Sensor 6

Set to range 65-155

Jonah's SG Statistics

data date	SG average	Above	Perfect	Below	SD	# readings	low	high
November 2	137	26	74	0	43.6	178	74	266
November 3	110	4	96	0	23.8	288	66	160
November 4	104	5	95	0	20.5	285	64	164
November 5	150	38	58	4	70.9	283	48	346
November 6	118	29	54	17	56.3	230	40	238
November 7	137	31	69	0	43.0	272	84	248
November 8	119	9	90	1	37.3	284	60	258
November 9	104				32	240	58	200
November 10	139				37	288	78	210
November 11	150				29	81	112	186
Total Sensor 6	125				45	2429	40	346

November 9, 10, and 11 are only from carelink data. The sensor fell out of my arm on the morning of the 11th. It was giving good data, as confirmed by a fingerstick only an hour before.

My mother and I did a lot of reading the literature and it does not look like taking ACE inhibitors helps young people without hypertension. I have low normal blood pressure and I'm 20; studies about similar diabetics who have taken ACE inhibitors have shown worse prognoses, microalbumin wise, for those on ACE inhibitors. And I surely do not need the side effects. So for now, I don't think we'll be doing that. We are scheduling a 24 hour urine collection for November 23rd and 24th. The endo is mailing me some information on taking the urine sample, and the lab said any large, clean, dry container will work, as long as I transfer the urine to one of their containers when I bring it to the lab.

Today has been an absolutely horrible blood sugar day. I had to eat and eat to treat hypoglycemia and fell asleep just past midnight. At 4:30, the CGMS woke me with a predicted hypo. I ignored it. At 5:00, it woke me with a predicted hypo, and showed double arrows down. I got up and checked my blood sugar at 78. I dropped below 50 despite eating about 75 carbs, and as soon as the CGMS showed me back in the triple digits, I took Novolog. An hour later I was over 300. I did not treat that. By noon I was back down to 60, which the meter confirmed at 64. I treated the hypo and bounced up around 350. After confirming that (when the CGMS still read read 305, the meter said 278), I took 3 units Novolog. My blood sugar continued to rise, peaked at 350, and then began an extremely rapid descent. As I type this, I am at 222 (oops now it's 204) with double arrows heading down, less than an hour past the 350. I think I took too much Lantus last night, hey? Ugh!

On a somewhat lighter note, the CGMS display shows 40 to 300. If you drop below 40, you don't show up on the graph and beside the graph where the number is, it'll say "below 40". Today was the first time I hit 300 wearing the CGMS (I don't hit 300 often), and what happens is I get a reading at the side, and instead of two pixels at the top of the display, four pixels show. I believe I should get numbers up to 400, but I hope that that isn't something I find by experimentation.

Changing The Lantus Time

I started taking Lantus during mid September of 2006 (I was on NPH for a short while following diagnosis). I was told that I needed one consistant time, so I chose morning, when I figured I was most likely to have a time that I'd be both awake and at home. Over the 25 and a half months since then, I have taken Lantus every morning, with maybe three exceptions when I forgot. I have also taken Lantus, especially expired Lantus which works more like NPH, in the afternoon or evening a number of times to deal with Lantus that just didn't cover me overnight. Sometimes it seems like Lantus runs out; other times I chalk it up to the fact that I have much higher basal needs at night.
In the last couple months, I've become increasingly frustrated with the rise in blood sugar that I'd see overnight. So on October 31 and November 1, I split the Lantus dose, and this morning, November 2, I did not take my Lantus in the morning. My blood sugar was fairly stable all day (though there was a higher than usual after breakfast peak), and just now, at 9 PM, I took 15 units of unexpired, normal Lantus. I hope it keeps me steady overnight.

Lab Results

My blood test results were all normal except the A1c. The doctor says that they've switched labs and they now have one in which the normal range is very slightly higher than the lab that they previously used. My A1c came in at 6.6% by this new lab, which probably translates to like 6.4% in the old lab or something.

One thing I didn't mention about Friday's visit was that I gave a urine sample. When the doctor gave me the cup to pee in, I felt reluctant, and after I had peed in it, I had an urge to take it and run. Like I was gonna get bad results. I told myself that maybe I was remembering how two years earlier, I got diagnosed with diabetes through a urine test. Or how two years before that, I got diagnosed with a urinary tract infaction with a urine test. But I dunno, I never felt so reluctant before.

The microalbumin levels in my urine came in elevated. The doctor says it's just a slight elevation, probably nothing and certainly not urgent, and we'll recheck when I'm next in, in two to four months. I started crying anyhow.

Guardian

A box of four sensors arrived on Tuesday, the first day of sukkot. After some discussion with my mother, I decided that I would start up the Guardian and insert a sensor on the second day of sukkot, when the prohibitions have less weight, and are more a matter of tradition. So after sundown, I recharged the transmitter, which took forever, put a battery in the guardian, inserted a sensor (very bloody business), connected the transmitter (green light), hit new sensor. The Guardian claimed to be getting a signal, and all was fine for ten minutes. Then a funny thing happened. The time on the side of the graph started going forward really fast, and soon was way ahead of the time at the top of the graph. Then it went beep beep beep lost sensor. I hit new sensor. It was fine for a few minutes, repeat. And again. My mother said I should call minimed, despite the holiday. I did. Stayed on hold for a long time, thinking about how diabetes distances me from the Jewish people, which extra distance I surely don't need. Person on the phone said she had to talk to the senior technician about it, senior technician said any problem with the timekeeping was with the guardian itself rather than a sensor or transmitter. They sent me a new guardian, which arrived at 10 AM this morning, and said that if they don't get the old one back within 14 days, I'll be charged 3500 dollars. That dollar amount sounded fishy to me since I didn't pay that much for it to start with.

The new model at first glance was exactly like the old one. However, so far it seems to have two improvements. One is that it gets the signal every time, instead of a lot of wacky missed signals. The other is that it displays odd numbers- right now it says 265. The previous model would've either said 264 or 266, but not 265.

My blood sugar has been hideously out of control for two weeks. I'm at my wits' ends.

Soccer Game

I'm in my senior year, and that means that I know most of my classmates. This quarter, I'm taking a course on statistics. Two of my classmates are student athletes- athletes whose tuition is paid for by being on a sports team. One of them in the pitcher of the softball team- she comes in with ice on her shoulder some mornings. She was in my oceanography course last spring, and I've gone to some of her games. The other student student athlete I hadn't had as a classmate before, but she's on the soccer team. Soccer season is now. I figured I'd go to a game.

The game was scheduled for 1 PM. I packed my bag with some library books to return, my diabetes supplies, a notebook for boredom, and lots of food in case of hypos. I went to wait for the bus just past noon, and missed a bus going by. The next one didn't come for forty minutes, and traffic was icky. It started to rain when we were halfway there, and I considered just getting off the bus and going to the library instead. I knew I was going to be late, and I didn't know how long a women's college soccer game would last. But I rode the bus all the way, and then went to the stadium. The rain was coming down harder, and some of the spectators were holding umbrellas. There were about five minutes left in the first half. The score was 0 to 0.

I sat down about two feet from the field, and it rained more. During halftime, the rain came down hard, and I asked somebody how hard it had to rain for the game to get rained out. He went and asked an official, and came back to say that games would only be called if there was lightning. It didn't look like lightning. The game resumed after halftime, and I saw that each half was 45 minutes. Real minutes, no subtracting minutes while waiting for penalty kicks or anything. My classmate is our goalie. I learned that in soccer, the goalie defines the team. The other team's goalie was physically amazing. First off, she was built. Second, she made a lot of amazing saves. A double digit number of saves. The ball was in her court a lot, and she didn't let. Our goalie, my classmate, was of a different style. She did a lot of shouting, directing her teamates. The ball rarely got close to her, and when it did, she ran in and got the ball and then kicked it way far away. Thirty minutes into the second half, she ran for the ball, and she didn't run fast enough. Somebody kicked the ball, and it went in the goal. 1 to 0. No more scoring happened during the rest of the game. Both goalies were amazing, but I bet my classmate is going to still be upset about letting in the one goal tomorrow.

A lot more raining happened though. I eventually stopped minding being wet, and just admired all the rain. The ground was so wet that when the ball skipped accross the field, it splashed and splashed at every bounce. And remember, this is a smooth, perfect, collegiate field. We got wet. After the game, when I got on the train, I took out my meter and found that it was... wet. Uh oh, uh oh, uh oh. I cleaned it out as best I could but couldn't get it to test my bloodsugar. I went to the library, stayed there awhile, and then went home, started reading through my books, thought I might be hypo, reached for my meter.

Stuck in a strip, but it didn't turn on. Tried a different strip, nothing. Pressed on the button, nothing. So I peeled my used test strip artwork off the back of the meter, and called Accu-Chek. Thought I was going to need a new meter, and the guy on the phone sounded like he thought so too. Then he asked me to open the battery cover, and check the battery. I did. Was the battery wet? No. Take it out and put it back in. Now try turning on the meter. It turned on! I told him to stay on the line while I tried to test my blood sugar. It worked! 78, though I didn't tell him that. I felt kind of foolish and hung up. No new meter, but I don't mind.

Today was the Ron Santo Walk to Cure Diabetes, but I didn't go. Did you know that Ron Santo didn't go on insulin until he had been diagnosed for two years? He wasn't even on insulin yet when he was my age, not until his third year in the major leagues did he take insulin. I read his autobiography on Rosh Hashana. He was diagnosed with prandials in the 400s and fastings normal, no symptoms, age 18. He didn't want to admit he was diabetic, refused insulin. Two years later got sick, lost a lot of weight, had leg cramps (probably ketosis), went on insulin. He is currently a radio announcer who announces Cubs games.

Sayings redone

If Poor Richard had been a twentieth century diabetic, do you think that the sayings might have been

A stitch in time saves nine.
A unit in time saves three.

If you will not hear reason she'll surely rap your knuckles.
If you will not heed ketones, he'll hospitalize your ass.

They that won't be counselled can't be helped.
They that won't be counselled can't be helped.

We may give advice but we cannot give conduct.
We may give insulin but we can't stop you eating.

Experience keeps a dear school, but fools will learn in no other, and scarce in that.
Endocrinologists give expensive advice, but fools will heed no other, and scarce that.

Rather go to bed supplerless than rise in debt.
Rather go to bed pumpless than rise in debt.

'Tis easier to build two chimneys than to keep one in fuel.
'Tis easier to cause diabetes than treat it.

Gain may be temporary and uncertain; but ever while you live expense is constant and certain.
Gain may be temporary and uncertain; but it will keep you alive and expenses down.

For age and want, save while you may; No morning sun lasts a whole day.
For sick days and poor days, add up the good days; the dawn phenomenon will rise again.

'Tis hard for an empty bag to stand upright.
'Tis hard for an unfilled scrip to fill a syringe.

Denied

Do I even have to say more? I'm not surprised, since all we did was run it past insurance and mine typically pays for the CGMS only if you make a case about why you need it- I would have a pretty good chance on appeal. But I don't feel like appealing. I think I'm going to pay for one more box of 4 sensors, for 145 dollars, wear them, and consider the CGMS experiment over. Because after the 4 sensors, my transmitter is probably going to go totally bad (it doesn't do so great as is) and warrantee will be over, and I don't want to pay for a new minilink.

100 Medical Things I've Learned

Today marks two years since an IV was stuck into one of my arms, and four bags of fluids started dripping down into veins. The second IV wasn't inserted until the 2nd because the first 6 sticks didn't get a vein. Today marks two years since a doctor promised me that in just a few days, I'd be feeling much better. Today marks two years since I came back to life. My father says that watching me during my first hour on insulin was like watching an inaminate object become animate- that's how different I looked. I was interested in medicine and disability long before diabetes, but diabetes has certainly changed the directions in which I've learned.

This is a list of 100 things I've learned in the last two years. Half of them are things I learned because I have diabetes, directly or indirectly; half of them are things I learned just because I am interested in the ways that bodies work. I can provide sources if you leave a comment wanting to know about a few, but I'm not going to find where I learned each one otherwise. I originally intended to make a list of 200 things, but it was taking too much time. A lot of these could probably be divided into two things though.

*1) Although the kidneys secrete most things proportional to their presence in the blood stream, glucose is the exception.

&1) Hemophiliacs typically have reduced levels of clotting factor, not an absolute deficit.

*2) Glucose is filtered by the kidneys in a piecewise function: f(x)=0 for xa. a is the renal threshhold.

&2) A normal human spine has a slight curvature. Unusual curvature, or scoliosis, can threaten the heart and other internal organs.

*3) Gastroparesis is gastic nerve death, and it causes slow digestion, abdominal stiffness, throwing up, and other gastric woes.

&3) Effective surgical anesthesia was not widely available until the mid-nineteenth century. The anesthetics used had been available for recreation use for forty years prior.

*4) Most mild cases of gastroparesis go undiagnosed. Of diagnosed cases, half are in diabetes. Between a fourth and a fifth of all T1s will be diagnosed with gastroparesis.

&4) Bites precipitate 1% of ER visits in the US. The three most common biters responsible are dogs, cats, and humans.

*5) Of ER visits due to drug reactions, insulin is the drug most often responsible.

&5) Immunotherapy, or measured increases in exposure to promote tolerance of a foreign substance, works for rabies as well as for allergies.

*6) Most autoimmune disease are more prevalent in females. The human autoimmune for of diabetes is the most prominent exception to the rule.

&6) Leukemia kills more adults than it does children. Some forms of leukemia are chronic illnesses.

*7) The only suspected cases of type 1 diabetes transmission involved diabetics donating bone marrow. The marrow recipients developed T1 diabetes.

&7) Allergies are always an IgE response to proteins. No protein, no true allergy.

*8) Injections typically fall into four categories: transdermal (into skin), subcutaneous (into fat), intravenous (into vein), and intramuscular (into muscle).

&8) Service dogs can help people with short term memory loss by prompting them and by warning them of danger. Less than half of service dogs serve the blind.

*9) Some dogs and cats can smell hypo and hyper glycemia.

&9) Imprinted genes are ones where which allele comes from which parent makes a difference in how the gene is expressed.

*10) The genes implicated in type 1 diabetes are paternally imprinted. That's why having a father with T1 confers 4x the diabetes risk that a mother with T1 does.

&10) Viruses become more mutagenic when passed through the blood of multiple people, as when blood recipients donate blood. This may be how SIV turned into HIV.

*11) Celiac Sprue is most common in people who have at least one R3 allele. 60% of T1 diabetics are homozygous R3/R4. T1s and their siblings have a 5% chance of developing celiac.

&11) People with Down Syndrome have a 5% risk of developing diabetes. They also have a 5% risk of developing celiac sprue.

*12) The primary function of the pancreas is to produce digestive enzymes. Early attempts at isolating insulin failed because the pancreatic extracts digested themselves.

&12) Fluctuations in testosterone level are responsible for some mood swings, but absolute testosterone level rarely is.

*13) Fluctuations in blood sugar level are much easier to feel than absolute blood sugar level. They are also probably more dangerous to the body.

&13) People typically have an increase in growth hormone production in the early morning.

*14) Growth hormone causes insulin resistance, and the early morning insulin resistance from growth hormone is called the Dawn Phenomenon.

&14) The cost to inject growth hormone in one person for one year is typically 20,000- 30,000 dollars. Children in the bottom 1% of height, as well as anybody with an absolute deficiency, is legally eligible to take growth hormone.

*15) After carbohydrates are digested, about half of them are stored in the level, for continuous slow release.

&15) Prolactin is a hormone whose levels are controlled by the pituitary gland. Tumors of the pituitary, which are fairly common, can result in high levels of prolactin.

*16) Bodies can convert some protein into glucose.

&16) For HIV positive men who want to have children, there exists a procedure called washing, in which the sperm are isolated from the semen. Sperm are not contagious.

*17) An acidic compound called a ketone is the waste product when people burn fat. A build up of these acids is ketoacidosis, and the most common causes are lack of insulin, and alcohol withdrawal.

&17) Most schizophrenics smoke cigarettes, but they don't get lung cancer. They do get other health problems from smoking.

*18) Being overweight is a good sign if you happen to have Type 1 diabetes. It means you're getting enough insulin. Overweight T1s live longer.

&18) Human weight is supposed to peak between the ages of about 55-60. People who are skinny at 60 may have difficulty living through the strains that age places on bodies.

*19) Even mild vitamin D deficiency in children is a strong risk factor in the development of type 1 diabetes- though whether the deficiency is the cause or effect has not been proven.

&19) Vitamin D deficiency sometimes happens to people who spend all of their time indoors/ wearing lots of clothes, and who don't eat diets rich in vitamin D.

*20) Veins are larger when people are hydrated; it is very painful to have blood drawn during severe dehydration.

&20) Drinking a lot of water can flush important stuff from the body (see *1).

*21) Diabetes can cause blindness in multiple ways. 13% of new cases of blindness in adults in the United States are from diabetes. More than 90% of diabetics have eye damage from diabetes after 20 years.

&21) Rheumatoid arthritis can cause sudden blindness. One of the first people to go around the world, James Holman went blind from arthritis at the age of 25.

*22) Rheumatoid arthritis is an autoimmune disease. Juvenile Rheumatoid Arthritis has onset exclusively in children, while 5% of people with the adult form are diagnosed before the age of 18.

&22) Rosacea is a condition in which the skin and/or eyes become flushed, chronically. It is only dangerous when it happens in the eyes.

*23) Heart Failure means that the heart isn't pumping out enough blood with each beat. People can live in heart failure for a long time.

&23) Stomache cancer is usually a form of food poisoning.

*24) Insulin is slightly carcinogenic. Insulin resistant people are at higher risk of cancer because they use more insulin. The only commercial insulin known to be more carcinogenic than Toronto is Lantus.

&24) The Yellow Fever Epidemic of 1793, which took place in Philadelphia, was the prompt for the first published criticism of racism in the United States.

*25) Diabetic neuropathy can affect the sexual function of both men and women. Many men with diabetes also have abnormal sperm production.

&25) Cystic Fibrosis is the most common reason for people to need double lung transplants. If a CF patient gets only one new lung, the CF destroys the new one; with a double lung transplant, no cystic fibrosis occurs in the new lungs.

*26) Almost 100,000 people are waiting for new kidneys. 3,000 are waiting for kidney-pancreas transplants.

&26) Breast size continues to be dependent on estrogen levels after puberty- a fall in estrogen levels will reduce breast size. It'll also reduce breast cancer risk.

*27) The first American to benefit from insulin injections was diagnosed with diabetes at the age of 15; put on insulin at 22; died at 61 from prostate cancer.

&27) Making the exhalation longer than the inhalation is calming. Calms me down enough to sleep through dentist visits.

*28) Dogs with diabetes are often eager for shots because they know that a shot means that food is coming soon. Wouldn't it be nice if humans were so trainable?

&28) Seizures typically result from too much electricity in one part of the brain (partial onset) or the entire brain.

*29) Hypoglycemic seizures typically start below 45 mg/dl. The seizure itself tends to raise blood sugar.

&29) Some people don't mind having seizures, or even enjoy them. Others experience terrible pain and/or anxiety.

*30) Most adults experience fluctuation in insulin sensitivity based on monthly fluctuations in sex hormone levels - even men!

&30) Acne breakouts are often precipitated by changes in testosterone levels. The dramatic cycles women experience explain why men are more likely than women to outgrow acne.

*31) People need insulin even when they're not eating. See *15.

&31) Metabolism slows down as people age. Renal threshhold increases.

*32) During DKA, potassium leaves the cells, goes into the blood stream, and gets filtered out by the kidneys. Dangerous potassium depletion results.

&32) Having a balance of sodium and potassium levels is usually, but not always, more important than absolute levels of sodium and potassium.

*33) Potassium is one of the most bitter substances necessary for survival. YUCK!

&33) Tardic Dyskinesia is the name of a side effect of many psychotropic medications, including lithium. It is an inability to control, or to promptly control, many small muscles at first, and others later, and is what many people think of when they think of the mentally ill.

*34) Sugar is not more dangerous to diabetics than other carbohydrates are. For me, sugar is easier with insulin than protein is.

&34) People who regain sight or hearing after long periods of blindness or deafness have sensory integration problems that improve with time, even though those of us born with sensory integration disorder tend not to improve much after reaching about puberty.

*35) Injections are least painful when they go into subcutaneous tissue (ie fat).

&35) The term shot, used to mean an injection, began to be used towards the end of the first half of the twentieth century, and was still considered slang in 1960.

*36) Autoimmune diseases are more common in lefties.

&36) The children of two left handed parents have a 50% chance of being left handed.

*37) The only vaccination that makes a difference in the long term likelihood of a person being diagnosed with type 1 diabetes is the TB vaccine.

&37) The usual TB test is an intradermal injection (although sometimes messed up and made a subcutaneous injection) that provokes a skin reaction in people with TB antibodies as well as those who are allergic to the ingredients in the shot.

*38) The first insulin intended to last longer than regular and commercially sold was PZI insulin, or protamine zinc insulin. Almost all insulin mixes since have contained zinc.

&38) NPH insulin is sold on the steroid black market (even though you buy it over the counter) as a weight gain tool. Way too dangerous, in my opinion.

*39) Going bald is an itchy proposition. Ugh. I was balding from malnutrition when I was diagnosed with diabetes.

&39) The brain can't process both deep pressure and pain sensations at the same time, which is why rubbing makes owies all better.

*40) A low fiber diet is one of the more effective dietary treatments for gastroparesis.

&40) Absolutely 0 gluten is the most effective dietary treatment for celiac sprue.

*41) Although most autoantibodies only increase risk of developing one disease, GAD 65 is implicated in type 1 diabetes, type 2 diabetes, Stiff Person Syndrome, and a few other neurological conditions.

&41) The flu vaccination is available in both the live and dead forms. The live form is the more common one. The vaccination is even available in nasal spray form.

*42) Risk of almost all infectious diseases is increased for diabetics. Risk is greater with worse blood sugar control, but does not decrease to 0 with intensive therapy (A1c below 6).

&42) Insulin shock therapy was once used like electric shock therapy continues to be used today. It was not effective in treating depression, and was discontinued in the main.

*43) When venous blood sugar levels drop below 45 mg/dl, the difference in brain function is visible on EEGs.

&43) It is illegal to drive in the state of IL with a disorder that your physician believes may give you 1 or more seizures per year.

*44) Glucagon is a hormone produced by alpha cells, in the islets on the pancreas, and it signals the liver to release glucose.

&44) Hormones are either water soluble or oil soluble. Oil soluble hormones are steroids by definition.

*45) Red blood cells are basically bags of hemoglobin. A portion of the hemoglobin is bound to sugar. What portion of the hemoglobin is bound depends on how long the hemoglobin lives for and what the ever blood sugar level is.

&45) Although the normal range for red blood cell counts of men and women overlap, the male range is about 10% above the female range. This is entirely testosterone dependent.

*46) Neuropathy itself is usually not a reason for amputation; it creates a strong vulnerability for infections and accidents. Smoking quadruples diabetics' major limb amputation risk.

&46) The vast majority of deaths in people with end stage renal failure are directly caused by either poisoning, from eating things the kidneys aren't there to clean out of the blood, or infection from the dialysis sites.

*47) Diabetics on dialysis typically have A1cs in the 6s and 5s because they don't eat much.

&47) Hemodialysis patients who have poor tissue health in the conventional dialysis sites can be dialyzed through the neck.

*48) Peritoneal dialysis offers a better prognosis than hemodialysis EXCEPT for diabetics. Peritoneal dialysis patients typically report a higher quality of life.

&48) DHEA is a hormone that stimulates production of sex hormones. It is an over the counter medication in the United States but prescription only in Canada.

*49) The normal blood sugar range of pigs is 20-80 mg/dl.

&49) 5-15% of the general population is stereoblind, meaning that we (I'm stereoblind) lack binocular vision.

*50) The body's ability to hormonally react to hypoglycemia decreases with duration of diabetes treatment regardless of level of blood sugar control.

&50) A gelastic seizure is one that features uncontrollable laughter or crying. They aren't thought to be very common.

Oy, Lantus

Sometimes I forget that Lantus really loses effectiveness over the course of a month. Yesterday morning I woke up with a bloodsugar of about 250, having taken two Novolog shots during the night. I had been going a little high in the mornings after fairly stable nights for about a week. I decided to open a new vial, since I'd been using the previous one for 34 days or something like that. I took the same dose. Last night, I was hypo, snacked, checked in another hour, was 75, ate a plum and a butterscotch candy (together 15-20 carbs) and went to sleep. When my father came by to tell me to get up, my blood sugar was 81 and by the time I actually got up two hours later it was 79. Wow. Lantus, you fiend!

In other news, I reordered my supplies yesterday, and there must have been some snafu, because my insulin and glucagon and test strips arrived today, shipped by overnight mail. Which I hope I'm not paying for. The polar packs were still frozen when they got to my house! That hasn't happened before. The stuff arrived in two boxes. The smaller one is about one cubic foot, and I was startled to find that the only thing inside was styrofoam, two polar packs, and a glucagon. The glucagon could easily have fit with the insulin in the other box. My syringes and needles have not arrived yet. I think I decided not to reorder lancets, since I seem to have enough of those. I am really running low on pen needles- I've been doing an unprecedented number of shots lately.

And in the final stretch of medical news, my testosterone levels were discovered to be way too high. I inject testosterone under medical supervision, and it appears that my dose was about 3x where it ought to have been. Maybe more. I am fantasizing that this means I don't really need to inject it. In the meantime however, my dose has been lowered and I have to get more blood drawn. Ouch! Last time it was drawn from my hand, and my hand looked like I had a mosquito bite. It hurt a lot, but it healed pretty well.

After the 594

That evening, I went hypo. I ate about 30 carbs. Stayed hypo. Ate another 20 carbs, and went to sleep. Woke up with a blood sugar in the 180-210 range. The ISIG on my CGMS wasn't all that high at the time (something like 8), so I pulled the sensor. Less than 24 hours after the 594, in the dentist's office, my blood sugar came in at 36. What a range!

I'm feeling a little less happy about the CGMS. I mean, I said no the IPORT partly because my first day on the IPORT, I had a bad site that resulted in a blood sugar of almost 400, which was the first time in over six months I'd been that high. That I was wearing the CGMS when I had my high score blood sugar makes me frustrated. I mean, it hadn't appeared that the sensor was going bad- the ISIG was something like 10, and it had been less than 2% off both of the earlier times that day that I'd checked.

During my first nine months managing diabetes, I counted every carb. I took a food scale with me wherever I went and I weighed and measured and I memorized the carb percentages by weight for over a hundred beans, grains, fruits and vegetables. I did most of my own cooking (I lived alone) and I measured everything going into the pot. I followed pretty strict carb ratios, which I adjusted on a weekly basis. I acheived A1cs of 6.5 and 6.3. My blood sugar didn't hit 300 for over five months, but it frequently went below forty.
These days, I have a much more relaxed attitude towards diabetes management. I don't have any carb ratios. I keep track like this well yesterday I ate about two thirds of this at this time and I took x amount of Novolog so and I ended up a little hypo so today maybe x+1 units would be right? Maybe? Eh, sure, why not. And the amazing thing is that I'm usually right. My blood sugar has hit 300 more often these days, but not that often, and I'm still in range for most of the day, whether or not I use the CGMS. My last A1c was 6.3.
My blood sugar spikes more now than it used to. I suspect that this is because of both my less attentive attitude (giving rise to more mistakes), and because the last of my beta cell function is done for.

In less than a month, I will have been on insulin for two years. I intend to write a list of 100 ways I've changed then. Right now though, I figure I'm at the best part of the diabetes journey. It's old enough that I really feel that I know what I'm doing and I'm comfortable doing it, and it's new enough that I don't have any major complications.

High Score of 594

I've been feeling high all day. Drinking lots of water, really sweaty, using the bathroom a lot. Later in the day, a little stomache ache. I checked my blood sugar a few times this morning, and it was within five points of the CGMS all three times. All three readings were below 100. So I trusted the CGMS this evening and took insulin for supper, which the CGMS showed as a very mild spike, and then continued eating as the CGMS showed my blood sugar fluctuating in the 80-110 range. I was about to go to bed, a bit past midnight, when I tested my blood sugar at 594. I was like, WTF?! NO! And I washed my hands and rechecked at 588. This may mean that my sensor has gone bad- if it doesn't agree with my morning reading, I'll take it out. The ISIG has been 6-12 the last two days, which is lowish but ought to viable, though not with a blood sugar of almost 600. I can't even enter that number as a calibration.

I took twenty units of Novolog as correction, and decided to stay awake a while longer to stay on the ball, because this is the highest I've ever tested and 20 is a very large correction for me. When I was diagnosed with diabetes, it was with a fasting blood sugar of 425 by meter, 453 by blood draw. With those fasting numbers, it seems highly probable that my postprandial numbers were in the 600-1000 range, but I never found out and had had no further readings above 400, and very few above 300 since the day I was diagnosed with diabetes. Today's readings are more than 100 points above any other reading I've had. You'd think I'd feel terrible, but frankly I feel fine. Just a little thirsty, and with 90 degree Fahrenheit weather, I think most people are feeling a little thirsty.

Right now, thankfully, my CGMS is showing my blood sugar climbing rather dramatically, so maybe it is just delayed.

I just tested my urine ketones, and they are negative. My number 1 diabetes goal is to avoid ever going into DKA again. I was diagnosed in DKA and when I came out of it, it was like having a long term pain removed- you almost don't realize how much pain you're in, until suddenly you are in dramatically less pain and you can think again and talk and walk and eat and drink and you're alive, like you only sort of were before. I believe that I spent at least three weeks in DKA before I was diagnosed with diabetes. I know that I wasn't in terribly severe DKA (7.25 with reference range of 7.35-7.45), and that it took over a week for my ketone strips to show negative ketones. I've had small ketones on two occasions since September 2006, both when I'd thrown up, unaccompanied by high blood sugars.

Post script: an hour and a half later, my blood sugar is down to 176. In general, I would consider this a slightly high reading. At the moment though, it strikes me as way too low, because I bet it's dropping quickly, yeah? Argh. I don't know what I'm going to do. Eat, I guess. Humph.

Stupid Care Link

Every now and then, I use the Carelink (yes, I got the free USB one now- thanks for the tip). And then I get my reports. And then I get mad.

For one thing, the "target range" on the reports is always 70-140. Which has never, ever, been my target range. So while the Guardian itself on its screen shows me that I spent the day 95% in my target range of 65-155, the carelink report says that I spent a mere 77% of the day in their stupid target range of 70-140.
It also rounds numbers incorrectly, doesn't give me a useable data download, won't overlay more than two weeks' numbers, doesn't give any interactive data, and won't put the insulin, exercise, food or other marker onto the actual graph. I don't care when I was alarmed; I care about what I did.

Happy Blood Draw Results

A1c is 6.3. My previous one was 7.0, and the ones I've had before are 7.0, 6.4, 6.3, 6.3, 6.5, 14, 16, going backwards and in order. I was hoping for lower than 6.3, but 6.3 is still OK with me and much better than 7.0. Maybe my next one will be lower, but maybe not. If it stays there even, that's not so bad.
The celiac antibodies were all in the normal range. WTF? I didn't realize that they could do that after being abnormal last time. But I'm still happy about that.

Endo Visit

My weight appears to have stabilized, good.
No neuropathy showed up when my endo checked, though he says that that doesn't absolutely rule it out.
Two tubes of blood were taken by the time my blood stopped flowing, which was perfect because that's how many were needed. The A1c will be in tommorow and the celiac antibody results will be back on Tuesday.
My endo was impressed by the Guardian and agrees that I should ask insurance to cover my sensors, says he will support me in that effort.
The endo says that allergy shots could be taken in my back if I want to avoid scarring areas that I inject with insulin. That sounds a little scary but I will ask about that.

Sensor 2

Jonah's SG Statistics

data date	SG average	Above range	In range	Below range	Standard Deviation	# of readings	low	high
Sensor 2:	108	10%	77%	13%	34.1	2898	40	252
June 8:	122	4%	96%	0%	19.1	143	80	164
June 9:	100	9%	73%	18%	27.7	288	50	166
June 10:	67	0%	14%	86%	11.5	37	56	98
June 11:	93	0%	80%	20%	25.7	287	40	146
June 12:	101	6%	85%	9%	27.8	288	42	194
June 13:	115	14%	74%	12%	30.1	257	44	168
June 14:	148	38%	62%	0%	44.7	288	72	252
June 15:	113	0%	100%	0%	21.5	288	72	158
June 16:	122	24%	73%	3%	36.1	285	66	214
June 17:	103	10%	80%	9%	26.0	285	64	170
June 18:	84	0%	74%	26%	20.6	288	58	144
June 19:	86	0%	66%	34%	21.7	164	52	134

On June 13, I removed the transmitter, recharged it, reattached it, hit new sensor. After two hours, I did a calibration and at that time my blood sugar was 46. Unfortunately, doing the first calibration with a hypo is a bad idea; the numbers from then until 1 AM on June 14 are inaccurate. On June 14 at 1 AM, Glukey said 128 and my blood sugar was 258. I calibrated. By the time I woke up in the morning six hours later and tested my blood sugar, Glukey was only 11% off, and in the afternoon when I checked, it was a mere 3% off. However, the last few hours of June 13th and the first hour of the 14th are highly inaccurate. Don't do the first calibration of a sensor while hypo.

The range I used during this sensor was a bottom limit of 70 all day, with an upper limit of 140 until 600 hours, then an upper limit of 160 until noon, and then an upper limit of 150 for the rest of the day.

Glukey

The battery cover on Glukey wouldn't unscrew, and I was chipping it with trying with the coins. The rep said not to use a screwdriver. I called the helpline, they said to use a screwdriver because they could replace the battery cap if needed, for free, but would rather not have to replace the whole thing, which is what they'd need to do if if the battery wouldn't come out. The screwdriver was like magic.
I inserted a sensor around 10:00 this morning. It is working fine. During the warm up I got crazy ISIGs like 160 and 0.00, but now it's at 17.72, and my blood sugar is about 170 (I just checked). I put it low on my right arm and it hurts a lot. Last time, it hurt pretty intensely for the first two days but not much after that. Right now if I move my arm wrong it sends a shooting pain through me. Yowch. I put IV-3000 down with a hole in it for the sensor beneath the whole sensor-transmitter contraption, and then band-aided the transmitter down.

Locker Renewal

I went to renew my locker and I was signing the contract and noticed that it says that the locker is subject to searches for drugs and other contraband. I was like, I keep medical supplies there, how often do they search. She was like, I don't think they actually search them regularly, do you have diabetes? I was like, how'd you guess- oh wait, was it my powered by insulin hat? She said no, my mother has diabetes.
I said what type. She said Type 1. I said How's that going for her?
She said it's going well, actually, her mother was diagnosed seven years ago in her thirties.
My locker is safely renewed. Good place to stash food needles and insulin.

Off Guard

It has been a bit over a week since I took out the sensor. My blood sugar has been not better or worse, really. The only real difference is that I feel rather uninclined to check my blood sugar.
One thing I learned from the Guardian is that I get much more acurate BG results if I wash my hands or feet, and so now if I don't want to wash my hands or feet, I don't want to check my blood sugar. And furthermore, my fingers and toes ache. They always ache. Checking my blood sugar a mere four times per day while on the Guardian was not a big enough decrease to allow my fingers to heal, or perhaps they are just very slow healers. In any case, I don't want to check my blood sugar.
Another thing the Guardian taught me is that my overnight blood sugars are not even vaguely linear. Not even three or four linear pieces. They go up and down and up and down and up and down and if I check my blood sugar an hour before and at bedtime, so what? That information no longer seems useful. My blood sugar takes a bumpy path all night long.
I am not super excited about wearing another sensor. Although my blood sugar was much better than average during the first week of sensor wear, it was not good the last week and I spent all night high despite the thing. I feel like my initial enthusiasm had more to do with it just being a good week.
One of the most frustrating thing about diabetes is that I have good weeks and bad weeks and I don't know why and the Guardian has demonstrated aptly that two nights in a row don't even tend to be as consistant as I'd thought. My nights are the most difficult. People talk about the pump allowing another basal, but that would do me no good because it is hard to predict which nights I'll go up; sometimes a night is just perfectly flat. All night long. And I didn't do anything different, it just happened that way!
The daytime isn't bad; the Guardian confirmed that I mostly don't have postprandial spikes and when I do, they're only by about 30 mg/dl. So not much of a big deal.
My meter average for this week is 113, and for the last 30 days is 117. My guess is that my A1c, when it gets tested in two weeks, will have dropped by at least half a point, back to the lower 6s. Maybe a little bit more. I am looking forward to finding out. I intend to also get screened for celiac again at that appointment.

I had some more teeth filled. I was half asleep through it again. The novocain really seems to make me drowsy, which is a known side effect that doens't happen to most people.

Finished Sensor 1

It lasted just under 3 weeks. I probably could have gotten it to last longer, but it was performing inaccurately that day and I was like screw this and yanked out the sensor. The target range set that the chart below gives is 70 as the bottom limit all the time, and 140 as the top from midnight until 6:30, 180 the upper limit from 6:30 until noon, and then 150 as the upper limit the rest of the day. I ran a lot more hypo the first week and had major problems with running high overnight the rest of the time.

Jonah's SG Statistics

time	SG average	Above range	In range	Below range	Standard Deviation
Sensor 1	112	10%	83%	7%	32.3
May 4	104	0%	89%	11%	23.8
May 5	110	2%	87%	11%	31.8
May 6	120	0%	100%	0%	19.9
May 7	102	2%	86%	12%	29.7
May 8	105	5%	88%	7%	25.5
May 9	125	23%	75%	2%	36.9
May 10	88	0%	47%	53%	34.9
May 11	86	2%	76%	22%	20.9
May 12	100	0%	99%	1%	21.6
May 13	110	11%	78%	11%	36.9
May 14	109	0%	100%	0%	20.9
May 15	113	13%	87%	0%	24.5
May 16	120	29%	71%	0%	34.6
May 17	146	37%	63%	0%	35.7
May 18	118	19%	78%	2%	35.4
May 19	106	5%	94%	1%	22.1
May 20	125	16%	78%	6%	38.4
May 21	120	12%	88%	0%	24.2
May 22	109	6%	82%	12%	27.8
May 23	109	8%	78%	13%	35.0

Guardian

Man, I am having fun with my little glukey. Who else thinks that I'm euglycemic almost all the time? I love that! According to glukey, the highest any of my meals has peaked at so far is 176, and the rest of the meals peaked below 150. YES!
I've had the sensor in my arm for just short of seventy-two hours now, and have been getting readings for the past 60. The rep said that I could try extending sensor life past each 3 day increment if the ISIG was above 5; so far it hasn't been below 8.7, and that's only when I'm hypo. The accuracy so far has been pretty good. Not perfect, but pretty darn good.

Here is a list of things I wish I could do with Glukey. Some of them might be features I just haven't located yet.
1. I want to reset the graphic so that the top of the screen is 200 rather than 315, so that I can see the slope more dramatically. I have yet to see a reading on here of 200, let alone 300, and I think that having the graph show my actual range is not a ridiculous request.
2. Show me what I've imputted for my meals and insulin. That would be so useful!
3. Let me upload the info onto my computer with a USB port. I don't seem to have whatever sort of outlet it is that goes with the cable that came with the comlink software, and neither does my dad's computer. That's a real bummer. If any of you have advise on how to find a computer to look at my data on, that would be helpful.
4.I want to be able to scroll back and look at the window that showed up 3 hours ago under the 3 hour graph. I want the 5minute by 5minute view of what happened after I fell asleep, not the 10minute by 10minute version.
5. Louder alarms. My first night with the sensors, I woke up at 3AM to a LO SG alarm. My accu-chek aviva confirmed that my blood sugar was 52. Scrolling back however, I saw that at 1 AM, my blood sugar'd been 40. Glukey apparently alarmed then too, but I didn't wake up.

Last night I ate supper and injected for it, around 1800 hours. At 2015 hours, I checked my blood sugar: it was 175. I took two units of Novolog and decided to take an extra five units of Lantus. I'm pretty sure I did. At 2223 hours, I was ready to go to sleep. I checked my blood sugar, expecting something between 100 and 200. My meter read 362. WTF?! I rechecked and it said 299, which was still way too high. I injected 5 units Novolog and set my alarm clock for 200 hours. I woke up about five minutes before the alarm would've gone off, checked my blood sugar at 160, injected 1.5 units Novolog- all by the light of my answering machine- and went back to sleep. In the morning I woke up with a blood sugar of 102. I think it's a little funy that a crappy night like that one is recorded as a success 'cause I woke up 102, but on the other hand I think I deserved it. I worked for that 102. Wish I knew what happened to make my blood sugar go so high.

My first sensor will be inserted tommorow night... wow.

Grumblings, and a Drawing on Needle Length

Minimed says that I only get four sensors with the guardian. That means that the guardian actually costs 760 dollars more than the navigator does.
I am wearing a small patch of IV3000 on my left arm, to see if I have an allergic reaction to it. I'm not looking at the arm, but since I don't feel anything, either it fell off or so far so good.

I was doing a shot on Saturday in front of another diabetic and she commented on how short my needles are (5mm). She says that that length is too painful for her, and said that it was maybe because I'm skinnier. I think though, that it has more to do with how thin my skin is (THIN!). If she were injecting, say, her forearm, she'd probably prefer the short needles. This is a graphic I did on the wisdom of picking the right length of needles. To be honest, most people have more fat than this in most spots that they'd inject.
Intradermal injections, which I have accidentally done when I've had too much angle going in, can cause a bump if the volume of the injected liquid is great enough and close enough to the surface. It leaks into the fat slowly, and it hurts for as long as the fluid remains there to irritate the pain receptors in the skin. OUCH!
Intramuscular injections can be as painless as subcutaneous ones, but they're often not. It's pretty easy to irritate a muscle.

Guardian Arrived

A little past noon, as I was getting ready to go to work and saying goodbye to my mother, the doorbell rang. I ran to buzz, then zoomed down the stairs, not quite colliding with a fedex dude. I started to ask him if it was my minimed guardian, then saw the minimed symbol and flourish on the box, and answered my own question. The fedex dude said he'd come with me for my mother to sign it, but I said I'd sign for it myself- my name on the box, wasn't it? I guess I'm still not looking my age. Nineteen and a half years old as of yesterday.

So I opened the box to look at the contents. There was a lot in there. Unfortunately, there were only four sensors. I was told that I'd be getting ten. I thought I must have figured wrong, but my mother said I should call Minimed, so I did. The customer service lady said that she knew that ten should've shipped with the Navigator, but that she wasn't sure about the guardian. She had me leave a voicemail for the same dude who I'd called more than a dozen times without reaching when I was figuring costs. I hope I get another six sensors. I already spent a goodly chunk of money and I was figuring on getting ten sensors. Not four!

Three other surprises in the box: I got ten things of IV3000, which I didn't know I was getting, and which suggests I was supposed to get ten sensors, 'cause a plain IV3000's not useful. I also got an operating manual that says it goes with the Navigator, which isn't what I got. I also got two batteries, which wasn't a very big surprise, though a nice one.

I was late for work.

three Things I've Learned

I'm still fairly new; less than two years into diagnosis. But I'm a lot farther and I've moved beyond the basics. Here are some things I didn't even used to know were there to ask about.

1. Carbohydrates are not the only things that you can eat that will raise your blood sugar. It is common for protein to be converted to sugars and to them raise your blood sugar sometime after carbohydrates will. Having lentils and beans for supper might raise your blood sugar a few hours later (because of the protein).
In addition, some substances, such as caffeine, may give you insulin resistance.
And a minority of diabetics, including myself, experience dramatic rises in blood sugar after consuming some artificial sweeteners.

2. Your diabtes really and truly does vary. Even though somebody else has your same type of diabetes, xe definitely does not have your same body.

3. Your meters are not very accurate, even when they're consistant. That's a fact of diabetes life. You can improve the accuracy of your meter, but it will still be inaccurate.

************************************************************************************

My Guardian shipped today. It's still in California.

Teeth Filled

I got three fillings done on Wednesday. This appointment went way better than the first one. It bordered on fun, even. The needle used for the local anesthetic is 27G, and the dentist used a topical before injecting, so I didn't feel much- mostly the suction of it coming out bugged me. I got two shots of the painkiller since I could still feel a lot after the first- as far as I could tell the second one didn't really make a difference. I felt a fair amount of pain when the cavities were being scraped out (at the most acute it was like having a shot with a 22G needle), and the cotton in my mouth didn't feel so great either, but overall I was really really sleepy and that prevented me from feeling much. Local anesthetics are not supposed to cause sleepiness and I'm not sure if they did in my case or if that was a coincidence.
My bloodsugar had been dropping before the fillings and anesthetic, and continued to drop afterwards; as far as I can tell the painkiller had no effect on my insulin sensitivity.
One thing I hadn't realized was that the dentist wouldn't want me to be eating afterwards, and my stuff to treat hypos all needed some chewing. As I was hypo at the end of the fillings, the dentist gave me a lemonade juice box (25 grams of carbohydrate of which none were fiber) and that kept my blood sugar up until the anesthetic had largely worn off. During the filling, my lip and tongue both got cut a little bit, and my gums are still a teensy bit sore, but mostly it's all better. Yay!

Getting a Guardian

It's decided: I am going to get a minimed guardian! I'm buying it as a cash item, in minimed lingo, meaning that we won't be applying for insurance aid. That's going to be 1339$ for startup costs that include one box of ten sensors. I figure I'll wear one sensor per month; if each sensor lasts about a week, then I'll be fairly part time on the sensor.
I had been thinking about the dexcom, and then I realized a few things. One, the dexcom doesn't allow you to calibrate by manually entering a blood sugar value; you can't use any old blood sugar meter. My insurance will only pay for test strips on the Accu Chek line of meters and adding in the cost of getting test strips for the one touch meant that the dex suddenly cost a lot more. Then I also realized that most people get more than the FDA approved 3 days from a guardian sensor, and that with that factored in, the Guardian sensors are much cheaper than the Dexcom ones. So I called Minimed, talked to somebody named Sarah about my questions on Wednesday, called her back on Thursday to say, Yes, that's what I want to do.
I told Sarah on the phone at Minimed that I'd had a reaction to the iports and asked about what if I have one to the guardian. She says that if it was a reaction to the adhesive (and it was- question is was it ONLY to the adhesive) then we can change the adhesives. But if it was a reaction to the plastic cannula, then we're out of luck. Minimed will take the transmitter and monitor back and reimburse me about 900 dollars if that happens.
I've transferred the money into my checking account, haven't got the details finalized, assume it will be another 2-3 weeks before I actually get the guardian.

Does TOO Hurt

I just read 30 ways to manage diabetes, a diabetes forecast article that's been circulating, and I'm cool with numbers 2-30, but number one says that insulin injections come in tiny needles and don't hurt. Well, I beg to differ: does TOO hurt.
No, they don't hurt as much as being sick does and it's really not such a big deal but!
My body is sore. My body is bruised. My body is scarred. My body has endured shots into bruises. My body has endured my desperate searching for a spot with a pinch that doesn't already hurt. My body has endured over 2000 injections of insulin in a year and a half's time, and it has bruised hundreds of times.
I got warned, when I was new to this injection business, to rotate my sites, so that there'd be less scarring. I got warned that you could get in the habit of using one spot and then it'd scar fast. I got warned that I'd get happy spots that wouldn't get good absorption and wouldn't hurt. I got warned- but they were wrong.
I rotate sites because they HURT. I don't heal well, I guess.
The people who say that shots don't hurt? They don't speak for me. Mine hurt.

u/kg or insulin sensitivity

I've read in books that a person without insulin resistance should use .5-1.0 units of insulin per kilogram of body weight per day. The Do You Know More than A Doctor About Insulin test says that a normal adult with type one diabetes uses only .5-.7 units of insulin per day.
I am a very active person. I do a hell of a lot of walking, and twice a week weight lifting (and I have to take insulin before I lift weights 'cause it consistantly raises my blood sugar). My job isn't a desk job though it doesn't involve much heavy lifting or anything. I'm not overweight. My family history includes one person with type 2 diabetes, and he developed it past the age of 60 when obese and having lost the weight he's also euglycemic now.
Nonetheless, when I'm not sick I average about .9 units of insulin per kg of body weight per day, and when I'm sick it's more like 1.2 units of insulin per kg of body weight per day. Do I have insulin resistance?
It doesn't sound right to me: for one thing, if I stop eating for a day I can get by with a mere 8-12 units of Lantus. Otherwise I take about 18 units (at least this week- it has fluctuated from 8 to 40, but in the last 18 months has probably averaged 16-17). My Novolog use for the day tends to be about twice my Lantus dose, although that's obviously not a constant.
My breakfast carb ratio is about 1:7, the first 20 carbs of lunch are covered by Lantus with the rest being about 1:20, same for a midafternoon snack. Supper is about 1:12. As far as I can tell, these are about normal for type 1 diabetics.
Question: I know that adolescents are expected to have a different insulin need- for the type one diabetics out there, what's your tdd compared to your weight? If you're over 25 and don't have significant kidney disease, did you need more insulin when you were 20 than you do now?

Six words and a visit to the dentist

Six words: Friends arrive only after great devastation.
'Cause when you've got no self confidence and you'd do anything to make a friend, people get repulsed your cloying desperation and it's only after you say "forget that, I don't need no friends" that you can love yourself and then people see that you're worth loving. You have to hit rock bottom on your own, which really sucks.
I was tagged by Megan, who is taking a nursing course with a really ignorant professor at the moment.

I go to see a dentist for the first time since July 2002. He tells me, very sternly, that my dental hygiene needs to improve. He says he's sure that I can find a toothepaste that I can tolerate and the floride is important. Yeah right. I am too intimidated to say anything; tears are threatening. Twenty minutes later I will bolt upright in his chair, gasping for breath, my teeth chattering, goosebumps on my skin, rocking myself, knowing that he is speaking to me and making out maybe half the words, unable to speak. I will lie back down without recovering the ability to speak.
LISTEN! I am autistic and I have severe sensory processing dysfunction. I put that on your form, which you glanced over in front of me. It took me a great deal of courage to get to your office. I'm scared. I don't need a lecture. I'm spending my entire paycheck to be here. I have very big problems in my life and my teeth don't rank very high on my list of concerns. I appreciate that teeth matter a lot to you, but you need to ask me how much my teeth matter to me and what level of care I'm willing to do for them, and you neeed to respect my answer. I do not neglect my teeth just because I'd like them to rot or because I'm ignorant. As a matter of fact, brushing my teeth is extremely painful for me. I'd rather be punched in the nose. Heck, I'd rather be kicked in the stomache. Are you hearing me? Listen!

What? Alcohol Consumption and Diabetes

I was browsing pubmed and came accross this study, which was conduced in California in the mid 90s. 40,000 adult diabetics were asked about their alcohol consumption, and their A1cs were drawn. The A1c results were sorted by self reported drinking habits. Guess who had the highest A1cs? The ones who didn't drink! Maybe the hypoglycemia pulls down A1c? Of course, the averages for all of the groups' A1c scores were over 8% (and below 9%), and the differences between the groups weren't that large.
I though that this was odd enough to deserve a blog post.

P.S. Still reading through pubmed, here's another study claiming that drinking at least weekly has a positive effect on diabetes outcomes. This one makes an even stronger argument, because instead of comparing A1c to drinking rates, it compares complication rates to drinking rates.

I think my blood sugars are getting better. According to my meter, the seven day average (n=40) is 119. The 14 day (n=71) is 134. The 30 day (n=123) is 145. Who da man? I'm going down down baby! (I hate that that stupid song still pops in my head- I haven't heard it in seven years!)
Yeah, my meter average was above 150 for like a month and I'm relieved to see it heading back down to normal. Yump. In case you're thinking, Only 123 checks in 30 days?! I think that I was using another meter for a lot of that time. At least, I hope so. My sense of time is pretty poor. It does seem like I haven't had to open new boxes of test strips as frequently as usual, but on the other hand I just started using boxes that contain two cannisters for a total of a hundred strips, rather than the old Accu-Chek boxes with one cannister for a total of fifty strips. That means fewer code chips.
I have no idea what's going on with my body that my numbers are getting better. My insulin needs seem to be heading down down baby. After a month of doing 25-40 units of Lantus per day, I'm down to about 20 per day for the last week. I was using Novolog at a rate of like 40 units per day, and now- maybe 20. In case you're thinking that that's still a lot of insulin for a small person, maybe I should tell you that I gained ten pounds in the last three months. Which is fine. A lot of it is muscle. I don't think weight lifting does anything good for my blood sugar.

ugh

The A1c is 7.0, up from 6.4. I think I can get it back down though; my blood sugar went totally icky for the nights for about six weeks and has been back to normal for the last week, and I think that that's the difference. But 7.0, yuck. My doctor didn't even say anything negative; I guess he knows that I already know it sucks.

Low BUN and Creatinine?

Had an endo visit this morning. Got weighed and measured, spent a long time talking.
The endo said a few things. One, he doesn't care where I inject, as long as I can get a pinch- it's enough fat. Two, different areas have different absorption rates and the research on the variance of absorption rates is contradictory. Three, if I need bigger syringes, he'll prescribe them. Four, yes I am probably on too much testosterone. Five, it is within the variety of normality for my temperature to be 99 degrees in the evenings but not in the mornings.
Very interestingly, I asked if I could see December's full results, and he said sure. I expected only two numbers to have been out of range- my A1c and blood sugar. However, an additional two results had been flagged by the lab- my BUN and Creatinine levels were both below the normal range. I asked my endo what those meant and why he hadn't mentioned it. He said that what's really getting measured there is how efficient my kidneys are in getting urea and creatinine out of my blood. So, more efficient kidneys are no problem he knows of. Also, my result was close to the normal range and he knows I don't have malnutrition. A look at the previous blood draws showed that both figures had dropped at each consecutive blood draw.
I thought I'd check online to see what could cause the low numbers. Two of the reasons are obviously not me: pregnancy and malnutrition. Eating too little protein can also lower these numbers- maybe I should eat more protein? As a vegan, if I stick to my parents' food, I don't get a whole lot of protein. Other causes are hyperhydration, which I guess could be a possibility, and severe liver damage. I have been highly symptomatic of liver problems lately, but my liver's gotten tested and tested and tested and seems to be fine. However, somebody close to me tested as having liver damage- though not any of the forms of hepatitis tested for- over the summer.
I think right now I'm going to try adding more protein to my diet.

Roche, Radio Shack, and 2 New 2032 Batteries

When yet another of my accu-chek aviva meters said that the battery was too low, I headed to radio shack. I didn't bring my meter with me. Walking into radio shack, I was greeted by a friendly guy around 50, who asked me what I was looking for. I told him that I wanted a battery, yea big, for my glucometer. He asked if I knew what type of battery, and I said no. He looked on his computer to find the battery type and couldn't. The radio shack computers don't have adobe on them, so that employees won't spend their time looking at more amusing things than customers, so he couldn't open the accu-chek aviva owners' manuel from online. So he called Roche customer service and handed me the phone.
After I picked the correct menu option (I HATE having to pick phone menu options), I was connected with a woman who told me the number of the battery I needed after about 40 seconds, but who then wanted to know all about me. She asked if I wanted a new battery sent to me, and I said sure. I also picked out a battery from Radio Shack, bought that (for 4.99 plus about 50 cents tax).
Well, a few days later there was a fedex box, about 8"x 4"x5" in front of my door. That's a lot bigger than is needed for one tiny battery- ten glucometers could fit in there. On one side of the box was a sticker that was probably the reason for the size of the box. It was red, white, orange, and black. It said:

Attention Fed Ex
Courier/Service Agent Express

DO NOT PUP AS DG

This package MUST be inspected by the origin location Dangerous Goods Specialist

Then there was a picture with a picture of a passenger airplane that said: DANGER DO NOT LOAD IN PASSENGER AIRCRAFT

APPLY LABEL TO SMALL PACKAGES BY WRAPPING AROUND CORNER OF PACKAGE ON DOTTED LINE

PRIMARY LITHIUM BATTERIES- FORBIDDEN FOR TRANSPORT ABOARD PASSENGER AIRCRAFT


My roommate says the sticker would be a cool thing to put on a guitar case. I wonder about how, if the battery in a sealed box can't be taken aboard a passenger airplane, how the hell I would be allowed to fly with it in my pocket? I'm glad I don't fly. I also think that the shipping and handling probably cost more than the battery did and it would have been cheaper to, I dunno, give me credit at radio shack or something like that.

EDIT: Blogger seems to be acting funny. The link to the picture that was in the middle of the sticker is: http://www.mayomedicallaboratories.com/images/specimen-transport/courier/danger_sticker_1.jpg

Silly Thought

Today I showed my father how to draw up glucagon. My mother says if I need a glucagon injection, I should call her. Wish I thought I'd have that luxury.

Another Accu-Chek Aviva Failure

Remember in August I got mad because my accu-chek meter gave some pretty inaccurate numbers, how I called the company and got a new accu-chek aviva and a new accu-chek compact?
Well, I've been using the accu-chek aviva and been pretty happy with it. Until... a month ago, it started giving me a low battery warning. Okay, whatever. I changed the battery. It kept giving me the warning. Whatever. On Friday, it refused to operate, beeping ERR and a picture of a battery. OK. I tried three new batteries, none of which worked. Used the sample strips sent to me with the accu-chek compact. Tried the aviva again, hopefully. ERR. Found one of my other accu-chek avivas, one that hadn't been real accurate, and I'm using it again.

Life Masters

I got my first call from a real life health educator in the Life Masters program. She didn't seem to really know the stuff that I got quizzed on last time, but whatever. She strongly suggested I see dentist, said that she thinks it's probably still worth it to get a flu shot. Said she couldn't answer my questions about the workings of my glucometers or about the wackiness of Lantus.

Wondering about Scarring

I'd like to see a research study on scar tissue caused by injections. Do you get more or less scar tissue pumping? Does blood sugar control affect the rate at which your body scars? To what extent does scarring accompany absorption problems? What percent of diabetics have absorption problems after 15 years of insulin? To what extent does scarring affect A1c? To what extent does rotation minimize scarring?
In the last 24 hours, I injected myself 11 times. Yump, eleven times. Granted, that's about double my mean, and about treble my median, but days like this are still not that rare. Sometimes I wonder, when I do a shot before and after meals (which is what I do with most large meals), is the potential scar tissue worth the control?
I don't have any diabetic scars. I have been injecting insulin for just under eighteen months. 18 months x 30 days per month x 5 shots per day = 2700 shots. I think that that's probably a slight overestimate of the number of insulin shots I've had. I think about the fact that diabetics at one point tended to take only two shots per day or so, and still got scar tissue within ten to fifteen years. If we figure 2 shots per day for ten years, that was only 7300 shots to get to scarring. I'll be at 7300 shots in another three years.
Some days I find myself pretty desperate for a site that doesn't already hurt. What will it be like when instead of bruises I have scars?

Bad Diabetes Day

Today was possibly my worst blood sugar day since diagnosis day.
I woke up with a blood sugar of 343, which is the third time I've woken up over 300 in the last seventeen months. I checked for urine ketones, which I think were negative (my vision wasn't so great).
I took some Novolog, some Lantus, skipped breakfast. Two and a half hours later, I realized I needed to get my butt out the door because I had a midterm to take very shortly. I took my blood sugar on the train, it was 54. I treated that with three packets of Domino's sugar. No, I don't know how many carbs that is.

My midterm was in a math class that I'm finding incredibly easy. My classmates, however, are not. In the quizzes we've had so far, the class average has been just over 50%, while I've made perfect scores. So, not a challenge. The test was in two parts, the first closed book and the second open notes (I didn't bother taking or using notes). The open book part I finished in about ten minutes, was the first to hand it in. I sat down and read a book while waiting for part II. I did not take out my meter, pricker, or sugar. I got part two and breezed through question one. Reading question two however, brought about the realization that my thinking was a little loopy; the question looked extremely difficult and I thought I might be hypo. I skipped question two and completed the rest of the test, then came back to two. Realized that the reason it looked difficult was probably a misprint. So I tried to walk over to the professor's desk. My gait was unsteady; I couldn't really gauge my distance from the ground. I'm sure I looked drunk. I asked him about the question and it was a misprint. So I finished that question, easy peasy, and turned in the test, first in the class to finish. My hands were shaking pretty badly. I went out of the room, sat down abruptly, fished in my pack for my meter, and tested. 33. Drank some sugar.

Later in the day I was very very hungry; I've eaten a ton today. I ate a lot last night too; I had gone to bed with a blood sugar of 203, but because I had active insulin and undigested food, I set my alarm for middle of the night and decided to sleep. The alarm didn't wake me, and I went high in the sky. My blood sugar today varied by an order of magnitude!

The rest of the day's reading were fairly uneventful. I talked in the class following to a classmate whose boyfriend's dad was recently hospitalized for hypoglycemia. I think I'm gonna bring in a glucagon and show her how it works and maybe even give it to her next week.

Fundus Camera?

Soon after I was diagnosed with diabetes, I went to an ophthamologist to have my eyes examined for diabetic problems. The nurse tried to insert eye drops into my eyes; when I kept jerking, she angrily called me a baby, taunted me, and told me that if I was acting like that, I obviously didn't care if I went blind and I could just leave.

Well, I eventually did get dilated but I didn't want to go back there ever again. The doctor's office recently called saying I was past due for another screening, but I'm not going. I don't want eye drops. And I don't want to deal with mean nurses either.

The studies I've read suggest that it's safe only going for an eye exam every other year as long as your previous exam showed you to be in fine eye health, and especially with my pretty decent blood sugar control, I figure I'm safe skipping this year's appointment. But sooner or later, I'll be wanting to have my eyes examined again, and just yesterday my parents and I talked about the difficulty of me not wanting my eyes dilated but wanting my eyes screened.

Well, today I watched a video on the use of the fundus camera in screening for diabetic neuropathy. Guess what? With the camera, you don't have to dilate the eyes in order to see any diabetic eye damage!

So now the question is, how do I find out which opthamologists or optometrists in the Chicago area use fudus cameras for looking at diabetic eyes?

Hypoglycemia and Spirituality

Last night at 0057 hours I tested at 97, went to bed, almost immediately felt hypo, protested to myself that I'd just tested and felt fine, that it was my insomnia making me restless. I sat up and did some Sudoku, noticed I was having to concentrate harder than usual. Retested at 119 hours with a 31. In 22 minutes, my blood sugar had fallen by more than twice what my blood sugar ended up as. Gah!

I ate a little bit, felt woozy. I sleep wearing just swimming trunks and I looked at myself and said, if I were to pass out and be discovered my 'rents in the morning, I'd want to be wearing more clothes. So I got dressed.
Still feeling woozy, noticed an apple. Made a long long dramatic blessing on the apple, like this Thank you G-d for fruit that grows on trees! To apples! And and carrrrrrbohyydratesssssss... Thank you for keeping me alive! (long pause) Thank you for hypos!
Then I ate the apple and thought about the way sometimes going hypo can make me feel alive in a way that little else does, and about how sometimes it's just really cool to be alive that way, and how, when I was early into diagnosis, I felt lucky to be going on the journey of diabetes, if only because I was gonna experience all this stuff I'd never thought about before, and how my sense of wonder and gratitude for and around diabetes had slowly dissappeared.
How stupid I was to let go of that wonder! How foolish to buy into the idea of tragedy, when living in the wonder and appreciation for the differences and goodness in all experiences is much more pleasant.

At 153, with my blood sugar up to 72 and the Sudoku mostly done, I went back to bed. I woke up at 800 hours with a blood sugar of 102; perfecto. I took two fewer units of Lantus this morning anyhow.

It was Symogii

So yesterday I tried 30 units of Lantus (it's a high dose, and the most I can measure in my syringes). Throughout the day, my blood sugar was highish, but the evening brought hypo after hypo. After treating a hypo at one AM, I fell asleep.
Woke up at 5:30 feeling really really thirsty and kinda dehydrated in other ways. Thought, dammit, the Lantus must really be expiring. Decided that I'd check my urine sugar, and that if that was positive, then I'd check my blood sugar.
The strip turned purple almost the instant the urine hit it. Stifling the urge to swear (my roommate, after all, was sleeping), I got myself a drink of water, headed back to my room, turned the light on and tested. Guess what my reading was?
51.
I guess I'm really lucky that the strip turned color! I ate a twizzler. Lay down and listened to the garbage truck and then my roommie's alarm going off and then fell asleep. Woke up at 11 with a blood sugar of 101.

By the way, I realize that nighttime lows are sometimes a problem, and often if I suspect Symogii I try lowering my Lantus dose to see what happens. But when Lantus expires, it usually has a shorter duration of action, and I guess I had been really suspicious because of what happened with the shipping.

Tempermental Lantus And Diabetic Pixel Art

Last night: went to bed with a 101. Couldn't fall asleep. One hour later, 100. Woke up around eight with a blood sugar of 256.
Previous night: went to bed with insulin on board, blood sugar 167. Couldn't fall asleep. One hour later, 147. Didn't touch it. Woke up eight hours later at 245.
Two nights part: had been treating hypos, went to bed with a 62. Couldn't fall asleep. Forty minutes later, blood sugar 94, left it alone, woke up 293! Couldn't believe it; I didn't treat the hypo that aggresively! Rechecked, 287.

So, I think maybe the Lantus that took two weeks to get here in the mail is expiring extra fast. Today I'm taking 30 units of Lantus, I'm going to do a 4 AM blood sugar check, and if I go up up overnight, then...
I think I'm going to start taking 5 units of August's vial of Lantus every night whenever I happen to go to bed. That stuff acts more quickly than normal Lantus, slower than Novolog. I only have about 50 units of it left. We'll see what happens. If I end up having to take two doses of Lantus daily for three months, I'm going to need to either ask for a prescription for more syringes, or else reuse syringes. My current scrip is for two syringes daily.

On tudiabetes, I started the Diabetic Jews group, and didn't add a profile picture. Deciding it needed one to spruce it up, I did this pixel art: It's 50x50 pixels, although it could obviously get smaller (cut off the edges). It's supposed to be a star of David made out of syringes.

Non-Injected Insulins

Exubera stayed on the market for about a year. It was a financial flop, but worked fine as a short acting insulin. Another inhalable insulin in development has been called off just now. Currently, multiple research studies are ongoing working on brining oral insulins to market.

Many in the blogospher and elsewhere scoffed when Exubera hit the market. They said that shots don't hurt that much, that a bong is too conspicuous, and that Exubera added nothing new. I admit it, I didn't run out and buy Exubera either. But I was excited. I was pretty sad about Exubera leaving the market. Why? Because shots do hurt. Certainly, the insulin shots don't hurt much compared to some of the other injections I take. But I've got bruises right now on my stomache, my breasts (I inject 'em), my legs, and my ass. I don't think I've got any on my arms at the moment, but that will probably change in less than a week. I get a new injection bruise almost every day. The I-Port red marks each lasted over a month.

That we lost the option of switching away from bruises- well, that stings.

Planned

This morning for the second time in less than a week, nobody came to check on me and I didn't go and say hey to my folks.
I had asked them, starting in October 2007, to check on me every morning by 10 AM if I hadn't come by or called or somehow let them know I was alright. Most mornings I let them know, before 10. Some mornings they've checked on me. Quite a few mornings, neither happens. With me waking up feeling A-OK in the 40s, and waking up feeling not so great in the lower 30s and upper 20s, I feel that it's important for somebody to be checking on me, every single day.
I told my mother that I am thinking about paying for one of those services where somebody calls you every morning, and if you don't answer, calls a contact and if there's still no answer, calls 911. I do not want to end up dead in bed. Nump.
My mother put on the calendar on each day for the rest of the calendar who (either herself of my fatehr) was going to come by, and at what time.
I live in the same apartment building as my parents. They live with my brothers on the second floor. I live with a roomate (a very cool guy) in the basement apartment. It shouldn't be so hard for someone to check on me every single day.

First Day of Class

Today was the first day of the winter quarter. I got to sleep around midnight and from three AM until around four thirty I slept in fifteen minutes bursts. Finally I decided to check my blood sugar. It was 256. Yuck. I got up, took some Novolog, went to the bathroom, laid down. Got up for the day at five thirty. Took Lantus.
Before my first class, at eight, I checked my blood sugar, in the lower 200s. I injected.
Before my second class, around eleven, I checked my blood sugar, around 200. I injected- two units Novolog.

My third class was Mainstreaming In Education: Including Special Needs Children in the General Classroom. Right up my alley, right? The professor opened by asking us to ask him whatever we wanted to about him. I asked him about whether he identifies as learning or otherwise disabled (short answer is yes, as ADD). A classmate asked him about his hobbies and he said he cooks. Another classmate asked if he could bring food in for the class. He said maybe as a potluck. I said, a potluck might be a good way to get to talk about mainstreaming kids with celiac sprue. Somebody else said, Yeah, or a peant allergy!
My professor then got thoughtful and said that yes, food in the school could be a special needs issue.
He talked about about a diabetic student. He started to describe diabetes and at first his description, though not precisely accurate, was good enough for me. It was a fairly typical description from a person who knows a couple diabetics. Then he said that juvenile diabetes is a hereditary condition that people are born with.
So I interrupted and said that actually, it's an autoimmune disorder that people are not born with; that the rare cases where people are born with diabetes is strictly speaking not type 1. My professor asked me a few questions about diabetes and I answered them to the best of my knowledge, though as briefly as possible.

Then guess what? I felt hypo. Not wanting to look like testing my blood sugar was making a point, I tested as inconspicuously as I could. 69. I pulled out a twizzler and ate it.

Later in class, we were talking about our experiences dealing with people with disabilities. I said that I identify as multiply disabled, that I'm involved in disability advocacy, and that I prefer the company of disabled people. My professor said that that's great. He told the class that people with disability have a voice- a loud voice, he said. He said that I (Jonah) will be speaking with that voice.

I hope I can remember to always make it clear that my opinions are NOT shared by all disabled people.