Sunday, July 31, 2011

A Life of Control - Book Review

A Life of Control: Stories of Living With Diabetes
by Alan Graber, Anne Brown and Kathleen Wolff

First of all, you've gotta admit that's an awesome title. A life of control, I want that. Second, it's got an awesome cover. The title is inscribed in the screen of a One Touch Ultra (not a mini). Third, it's got a pretty impressive variety of diabetic stories inside, from the blind diabetic running a small store to the marathoner who runs only a half marathon the year she's diagnosed.
But despite all of that, this is not a great book. It is a compilation of stories of people with diabetes with the opinions of the authors interjected here and there, and in their interjections, they mess up the flow of the book, introduce numerous logical inconsistencies, while failing to offer insight or criticisms more sophisticated than someone entirely uneducated about diabetes could come up with.
I would not recommend this book to anybody who doesn't already know that weight control is not crucial to blood sugar control, pump users don't have more severe diabetes, sugar for diabetics is not akin to alcohol for alcoholics, and doctors can be judgmental idiots.
I would recommend this book to people who are secure in their knowledge about diabetes and are merely curious to see a wide range of other diabetics, including some you're unlikely to find online.

Friday, July 29, 2011

Feeding the Insulin

I was trying to figure out my insulin to carb ratios in order to write them down in an "in case I am unconscious" script, and it got me thinking about why I no longer know or really care about my insulin to carb ratio. My stomach stopped hurting (baruch Hashem! as we say in my community) about a month ago, and since then I've been doing something I haven't done in a loong time. It is what I call feed the insulin, and it is definitely part of why my blood sugar average is down by 20 mg/dl from June.

Here's how a typical breakfast or supper goes for me, if my blood sugar is in the 80 to 180 range before I eat:

Step 1: I take a lotta Novolog (or Regular). Somewhere in the range of 8 to 15 units.

Step 2: I wait 10 to 20 minutes.

Step 3: I eat about forty grams of carbohydrates over the course of about twenty minutes.

Step 4: I wait ten minutes and see what my Dexcom shows my blood sugar as doing or not doing.

Step 5: . If blood sugar is level, I eat more. If blood sugar is falling, I eat lots more If blood sugar is rising or high, I don't eat.

Step 6: About two hours after I took the insulin, I take a look to see if I need more insulin or more food. Usually after breakfast, it's more food, and after supper it's been more insulin.

Tada! For the record, when I do count the carbs, it appears that my breakfast ratio is about 1 unit to 8 grams of carbohydrates. I haven't counted enough suppers lately to have a good idea as to what my ratio is in that department.

Feeding the insulin has generally gotten a bad rap in diabetes history. It's often associated with fixed dose insulin regimens, particularly ones based off of NPH. The most widely touted advantage of the basal bolus regimen is that you don't feed the insulin; the insulin feeds you. But I think feeding the insulin has gotten the short shift.

If I decide how much insulin to take- I say I'm 5 units of hungry or 15 units of hungry- and then watch the monitor to find out how hungry that really is, I get much more stable blood sugars than if I decide I'm 75 carbs worth of hungry and then use yesterday's formula to find out how much insulin that is.
And if it turns out that I'm more than 5 or 15 units of hungry, well, I can inject again.

I continue to have more problems with my overnight blood sugars than my daytime ones. Too bad I don't stay up all night eating.

Tuesday, July 12, 2011

My brother Tree is home for the summer. And, I just realized, he has a Windows laptop! Now, you may be thinking, Jonah is a Windows fan?! but it's not that. It's worse. I'm a Dexcom user. Dexcom only lets you review data (other than the past 24 hours' graph) on the computer (or print outs). And Dexcom software is designed to only run on Windows. And I really wanted to look at my averages.

The good news is, my July average so far is 132, which is a huge drop from my June average which was 158. I had been dreaming that it would be lower, but oh well. It was informative for me to look at the hourly trend chart of the past couple of weeks. My blood sugar is apparently hitting a high at midnight- there's a sharp rise in the hours coming up to midnight- and then it falls until by 6 am I'm typically low. So I think I need to take it easier on the Lantus.

The Regular so far isn't really doing what I meant it to- it seems to be kicking in at roughly the same speed as Novolog and also it's not lasting as long as I hoped. Frankly, it seems a lot like Novolog.I guess it's worth knowing if Regular does act just like Novolog for me, since Regular is cheaper, but it's not what I hoped to find.

I'm already thinking about what to write about when I do November facts this year (if you don't know what I'm talking about, read the archives for November 2010). For sure I want to write about lipodystrophy. I also want to look at trends in complications. If there's anything diabetes fact related you'd like me to write an essay on, let me know between now and halfway through November.

Friday, July 08, 2011

New Shipment of Diabetes Stuff

When I started getting Accu-Chek aviva test strips, they send me boxes that each had one canister of 50 strips. A few years ago, they switched to sending me boxes that each had two canisters of 50 strips each, the practical difference being that I got half as many code chips. In this shipment, they've gone back to boxes with one canister of fifty strips.
picture with a small, cubic, box of test strips, next to a box with twice the volume

I'm switching from mini pen needles, which are 5mm and 31G, to nano pen needles, which are 4mm and 32G.

picture of purple and white mini needles box and green and gray nano needles box, as seen from the top

As a math teacher, I was really struck and not at all happy to see the major mathematical error on the back of the Nano needles' box. It has a picture comparing a Nano needle to a short needle. The caption says "BD Ultra-Fine Nano is 50% shorter & 8% thinner!" and underneath, written on the pictures of the needles, it says 4mm² an 8mm² on the green one. But the dimension being described is length, not area. The difference is between 4mm and 8mm, not mm². This is a crucial difference.

A picture of the the ad described above

The opticlick Lantus pen cartridges have been discontinued, so the pharmacy called my doctor and asked for a prescription for a different form of Lantus. I expected to get vials, but to my surprise I got these Solostar disposable pens:

an open box showing five gray pens, and another showing three cartridges

Unfortunately, although I wanted syringes with half unit increment markings, I once again got the ones with whole units. The box with the half unit increment markings is from almost a year ago.

Two boxes advertising BD Insulin Syringes with the BD Ultra-Fine needle- one in white an purple that and one in gray an purple. The gray and purple also shows a display of marks with half units and whole unit measurements

Sunday, July 03, 2011

Ordering Insulins

I've been getting most of my diabetes prescriptions through Prime Mail pharmaceutics but I'm starting to rethink that. It's been a big hassle, dealing with them. They have sent me the wrong stuff or called because they couldn't figure out what I wanted or insisted that my doctor rewrite a prescription or called my parents instead of me and also they haven't changed my sex in their system, I don't know why, so every time they call they want to talk to "Ms. Jonah" and I tell them no can do but you can talk to me, "Mr. Jonah" and they get kind of flustered and ask for my date of birth but they must not be making a note of it because I have to listen to the same thing over and over.

Anyways, on Friday they called a few times. First they called my parents' number but I wasn't there. Next they called my number. They wanted to know something about the credit card. It's my father's credit card, so I went over to my parents' and gave my phone to my mother to deal with that.
They called a little later in the morning to say that the Novolin R prescription (that's Regular, FYI) had been written as a one month prescription and therefore they couldn't fill it, so they wanted me to call my doctor and get a new prescription for a larger amount of Novolin R. I tried unsuccessfully to make the point that the one vial of Novolin R was in fact intended for a three month supply, and that you could tell this from how my doctor wrote the prescription (he wrote Novolin R, one vial, three to six units per day, refills: 2). As six units per day for three months is still less than a thousand units, and since the refills are generally meant to written so that the doctor won't have to rewrite the prescription for a year, I thought it was totally obvious that my doctor meant it to be a three month supply, but apparently not.

So then I hit upon the bright idea of taking the prescription to a local pharmacy. The reason I use prime mail is cost. So I asked them how much it would cost. The website had indicated 17 dollars; the woman on the phone said it would be 20 dollars if it was written as a one month supply, or 46 dollars if written as a two months supply. Keeping this in mind, I went to walgreen's. I had walgreens call Prime Mail and get my prescription. Within a couple of hours (I went out and came back) I had my vial of Novolin R. I paid $17.64 and insurance made up the remaining $51.34. Not too bad!

My parents have been getting a bunch of automated calls for me about my Lantus; apparently the opticlick cartridges are being discontinued, so they want me to take Lantus from vials, and they need a different prescription from the endo, but he hasn't gotten back to them yet so they want me to pester him.

Unfortunately my blood sugar was doing funky things already so it might not have been the best day to introduce the regular but I took three units of regular (combined in a syringe with nine units of Novolog) at supper time. I also dropped that night's lantus dose. I woke up in the morning with a nice blood sugar (88 mg/dl) but the night looks to have been bumpy. I took three units of regular again with my supper a few hours ago. I'm not sure what my bg is doing right now- it looks like it's jerking up and down by itself but maybe it's just my sensor dying.