Stupid Diabetes

I woke up at quarter to 7 this morning with the pump going HIGH- over 400.
So I tested on my meter - 281. Stupid pump, I say, and put in the number plus carbs for breakfast. One minute later: beep beep beep NO DELIVERY. Stupid pump, I say, and take it off, and the sensor too for good measure. Then I take a shot of about four times the pump's recommendation, set my alarm clock for 8 am, and go back to sleep.
8 AM, I wake up and test. Meter says 282. Stupid diabetes, I say, and test my urine ketones. Moderate.
Just tea for breakfast.

P.S. As a side note, my basal rate from 6 am to early afternoon is 0.15 u/hr, and I took a shot of 12 units, so the lack of basal delivery in that hour is kinda unlikely to have mattered.

P.P.S. I've been feeling pretty tired lately and kind of burned out and nobody seemed to be reading this anyways is why I haven't been posting.

10 Things About Metformin

- Metformin is currently the most commonly prescribed medication for type 2 diabetes; at least 4% of all Americans are taking it.

- Metformin is the only diabetes medication shown to reduce risk of heart disease vs no medication at all.

- Metformin is also prescribed for polycystic ovarian syndrome.

- Metformin interferes with digestion and often causes diarrhea.

- Roughly 5% of type 1 diabetics are taking metformin. In type 1 diabetics, metformin reduces insulin needs but those on metformin generally don't have lower A1cs or any difference in hypoglycemia rates.

- Metformin can be prescribed to prevent type 2 diabetes, and sometimes is.

- Metformin is available in brand and generic form, in pills and liquid.

- Metformin is in the medication class called "biguanides" and because another of the biguanides caused an awful lot of lactic acidosis when people took it and drank alcohol, drinking alcohol with metformin is not recommended. However, only about a dozen cases of lactic acidosis on metformin are known to have occurred. Ever.

- Although it's not an officially recognized side effect, I have met two people who've told me that taking metformin gave them brain fog. Metformin IS known to exacerbate vitamin B12 deficiencies, and a few studies have had inconclusive results when trying to figure out what effect metformin may have on dementia.

-Metformin was first described in an article in 1922, but was not FDA approved until 1995.

Diabetes affects the Brain

Shortly before I was diagnosed with diabetes, I began experiencing memory problems. They continued to get worse for months after I was diagnosed, and my memory has never returned to what it was before my diagnosis.

The changes in my memory were more life changing for me than diabetes- and y'all know diabetes was a game changer.

I don't know for certain whether or not diabetes was responsible, but I suspect it was.

Diabetes is associated with cognitive impairment in many domains as well as an increased risk of dementia in middle aged adults. DKA (which I was in at diagnosis) is associated with poorer cognitive performance for quite a while after the recovery from DKA. 

I have read a lot of studies in which diabetics do a lot worse on cognitive tests and school performance; I've read others where there is no difference, and even a couple of studies where diabetics outperformed their siblings in school (maybe diabetes messed with sibling homelife, but the diabetics and not their siblings were given some slack in school?)

However, whatever the cognitive performance, diabetes undeniably is associated with brain changes visible on brain imagery:

http://diabetes.diabetesjournals.org/content/early/2014/06/12/db14-0348.full.pdf+html

And of course, diabetes increases risk of stroke.

Lipodystrophy

Lipodystrophy- changes in fat composition as a result of injections, especially insulin injections- happens in two major types.

Lipohypertrophy occurs to at least a mild extent in the majority of people who have used insulin for five or more years; it tends to make itself known by a puffiness in the area(s) used most often for injection.

Lipoatrophy, where the fat from an area disappears, is much  rarer. I don't think anybody's done any good studies on lipoatrophy's incidence or prevalence, but my sense is that it occurs in 1-2% of long time insulin users.

Both types of lipodystrophy can change the insulin absorption. In most cases, it just makes it less consistant; in extreme cases it may prevent insulin absorption in those areas entirely. Recovery in a specific area may or may not happen after changing where the insulin is injected or infused, changing the insulin delivery method (from pump to shots or the other way around), or changing insulins.

Personally, I have so far experienced very mild lipohypertrophy on my thighs and that's it as far as visible lipodystrophy is concerned. However, I have gained a significant amount of fat because of being unable to walk nearly as much since my foot injuries in June, and I thought I'd try the Quick Sets again. Two out of two kinked, and this time I can't blame a lack of fat... I'm gonna blame scarring and/or abnormal density of fat tissue.

Interferon Alpha Treatment Can Cause Type 1 Diabetes

Years ago, I had dramatically elevated liver enzymes for a few months. While waiting for answers from the medical professionals, I went looking online for information about hepatitis, and on a hepatitis information board, I met a couple people who had developed type 1 diabetes within a year of being treated for hepatitis C; they said it was a risk of the treatment. As it turns out, the professional literature suggests that but has mostly hesitated to come out and say that the treatment definitely causes T1D.

Chronic hepatitis C infection is associated with an increased incidence of type 2 diabetes, which makes some sense because the liver is involved in so much of glucose regulation.
The only curative treatment for hepatitis C, interferon alpha treatment, is known to trigger autoimmune diabetes.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4138583/

When I  look up interferon and diabetes, however, I get a lot of results that have nothing to do with hep C.  Because an interferon, as it turns out, is a signal that cells send out to inform the rest of the body that they have been infected. And interferons are involved in the development of autoimmune disease, because in some autoimmune diseases- including type 1 diabetes- the organ that comes under attack from the immune system sends out interferons. Whether that pre- or post- dates the immune attack is uncertain- but this plays a part in the debate about the possibility that autoimmune diseases don't start out as autoimmune diseases. http://www.ncbi.nlm.nih.gov/pubmed/23966997
Genes for specific forms of interferon increase type 1 diabetes risk- although not enough to be anywhere close to the whole story. http://www.ncbi.nlm.nih.gov/pubmed/24402011

Glucokinase

The typical gene for glucokinase can produce two different but very similar forms of glucokinase. One of these forms is typically produced in the brain and pancreas; the other form is produced in the liver.

This is because, among its other jobs, glucokinase is responsible for converting glucose to glycogen for storage in the liver, and its also responsible for signaling to our islet cells so that they know how much insulin and glucagon to produce.

People with one normal copy of the glucokinase gene and one copy that doesn't work as well generally have MODY 2- something whose classification as a diabetes is debatable. These people's bodies maintain blood sugar in a range as narrow as normal, but higher- they have a higher blood sugar set point that the body aims for. Attempting to treat it is difficult because of the body having an intact response to hypoglycemia, and that response kicking in at fairly high blood sugar levels. Fortunately, the risk of diabetes complications from MODY 2 is very low and so most doctors don't recommend treating it.
 Although it doesn't predispose people to type 2 diabetes, when type 2 diabetes happens in a person  who has MODY 2, it can be very hard to treat.

People with two copies of the glucokinase gene that don't work well may have neonatal diabetes, and there are also mutations of the gene that cause abnormally high production of insulin with hypoglycemia.

Kimmelstiel and Wilson's Syndrome

Once upon a time, diabetic kidney disease was rare. Diabetes tended to either: occur so severely that death resulted from DKA or occur in elderly persons (or at the least, elderly for their time) who tended to die of infectious disease before kidney disease could catch up with them.

In December 1936, Clifford Wilson (1906-1997) and Paul Kimmelstiel (1900-1970) published a paper about kidney disease in the American Journal of Pathology called Intercapillary Lesions in the Glomeruli of the Kidney, describing kidney disease (with intercapillary lesions in the glomeruli) that primarily occurred in diabetics who also had hypertension and kidney disease signs and symptoms  such as albuminuria and edema. They speculated that diabetes might be the cause.

As an aside, the current wikipedia article mistakenly cites a different article by these two authors as the paper that first described diabetic nephropathy, but in fact their article on benign and malignant hypertension's only mention of diabetes is in noting that a small portion of autopsies showed pancreatic lesions.

Wilson and Kimmelstiel's description of diabetic kidney disease earned them the naming of the major type of diabetic nephropathy- Wilson-Kimmelstiel Disease.

However, it should be noted that the first paper mentioning that kidney changes could be seen in some diabetics was published in 1854.

Today, diabetic nephropathy is a major cause of death for type 1 diabetics; in some populations, it is the top cause but in most groups it ranks #2 or #3.

Source:
Landmark Papers in Nephrology, ed John Feehally et al. 2013

Things That Lead to Incorrect Type 1 Diabetes Diagnoses

-Not everybody with diabetes antibodies develops type 1 diabetes, and some people coincidentally have diabetogenic antibodies and non-type 1 diabetes. This is particularly true of people with only one positive diabetes antibody diagnosed with diabetes as adults.

- Many doctors incorrectly assume that diabetes in a child is type 1, and don't test anything else; or despite tests that don't support a type 1 diagnosis, don't know what else to think.
I always think of this when I remember a family I met on the DOC many years ago whose son was diagnosed with diabetes with a blood sugar over a thousand and was in a nonketotic hyperosmolar hyperglycemic coma at the time. He was antibody negative. But he was also ten years old. So they diagnosed him with type 1 diabetes anyways and put him on insulin. About a year (maybe two years?) later, he went off insulin and about six years later he's still off insulin.

- A lack of available other diagnoses. Type 2 diabetes is by definition diabetes caused by an insulin secretory defect on top of a background of insulin resistance. However... that description does not hold true for a very large portion of adults with type 2 diabetes diagnoses, and many doctors are reluctant to make a diagnosis of diabetes that's not type 1 or type 2, particularly because the other available diagnoses are other specific diabetes and gestational diabetes, and it's often impossible to say what specific other the diabetes is. So if they're pretty sure there's not an insulin secretory defect on top of insulin resistance, and they're pretty sure it's diabetes... then you may get a type 1 diagnosis.

- The c-peptide test of insulin production needs to be performed when a person is NOT in DKA, and has a blood sugar that's only slightly high to be a good measure of insulin producing capacity.

Based on studies of c-peptide levels in people with longstanding diagnoses of type 1 diabetes, I think that at least 5% of type 1 diabetes diagnoses are incorrect.

Frank Rizzo, Former Mayor of Philadelphia, was a diabetic

Frank Rizzo, who was head of the Philadelphia police department from 1967 to 1971 and mayor from 1971 to 1983, was diagnosed with diabetes around age 19 (he served one year in the Navy and was discharged because of his diabetes diagnosis).

I believe he had type 1 diabetes despite the fact that he himself referred to it in public as "mild diabetes" because:
-after his death, his doctor mentioned that he took insulin
-he was diagnosed no older than 20
-it was severe enough a case of diabetes that it was diagnosed in 1939 (when mild cases didn't tend to get diagnosed) and to get him discharged from the navy in a time of war- which would not have been the case if he could have gotten away with controlling it via diet.

If I am correct, then Rizzo lived with type 1 diabetes for just over fifty years; he died in 1991 at the age of 70.

I have,  TBH, mostly heard negative things about Rizzo's mayorship- particularly about police brutality and racism. Nonetheless, he was a remarkable figure... and he had diabetes during all of the famous parts of his life.

People Normally Have Blood Sugar

I have heard people say that  somebody "has blood sugar" when they mean "has diabetes". Today, that  sounds ignorant; two hundred years ago it would have been scientific opinion.

I have not been able to tease out which sources are accurate with regards to who did what in terms of figuring out that in general blood DOES contain sugar. However, the following people seem to have been involved:

Hermann von Fehling (1812- 1885) a German chemist, after whom Fehling's solution is named. He lived in what is now Germany, and he studied chemistry. His solution is used to test for the presence of sugar, and it was still in use as the primary test for sugar when insulin came around. He developed it in 1848, and appears to have been aided in part by

Barreswill 1817-1870 a photographer, who was working on developing chemicals for better colors in pictures; finding out what chemicals changed color in reaction to what  was useful to Fehling, who may have been a friend of his.

Claude Bernard (1813-1878) whose experiments on animals demonstrated that the liver releases sugars in the blood stream even in animals that haven't been consuming sugar, and that beyond  a shadow of a doubt, sugar in the blood is normal. His main experiments with the pancreas were with digestive juices; he suspected diabetes was caused by signaling issues between the liver and brain.

Worms

One of the more strange sounding books  that comes up when I search my library's catalog for books on autoimmune diseases is An Epidemic of Absence, which I have not read. It takes the cleanliness hypothesis- the idea that the immune system makes more errors and creates more disease when there are fewer antigens in the environment (an antigen is any surface that antibodies may target)- and blows it further.
According to the book jacket and reviews, it claims that the absence of internal parasites  is bad for us!
So I didn't read it.

However, I was reminded of it when I came across this study today. The article about the study mentions that type 1 diabetes rates are lower in areas where it is common for humans to have worms. For the study, the researchers took worms from sheep bile ducts, and then injected the worms into a strain of mice that's been bred to have autoimmune diabetes. In the control group, 80% of the mice developed diabetes; in the group that was given worms, 16% developed diabetes.

New Pancreas Transplant Guidelines Kick In This Month For United States

The new guidelines change a little bit how they decide who gets dibs on organs.
When reading about the guidelines, I read a patient brochure that UNOS (the organization that decides who gets priority for organs) just put out. It's extremely interesting how different the minimum eligibility criteria are for pancreas transplant vs islet transplant vs pancreas with kidney.

Here's a link to the brochure:
http://www.unos.org/docs/Pancreas_Brochure.pdf

Fructosamine

I was looking through past years' November facts, and I see that I wrote about fructosamine levels in hair (which can in fact be used to figure out a good estimation of average blood sugar during the time the hair was growing) but I didn't mention...

Fructosamine is often used instead of the HbA1c to monitor blood sugar control in diabetics whenever there's a reason to believe that the HbA1c will not be accurate in that person, for example, if the person has been very anemic, or if the person insists that their blood sugars have been much higher (or lower) than the A1c indicates.

Starting the November Facts with a YOUCH

Tropical chronic pancreatis is a rare disease, found mostly in tropical places. It usually begins in the age 10-30 range, begins with pain, and progresses to cause poor digestion of fat due to pancreatic exocrine deficiency and then diabetes. The diabetes usually doesn't start until ten or more years after the stomach pain, but it needs treatment with insulin. Cause remains unknown, although the disease has been studied for at least sixty years.

5 Things Make a Post P.S no, 6 things PPS no, 7 things

1. On Saturday I was sitting on the couch reading and fiddling with my pump and I noticed the sticker on the end had fallen off. Being that it was Shabbes, I didn't think about it too much. Sunday morning, I called and asked if they could send me a new sticker- it's cushiony and I assume it helps the pump to not get broken if it I fiddle with it. The lady on the phone put me on hold to check, and came back and said she couldn't send me a sticker, but since it is an important sticker, they were going to replace the pump. Pump the 4th is dead, long live pump the fifth!
They are out of purple, so pump #5 is clear.
For anybody keeping track, pump #1 was replaced due to repeated motor errors (after six weeks), pump #2 was replaced due to a software error (after three weeks), pump #3 was replaced due to repeated motor errors (after four weeks), pump #4 was replaced due to a sticker falling off (after six months).


2.  While making beds, I've been subjected to a lot more TV than I would otherwise watch, including ads for invokana. I keep meaning to write a letter to the FDA on why it should not have approved invokana, or failing that, a rant here. If not sooner, expect a rant in November.

3.  I stopped taking the ibuprofen after a while because it made me vomit too much. My feet are both still swollen and my wrists are too, but they're not hurting much. I'm still afraid to walk long distances.

4. I have decided that, God Willing, this upcoming (Jewish) year is the one in which I become a foster dad. Towards that end, I'm hoping to move in November, spend a couple weeks furnishing the apartment etc, get a physical, get a homestudy, take the licensure classes and be licensed around February.  We'll see.

5. My brother is getting married next week!!!

6. I passed my eight year mark on insulin. My memory remains impaired compared to Before, and I no longer have any vivid memories of anything relating to my diagnosis. So it's much less emotional. This will be the year I get my own insurance (I became eligible at work a few months ago but still have a couple months until I have to get off of my dad's).

7. My computer broke. That's a big part of why I haven't been online much lately. I am typing this at the library.

The podiatrist says

that I have tendinitis in two tendons in my right foot and one tendon on the left. She put the right foot in a soft cast and recommended staying off my feet as much as possible and 600 mg ibuprofen three times a day for three weeks.

She also says this kind of tendinitis is much more common in rheumatoid arthritis.

Feet

Last Sunday my right foot felt cramped, like I needed to pop every knuckle in the foot. I stretched a bit and didn't think more of it.
On Monday it was a little achy but I walked to and from work anyways.
On Tuesday, I decided to wear a different pair of shoes in case that was the problem. I left the house intending to walk to work, but the pain stopped me before I reached the end of my block.
 I took the bus to work, tried not to limp at work, took the bus home. At home I took  my socks and off and.... gee willikers wonka my right foot had an egg size swelling!

So I called my endo. He recommended taking 400 mg ibuprofen every six hours and to let him know if I got a fever or it got worse. I got children's ibuprofen and took it 400 mg every six hours and nothing changed except that my left foot swoll up too. I limped through Wednesday and Thursday, and on Friday afternoon I went to see him. He gave me a podiatric referral.  The endo said he doesn't know what the swelling on my foot  is; it doesn't look familiar but it doesn't look infected either.

And by the way...
- Children's ibuprofen has high fructose corn syrup. Don't know how much, but I'm guessing about 10 grams in a 400 mg dosage, because of how much it raises my bg.

6 months on the 530G

Well, my A1c is 6.4%.  That's higher than it's been for the last couple years, but not by much (my previous three readings were 6.3, 6.0 and 6.2).
So in terms of the A1c, I guess switching to a pump has not made any major change.

Switching to the 530G did not make a difference to my hypoglycemia in the first couple of months, as far as I could tell. However, in the last few months, there has been an extremely dramatic reduction in the frequency and severity of my hypoglycemia, particularly at work and also asleep. It has NOT helped with mealtime hypoglycemia, a major issue for me (where I bolus and go low due to food not absorbing).

I thought I was having a lot more, and more severe, highs. However, my A1c does not reflect that, so perhaps it's not as bad as I thought.

I have not been able to do as much site rotation as I would like. Neither of the types of teflon set worked for me, and the longest tubing length is not available for the "steel cannula" (I put that in quotations because really it's just a needle). So although absorption is fine in my arms, I can't, with short tubing, wear it comfortably there. The legs hurt way too much. That leaves the butt and abdomen. I've been using sites on the abdomen further up than I had before, which necessitates shaving the area, and still doesn't leave me with all that much available tissue.

My pump reports that my average TDD over the past 12 weeks is 39.5 units. For the 9 week period prior to pumping, I averaged 32 units. I believe that this is a significant increase in my TDD.

I gained four pounds since starting on the pump, which probably doesn't have anything to do with it. I'm happy about it anyways.

Features and symbols on the pump that I do and don't use:
Homescreen symbol showing how full the reservoir is... not useful. One bar means anything from 0 to 45 units, and everything beyond that is plenty.
Clock- look at and use a lot.
Communication symbol with sensor... ignore. I'm always looking at the graph anyways.
Battery bar- useful but it gains as well as loses bars, so I don't really know what to make of it.
Bolus wizard- don't use. I haven't been carb counting regularly in years, and the evidence suggesting that it helps is weak. I did have it set up at first but I just don't see it being helpful.
Square bolus and dual bolus- for the most part I have just set an increased temp basal instead, but I have occasionally used this feature. Right now it's turned off.
Audio bolus- used it at first, stopped. I never wear the pump in a way that I can't look at the screen, and audio bolusing is SLOW.
Bolus using the "B" button- rarely remember to use it.
Manual Suspend- I use this mostly when I disconnect, but occasionally to cancel a bolus in progress that I've thought better of.
Sensor is usually on, although not always. I generally have only the predicted low, predicted high, low suspend, weak signal, and calibration due alarms on.
I currently have five basal rates in my standard basal. I don't use the basal patterns, although I initially gave them a try. I would use them more if I could have more than two alternates, they would automatically switch on on particular days of the week, and they did not result in a "special status" circle on the home window.
I usually use temp basals where I set the rate. I change it to percentage, and set a temp basal percent, when I want a temp basal to run during periods where the basal needs would change. I would LOVE to be able to set a temp basal profile rather than one temp basal(ie, next two hours 0.5 u, following two hours 0.4 u). I probably use temp basals on about 4 days of any given week.
I don't bother locking the keypad. I tried that at first, to stop butt-basaling, but it unlocks itself when it alarms and that's just too useless.
I occasionally set the alarm clock. I wish it allowed one time alarms instead of repeating the 1:15 alarm everyday.
I often look at daily totals. I like to know where I stand.
I have had the alarm at various settings.
I don't use the connecting meter. Not gonna have insurance pay five times as much for test strips. Plus don't like navigating that meter.
I don't currently use capture event, because I rarely upload data.
I find the active insulin settings only slightly useful. I would like to program my own way to calculate IOB. I like seeing last bolus, but would like the status screen to show all boluses within the previous four hours. Then I can more easily calculate for myself a more realistic IOB.
I think it's really silly that the status screen shows me when I started my reservoir, rather than when I changed infusion sets. Those are the ones I'm much more concerned about.
I like seeing units left, but often use it past 0, because it's got quite a bit past 0.
I like seeing ISIG, and next cal is nice but would be nicer if it were accurate.
The backlight is nice. I forgot that there was a way to turn it on when you're not on the homescreen, and finding that again was great.

Oops?

I read a  study that kept using the term insulin dependent diabetes mellitus to describe a group of people who seemed unlikely to be type 1 diabetics (they were on average 68 years old diagnosed at age 53, their average BMI was 30, and they were more than 1% of the study area's over-50 population). When I got to where it said they classified people as type 1 diabetics aka insulin dependent based on their answering yes to the question "Are you an insulin dependent diabetic" I was sure that the population was in fact mostly type 2s who were taking insulin.

So I fired off  an email to the study authors, telling them that their premise that insulin dependent diabetes has blah blah blah effect was not really valid.

Only then did I read the rest of the study. At the end of the limitations, the authors admit that their insulin dependent population seems unlikely to actually be absolutely insulin dependent because less than 10% of the "insulin dependent diabetics" were diagnosed under the age of 30.
They say that their group of "insulin dependent diabetics" is type 2s who are "relatively insulin dependent". Which, although I think it's a bunch of bull hookie, still means my email was not exactly news to them.
Oops.

It's been six months pumping. I've got an endo appointment for Monday, and I'm holding out for the A1c and discussion with the endo before I weigh in on the pump.

Decisions, decisions

I got a piece of mail yesterday that brought unwelcome news.

It was a flyer from Activa Brand Products. It said that due to new regulations regarding sterilization of vial adapters, both Activa and Medi-Jector have stopped selling supplies.

However,  Activa is trying to figure out if they might be able to continue, with raised prices, so they are asking for people to commit to supporting the company.

Now, I don't really think I'm gonna stick with pumping. The sensors have misled me and resulted in me getting extremely high blood sugar twice recently (pump read 87 and meter said 357; pump said 60 and meter said 436). I've had numerous lost sensors recently.
The number of sites that work for me is too limited for the infusion sets and the sites are not healing well. Absorption is slower than with shots. I have a lot more highs. And I just don't much like it.

Buuut... it actually has made  dealing with lows easier. LOTS easier! Both the low suspend and the ability to turn down basal help.

 So I was thinking I might wait and get an A1c (I'm way overdue- working full time makes it harder to find time for doctor visits) and see where it's at so I can think about whether or not the highs are as problematic as I think they are (I'm guessing my A1c is up by more than a point and less than a point and a half).

I've also been thinking it might be good to use the pump to allow me to experiment with NPH. 

And wondering if I'm stuck with the pump for a while longer because I don't think insurance will want to pay for a new Dexcom for me within a year of me starting on this pump (could be wrong on that score).

So, thinking about the jet: with the raised prices, it's probably only economic for me to get membership and buy from Activa if I order a lot of years of supplies. On the jet, I need very few supplies partly because my insulin needs on shots are only about 70% of my insulin needs on the pump (nope, my insulin needs have not dropped- still taking about 45 units per day pumping vs  32 I was averaging on shots). But I kind of feel like keeping the jet injector business going is a good thing.

Thoughts, anybody?

Tired

I started working as a CNA in August, and my coworkers are a lot of tough ladies (also two men I haven't got to know because they work nights and I usually work 7 am to 3 pm). Some routinely work 3 or more jobs, sometimes 24 or more hours in a row... and they're grandmothers! Me, on the other hand... I can't work a 12 hour shift without falling apart. I've been getting just a little bit of teasing about it, from women who say, "I'm 60 years old, I work 12 hours and then I love to go dance karaoke- you're a young man, you have no excuse".

Last night,  I went into work for my very first night shift, and somebody asked me if I was going to be working 16 hours- to work my usual day shift as well. And I said "NO!" and she said that she had worked the previous night shift, had worked private duty for 8 hours, and then worked her usual, the evening shift- she'd worked 24 hours straight. And she's a grandma.

And I... I offered diabetes up as an excuse. I said that because of diabetes, I haven't had a solid night's sleep in 8 years. Which is not quite true; but I have 3-4 nights per week with lows and/or highs bad enough that either I stay up late because of them, or they interfere with the quality of my sleep. And 8 years puts me a few months before my dx, but April 2006, I had started wetting the bed and couldn't sleep due to thirst, so I think it's pretty fair to say that my sleep was being interrupted by diabetes then.

I feel a little guilty and uncertain blaming diabetes for my lack of sleep. I was never the world's champion sleeper, even when I definitely didn't have diabetes. And I'm aware that there are many type 1 diabetics out there who are capable of working 24 hour shifts and who probably would not appreciate me saying that diabetes is why I can't do a 12 hour shift. In fact, a few of my coworkers are type 2 diabetics... but not, as I understand it, in any kind of symptomatic way.

I believe that I am impaired by diabetes.
I do not believe that blood sugars like mine would impair everybody.
I believe that I have the right to say that I am impaired by diabetes.
I do not believe that I have the right to say that diabetes is by its nature impairing.
I believe that it is not my fault that I am impaired by diabetes.

And these are hard things to reconcile.

Not Much Management Monday March 31st

Rose overnight from about 0130 hours, when my bg was about 120, until about 0400 hours, when sg was 210.

When I got up at 630, sg was 211 and bg was 246. 

Had 2.4 u correction at the time; went to synagogue, sg had dropped to 190 at the end of services near 0800 when I bolused 10 units. Ate 20 g of crackers and I think 48 g of oatmeal (uncertain regarding the oatmeal because my father cooked it with raisins).  SG was down to 130 at 0900, rose a little bit and dropped; at lunchtime was 90 and looking stable. Took only 0.5 units for a snack of two rice cakes.  SG shot up to 155 by 1400 hours, and then drifted up a little so when I left work SG and BG were both 175. Took 1.1 units and walked home (2 1/4 miles). SG stayed steady the whole walk home but took a nose dive as soon as I got home. Bolused 8.5 units and ate supper without carb counting; it was split pea soup and noodles and I ate four bowls. SG dropped to 95, then came up to 140, and is now drifting very slowly downward. 

Today's blood sugar has been rotten and I don't want to post it. I was over 300 a couple times. I had 140 grams of carbohydrate for breakfast, took 17 units, and apparently should have taken 21 units. Correcting the resulting high resulted in lows. I don't know how much I ate for the lows, but I rebounded badly.
BLAH BLAH BLAH.

Monday Management March 17

At 0000, SG read 75.
I was asleep. The pump had suspended itself an hour earlier due to its belief that I was low.

At 0100 SG read 143, and turned the basal on at a rate of 0.6 u/hr. I slept on.

At 0200 SG read 201. I slept.

At 0300 SG read 236. I slept.

At 0400 SG read 248. I woke up briefly, bolused 1.5 units, and went back to sleep.

At 0500 SG read 236. I slept.

At 0600 SG read 207. I woke up a little later, thought it was dropping, left it alone, went to the synagogue. At 630, basal dropped to 0.3 u/hr.

At 0700 SG read 206. At 7:17, I decided it wasn't dropping enough and bolused 1 unit.

At 0800 SG read 187. I calibrated and bg on the meter was 147. Bolused 10 units at 820. At breakfast at 845. Breakfast was cereal with soymilk (24 grams carb for the cereal, 2 for the soymilk), a hamentash (about 25 grams), three large jellybeans (9 grams), 1/4 cup trail mix (10 grams), and some lettuce and hummus (1 gram?). Total of about 70 grams carbohydrates.

At 0900 SG read 115. At 9:35, I decided to change the basal to 0.15 u/hr.

At 1000 SG read 90.

At 1100 SG read 61. I suspended the pump (briefly), and at 1120, I ate lunch, which was tangerines (19 carbs) and bissli (21grams). I unsuspended the pump (so it resumed basal at 0.3 u/hr), but did not bolus for the 40 grams of carbs.

At 1200 SG read 98.

At 1300 SG read 138

At 1400 SG read 154. At 1430, basal increased to 0.425 u/hr.

At 1500 SG read 168.

At 1600 SG read 162.

At 1700 SG read 152. At 1720, bg on the meter was 175. Bolused 10 units at 1735 (I wanted to wait for the calibration to take). I also changed sets so I may have missed a fortieth of a unit in there.

At 1800 SG read 155. I ate supper, which was barley (just over a cup, so 40 grams) and eggplant tomato and tempe, about 10 grams of that.  Desert was an apricot and some raisins (about 15 grams).

At 1900 SG read 88.

At 2000 SG read 105. Bolused 1.7 units at 2018, and ate a packet of bissli (21 grams). Basal increased to 0.6 u/hr.

At 2100 SG read 99. Bolused 1.6 units. Ate another packet of bissli (21 grams).

At 2200 SG read 125. At 2220, with SG reading 137, bg read 185. Bolused 0.5 units, went to bed.

At 2300 SG read 186.

At the very end of the day, SG read 169

Monday Management, March 10

I went to bed Sunday night at 11 PM with a blood sugar around 204 and I bolused 1 unit correction.

At midnight my SG was reading 161. Basal was at 0.7 u/hr.
At 100 hours my SG was reading 145.
At 200 hours my SG was reading 132
At 300 hours SG was 137
At 400 hours SG was 177. Basal increased to 0.8 u/hr.
At 500 hours SG was 229
At 600 hours SG was 258. I woke up at 6:10 and bolused 4 units of correction. Felt lousy. At 6:35, tested bg - it was 246.
At 700 hours SG was 247.
At 7:15 I bolused another 2 units.
At 800 hours, SG was 258. Checked bg- 259. Changed sets. Bolused 10.3 units. Realized later I forgot to prime set so probably 2 units of that was in the priming. Basal dropped to 0.2 u/hr
At 900 hours, SG was 222. Ate ~35 grams carb.
At 1000 hours, SG was 222 again.
At 1100 hours SG was 154 dropping rapidly and I was feeling a little woozy. Between 1100 and 1200, I had two lemon head friend gummies, at 10 grams of sugar each.
At 1200 hours SG was 111. At 1230, I had one packet of instant oatmeal (28 g carbs) and bolused 0.8 units.
At 1300 hours SG was 170.
At 1400 hours SG was 132. Realizing that bg was dropping and basal was about to increase, I set a temp basal in order to keep the basal at 0.2 u/hr.
At 1500 hours, SG was 93.
At 1600 hours, SG was 59, and I had another lemon head friends gummy - 10 grams sugar- and started walking home. At 1630, basal increased to 0.425 u/hr
At 1700 hours, SG was 79. At 1715, with SG 87, bg was 111.
At 1800 hours, SG was 93. Bolused 10 units for supper, and ate supper immediately. I had one bowl of brown rice, two bowls of split pea soup, and one bowl of zucchini.
At 1900 hours, SG was 180.
At 2000 hours, SG was 181. Basal increased to 0.6 u/hr.
At 2100 hours, SG was 153.
At 2200 hours, SG was 133. BG was 134. I bolused 0.1 u at 22:50
At 2300 hours SG was 150
And I finished the day with an SG of 123.

4 units at 6:11 and 2 units at 7:15 and 10.3 unis at 8:05

Just Call Me Pump Killer

Last week I called to re-order supplies, they told me insurance said I couldn't reorder til March 2, and that on March 2 it would be shipped overnight. It's March 6 and I hadn't heard anything or received anything so I called back. Turns out insurance hadn't approved the reservoirs for shipping until APRIL. Of course, now I'm out of sure Ts and am gonna have to use some of the quick sets. My new sure Ts and sensors will be here Monday or Tuesday.

Then I tried to bolus for lunch... motor error. They're replacing this pump.
Pump #1 was replaced due to repeated motor errors.
Pump #2 was replaced due to a software error (although I called because I had a no delivery error fairly soon afterwards).
Pump #3 is being replaced due to repeated motor errors.

I have been pumping now for 88 days. That means my average pump has lasted just 27 days. My first one is the one that made it over a month. This one has lasted three weeks.

Monday's Diabetes February 24th

Last few hours of Sunday had 0.4 u/hr basal.

Bolused 3 unit correction at 2233 hours, another unit at 2322 hours.

At midnight the CGM read 265 and I bolused another half unit (which was a BAD IDEA). The basal rate went up to 0.7 u/hr.
At half past midnight I checked blood sugar getting ready to go to bed. CGM read 244 with a down arrow; meter read 151.I eat one and a half large graham crackers in an effort to counteract the IOB.

At 100 hrs, I was lying in bed not yet sleeping; CGM read 145.

At 200 hours, CGM read 115, I slept on.

At 300 hours, CGM read 110, I slept on.

At 400 hours, CGM read 138 and I slept on.

At 500 hours, CGM read 146 and I slept on.

At 600 hours, CGM read 107 and I got up. At 630, CGM read 139 and my meter read 143. Calibrated.

At 700 hours, CGM read 140. I was in the synagogue. At 728 my predicted high alarm went off and the CGM read 153.  I bolused 1 unit.

At 800 hours, CGM read 155.  I tried to bolus 9 units for breakfast. The pump claims to have delivered 8.95 units; it followed that with a MOTOR ERROR. I changed out the set. It probably took me 15 minutes before basal resumed at the lower, 8 am rate of 0.2 u/hr.
For breakfast, I first ate one cup of toasted oats with 3/4 cups soymilk. I felt nauseas, but didnt' throw up so about fifteen minutes later I ate one cup of frosted flakes with 3/4 cups soymilk. I didn't feel up to eating anything more.

At 900 hours CGM read 103. I missed the bus and walked to work (2 miles).

At 1000 hours CGM read 95

At 1100 hours CGM read 79. At 11:18 the Threshhold Suspend alarm went off and I told the pump to go ahead and suspend itself.
At 11:30 I ate about 20 grams of carbohydrate worth of white bread.

At 1200 hours CGM read 43.
At 1230 the CGM read 74 with an up arrow, and I restarted the basal for the pump.

At 1300 hours CGM read 94.

At 1400 hours CGm read  106   . Basal rose to 0.4 u/hr

At 1500 hours CGM read 123

At 1600 hours CGM read 125

At 1700 hours CGM read 148 and I bolused 10.5 units for supper. I ate 1 cup of beans, 1 cup of sticky rice (brown), 3 slices of bread, and some tempeh.  Also about a quarter cup of squash.

At 1800 hours CGM read 150 but I thought about how much I'd eaten and I bolused another 3 units. At 1853, my meter read 263.

At 1900 hours CGM read "WARM UP"

At 2000 hours, CGM read 255. At 2022 I bolused another 3 units.

At 2100 hours, CGM read 273.

At 2200 hrs, CGM read 199. At 2250, raised basal to 0.6 u/hr. At 2255, my meter read 82.

At 2300 hrs, CGM read 151. I ate half a bowl of frosted flakes.

The day ended with CGM reading 121

Monday's Diabetes February 17th

I've decided to log the hell out of Mondays for the next long while. Note: I don't count fiber in my carb counts.

So here is Monday, February 17th.

The last few hours of Sunday, I had had 0.4 u/hr as basal, had bolused 1 unit at 2032 hours, another 1 unit at 2137 hours, and 5.5 units at 2227 hours. I had eaten something.

At midnight starting Monday my CGM read 69. My basal switched to 0.65 u/hr.
At 0020 hours, I ate a fig bar (15 grams of carb) because I thought I was low.

At 0100 hours, the CGM read 101. I was thinking about bed, but feeling kind of low. At 0110, the CGM read 99, but my blood sugar on the meter was 232. I decided to leave it alone due to IOB. I went to sleep.

At 0200 hours, the CGM read 144. I slept on.

At 0300 hours, the CGM read 116. I slept on.

At 0400 hours, the CGM read 163. I slept on.

At 0500 hours, the CGM read 194. I slept on.

At 0600 hours, the CGM read 194. I slept on.

At 0700 hours, the CGM read 228. I slept on.

At 0800 hours, the CGM read 251. At 0830, because of the CGM, I took a 4 unit bolus. At 0835, I checked my blood sugar on the meter. The meter read 300 (accompanied by a thermometer because it is under 50 degrees Fahrenheit in my room and the meter doesn't think it should be trusted at that temperature). I bolused another 2 units.
My basal went down to 0.4 units/hr.

At 0900 hours, the CGM read 246.  I drank half a cup of soymilk at 0930(1 gram carbohydrate), plus some water, and left for work.

At 1000 hours, the CGM read 209. I lowered the basal to 0.2 u/hr.

At 1100 hours, the CGM read 123 and I was thinking about lunch.

At 1200 hours, the CGM read 62. About 1210, I ate an applesauce pouch (13 grams carbohydrate) and at 1235 I had a packet of maple syrup instant oatmeal (29 grams carbohydrate). At 1240 I bolused 1 unit (yes, a post bolus!)

At 1300 hours the CGM read 107.

At 1400 hours the CGM read 150. Basal went up to 0.4 u/hr.

At 1500 hours the CGM read 141.

At 1600 hours the CGM read 109, and I was wrapping up at work.

At 1700 hours, the CGM read 74 and I was walking home, so I had another applesauce pouch (13 grams). At 1725 when I got home, the CGM read 69 and my meter read 84.

At 1800 hours the CGM read 74.

At 1900 hours the CGM read  105. At 1905 hours, I bolused 13 units.
I ate two cups of cooked beans - two cups includes some water and also some carrot and onion cooked in, so probably around 50 grams (this is where the fiber really matters- it would be 80-90 grams if I included fiber).
After about 45 minutes, I ate three slices of my father's whole wheat bread, weighing 140 grams which comes to about 63 grams of carbohydrate.
I ate it with 2 cups of my mother's stewed tomatoes. 22 grams carbohydrate, and 14 olives (they were not salted, and probably add 1 gram of non-fiber carbohydrate).
Total meal: 136 grams carbohydrate.

At 2000 hours the CGM read 82.
At 2045 hours I ate 6 cups of popcorn (30 grams) and about a tablespoon of Brewer's Yeast (7 grams). I bolused 3.5 towards the end of the hour.

At 2100 hours the CGM read 152.

At 2200 hours the CGM read 159.

At 2300 hours the CGM read 163. However, the meter read 132 at 2315 hours.

Monday closed with the CGM reading 159 (with an up arrow, but I don't think it means it).


Conclusions?
Well, my supper ratio of 1:10 seems to work pretty darn well. I probably should have bolused a teensy weensy bit more.
I'm not sure if my overnight basal is okay or what. What with that extremely discordant CGM/meter pair around 1 am, it's hard to know if I really rose all night or if the CGM just caught up to the meter. Probably need more basal.

Paying attention today taught me that I forgot to reset the DIA for this new pump. It was set at 6 hours and so it was making my IOB bigger than it should have been (my real DIA is probably around 4 hours). Also, I'm not prebolusing like I thought I was.

Another One Bites The Dust

Yesterday morning as I was lying in bed trying to convince myself it was time to get up, my pump alarmed A52. It restarted and then it wanted me to reset the time, etc. I spent some time with that, then went to work.
This evening, when I attempted to bolus for supper, I got a No Delivery alarm; I cleared it and tried again and got another No Delivery.
I tried to call medtronic and got a "the wait time for a representative is over 30 minutes" so I hung up, took a shot, and had supper.
I called again and got a representative with no wait time at all (I think that's the first time that's happened). Due to the A52 alarm, they are replacing this pump, too.

For the record, pump #2 lasted about three weeks.

Dear Medtronic, PLEASE NOTE, YOUR BACKLIGHT IS NOT FOOLPROOF

I woke up around 1:40 am, hypo and confused. I was trying to get to the backlight on my pump. I knew I had set the CGM graph to not turn itself off (I did that for the sabbath so I wouldn't have to press buttons so much) and that I had figured out that if I just pressed ACT ESC DOWN from any of the main four screens, it should then give me the backlight.
Parenthetically, I had gotten tired of trying to guess how many times I needed to press ESC before getting to the home screen, from which I could press DOWN to get the backlight- there is no way other than getting to the homescreen first or turning on an alarm to get to the backlight generally speaking.
Well, it didn't work, probably because I pressed down first or something.  It made some "cancel" noises. It made some beep noises. I wondered if I was drawing a monster with an etch a sketch atnd I started pressing lots of buttons. Still no backlight. Was it broken?

Finally, I got out of bed and turned on the light. I was on the main menu screen. I hit escape and scrolled through the screens. The CGM screen was reading 49; it was on the 6 hour screen and I could see a big drop had happened until about 10:30, when I was still awake and had treated it; it had gone up a bit to about 75, which was when I had fallen asleep. After I fell asleep it fell to about 46 and then rose.
I went to utilities and saw that I had had the threshhold suspend kick in; I guess I turned it off while trying to turn on the backlight (that would be the second time I've done that- the first time I didn't realize what I'd done, thought the suspend feature didn't work, and called the helpline people, who took an hour to tell me I had turned it off myself- oy my sleep).

So I went and ate and treated the hypo and then I scrolled through the screens and noticed something funny. On the Sensor Status Screen, it said Next Cal: 13:46.
That meant that I had entered a calibration at 1:46.
Big problem, I didn't remember entering any calibration at 1:46.
I went to main menu ->sensor-> calibration hist-> and it told me that my most recent calibration had been at 22:38 hours, and was a bg of 75, just like I thought.
But I happen to know that medtronic does not put calibrations in the history until 15 minutes after they've been entered, and it was less than 15 minutes after 1:46. Medtronic doesn't enter them in the history because medtronic doesn't USE them for 15 minutes after they've been entered (to account for the theoretical 15 minute lag, which, btw, is seriously theoretical). This allows it to also have a sort of nice feature which is that if you enter in two calibrations within 15 minutes, it assumes the first one was in error.
That meant I had until 2:01 to enter in a real calibration or it was going to use whatever it was I had entered by accident.  I made it just in time. My real calibration says my bg was 69 mg/dl at 2:02 am (no I don't know why that was in time, it shouldn't have been by my calculations).

So, lesson learned, I better turn on the Lock Keypad feature before bedtime. Because next time I might bolus myself by accident. Or enter in another bogus calibration leading to some very bogus numberss turning on a bogus  threshhold suspend and making me wonder what the heck was wrong with my CGM.

Dear Medtronic, please please please put a backlight button on your next pump that can be turned on from ANY screen.

Labs Mostly Normal

My rheumatologist does something none of my other doctors do: she mails patients their lab results.
Mine came in the mail today. I had been hoping they would be accompanied by the x-rays results, but they weren't.

She had tested me for hepatitis, which occasionally causes arthritis. My transaminases and bilirubin were normal and I test negative for hepatitis B and C viruses. I also, unfortunately, test negative for hepatitis B antibodies, which means that despite the series of hepatitis B vaccinations I received 15 years ago, I am not currently protected against hepatitis B and, given that I work in health care, should be re-vaccinated.

My white blood cell counts were all normal, my hemoglobin was on the high side at 16.7 g/dl (good enough for me), and my mean corpuscular volume was very slightly high (which it has been before).

My glucose level was 66 mg/dl, which I find concerning because I had just tested with the Bayer Contour Next Link and it had read 81. Grrr. If your bg meter is not accurate, how can your CGM do any better?

My calcium level was slightly high at 10.5 g/dl, which is frustrating- it's been high like that before, which is abnormal enough that I've been tested for a parathyroid tumor, which I don't have. I was going to get more tests back then but it normalized before we got around to it. Maybe now I should have that 24 hour urine calcium test?

My albumin was slightly high, probably from mild dehydration.

The inflammation markers were low, which this lab considers normal. The c reactive protein was undetectable (as always), and the sed rate was 2 mm/hr which is pretty much the same as always.

The doctor note to patient attached said: "Labs mostly normal."

Overall, of course, the doctor is right. These labs are mostly normal; they do not indicate any kind of emergency. And yet I am not comforted.

Hodgepodge Post

Pumping has been  going okay for the last week or so- no site failures. Still, when I saw a new doctor (a rheumatologist) two days ago and she had gotten records from another doctor, and the list of medications I'm on didn't agree with regards from Lantus, and she asked if I was on Lantus, I said no. I said, "I just started pumping so I stopped taking Lantus but I hate pumping so maybe I'll be back on Lantus." I'm not sure why I'm still pumping if the phrase "I HATE PUMPING" comes out of my mouth so readily.

I got a replacement pump but am still using the first one- am going to switch to the replacement one today for my insulin delivery. Have been running both with the same sensor to show CGM data which has been interesting because they have shown identical ISIGs at identical times with different interpretations (for instance, just now one alarmed low and showed 72 with one down arrow while the other alarmed low and showed 72 with two down arrows).

I saw a rheumatologist two days ago. She sent me for x-rays. She says that my symptoms are a "high suspicion for rheumatoid arthritis". She says somebody in his 20s should heal from injuries much much much better than I have. I fingered the diabetes. She said no- she says she doesn't have a whole lot of young diabetics coming in because of long standing pain in their hands- therefore it's not diabetes. So... while waiting for results I am experiencing what I hope are nocebo symptoms of pain throughout my hands and feet.

Lee Ann at The Butter Compartment has been trying to eat vegan and posting about it and also writing about her past with an eating disorder. Which triggers thoughts in me about how, when I was nine, I tried to starve myself because I wanted to die (nope, didn't care about being skinny). It didn't work, but I discovered that I could get a real thrill, a sort of high feeling, off of not eating. When I was ages 13 and 14 and 15, I did not eat (or drink) at all during daylight hours on Mondays or Thursdays. Sometimes the feeling was so good that I extended my fasts to two or even three days. It gave me a feeling of euphoria. Plus I always got sick to my stomach when I resumed eating so I didn't like that. I stopped doing it when it stopped feeling good, when I was 15, which just so happens to be only a few months before the weight loss started that didn't stop until I was diagnosed with diabetes. I sometimes wonder what, if anything, the not eating may have had to do with the diabetes.
Also, I am vegan. I've been vegan now for 14 years, and I am 25 years old, which is to say that I've been vegan for most of my life (vegetarian a couple years longer- vegan since January 2000 and vegetarian since November 1997). I became a vegan because of uncertainty about ethics and a desire to err on the side of caution. I've stayed a vegan for no reason except that it feels right.

Lee at lifeafterdx is a favorite blogger of mine and he's blogged only twice recently- he's had chickenpox. And memory loss from the chickenpox. His blog on the topic of memory loss made me think a lot about my memory loss. Increasing evidence says that it's not so rare for people to have memory loss like mine after DKA. It's been more than 7 years since I was in DKA. My cognitive function and memory have been very slowly improving for years. And yet the difference in my cognitive function and especially in my memory is profound.  I no longer deal with a persistent sense of disorientation. I expect myself to have the capabilities that I really have, now. But that memory loss is still a pervasive part of how I experience everything all day everyday now.

Things I Have Liked About Pumping

I've been pretty down on pumping, and even trying to make a list of good things, I keep thinking- yeah, well, coulda done that on shots. But there are still a few things:

• Without Lantus coverage, my basal needs become much more transparent. Having tried a pump, I now have a much better idea about what my Lantus was doing (and I think I'll try NPH if/when I return to shots).
• No Lantus shot. After more than 2500 days in a row with a Lantus shot (I am GOOD), this feels WEIRD. In a good way.
• Although I have still had lots of lows, it has been easier to avoid them, and especially to avoid a long string of them.  Especially the activity related lows. The my-meal-is-not-digesting lows have been their same horrible selves.
• Figuring things out about the pump. This does not actually help with anything but my mood.
•  That it's connected to me! No scrambling around looking for my insulin or syringes or the Dexcom. I just find the infusion site and reel it in.

Half an hour ago  I got a motor error while trying to correct, for the fifth time in a row, a bg above 250. The infusion site was a sure-T.

And the previous one was so nice too.

Now I have had true failures with ALL of the available infusion sites.

EDIT: Minimed is replacing my pump. The replacement will arrive on Monday.

40 days on the 530 G and I finally figured out that...

 It IS possible to see sensor data on here. You go to utilities in the main menu, then daily totals, then either average or one of the days. Then act. That takes you to a screen that only has insulin delivery stats. Then act again. That takes you to sensor stats, which are SG average, Above Hi Limit, within limits, below low limit, SG Std. Dev., #Hi Alert, #Lo Alert, # Predict Hi, #Predict Lo, #Rise Rate, #Fall Rate, Number SGs. Act again takes you to Meter Stats- BG average, Number BGs, Meter L/H, Manual L/H. Act again takes you back to insulin delivery stats.

BTW, I did look for this almost immediately when I got the pump and numerous medtronic employees couldn't tell me where to find this data (one said he thought it was there but after looking for it for a few minutes he said maybe not on this model).

It's been a day short of two weeks since I last posted.  I've changed sets seven times since then (seven site changes in 13 days... not exactly 1 change every 3 days!).

I had one more quick set fail (it gave a "No Delivery" alarm the first time I tried to bolus with it, and kept "No Delivery"ing so I pulled it), and one quick set that worked.

I had one silhouette that worked and one that failed (it gave "Motor Error" when I tried to bolus, and I thought the pump itself was broken but the minimed people tell me it was the site).

I had two sure Ts that worked, one ripped out, and I just inserted my fourth sure T. 

Of the sites that DID work, all have been getting pretty itchy and the sites have hard lumps at them when I remove the sites.  It seems to take about a day for them to get itchy.

The CGM portion continues to work fine. I've changed sensors twice since my last post- I changed sensors almost immediately after the post when the sensor went lost. I realized that it seems like when I restart a sensor, they go "lost" 1-2 days later, so I tried with the next one to take the transmitter off and recharge it and see if that helped. It did, but the numbers went wonky a few days later (not in the showing low when high or vice versa category, more like showing 300s when I'm 200s and showing 50s when I'm 90s kind of thing), so that one I wore for ten days.  And the sensors have not been itchy or painful more than extremely slightly- compared to the pump sites they really are not any problem at all.

I am using Novolin R in the pump, and I know that even if I use twice as much Novolin R as on shots, my insulin cost is still down compared to using Lantus because Lantus is expensive (btw, the Brazilian gov't just decided to stop paying for Lantus in light of Sanofi's increase in prices + lack of proof that it does anything better than NPH).

However, it still kind of bugs me how much Regular I'm wasting on priming sites and cannulas and how much more insulin I seem to be using. People told me that on a pump I would have a lower total daily insulin usage. My pre-pump total daily insulin usage over the previous few months averaged 9 units of Lantus and between 23 and 24 units of Regular per day- a TDD of 32 to 33 units. On the pump my TDD has averaged 37 units. It feels like a lot.

My bgs on the pump have included  more numbers above 300 (seven days in the past month with highs above 300), and it's often been hard to get them to go down- the turnaround time on my highs feels like forever although actually it's not. I'm not sure if I've had more or fewer lows. It does seem like I've had fewer severe lows although I've had two really problematic ones (the kind where my thinking is drastically affected) and I'm wondering if that might be because of how much more sleep deprived I am. This thing goes off all night practically every night.

For a somewhat different topic: some thoughts on how the pump's design could be improved:

• Offer more basal patterns, and let me name them! Not "pattern A" and "pattern B" but "chess day" and "AM work shift" and "saturday". Also, do NOT put a "special status" circle to signify I'm using anything other than the "main" basal pattern.
• I really miss the Guardian features on this pump. WTF are you doing not letting me see any sensor data other than AUC and the last 24 hours' numbers?
• Offer bolus patterns, to be optionally linked with basal patterns.
• Let me customize my IOB features- let me program in what percentage of the insulin is used up in what amount of time. Because the available options just aren't my reality.
• When I'm running a low basal rate, like 0.150 u/hr, I'm aware that means that I'm getting 0.025 units six times per hour. I'd like to know what six times, so that if I want to disconnect for five minutes, I can pick five minutes when it wouldn't be giving me any insulin anyways.
• On the CGM, it would be nice to have two separate high threshholds. Alarm at me when I hit 160 and if I stay above 160 for three hours... but also alarm earlier if I hit 260 (for example).
• Don't go to lost sensor in just 40 minutes please.
• Make a stronger transmitter. It's pathetic to have it lose the signal just because I rolled half way over in my sleep.
• Boluses often take a long time to deliver- if I want 8 units for breakfast, that takes two or three minutes. That's fine. What's not fine is that for that whole time, I'm locked out of changing my basals, changing anything in the sensor (like entering in a calibration, or telling it to find lost sensor, or changing glucose limits). Come on!
• It is extremely not cool that a site that is marginally working does not trigger any alarms. I got ketones and lots of high blood sugar without any kind of alarm except for high alarms when I had a cannula folded in half. Apparently if a little insulin is making it through every now and then it doesn't trigger alarms as much. Not cool.
• The buttons to turn on the backlight and to go to the Bolus Wizard only do those things from the home menu. If it's the middle of the night and I want my backlight, and I don't know what screen I'm on 'cause I can't see it, that is really really annoying. Give me a backlight button that works no matter what screen I'm on. 
• If a bolus is in progress and I want to cancel it, I should not have to suspend the pump. There should be a menu on the bolus screen where I can arrow down and cancel bolus in progress.