So here is the question: How do I find out, before choosing an insurance, whether or not it would cover a CGMS for me? My googlesearch so far has not been useful.

If you are in Illinois and have been either approved or denied for a CGMS by your insurance, particularly if you are in my age range, please let me know which insurance and what decision.
I am on BCBS-IL-PPO and they are covering for persons 25 and up who check blood sugar 8x+ per day, and who are willing to wear a blinded CGMS for three days first. I think you also have to have hypos below 50 but that is not a problem here. My problem is, I am 20. I will be 21 by the time I switch insurance plans, but this still means I need an insurance that isn't following the stupid JDRF study as the basis for its decisions.

BCBS-IL-HMO covers CGMS for everybody as far as I've heard.

Any other Illinois experiences? Knowledge of a dependable online resource? Way to look at insurance websites or call them up or anything like that?

YES!

I called the patient information network a few minutes ago, got my message.

"Jonah, your test is back [sic]. Your guesses were surprisingly accurate. Your hemoglobin A1c is 6.4%, like you guessed it would be. Your TSH is 0.88, which is normal- the normal range is .4-4. So, that's very good! Call me if you have any questions."

I love that he says "That's very good!" most of the time when telling me my A1c. When I was in his office on Friday, there was a drug rep in there, and I tested my blood sugar (88). The rep asked me if I was testing my A1c, and I said no, I was testing my blood sugar. He looked confused, so I told him an A1c is a sort of a measure of average blood sugar, where as I was testing my blood sugar of the right now. Then I went and sat next to the rep and showed him the components of my meter and the memory. He was fascinated, and said so (hopefully this was not sarcasm that my autistic brain missed). However, when I scrolled back he said that my blood sugar had quite a lot of variability, so I said I was doing exceptionally well for a person of my age (20 years) with my islet cell function (not enough for a cpeptide to measure anything). I told him I thought my numbers translated to an A1c of 6.4, and he thought for a moment, and said, "That's pretty high, right?" and I said well, it's high for a nondiabetic, but it's very good for a 20 year old type 1 diabetic." Eventually, I said, "You must not be a diabetes drug rep, right? What kind of stuff are you selling?" and he told me that he was there with blood pressure medicines. Which, so far, I don't have any reason to be very interested in.

So anyways, I am quite happy about the drop in HbA1c. I would love to see it drop even lower, but this appears to be my floor; my A1c readings not counting those within a week of diagnosis have been: 6.3, 6.3,6.3,6.4, 6.4, 6.5, 6.6, 6.9, 7.0, 7.2.
So while I've shown myself to be quite capable of getting higher A1cs, it also looks like what I get when I pour myself into it and my body cooperates is 6.3-6.5. And in light of that fact, 6.4 is a very nice number.

Today's Endo Visit

Was not so good, not so bad.

My weight was down a teensy bit from three weeks ago at my other doctor's office. That's not good news, but not horrible news.
I received a seasonal flu vaccine in my left shoulder, and a pneumonia vaccination in the right shoulder, and had blood drawn for an A1c and TSH (expect a post on that topic on Monday or Tuesday).
I had my feet checked for neuropathy and didn't do too great but not horribly. I wanted them checked partly because I check blood sugar on my toes and would stop if there was evidence of neuropathy After he did the check, the endo said, "Well, that's not such strong evidence of neuropathy, but you probably should stop checking the toes." So.... I think that I do have neuropathy in my feet. I felt the filament just fine, and I could tell if he was bending my toes up or down, but when he touched a vibrating thingy to my big toes in turn and asked me to tell him when the vibration stopped- I couldn't tell. I think that means I have neuropathy, but on second thought I'm not sure. Maybe I should have the conductivity test done... but why bother? The doctor wants me to stop with testing on my feet due to risk of infection. I asked him if my immune system is really compromised with my level of blood sugar control. He said no, BUT since my blood sugar control isn't guaranteed to stay stable and can get worse fast (and did get a lot worse this past spring for a couple months), it's just overall best not to risk it. Feet are too vulnerable, he said. However, I am not fully convinced.
We also discussed switching me from Lantus to Levemir. He said that studies show that Levemir is more consistantly bioavailable than Lantus, meaning less daily variation in how the drug works. I told him I would think about it... and I am. Have any of you switched from Levemir to Lantus or vice versa?

Both my most favorite and least favorite part of the visit is the blood draw. It's my least favorite because it hurts, but it's my most favorite because we sort of chit chat. I know autistic people aren't supposed to like small talk, but I do. I love how you can discover odd and unexpected things about people. I asked my endo what prompted him to go into endocrinology and he said it was working at the University of Michigan when Jerome Conn decided from the evidence that hyperaldosteronism existed and set about proving it. This was back in the days when they couldn't image these things, which is what they now do, and nobody was sure that there would really be such a thing. When the very first patient was sent into the OR on Conn's suspicion that he had an aldosterone producing tumor on his adrenals, the hospital caferia was abuzz, waiting to see if the guy really did have a tumor- and he did!

I just looked up Jerome Conn and his syndrome, and it was discovered in 1955! I didn't realize my endo was that old. That means my endo has been practicing medicine for over fifty years. My father was born in 1955.