D'You Want to Be Profiled?

Last year in my month of diabetes posts, I profiled some of the lesser known well known diabetics- Jackie Robinson (as well as his brothers Mack and Edgar), Ann Rice , Sonia Sotomayer and Leonard Thompson.

This year I would like to profile another few interesting diabetics. If you are on insulin and would like to be profiled and you have some interesting accomplishments (which most people do) then let me know.

What's Luck Got To Do With It?

Towards the beginning of July 2011, a miracle happened. My blood sugar went below 200... and it stayed below 200 for FIVE DAYS. It was the first time since 2008 that I had stayed below 200 for more than one day. I had previously stayed under 200 on less than five days in 2011. I had averaged less than one day per month in which I'd stayed under 200 for all of my months I'd been monitoring my blood sugar.
And the thing was, I wasn't doing anything any differently than I'd been doing it for months.
I had an endo visit with an A1c in June 2011. My A1c then was 7.0%. About a week later, my blood sugar mysteriously got much more stable and easy to control. Although I certainly see highs and lows (some of them very high and very low), and especially at night, often my blood sugar has been stable. It is amazing. I have no idea why it is happening. It takes days off (the last three have been bouncy) but has been back to stability enough that when the line seems straight, I trust it to stay straight while I (for instance) change my sensor. And my A1c last week was 6.1%. If this keeps up, my next A1c might easily be under 6%.

When I talked to my endo and told him that my blood sugar was much more stable- that I now often see straight lines on my Dexcom, some for as long as TWELVE HOURS!, he asked me if it was because I had figured stuff out, if my long experience has been paying off. The answer is no, or at least, not really- because my blood sugar is still, without a doubt, willing to go very high if I eat out of proportion to the insulin I take, an it sometimes plunges for no reason and would do worse if I didn't react promptly- but overall, the answer is no.

So I've been thinking about the variation in my blood sugar control over the past five years. My A1c hasn't actually varied by a lot- from 6.1 at its lowest to 7.2 at its highest- but it has varied. The question in my mind is: how much of that variability has been due to the variability in the intensity of my diabetes management?

It very clearly has mattered whether I do something v nothing- a missed meal shot means a blood sugar of over 400 usually, and my A1c at diagnosis was over 16%. And there was one A1c rise that happened when I was guessing at all of my carb counts (that's the 7.0 in March 2008). And my A1c did fall right when I went on the Dexcom.
But my A1c rose when I went on the Guardian, and the recent drop in my A1c had nothing to do with my efforts, and the facts of my diabetes itself have nothing to do with my efforts.

Without my efforts, the A1c of 6.1 would be impossible. And the fact that my A1c has not been back up to my pre-dx levels, I take credit for. If I was lax about taking shots, I would have regain an A1c of 16% if I didn't die first. But the difference between my A1c of 6.1 and 7.2 does not reflect any difference in my effort, and I don't think it reflects a difference in the insulins I've used or my blood sugar monitoring. It just is.

And that is why I am more motivated by reading about diabetes in the abstract than my own meter. Diabetes facts to honor diabetes month to start on Tuesday.

Dexcom Death Knell- A Story With Picture

I was sitting at my computer last night, when all of a sudden my Dexcom made a loud short high BEEP sound. I picked it up and pressed the buttons- no response.



I put it down, saddened. A couple of minutes later, the Dexcom produced two long very loud, low beeps, and shook as long as it beeped. It initialized and turned on.



It allowed me to look at data for a few minutes


and then went to the shrill beep, the blank screen, and a couple of minutes later, initialized again.

I got the webcam set up in the expectation that this would happen again, but when the third five minute period went by, I instead got a shrill beep and then:




It would allow me to turn it on to view the error code, and that was all. I decided to hit the reset button to see what would happen. The reset button is on the back of the dexcom and you can reach it by inserting a stiff thin wire... or a needle.


It beeped when I hit the button in back with the needle, but other than that there was no immediate result. However, after a minute it initialized... but then went straight to the error screen:



After repeating this a couple of times, I gave up.

I tried it again in the morning, and this time, after initializing, it gave readings for about twenty minutes before showing the error screen briefly, and then became totally nonresponsive. I can't get it to turn on, to beep.... nothing.
I called in to order Dex The Fourth this morning.

This Dexcom died very much in a way similar to my first Dexcom, except that that one did the whole initializing, working for a while, then spontaneously initializing, for a week or two before dying.

I got ready for a rough Yom Kippur fast because all of my fasts in the previous year had been rough. There was Yom Kippur 2010, in which I developed very large urine ketones and wasn't sure what I should do because it had never happened before. There was T'isha B'Av, where my blood sugar behaved itself but my stomach didn't and the nausea persisted for two weeks post-fast. There was the nonreligious personal fast of June 2nd in which I drank water but developed large ketones anyways. There was Ta'anis Ester, on which really high blood sugar forced me to correct and the correction brought me low and ended my fast in under six hours. And on the fast just the week before Yom Kippur, my stomach cramped badly enough that I gave it up and ate before it could get worse.

So, the night of Yom Kippur, I dropped the Lantus dose from 10 units to 6 units. I stayed home to minimize exertion the day of the fast. I corrected conservatively for highs but nonetheless ended up taking four correction shots before I went to sleep for the night. I woke up with a blood sugar of roughly 170 in the morning. I bounced a little bit after waking up, and then spent the next six hours with Dexcom readings in an almost perfect straight line at 160. Because I was feeling so well with only an hour and a half left of the fast, I checked my blood sugar; the meter said 148 to the Dexcom's 161. I walked to the synagogue (about 1 and 3/4 miles) with no discernible change in the line.
Yom Kippur was the easiest fast I've had in the past thirteen months.

Unfortunately, I forgot to prebolus before breaking the fast (I mean, I injected just as I started eating) and I spike to the 290s before coming down. I took nine units that night, which kept me right on the edge of low, and spiked very dramatically when I ate a small roll for breakfast this morning. In fact, you can see me coming down from that spike (keep in mind I was 70 half an hour before the beginning of this 24 hour graph) and having a roller coaster-y day.

I am posting this Dexcom graph because, on diabetes art day a month ago, somebody put a picture entitled glucoaster, a word that I assume means to have blood sugars very high and very low in close proximity, so that he graph looks like a roller coaster. But the graph in the picture was a dream! Yeah, it went up and down- but not very high or very low. I would like to show you something a little closer to a real coaster (though not my most dramatic works, I'm afraid). I'm also posting this sort of as a response to Reyna's comment on my last post, about how stable my blood sugar looked. My blood sugar is a lot more stable in the past year than I've been accustomed to. But I don't have a typical day. And there was a day last week in which I spent more than 10 hours below 60, a lot of that time below 50- stable, yes, but not the good kind. My A1cs in the last five years have ranged from 6.1 to 7.2 and they are not accomplished by any small amount of effort or tweaking.
I do not experience some of the challenges that other D folks do- I don't really have dramatic exercise drops, for instance, and I usually escape mealtime spikes. But I very rarely spend a night in range (in range meaning 60 to 180) and I see both 30s and 300s on a regular basis. Anyways, here's today:

Forgive Me

Well, if I'm not supposed to write about... that... today, then there's another obvious thing to write about because today is erev Yom Kippur. I guess that Day of Atonement Eve in English, but that really doesn't sound the same to my ears. I've decided to spend the day at home praying this year to maximize my odds of a successful fast. I hope that's how it works out.

Anyways, one of the traditional things we Jews do at this time of year (well, actually, I'm a bit late- probably should have done this a couple weeks ago) is to try and find out if we've been offending anybody, if we have anything to apologize for (if?), and then to apologize. So, uh... it seems likely that I've offended somebody. I'm sorry. If there's anything I've been saying that's been secretly bugging you all year, let me know. You can leave a comment. You can even send me an email. For the next few weeks I will check email at twerpchicago at hotmail dot com (not my regular email address).

To all the Jews reading this, I hope you have a meaningful Yom Kippur, an easy fast, and a good year.

Dexcom Graph Interpretation

It's been so long since I published a post with a picture or video of me, I figure none of my current readers were reading the blog then. So, here I am. I wanted to show how I'm wearing the sensor in a more forward part of my arm than usual. I also wanted to show why; that the backs of my arm are all red and bumpy, but the sensitivity on the webcam was frustrating me so I didn't. I guess it's not that bad but every time I ask my parents where to put a new sensor they let me know that the part of my arm that's hard to see still looks really irritated. But this location is feeling fine so far, despite being a place where I generally wouldn't even do a shot on account of it is not exactly fatty.
Anyway. I also wanted to illustrate how the Dexcom graph looks. The current sensor was inserted pretty close to 24 hours before the picture was taken. So you can see a little area where there's no data in the warm up period. You can see the overnight data, which doesn't make the most perfect of lines- the trace is not really good at the beginning. Those little horns on the top of the mountain blood sugar at the beginning are probably the Dex's imagination. When I got up at 6 AM, the Dexcom read 226 and my accu-chek aviva said 202, which is in the ballpark and not too shabby. The trace for the rest of the day is much better with no weird shapes or sudden bumps. I next tested my blood sugar just over twelve hours later, when the Dexcom had already been telling me that I was low for close to an hour and I was a little suspicious. Dexcom said 57; my accu-chek aviva said 52. Once again, about 10% off.
This graph is interesting for a third reason. When I woke up in the morning with a high blood sugar, I thought maybe my Lantus dose was too low. But a review of the graph suggested to me that that hadn't been the problem. Because right around 1 AM, when I was asleep (I went to sleep within half an hour of the initial calibration), there's a low, and then within that hour, there's a rise in my blood sugar of about 150 mg/dl. That may indicate a rebound (that fabled beast which some claim is only a story) or it could be the last of my supper or something; in any case, it's not basal drift. If I had no Lantus whatsoever on board, my blood sugar wouldn't rise that quickly (if I have no Lantus at all for the night, my blood sugar rises about 50 mg/dl/hr). So I didn't raise the Lantus dose tonight- thank you, Dexcom.

By the way, in the picture I'm wearing a purple t-shirt that says BYC for Broadway Youth Center, which is one of the only spaces for queer youth in Chicago. It particularly caters to street youth, and offers stuff like showers and toiletries as well as a drop in center and programs. I've been going there for six years. However, almost nobody has seen me in this shirt because I almost always wear long sleeves in public.

In my first year on the Dexcom, I wore about fifteen sensors on my arms, exactly four on my legs, about ten on my stomach, and only two on my butt. The two I'd worn on my butt weren't stellar in terms of performance or longevity, but they did both last a week, and I figured I'd give the location another two tries.
Those two tries were my most recent two sensors. The first one was, from the get go, not so great; it kept being off and having ???s. It also started hurting after the third day. But it got to the end of the week still working, not being quite off enough to cause errors, and since I was out and didn't want to change sensors, I restarted it. It went to ??? within a few hours and I pulled it after 8 days of wear. Oddly enough, I had a brownish-purple bruise under the plastic part of the sensor.
The most recent one worked well from the beginning. It sometimes overstated or understated a low or high but wasn't wrong about whether I was high or low, had no ??? episodes, and didn't hurt, except when I caught it on door knobs (my butt is at door knob height, apparently). It was a no-brainer to try to restart it today when it hit the one week mark, but it failed to restart; the initial calibration caused a SENSOR ERROR 1 and it didn't change its mind about that even after six hours, so I pulled it. It's not the first sensor that seemed to have been working well that wouldn't restart.
My general feeling about sensors on my butt is that they are less likely to work well than sensors on my arm or abdomen but are probably worthwhile just for the sake of site rotation. Certainly, I don't mind moving the Lantus shots to my abdomen while wearing the sensors on my butt.

But thinking about the last few sensors has made me wonder about how to rate sensors on quality instead of longevity. Minimed's software uploads allowed a really easy comparison so you could see how the sensors were doing in terms of accuracy. The closest Dexcom comes to offering a quality evaluation of itself is to show how many data points I got on a given day and while that's certainly interesting, it's not enough to show quality, since a data point could be missing for many reasons other than ??? or sensor error, and a data point that's present doesn't prove it was any good.

This may also be an opportune time to point out, for those of you reading this through a feed, that I have some about me pages at the top of this blog. I had three and have just added a fourth, about the Dexcom sensors.