And I didn't even THINK of it as Diabetes Awareness Month.
At the moment I'm on the last of my infusion sets on the pump. I used my last few sure-Ts in double time; I wore them the regular way and then shaved another area, put alcohol on it, put medical tape on it, took the sure T needle out of me and then put it back in through the medical tape, and then taped it on and wore it another 2-3 days. Worked beautifully!
I'm not exactly thrilled by the sum of money Dexcom charged my insurance for the current round of sensors. $800 per box. Seems like almost yesterday I was buying my own sensors at $289 per box (with 7+ and no insurance coverage). And I remember posting at some time around then Dexcom's financial statement, showing that manufacturing costs were less than half the cost of Dexcom, but that administrative costs were roughly equal to it, so that at that time, Dexcom was pretty deeply in debt. So I guess they need to charge more (or really reduce unnecessary costs) but youch! It really makes me not want to order sensors.
After about a month of average insulin per day being 23 units, all of a sudden I started going way high so I'm on the fourth day in a row of over 40 units per day. Don't know why! Weight is still around 46 kilograms (maybe up to 47?)
Tuesday, November 03, 2015
Friday, September 11, 2015
Labs
I saw the doctor on Wednesday. My endocrinologist is out of the HMO network. I told her that in that case, for now I'm not going to see an endocrinologist.
I asked for an A1c and a vitamin B12 level.
The A1c is 6.8%; for me that's neither great nor terrible, a little higher than I've averaged over the years but well within my range.
The vitamin B12 level, unexpectedly, was 1115 pg/mL. The normal range for that lab goes from 211 to 911. The last time I had it measured was about five years ago, at which time it was about 400. I am a vegan- have been since January 2000- and don't take any B12 supplements, so how the heck my level came back that high, I have no idea. Vitamin B12 is found in some plant sources but is thought to be difficult to digest from those sources. I do drink soymilk and eat cereals with B12 added, but that shouldn't make that big of an impact, aside from which I haven't had any soymilk in about a month due to the cost.
The doctor feels that both of my results are great and nothing to worry about.
Personally, I wonder if it's related to my polycythemia.
I asked for an A1c and a vitamin B12 level.
The A1c is 6.8%; for me that's neither great nor terrible, a little higher than I've averaged over the years but well within my range.
The vitamin B12 level, unexpectedly, was 1115 pg/mL. The normal range for that lab goes from 211 to 911. The last time I had it measured was about five years ago, at which time it was about 400. I am a vegan- have been since January 2000- and don't take any B12 supplements, so how the heck my level came back that high, I have no idea. Vitamin B12 is found in some plant sources but is thought to be difficult to digest from those sources. I do drink soymilk and eat cereals with B12 added, but that shouldn't make that big of an impact, aside from which I haven't had any soymilk in about a month due to the cost.
The doctor feels that both of my results are great and nothing to worry about.
Personally, I wonder if it's related to my polycythemia.
Tuesday, September 01, 2015
9 years
Today marks nine years on exogenous insulin. In this ninth year that insulin gave me, I worked full time, bought a two bedroom condo (about 70% with money earned in the last nine years and 30% a loan from my mother), and made a lot of progress towards foster home licensure (I should be licensed around January).
On Wednesday night I went to bed with a blood sugar of 162. I woke up at 3:45 Thursday morning with the suspicion that I'd forgotten Lantus. My meter said 433. I took 10 units of Regular. When I got up at 6 am, I was down to 350; I took 8 more units, and called in to say I'd be a couple hours late to work, if it was alright. It was. I took a bath and put on the pump.
On Friday Edgepark called and told me that they had the paperwork and could ship my sensors if I wanted them. I said YES. They were there when I returned from prayers Monday morning.
So today I'm wearing two medical devices whereas last week I was wearing 0.
Wearing a Dexcom is a pleasure, as always (except when it alarms too much).
Wearing the pump has been unexpectedly pleasant. Starting it knowing it's short term and already having a good basal profile makes a difference.
This past year, I've spent 20% of the time on NPH, 16% on Lantus, and 64% pumping. I spent about 65% CGMing with SofSensors and about 25% using DexG4, with about 10% of the year not CGMing. Novolin R was the only bolus insulin I used. My A1c was measured only once this year, at 6.9% although I intend to have it measured on September 9th.
Looking at last year's post on 8 years on insulin, I have the following updates:
My feet have been swollen for between 14 and 15 months now. They are typically sore, but not excruciatingly so. I can't walk fast or run or take long walks (more than two miles at a stretch). I have made a lot of life changes in order to be on my feet less. However, I am still on my feet a lot of the time.
Last year I was hoping to be licensed around February 2015. Haha. Right now I'm shooting for January/February 2016.
My oldest brother is in fact married; his wife is eight months pregnant. I'm going to be an uncle!
I have a computer but no home internet access.
On Wednesday night I went to bed with a blood sugar of 162. I woke up at 3:45 Thursday morning with the suspicion that I'd forgotten Lantus. My meter said 433. I took 10 units of Regular. When I got up at 6 am, I was down to 350; I took 8 more units, and called in to say I'd be a couple hours late to work, if it was alright. It was. I took a bath and put on the pump.
On Friday Edgepark called and told me that they had the paperwork and could ship my sensors if I wanted them. I said YES. They were there when I returned from prayers Monday morning.
So today I'm wearing two medical devices whereas last week I was wearing 0.
Wearing a Dexcom is a pleasure, as always (except when it alarms too much).
Wearing the pump has been unexpectedly pleasant. Starting it knowing it's short term and already having a good basal profile makes a difference.
This past year, I've spent 20% of the time on NPH, 16% on Lantus, and 64% pumping. I spent about 65% CGMing with SofSensors and about 25% using DexG4, with about 10% of the year not CGMing. Novolin R was the only bolus insulin I used. My A1c was measured only once this year, at 6.9% although I intend to have it measured on September 9th.
Looking at last year's post on 8 years on insulin, I have the following updates:
My feet have been swollen for between 14 and 15 months now. They are typically sore, but not excruciatingly so. I can't walk fast or run or take long walks (more than two miles at a stretch). I have made a lot of life changes in order to be on my feet less. However, I am still on my feet a lot of the time.
Last year I was hoping to be licensed around February 2015. Haha. Right now I'm shooting for January/February 2016.
My oldest brother is in fact married; his wife is eight months pregnant. I'm going to be an uncle!
I have a computer but no home internet access.
Wednesday, August 26, 2015
Still no sensors
The referral I got was for the wrong endo.
Then edgepark dropped my account.
I gave up. I have a doctor appointment for September 9th with the primary care doc; maybe we can get it cleared then.
Minimed sent me a letter saying there's a recall of the infusion sites I have. I haven't decided whether to call them and have them replaced, or not.
I've been having a lot of nocturnal hypo- and hyper- glycemia with strange dreams.
And 11 days ago, I developed a sudden and severe headache. My blood sugar was 39. However, the blood sugar's gone up and the headache has persisted. For 11 days!!! Tired of that.
I am currently taking the first group of classes towards my foster care licensure. That is going reasonably well.
Then edgepark dropped my account.
I gave up. I have a doctor appointment for September 9th with the primary care doc; maybe we can get it cleared then.
Minimed sent me a letter saying there's a recall of the infusion sites I have. I haven't decided whether to call them and have them replaced, or not.
I've been having a lot of nocturnal hypo- and hyper- glycemia with strange dreams.
And 11 days ago, I developed a sudden and severe headache. My blood sugar was 39. However, the blood sugar's gone up and the headache has persisted. For 11 days!!! Tired of that.
I am currently taking the first group of classes towards my foster care licensure. That is going reasonably well.
Wednesday, July 22, 2015
HMO Experience So Far
1. When I went to get my insulin, test strips, and syringes at Walmart, my insurance paid 100% of the syringe cost (450 free syringes!), and 0% of the test strips and insulin. I spent $170 buying two vials of R and 500 Relion Prime test strips.
2. I called Dexcom to see if my insurance would pay for sensors. They said yes, BUT I have to go through EdgePark.
I called Edgepark. They said my insurance would cover 100% after a $200 deductible, however, we needed a new letter of necessity from my endo. I asked if they needed a referral for the endo. They said no.
A week later I got a call from my endo's office saying that they'd tried to write me the letter of necessity but were told I needed a referral. They'd tried to get the referral themselves, but were told I needed to get it myself.
I called the clinic that I listed as my primary care providers. They said usually you have to come in in person, and it takes 2-3 weeks to get a referral, but they'd leave a note for my provider.
Two days later- on a Sunday- I got a call from my provider asking me what was going on. I told her. By the end of the phone call she had faxed a referral to the endo.
On Tuesday EdgePark called to say that I needed a referral and asked what the phone number of my primary provider was. Hahaha! Ahead of you, edgepark. Way ahead of you.
Anyways, after three weeks of this ball game I've used up my sensors. Don't know how long till I get any.
2. I called Dexcom to see if my insurance would pay for sensors. They said yes, BUT I have to go through EdgePark.
I called Edgepark. They said my insurance would cover 100% after a $200 deductible, however, we needed a new letter of necessity from my endo. I asked if they needed a referral for the endo. They said no.
A week later I got a call from my endo's office saying that they'd tried to write me the letter of necessity but were told I needed a referral. They'd tried to get the referral themselves, but were told I needed to get it myself.
I called the clinic that I listed as my primary care providers. They said usually you have to come in in person, and it takes 2-3 weeks to get a referral, but they'd leave a note for my provider.
Two days later- on a Sunday- I got a call from my provider asking me what was going on. I told her. By the end of the phone call she had faxed a referral to the endo.
On Tuesday EdgePark called to say that I needed a referral and asked what the phone number of my primary provider was. Hahaha! Ahead of you, edgepark. Way ahead of you.
Anyways, after three weeks of this ball game I've used up my sensors. Don't know how long till I get any.
Friday, June 12, 2015
Was it pumping? Or was it that CGM?
So... I've been back on shots for almost three months now and YAY shots. I've had more lows but whereas I don't think I stayed under 200 for an entire day even once on the pump (maybe I did once or twice), I've been averaging staying under 200 once/twice per week again. I am not sure if this is really the shots or the Dexcom.
I have been bad about calibrating lately. I had a run of not so great sensors, but the current one is in its third week and so accurate that even though I have had the blood drop flashing at me for five hours, when I tested just now, Dexcom was reading 119, and my meter read 119 as well. That doesn't really motivate me to test more ... SMIRK.
The HMO insurance was finally processed today, and backdated June 1st. The only think I've used insurance for so far was buying insulin and syringes and we'll see if the HMO pays for it given that it was prescribed by the endocrinologist; a specialist I didn't have a referral for.
I have been bad about calibrating lately. I had a run of not so great sensors, but the current one is in its third week and so accurate that even though I have had the blood drop flashing at me for five hours, when I tested just now, Dexcom was reading 119, and my meter read 119 as well. That doesn't really motivate me to test more ... SMIRK.
The HMO insurance was finally processed today, and backdated June 1st. The only think I've used insurance for so far was buying insulin and syringes and we'll see if the HMO pays for it given that it was prescribed by the endocrinologist; a specialist I didn't have a referral for.
Sunday, June 07, 2015
DAISY!!!
The Daisy - Diabetes AutoImmunity Study in the Young - is one I've read about before (maybe even posted about before). It follows children with close family members with type 1 diabetes, from birth, looking to try to find out what causes type 1 diabetes. The study has been ongoing for a little more than ten years.
Today, DAISY released something of a bombshell. The study authors say that among the 142 children with diabetes antibodies, the 42 children who have diabetes now consumed significantly more sugar and sugar-sweetened drinks, and the association is strong enough to say that it's not random.
Now, if I was reading this without an emotional investment- or perhaps because I've heard "You're so skinny you must have a sweet tooth" I would probably read this as saying that sugar causes type 1 diabetes.
However, the study authors don't QUITE say that. What they are saying however, is that it's very likely that sugar speeds up the development of type 1 diabetes in those who are developing it. Sugar intake didn't, after all, change the risk of having antibodies, and the kids in the study are all still below the median age of type 1 diabetes diagnosis; among the 100 kids who are antibody positive but still non-diabetic are surely many kids who will have diabetes ten years from now.
Looking at this data, it's possible that after ten years the association between sugar consumption and having diabetes will be gone, because the sugar didn't really change who got it, just how fast.
It's also possible that sugar intake will turn out to have caused diabetes in some of the antibody positive- we know that some people with diabetes antibodies stay non-diabetic.
Past papers I have read on nutrient consumption in relatives of type 1 diabetics did not show any relation between sugar consumption and developing diabetes. However, they didn't look only at antibody positive people; and perhaps the sugar consumption only matters after the antibodies are there- maybe the overall impact is too tiny to see when you look at a large population.
Depending on how the study comes out ten years hence, I may find myself in the smug position of being able to say that how much sugar I ate has nothing to do with ME developing diabetes (dx at age 17 after all). Or... I may not.
For the record, the first monetary purchase I ever made (illicitly, at age 3) was a sugar-sweetened beverage. My household eats a much lower-sugar diet than most American households, and especially we did then. I spent more than two years eating nothing with "sugar" or "corn syrup" in the ingredients when I was a preteen. However, I do have a sweet tooth. And at this point? I'm not regretting it yet.
The full text is NOT free. Here's the abstract.
Today, DAISY released something of a bombshell. The study authors say that among the 142 children with diabetes antibodies, the 42 children who have diabetes now consumed significantly more sugar and sugar-sweetened drinks, and the association is strong enough to say that it's not random.
Now, if I was reading this without an emotional investment- or perhaps because I've heard "You're so skinny you must have a sweet tooth" I would probably read this as saying that sugar causes type 1 diabetes.
However, the study authors don't QUITE say that. What they are saying however, is that it's very likely that sugar speeds up the development of type 1 diabetes in those who are developing it. Sugar intake didn't, after all, change the risk of having antibodies, and the kids in the study are all still below the median age of type 1 diabetes diagnosis; among the 100 kids who are antibody positive but still non-diabetic are surely many kids who will have diabetes ten years from now.
Looking at this data, it's possible that after ten years the association between sugar consumption and having diabetes will be gone, because the sugar didn't really change who got it, just how fast.
It's also possible that sugar intake will turn out to have caused diabetes in some of the antibody positive- we know that some people with diabetes antibodies stay non-diabetic.
Past papers I have read on nutrient consumption in relatives of type 1 diabetics did not show any relation between sugar consumption and developing diabetes. However, they didn't look only at antibody positive people; and perhaps the sugar consumption only matters after the antibodies are there- maybe the overall impact is too tiny to see when you look at a large population.
Depending on how the study comes out ten years hence, I may find myself in the smug position of being able to say that how much sugar I ate has nothing to do with ME developing diabetes (dx at age 17 after all). Or... I may not.
For the record, the first monetary purchase I ever made (illicitly, at age 3) was a sugar-sweetened beverage. My household eats a much lower-sugar diet than most American households, and especially we did then. I spent more than two years eating nothing with "sugar" or "corn syrup" in the ingredients when I was a preteen. However, I do have a sweet tooth. And at this point? I'm not regretting it yet.
The full text is NOT free. Here's the abstract.
Wednesday, June 03, 2015
Again Insurance
My new plan went into affect Monday, but I didn't get an insurance card in the mail. I went to talk to the guy at work in charge of getting us all insured and all that, and found that our insurance cards wouldn't be out for a while, because our enrollments weren't in the system. We could use our old insurance cards, and after the new insurance was in the computer, we would get either a refund or a bill for the difference between what old insurance and new insurance covers.
That means, I can't go to the pharmacy, have them fill a prescription using my card, and find out how much I'm paying for anything! Or find out if my new insurance (an HMO) is even going to pay for any prescriptions written back when I was on the PPO.
Is this legal?
That means, I can't go to the pharmacy, have them fill a prescription using my card, and find out how much I'm paying for anything! Or find out if my new insurance (an HMO) is even going to pay for any prescriptions written back when I was on the PPO.
Is this legal?
Tuesday, June 02, 2015
BPA
Bisphenol A is a compound found in plastics. More than 40 years ago, it was reported to cause metabolic syndrome in rats, and some countries have banned its sale in utensils; in the United States we continue to drink out of bottles made with BPA.
This meta-analysis of human studies provisionally published yesterday looks to me like it confirms the link between BPA and type 2 diabetes. The authors of the meta-analysis claim that the evidence supports but does not definitively show that BPA is harmful. Well... all I'll say is, I'm convinced I don't want to drink out of BPA containing vessels nor have children drink out of them.
The authors of the study brought me up short though, when they said that the plastics alternatives often used when BPA is banned appear to have similar metabolic effects.... uh oh
http://www.ehjournal.net/content/pdf/s12940-015-0036-5.pdf
Sunday, May 31, 2015
Dehydrated Musing
Among the symptoms that I have both while hyperglycemic and hypoglycemic are thirst and dehydration, particularly dehydration when waking up (when I've been high or low for a while without drinking because I've been asleep).
On Saturday I woke up at 3 AM, feeling dizzy and needing to pee. I went to the bathroom and went like a racehorse; I then checked my bg on dehydrated tingly fingers. 60 mg/dl.
I started wondering if maybe the kidneys make more urine in order to concentrate the blood sugar when your blood sugar is low-ish, as a defensive mechanism for sleeping people.
Anybody know?
On Saturday I woke up at 3 AM, feeling dizzy and needing to pee. I went to the bathroom and went like a racehorse; I then checked my bg on dehydrated tingly fingers. 60 mg/dl.
I started wondering if maybe the kidneys make more urine in order to concentrate the blood sugar when your blood sugar is low-ish, as a defensive mechanism for sleeping people.
Anybody know?
Friday, May 29, 2015
Faith
Over the years I've observed that people tend to have one of three attitudes towards diabetes complications:
- Fatalistic. The complications will happen to me. I cannot prevent them. I'm doooomed...
-Messianic. The complications will not happen to ME because I know the secret of diabetes control! And therefore I will never have any complications.
-Oblivious comes in three flavors:
Type Young Oblivious- kids who are not really aware of complications.
Type Two Oblivious - adults who see diabetes as a really minor medical issue of no real significance (a subset of type 2 diabetics, mostly)
Type Cure Oblivious- people who believe that a cure for diabetes will render complications moot point soon enough that they won't matter for us. Just hold on to your health for five more years and you're good.
In real life, none of us knows our future, but uncertainty is difficult to live with, hence our tendency to assume the best or worst.
Those who have read my blog much probably know that I lean towards being fatalistic regarding my future. I have spent a lot of blog space expounding on studies showing high complication rates for diabetics with fairly good blood sugar control, talking about the difficulty in getting that fairly good blood sugar control, agonizing over whether various extra health problems are related to diabetes, and being generally pessimistic about the whole thing.
Yesterday my mother and I went to my bank and I cashed in my savings bonds and my mother wrote me a check and at home I signed a paper saying she was loaning me money (for tax purposes- without it she'd get charged gift tax) that I am supposed to pay back over ten years (I intend to pay it back in half that time) and I kept thinking about the leap of faith I am taking, and the leap of faith that I am asking others to make for me:
Faith that I will be in good enough health to work for another ten years to repay a loan.
Faith that I will stay in good enough health to take care of children all the way through to adulthood.
Faith that I will be able to climb the stairs to the condo for long enough to repay the investment.
I am humbled.
I am grateful.
I am scared.
- Fatalistic. The complications will happen to me. I cannot prevent them. I'm doooomed...
-Messianic. The complications will not happen to ME because I know the secret of diabetes control! And therefore I will never have any complications.
-Oblivious comes in three flavors:
Type Young Oblivious- kids who are not really aware of complications.
Type Two Oblivious - adults who see diabetes as a really minor medical issue of no real significance (a subset of type 2 diabetics, mostly)
Type Cure Oblivious- people who believe that a cure for diabetes will render complications moot point soon enough that they won't matter for us. Just hold on to your health for five more years and you're good.
In real life, none of us knows our future, but uncertainty is difficult to live with, hence our tendency to assume the best or worst.
Those who have read my blog much probably know that I lean towards being fatalistic regarding my future. I have spent a lot of blog space expounding on studies showing high complication rates for diabetics with fairly good blood sugar control, talking about the difficulty in getting that fairly good blood sugar control, agonizing over whether various extra health problems are related to diabetes, and being generally pessimistic about the whole thing.
Yesterday my mother and I went to my bank and I cashed in my savings bonds and my mother wrote me a check and at home I signed a paper saying she was loaning me money (for tax purposes- without it she'd get charged gift tax) that I am supposed to pay back over ten years (I intend to pay it back in half that time) and I kept thinking about the leap of faith I am taking, and the leap of faith that I am asking others to make for me:
Faith that I will be in good enough health to work for another ten years to repay a loan.
Faith that I will stay in good enough health to take care of children all the way through to adulthood.
Faith that I will be able to climb the stairs to the condo for long enough to repay the investment.
I am humbled.
I am grateful.
I am scared.
Monday, May 25, 2015
Holiday Weekend
On Friday I left work shortly before 5 PM and checked my Dexcom. It turned on showing... static. Nothing but a black gray and white array of dots. Be still my heart! I tried again and it said: Out of Range for 4:53:06. Waited a minute and tried it again: Out of Range for 19:35:34.
OK, called Dexcom. After being on hold a while, a customer service tech (named Matthew) called back while I was on the bus. While on the phone with him, the Dexcom changed to say Error HWRF Call Tech Support. He told me in that case I should press the restart button with a paper clip. I got home and pressed the restart button and it started up, but asked me to input the time and date, and showed no bg history on the graph. He said that's not what it's supposed to do, and that they'd send me a new Dexcom. He also said the FDA required them to ask my weight, and that if there was water damage (which he didn't suspect) that there'd be a $199 charge.
I was going to use the other Dexcom G4 (which still works) but the sensor failed and so I yanked it and gave up the ghost.
Saturday I tested my bg 6 times and it ranged from 79 to 106; WOW!
Then Sunday my bg meter gave errors for four strips in a row. I thought it was broken, but a few hours later it worked again (I was 186).
I don't know what was up.
OK, called Dexcom. After being on hold a while, a customer service tech (named Matthew) called back while I was on the bus. While on the phone with him, the Dexcom changed to say Error HWRF Call Tech Support. He told me in that case I should press the restart button with a paper clip. I got home and pressed the restart button and it started up, but asked me to input the time and date, and showed no bg history on the graph. He said that's not what it's supposed to do, and that they'd send me a new Dexcom. He also said the FDA required them to ask my weight, and that if there was water damage (which he didn't suspect) that there'd be a $199 charge.
I was going to use the other Dexcom G4 (which still works) but the sensor failed and so I yanked it and gave up the ghost.
Saturday I tested my bg 6 times and it ranged from 79 to 106; WOW!
Then Sunday my bg meter gave errors for four strips in a row. I thought it was broken, but a few hours later it worked again (I was 186).
I don't know what was up.
Tuesday, May 19, 2015
Big Day
Today I deliver earnest money for a condo! It was January when I first started viewing places (and didn't even know what earnest money was). This is the third condo I've put in an offer on. The first one was counteroffered but for more money than I was willing to pay for it. The second was kind of accepted but the owner died and then the heirs didn't agree about selling it to me and after waiting more than a month I said forget it, you guys still don't know what you're doing, I'm looking elsewhere. I really liked that place though. Anyways, the third place I offered on last week, they counter-offered, I counter-counter-offered, they counter-counter-counter offered, I said OK.
Today the How-Long-Will-One-Vial-of-NPH-Last experiment ends. The NPH isn't dead but the blood sugar's been crazy for four days and yesterday the protamine started sticking to the sides of the vial. I haven't quite made up my mind whether I resume pumping tonight, or go on Lantus. Then I think I'll go back to NPH; it's just so darn cheap. And the answer to how long it was good for? I think 10 weeks. It was not refrigerated at any part of those 10 weeks, FYI, and my bg average was around 140 for the entire period.
My middle brother, the one I never did interview here, is starting a 24 hour trial period at a group home today. The home is trying out three candidates for one slot... and I can't imagine they'll pick him. But I have the whole night all to myself!
Today the How-Long-Will-One-Vial-of-NPH-Last experiment ends. The NPH isn't dead but the blood sugar's been crazy for four days and yesterday the protamine started sticking to the sides of the vial. I haven't quite made up my mind whether I resume pumping tonight, or go on Lantus. Then I think I'll go back to NPH; it's just so darn cheap. And the answer to how long it was good for? I think 10 weeks. It was not refrigerated at any part of those 10 weeks, FYI, and my bg average was around 140 for the entire period.
My middle brother, the one I never did interview here, is starting a 24 hour trial period at a group home today. The home is trying out three candidates for one slot... and I can't imagine they'll pick him. But I have the whole night all to myself!
Sunday, May 17, 2015
Blogs I Met And Liked This Week
I can't find some of the ones I know I read and liked. While looking, I found more. But here are four I like:
1. T1D and Gluten Free No clue what the name of the blogger is, but her daughter has diabetes and celiac. They're carb counting and pumping (neither of which I've been doing in a while). But reading back through her blog, I see she experimented with a dummy pod, CGM, poking her finger, and eating gluten free to half way experience her daughter's challenges. Kudos!
2. Thomas' Diabetes Blog is written in two languages, by Thomas, a T1 D veteran. And he took apart a pump and put the pictures on his blog!
3. Canadian D-Gal by Scully, a type 1 diabetic experiencing some burnout, and making it funny. She manages her diabetes (I think) in the kind of lazy way that still takes an awful lot of effort (like me!)
4. Joy Benchmarks is by Marie Smith and is focused on finding the good things in life even when life throws you an awful lot of hardballs. Which it has her; she has myasthenia gravis, had thymus cancer, and has diabetes. And still appreciates the little things. And the big things too.
And the honorary 5... maybe one of you knows which it is. It's by a woman who is 55 and was diagnosed at age 24 and she wrote a great post about running and she collects something village collectibles and she had a foot infection some years ago and she's got an A1c under 6% if I remember right. And her picture is on the upper left corner of the blog. I liked it but I can't seem to find it again.
P.S. Oops, here's the link to the page of other people's favorites.
1. T1D and Gluten Free No clue what the name of the blogger is, but her daughter has diabetes and celiac. They're carb counting and pumping (neither of which I've been doing in a while). But reading back through her blog, I see she experimented with a dummy pod, CGM, poking her finger, and eating gluten free to half way experience her daughter's challenges. Kudos!
2. Thomas' Diabetes Blog is written in two languages, by Thomas, a T1 D veteran. And he took apart a pump and put the pictures on his blog!
3. Canadian D-Gal by Scully, a type 1 diabetic experiencing some burnout, and making it funny. She manages her diabetes (I think) in the kind of lazy way that still takes an awful lot of effort (like me!)
4. Joy Benchmarks is by Marie Smith and is focused on finding the good things in life even when life throws you an awful lot of hardballs. Which it has her; she has myasthenia gravis, had thymus cancer, and has diabetes. And still appreciates the little things. And the big things too.
And the honorary 5... maybe one of you knows which it is. It's by a woman who is 55 and was diagnosed at age 24 and she wrote a great post about running and she collects something village collectibles and she had a foot infection some years ago and she's got an A1c under 6% if I remember right. And her picture is on the upper left corner of the blog. I liked it but I can't seem to find it again.
P.S. Oops, here's the link to the page of other people's favorites.
Saturday, May 16, 2015
A Great Line From A Defunct Blog
I used to have a xanga account with a regular blog, but also with a "pulse" blog.
It was like twitter- a limited number of characters per post. I always started it with a blood sugar. Here's one of the last ones:
That pulse thing lasted from March 2007 until October 2011, and makes for an interesting read. Xanga closed the free accounts around 2013.
This reminiscing prompted by the:
It was like twitter- a limited number of characters per post. I always started it with a blood sugar. Here's one of the last ones:
176 One of my K students today said another kid said The B Word. I was dubious. "He said 'Butt'" the kid insisted. :->
That pulse thing lasted from March 2007 until October 2011, and makes for an interesting read. Xanga closed the free accounts around 2013.
This reminiscing prompted by the:
Friday, May 15, 2015
Wildcard: Crazy Stories
When I think diabetes crazy stories, it occurs to me that most of those I've heard involve somebody being unprepared for a hypo. Eh, forget that. Here's what I think are my top three:
1. For about a year I kept hearing from folks that they knew somebody I should meet, SJ. And one evening I went to an event and saw somebody with an insulin pump so I went and said hi and it was SJ! So when I said that I had had a difficult year since my diabetes diagnosis, SJ said, "Why would that be difficult?" and meant it non-humorously! I was flabbergasted. We didn't connect.
2. I used to go to a transgender support group and folks there knew that I was diabetic. One evening after the group, a person there told me that he was dating a woman with diabetes and asked me what he should know. I asked him to tell me a little bit about how she managed her diabetes, and also how she felt about her diabetes, from what he could tell. He told me she was on shots, but used to have a pump, and that he wasn't really sure but she was vocally fat-positive so he didn't think she'd be self-conscious about diabetes. I gave him some advice (learn to use a glucagon) and on the way home I started thinking about it... and realized that by his description of her diabetes, I knew who she was. I met her through this blog.
3. Gushers are always good for crazy. Gushers are those times somebody does a finger poke, squeezes, and instead of getting a drop of blood... it squirts up and makes a dotted line down his shirt. My first one happened when I was showing a friend what a no-big-deal blood sugar checks were, six months after diagnosis.
This reminiscing brought to you by the:
1. For about a year I kept hearing from folks that they knew somebody I should meet, SJ. And one evening I went to an event and saw somebody with an insulin pump so I went and said hi and it was SJ! So when I said that I had had a difficult year since my diabetes diagnosis, SJ said, "Why would that be difficult?" and meant it non-humorously! I was flabbergasted. We didn't connect.
2. I used to go to a transgender support group and folks there knew that I was diabetic. One evening after the group, a person there told me that he was dating a woman with diabetes and asked me what he should know. I asked him to tell me a little bit about how she managed her diabetes, and also how she felt about her diabetes, from what he could tell. He told me she was on shots, but used to have a pump, and that he wasn't really sure but she was vocally fat-positive so he didn't think she'd be self-conscious about diabetes. I gave him some advice (learn to use a glucagon) and on the way home I started thinking about it... and realized that by his description of her diabetes, I knew who she was. I met her through this blog.
3. Gushers are always good for crazy. Gushers are those times somebody does a finger poke, squeezes, and instead of getting a drop of blood... it squirts up and makes a dotted line down his shirt. My first one happened when I was showing a friend what a no-big-deal blood sugar checks were, six months after diagnosis.
This reminiscing brought to you by the:
Thursday, May 14, 2015
If I Could Change One Thing Related to Diabetes...
It'd be the focus of the conversations.
I think people need to think a lot more about how things affect real outcomes (complications, death, daily function) than A1c. There're too many diabetes meds that have no evidence of affecting anything in a good way except the A1c.
I think we need to think a lot more about finances- not our personal finances, but the finances of social security et al. And what we can do to make medical care more equitable.
I think we need to think more about medical pollution. And what we sacrifice in the name of disposables.
I think we need to think about how much diabetes does or DOES NOT matter in terms of global health.
I think we need to think more about the things we take for granted about our own diabetes convictions.
If I could change one thing about all of these conversations... it would be to remove the influence of marketing campaigns. Marketing campaigns for the ADA, JDRF, drug companies, pump companies, insurance companies- all of them. What would we talk about, diabetes wise, if nobody had pushed the idea of a diabetes epidemic, the superiority of any diabetes control method over any other, or pretended that they had The Answer to diabetes?
This piece prompted by the:
I think people need to think a lot more about how things affect real outcomes (complications, death, daily function) than A1c. There're too many diabetes meds that have no evidence of affecting anything in a good way except the A1c.
I think we need to think a lot more about finances- not our personal finances, but the finances of social security et al. And what we can do to make medical care more equitable.
I think we need to think more about medical pollution. And what we sacrifice in the name of disposables.
I think we need to think about how much diabetes does or DOES NOT matter in terms of global health.
I think we need to think more about the things we take for granted about our own diabetes convictions.
If I could change one thing about all of these conversations... it would be to remove the influence of marketing campaigns. Marketing campaigns for the ADA, JDRF, drug companies, pump companies, insurance companies- all of them. What would we talk about, diabetes wise, if nobody had pushed the idea of a diabetes epidemic, the superiority of any diabetes control method over any other, or pretended that they had The Answer to diabetes?
This piece prompted by the:
Wednesday, May 13, 2015
The Medical Supplies STUFF Situation At My Place
Insulins:
I have 11 empty vials that used to contain Regular. 1 vial with about 80 units left. 1 full unopened vial of Regular. 1 box with an unopened Lantus pen that expires in December, in the fridge. 1 vial of NPH with roughly 150 units remaining.
OOH, I apparently also have a vial of Regular with a vial adaptor on it, containing around 100 units. Probably no good anymore since my guess is I opened that vial a year and a half ago. Also a very expired vial of opened Lantus about half full, and a cartridge about 1/3rd full.
Insulin Delivery:
I have a clear minimed pump, just sitting on my counter. It has a battery and I'll probably use it again somebody because I also have 12 unopened sure T sets, as well as at least one quick set (I thought I had two but I only see one), and 13 reservoirs. I have a Medtronic Quick-serter that has been used roughly five times. Also a silserter, used three times. I have lots of loose batteries and a package of two unopened ones from minimed.
I have one jet injector and two unused vial adaptors. Also a cleaning block, and a bottle of isopropyl alcohol (green).
I have roughly 160 U-100 31G 0.3 mL half unit syringes still in their bags, unused, as well as a few hanging around and some used ones too.
I have a box of pen needles (Ultra Fine 4mm 32G) with about 80 left.
I hung onto the unused I-Ports for a ridiculously long time, but I think they're gone now.
I have a NovoPenMate.
CGMs:
I have one Guardian, probably dead, and one Sof-Senser, extremely expired. One Mini-link. Two Medtronic chargers and one seashell transmitter.
Two Dexcom 7-pluses, and one 7+ transmitter that I see.
Two Dexcom G4s, one of which I'm wearing. One transmitter, which I'm wearing.
Two sensors in the drawer. Four chargers and lots of cables.
A roll of medical tape.
A couple things of the tape used for enlite sensors.
Blood sugar monitoring equipment:
Three (or more?) multiclix lancing devices, all but one of which are missing their caps (darn caps break every year or two). A box with 14 drums.
An Accu-Chek Aviva, a Bayour Contour, a OneTouch Ultra2, a green OneTouch Ultra Mini. One red and one blue Relion Prime.
One full box of Relion Prime strips, one vial half used.
Five cases.
Four assorted other lancing devices that I see and about thirty unused lancets of the kind you can stick in most devices.
Other:
About 200 alcohol wipes (I really only use them to wipe off the vials about once a week).
A bunch of different types of CGM and pump cases.
4 detergent bottles repurposed as sharps containers (4?! why do I have four in my room? something needs to be done about that...)
A medical bill I haven't paid. Some I have.
Some glucagons. But the most important one is upstairs for my parents. It's the only one that's not expired.
About six monitoring logs that came with meters.
Some instruction manuals I should throw out because you can find them all online anyways.
Non-diabetes:
A bunch of samples of Zyrtec (maybe from 2007?)
Some chewable ibuprofen.
One empty and one mostly full tube of Voltaren.
One empty and one mostly full vial of Depo-Testosterone.
Some 23 G needles that screw on. I don't have the syringes for them and I ought to throw them out.
Well, that embarrassing look through my medical supplies was brought to you by the
P.S. I found an old I-Port. Also a Nova Max meter. And I can't believe I forgot to mention my Frio!
I have 11 empty vials that used to contain Regular. 1 vial with about 80 units left. 1 full unopened vial of Regular. 1 box with an unopened Lantus pen that expires in December, in the fridge. 1 vial of NPH with roughly 150 units remaining.
OOH, I apparently also have a vial of Regular with a vial adaptor on it, containing around 100 units. Probably no good anymore since my guess is I opened that vial a year and a half ago. Also a very expired vial of opened Lantus about half full, and a cartridge about 1/3rd full.
Insulin Delivery:
I have a clear minimed pump, just sitting on my counter. It has a battery and I'll probably use it again somebody because I also have 12 unopened sure T sets, as well as at least one quick set (I thought I had two but I only see one), and 13 reservoirs. I have a Medtronic Quick-serter that has been used roughly five times. Also a silserter, used three times. I have lots of loose batteries and a package of two unopened ones from minimed.
I have one jet injector and two unused vial adaptors. Also a cleaning block, and a bottle of isopropyl alcohol (green).
I have roughly 160 U-100 31G 0.3 mL half unit syringes still in their bags, unused, as well as a few hanging around and some used ones too.
I have a box of pen needles (Ultra Fine 4mm 32G) with about 80 left.
I hung onto the unused I-Ports for a ridiculously long time, but I think they're gone now.
I have a NovoPenMate.
CGMs:
I have one Guardian, probably dead, and one Sof-Senser, extremely expired. One Mini-link. Two Medtronic chargers and one seashell transmitter.
Two Dexcom 7-pluses, and one 7+ transmitter that I see.
Two Dexcom G4s, one of which I'm wearing. One transmitter, which I'm wearing.
Two sensors in the drawer. Four chargers and lots of cables.
A roll of medical tape.
A couple things of the tape used for enlite sensors.
Blood sugar monitoring equipment:
Three (or more?) multiclix lancing devices, all but one of which are missing their caps (darn caps break every year or two). A box with 14 drums.
An Accu-Chek Aviva, a Bayour Contour, a OneTouch Ultra2, a green OneTouch Ultra Mini. One red and one blue Relion Prime.
One full box of Relion Prime strips, one vial half used.
Five cases.
Four assorted other lancing devices that I see and about thirty unused lancets of the kind you can stick in most devices.
Other:
About 200 alcohol wipes (I really only use them to wipe off the vials about once a week).
A bunch of different types of CGM and pump cases.
4 detergent bottles repurposed as sharps containers (4?! why do I have four in my room? something needs to be done about that...)
A medical bill I haven't paid. Some I have.
Some glucagons. But the most important one is upstairs for my parents. It's the only one that's not expired.
About six monitoring logs that came with meters.
Some instruction manuals I should throw out because you can find them all online anyways.
Non-diabetes:
A bunch of samples of Zyrtec (maybe from 2007?)
Some chewable ibuprofen.
One empty and one mostly full tube of Voltaren.
One empty and one mostly full vial of Depo-Testosterone.
Some 23 G needles that screw on. I don't have the syringes for them and I ought to throw them out.
Well, that embarrassing look through my medical supplies was brought to you by the
P.S. I found an old I-Port. Also a Nova Max meter. And I can't believe I forgot to mention my Frio!
Tuesday, May 12, 2015
Things I Don't Say, and Who I Don't Say Them To
1. Some time ago, I was responsible for a diabetic man who had an extremely symptomatic hypoglycemic episode while we were together on a bus. I gave him the food I had, but he was semi-conscious, I called his caregiver. She told me to put him on the phone; when he gave it back, she told me to call 911 (which is the number for emergency services). I called 911, the 911 operator called an ambulance. The bus was stopped and everybody had to get out and wait for another. The paramedics came. They tested his blood sugar. It wasn't even all that low- the kind of number I see a few times a week. The paramedics told me I did the right thing and how dangerous it was, and squirted a sugar gel in his mouth and gave me a lecture on how it wouldn't hold his blood sugar up, etc. The diabetic said I saved his life, etc.
I didn't tell the paramedics I'm diabetic. I didn't tell the bus driver. I didn't tell the bus driver's supervisor, who came by to confirm he hadn't stopped the bus for his own fun and games.
I'm not sure why. But a lot of times when I'm the nurse's aide accompanying a diabetic to an appointment about feet or eyes or whatever, I don't say anything when they lecture us about how you have to take care of those diabetics...
I dunno. It just doesn't feel comfortable.
2. When people talk about how avoidable complications are, I usually correct them. But not if they're somebody who doesn't have diabetes complications, and does have diabetes, and not if they're a parent of such a person. It's just mean.
3. I like to act like I know everything that's knowable. It's a character flaw. Sometimes I say I have no idea why my blood sugar is doing something, when I have some idea. Sometimes I say I know why my blood sugar's doing something, when I really don't quite know. I don't like being uncertain about uncertainty.
4. I have been burned regarding putting personal information on the open internet where anybody can see it. But I created this blog because I wanted to document how menstruation impacted my blood sugar and I wasn't comfortable mentioning the fact that I menstruated elsewhere in the diabetes internet world. As a matter of fact, I think I menstruated exactly four more times after creating the blog, and it's ancient history to me now, but I am still very quiet about the things about my life that separate me from normal people other than diabetes, in the diabetes online community, for fear of breaking the tenuous links I make.
5. When I am trying to teach people about diabetes management, I tend to either: not mention it if my bloodsugar is high or low, or to act like it's a no-big-deal thing. I can deal with all kinds of blood sugar; over 500 and under 30 are both reasonably comfortable terrain for me. However, that does not mean that I have anywhere near the level of certainty with them that I sometimes claim. And I'm not a stranger to either sort of number, as occasional as they may be.
P.S. 6. I rarely mention health issues that I'm ignoring. Diabetes- I'm pretty on top of. My teeth? Not so much. Sorry.
So in conclusion: If you call me on something, I will answer you true (unless you're a jerk). But there are things I often don't volunteer.
This post was prompted by the
I didn't tell the paramedics I'm diabetic. I didn't tell the bus driver. I didn't tell the bus driver's supervisor, who came by to confirm he hadn't stopped the bus for his own fun and games.
I'm not sure why. But a lot of times when I'm the nurse's aide accompanying a diabetic to an appointment about feet or eyes or whatever, I don't say anything when they lecture us about how you have to take care of those diabetics...
I dunno. It just doesn't feel comfortable.
2. When people talk about how avoidable complications are, I usually correct them. But not if they're somebody who doesn't have diabetes complications, and does have diabetes, and not if they're a parent of such a person. It's just mean.
3. I like to act like I know everything that's knowable. It's a character flaw. Sometimes I say I have no idea why my blood sugar is doing something, when I have some idea. Sometimes I say I know why my blood sugar's doing something, when I really don't quite know. I don't like being uncertain about uncertainty.
4. I have been burned regarding putting personal information on the open internet where anybody can see it. But I created this blog because I wanted to document how menstruation impacted my blood sugar and I wasn't comfortable mentioning the fact that I menstruated elsewhere in the diabetes internet world. As a matter of fact, I think I menstruated exactly four more times after creating the blog, and it's ancient history to me now, but I am still very quiet about the things about my life that separate me from normal people other than diabetes, in the diabetes online community, for fear of breaking the tenuous links I make.
5. When I am trying to teach people about diabetes management, I tend to either: not mention it if my bloodsugar is high or low, or to act like it's a no-big-deal thing. I can deal with all kinds of blood sugar; over 500 and under 30 are both reasonably comfortable terrain for me. However, that does not mean that I have anywhere near the level of certainty with them that I sometimes claim. And I'm not a stranger to either sort of number, as occasional as they may be.
P.S. 6. I rarely mention health issues that I'm ignoring. Diabetes- I'm pretty on top of. My teeth? Not so much. Sorry.
So in conclusion: If you call me on something, I will answer you true (unless you're a jerk). But there are things I often don't volunteer.
This post was prompted by the
Friday, May 08, 2015
Insurance
I went to an insurance informational meeting today. My employer currently offers 4 insurance plans. As of June 1, they will be offering four different insurance plans.
I think I am going to have to switch to an HMO plan because if I went with the PPO most similar to my current plan (what they'd put me on if I don't fill out any forms), then I would spent over one year:
Premiums: $943
Doctor visits if I saw the endo three times, podiatrist three times (given I have one year of swollen feet), primary care twice: $1020
Insulin, test strips, syringes (if I stay with NPH + R): about $700
Dexcom: about $800
And if I were to go to the emergency room: $400. If hospitalized: $200/day plus 20%
Whereas with HMO:
Premiums: $65 or $350, depending which one
Doctor visits if I saw the number above, plus another primary care because I would need to get referrals: $690 or $300, depending on the plan
Insulin, test strips, syringes (if I stay with NPH + R): probably about $360
Dexcom: free
Hospital including ER visits: free
I think I am going to have to switch to an HMO plan because if I went with the PPO most similar to my current plan (what they'd put me on if I don't fill out any forms), then I would spent over one year:
Premiums: $943
Doctor visits if I saw the endo three times, podiatrist three times (given I have one year of swollen feet), primary care twice: $1020
Insulin, test strips, syringes (if I stay with NPH + R): about $700
Dexcom: about $800
And if I were to go to the emergency room: $400. If hospitalized: $200/day plus 20%
Whereas with HMO:
Premiums: $65 or $350, depending which one
Doctor visits if I saw the number above, plus another primary care because I would need to get referrals: $690 or $300, depending on the plan
Insulin, test strips, syringes (if I stay with NPH + R): probably about $360
Dexcom: free
Hospital including ER visits: free
Wednesday, May 06, 2015
Blurbs From Pubmed
A group of scientists put gendine on a teflon cannula and showed that it kills common and serious skin infections. They want to make cannulas that can be worn for two weeks instead of three days. Personally? Strikes me as itchy. But then, teflon didn't work for me anyways.
I wonder if it would contribute to microbial resistance too.
The last thing the diabetes mamas would want to hear: fatter mothers have more type 1 babies. Although the authors of the study conclude that this is a CAUSAL relationship and is responsible for the increase in type 1 diabetes, frankly, there are way too many other possibilities for the relationship of facts. For instance, maybe the relationship is that age increases both risks.Plus, the increase in risk was only around 30%, which is not enough to explain the variance seen in type 1 incidence in the study area (Sweden).
All I can say is, I won't be sharing this blurb with my mother (who was non-overweight before I was born anyways).
Another study shows Sjogren's and type 1 diabetes share some risk factors. http://www.ncbi.nlm.nih.gov/pubmed/25940005
The Look AHEAD trial, which had some type 2 diabetics exercising a lot and others not, found no difference in heart attacks, strokes, serious angina, or death from heart disease, even after ten years. They did find differences in blood sugar control, physical fitness and in weight loss.
There appears to be a small increase in type 2 diabetes risk with greater air pollution.
Wednesday, April 29, 2015
My blood sugar started going up fast shortly after I posted last night. I took 2/3rds of my usual bedtime NPH dose and was steady just over 200 the rest of the night. Blood sugars today have been unexceptional; highs and lows but not extreme ones (for me).
I went to see the optometrist today. He did a dilated eye exam and saw no evidence of retinopathy. I told him I've been having trouble seeing up, and he did a basic screening test for peripheral vision loss, where he held his fingers at the sides or up and down and wiggled one and asked me which one he was wiggling. One of the times he held one finger high up enough I wouldn't have been able to tell if he was wiggling it, but he wiggled the down hand finger that time. I'm still not convinced that I haven't lost the upper periphery of my vision, but I passed the screening test. And my glasses prescription is the same.
I went to see the optometrist today. He did a dilated eye exam and saw no evidence of retinopathy. I told him I've been having trouble seeing up, and he did a basic screening test for peripheral vision loss, where he held his fingers at the sides or up and down and wiggled one and asked me which one he was wiggling. One of the times he held one finger high up enough I wouldn't have been able to tell if he was wiggling it, but he wiggled the down hand finger that time. I'm still not convinced that I haven't lost the upper periphery of my vision, but I passed the screening test. And my glasses prescription is the same.
Tuesday, April 28, 2015
Lots of research shows that most type 1 diabetics do, in fact, make a little tiny bit of insulin.
More controversial is evidence for and against that little bit mattering.
Most of the time, I see absolutely no evidence in my blood sugars of any making of insulin going on inside me.
I have never had insulin requirements anywhere close to low enough to qualify for any of the sorts of research studies that want definite honeymooners; my insulin needs have consistently been in the 0.7- 1.0 u/kg range.
I don't have the immunity from highs or lows that a cushion of making insulin brings. And I haven't been prone to bizarre unexplainable lows since my first two years on insulin.
But every now and then...
Yesterday at lunchtime I was low, which on NPH has been unusual (which is exactly the opposite of what I expected from NPH, but it seems very little has happened as expected when I've changed insulins).
I ate 60 grams of uncovered carbs for lunch- a pita bread with jelly, plus pretzels with hummus. My blood sugar did not go above 100.
My supper blood sugar didn't go above 140. My overnight blood sugar stayed below 100.
Today after breakfast I went to 70, and I stayed between 70 and 100 until late afternoon, even though once again I ate an uncovered lunch. After work I ate 20 grams more uncovered and went up, but only to 160; I was down to normal range by suppertime. Blood sugar did not go up at supper. Around 9 PM I started thinking about a bedtime snack (on NPH I need one) and started wondering if I had taken my NPH. I don't remember doing so- I ate supper early so I may or may not have mixed the supper R with N.
My blood sugar took a dive so I ate that snack.
I keep checking my blood sugar because the CGM numbers look so unbelievable to me. My numbers haven't stayed so low for a two day period since before I started pumping.
There are explanations possible other than insulin production- in particular, I could have some previous site that's absorbing slowly, and I could just be more insulin sensitive and have used too high insulin doses and coincidentally eaten in ways such that the insulin release from injection sites was coinciding with the digestion.
I also could be digesting poorly- a distinct possibility.
Or hey- I could be minihoneymooning.
More controversial is evidence for and against that little bit mattering.
Most of the time, I see absolutely no evidence in my blood sugars of any making of insulin going on inside me.
I have never had insulin requirements anywhere close to low enough to qualify for any of the sorts of research studies that want definite honeymooners; my insulin needs have consistently been in the 0.7- 1.0 u/kg range.
I don't have the immunity from highs or lows that a cushion of making insulin brings. And I haven't been prone to bizarre unexplainable lows since my first two years on insulin.
But every now and then...
Yesterday at lunchtime I was low, which on NPH has been unusual (which is exactly the opposite of what I expected from NPH, but it seems very little has happened as expected when I've changed insulins).
I ate 60 grams of uncovered carbs for lunch- a pita bread with jelly, plus pretzels with hummus. My blood sugar did not go above 100.
My supper blood sugar didn't go above 140. My overnight blood sugar stayed below 100.
Today after breakfast I went to 70, and I stayed between 70 and 100 until late afternoon, even though once again I ate an uncovered lunch. After work I ate 20 grams more uncovered and went up, but only to 160; I was down to normal range by suppertime. Blood sugar did not go up at supper. Around 9 PM I started thinking about a bedtime snack (on NPH I need one) and started wondering if I had taken my NPH. I don't remember doing so- I ate supper early so I may or may not have mixed the supper R with N.
My blood sugar took a dive so I ate that snack.
I keep checking my blood sugar because the CGM numbers look so unbelievable to me. My numbers haven't stayed so low for a two day period since before I started pumping.
There are explanations possible other than insulin production- in particular, I could have some previous site that's absorbing slowly, and I could just be more insulin sensitive and have used too high insulin doses and coincidentally eaten in ways such that the insulin release from injection sites was coinciding with the digestion.
I also could be digesting poorly- a distinct possibility.
Or hey- I could be minihoneymooning.
Friday, April 17, 2015
Insulin Potency
When I filled my prescription for NPH, the pharmacy tech said it was good for 28 days. The patient insert, however, stated 42 days. I have so far used it for 42 days. I think maybe I've seen a loss in potency in the last week but am not sure. Looking for definitive answers, I found this non-answer of an article:
http://care.diabetesjournals.org/content/26/9/2665.full
In which none of the manufacturers advocates 42 days, one says 7 days (!) and much evidence is offered that the decline in potency of Lantus over time is more noticable than that of NPH.
When I personally tried using a Lantus vial (out of the fridge) for as long as I could, it was day 53 when I gave up on it due to very high blood sugar for the previous two nights. I have used Novolog past five months and it worked fine; I've used a vial of Novolin R for about two months with no problem.
Now I guess I'll give the NPH a whirl and see how long it lasts... maybe? I keep going back and forth with myself about whether I should bother.
http://care.diabetesjournals.org/content/26/9/2665.full
In which none of the manufacturers advocates 42 days, one says 7 days (!) and much evidence is offered that the decline in potency of Lantus over time is more noticable than that of NPH.
When I personally tried using a Lantus vial (out of the fridge) for as long as I could, it was day 53 when I gave up on it due to very high blood sugar for the previous two nights. I have used Novolog past five months and it worked fine; I've used a vial of Novolin R for about two months with no problem.
Now I guess I'll give the NPH a whirl and see how long it lasts... maybe? I keep going back and forth with myself about whether I should bother.
Monday, March 16, 2015
Phoo on Glu
I just did a Glu survey last week and I'm still feeling disgruntled. There was no feedback form and it was written HORRIBLY and unlike most of the surveys I take there wasn't a "write to plony almony with comments or complaints" at the beginning plus as the consent form says, it's a commercial thing for profit.
And this is of and for the diabetes community?! Screw that. I'm not filling out any more glu surveys.
And this is of and for the diabetes community?! Screw that. I'm not filling out any more glu surveys.
Sunday, March 08, 2015
On Friday I got back on the Dexcom.
On Saturday, after fifteen months of pumping, I took off the pump and started on NPH (with R).
So far, my thoughts:
1. I NEED to get a vial protector to put on one vial because the N and R look way too similar. Feel too similar too.
2. Wow is it ever nice to get undressed without pulling on tubing.
3. Too bad I can't do corrections by just pressing a button.
4. I haven't figured out how NPH works in my body yet. I keep jumping to guesses that are proved wrong within hours.
On Saturday, after fifteen months of pumping, I took off the pump and started on NPH (with R).
So far, my thoughts:
1. I NEED to get a vial protector to put on one vial because the N and R look way too similar. Feel too similar too.
2. Wow is it ever nice to get undressed without pulling on tubing.
3. Too bad I can't do corrections by just pressing a button.
4. I haven't figured out how NPH works in my body yet. I keep jumping to guesses that are proved wrong within hours.
Wednesday, March 04, 2015
Thinking about active insulin
On the Minimed 530 G, if I go to Basal Review, Standard Basal (11.35 u total), it looks like this:
Which looks much more like a smooth rise from 2 in the afternoon until three in the morning, and a drop from five in the morning until about nine in the morning.
1)00:00 0.850 U/H
2)05:30 0.200 U/H
3)14:30 0.450 U/H
4)20:00 0.600 U/H
If I pretend that Regular (which is the insulin that I pump) is equally active in the hour that I get it and the subsequent three hours, then the amount of basal insulin lowering my blood sugar in each hour is:
0000-0100) 0.6625
0100-0200) 0.7250
0200-0300) 0.7875
0300-0400) 0.8500
0400-0500) 0.8500
0500-0600) 0.7688
0600-0700) 0.6063
0700-0800) 0.4438
0800-0900) 0.2813
0900-1000) 0.2000
1000-1100) 0.2000
1100-1200) 0.2000
1200-1300) 0.2000
1300-1400) 0.2000
1400-1500) 0.2313
1500-1600) 0.2938
1600-1700) 0.2563
1700-1800) 0.4188
1800-1900) 0.4500
1900-2000) 0.4500
2000-2100) 0.4875
2100-2200) 0.5250
2200-2300) 0.5625
2300-0000) 0.6000
Which looks much more like a smooth rise from 2 in the afternoon until three in the morning, and a drop from five in the morning until about nine in the morning.
Sunday, March 01, 2015
7 Prescriptions And What Became of Them
I went to the endocrinologist recently and got six prescriptions:
- Novolin R, as usual.
- 6 Relion Prime test strips per day- as usual.
- Syringes, for when I go off the pump, because the jet injector company appears to be out of business.
- Novolin N, to give a try.
- Glucagon, because the only ones I had were expired.
- Multiclix drums, because I ought to change my lancet every now and then.
Then I took the prescriptions to Walmart. Here's what happened:
- Insurance covered it but paid nothing. I paid $75 for three vials.
- Insurance denied saying I needed prior authorization for such a large number. Also, that step testing was required. Paperwork was faxed to the endo. Does this make sense? No, particularly not given that my plan's formulary specifically states that PAST six per day, prior authorization is needed. I did not fill this 'scrip
- Insurance covered but did not pay. So I bought just two boxes.
- Insurance covered but did not pay. I bought one vial for $25.
- The pharmacy had none in stock. As it turns out, insurance covers this and pays most of the cost, leaving me with $30 to pay should I ever fill the prescription.
- Insurance paid 100%. I paid nothing for lancets.
Somehow this whole business seems backwards to me. They'll pay for the glucagon and lancets, which I could arguably do without, but not the insulin, syringes, or test strips?
I also called Dexcom last week to ask about getting insurance coverage to buy a new system. They left me a voice mail message saying that it's covered and I just need to call them back and approve it. Of course, I want to know how much insurance would leave me to pay, given that it has covered but left me with the full cost of most of my prescriptions so far!
In other news, I am now eight and a half years past diagnosis. My eyes still see, my heart still beats, my kidneys are making urine aplenty, and my feet are both still attached.
Saturday, February 07, 2015
Measurements of Depression and Diabetes
It's often reported that diabetics are more likely to be depressed. However, it's really hard to believe that measures of depression are accurate with regards to diabetes.
I just read a study on depression in type 2 diabetics right before starting insulin, and after 6 months on insulin, that reported that insulin (and especially the drop in A1c) lowered rates of depression.
To measure depression, they used the PHQ-9 scale, which I've taken myself at an awful lot of doctor visits. It was developed by Pfizer to help market antidepressants.
Here's how I would have scored the day before I went on insulin:
Q1: Over the last two weeks, how often have you had little interest or pleasure in doing things?
A: Well- I am still interested but it hurts to move, so not much pleasure. Let's say every day (3 points)
Q2: Over the last two weeks, how often have you felt down, depressed, or hopeless?
A: I felt desperate and determined, so I'll say not at all (0 points)
Q3: Over the last two weeks, how often have you had trouble falling asleep, staying asleep, or slept too much?
A: Well gee whiz, I can't sleep when I'm being eaten alive by thirst, and every time I do fall asleep, the need to pee wakes me up. Every single night! (3 points)
Q4: How often have you had trouble with having little to no energy?
A: Every minute of every day (3 points).
Q5: How often have you had an unusually big or little appetite?
A: I'm starving! (3 points)
Q6: Feeling bad about yourself- that you are a failure and have let yourself or others down?
A: Not all of the time, but I feel unable to meet my obligations. Let's say "several days" (1 point)
Q7: Trouble concentrating on things, such as reading the newspaper.
A: I lost the ability to keep concentrating enough to count to 20 roughly three weeks before my diagnosis. (3 points).
Q8: Moving slowly, or the opposite, being fidgety.
A: Well, okay, I'm autistic anyways, so this is one I continue to score positively on. But at the time of diagnosis, it had gotten hard to walk, and people were noticing. 3 points.
Q9: Thoughts of hurting and/or killing yourself.
A: Actually, for the first time in many years, I STOPPED having these thoughts shortly before I was diagnosed. 0 points.
Bonus Question: How difficult have these things made it for you to do your work and get along with people?
A: Really difficult.
According to the study I just read on type 2 diabetes, a score of 15-19 qualified as moderately severe (20 was severe depression).
And yet, I was not depressed, just in DKA.
The article said every 1 point drop in A1c lowered score by an average of 40%. I say yeah, that's cause the high A1cs mess with memory, energy, sleep, and hunger, not because they cause depression. It's not pathological to feel exhausted and hungry if you're high.
Why I Won't Be Recommending Afrezza
Inhaled insulin is once again on the market, but I have four good reasons not to use it. Here they are:
-Dosing is in increments of 4 units. So for your breakfast insulin, you can take 4 units, 8 units, 12 units, 16 units, 20 units, or 24 units. Or none. And for corrections, you have the same options. I'm sorry, 4 units is way too big of an increment. I like to be able to treat highs of 220 when I go to bed, and 4 units would be overkill (big overkill).
-No clinical trials were done with diabetics whose A1cs were below 7. When enrolling patients for trials, Afrezza was tried only in diabetics with A1cs above 7% (and below 10%). Afrezza was compared to using an inhaler that didn't contain a medication (in T2s) and to injected Novolog (in T1s). 6 months later, 27% of Novolog users got A1cs at or below 7% - twice as many as with Afrezza (13% got down there on Afrezza). Additionally, the average drop in A1c over the six months was 0.40% on Novolog vs 0.19% on Afrezza, which is statistically significant.
I'm not sure how much of this difference is because Novolog can be dosed in smaller increments.
-Afrezza has a significant risk of causing reduction in lung function. I like my lungs. Admittedly, it probably doesn't cause lipodystrophy, and it might be a reasonable choice for people with severe lipodystrophy and fairly high insulin needs.
-Although I have not seen any proof of what Afrezza will cost, estimates put it in the neighborhood of $100-$200/month without insurance. The discount card makes it cost $30/month with non-governmental insurance. I pay $24.88 per vial of Regular.
-Dosing is in increments of 4 units. So for your breakfast insulin, you can take 4 units, 8 units, 12 units, 16 units, 20 units, or 24 units. Or none. And for corrections, you have the same options. I'm sorry, 4 units is way too big of an increment. I like to be able to treat highs of 220 when I go to bed, and 4 units would be overkill (big overkill).
-No clinical trials were done with diabetics whose A1cs were below 7. When enrolling patients for trials, Afrezza was tried only in diabetics with A1cs above 7% (and below 10%). Afrezza was compared to using an inhaler that didn't contain a medication (in T2s) and to injected Novolog (in T1s). 6 months later, 27% of Novolog users got A1cs at or below 7% - twice as many as with Afrezza (13% got down there on Afrezza). Additionally, the average drop in A1c over the six months was 0.40% on Novolog vs 0.19% on Afrezza, which is statistically significant.
I'm not sure how much of this difference is because Novolog can be dosed in smaller increments.
-Afrezza has a significant risk of causing reduction in lung function. I like my lungs. Admittedly, it probably doesn't cause lipodystrophy, and it might be a reasonable choice for people with severe lipodystrophy and fairly high insulin needs.
-Although I have not seen any proof of what Afrezza will cost, estimates put it in the neighborhood of $100-$200/month without insurance. The discount card makes it cost $30/month with non-governmental insurance. I pay $24.88 per vial of Regular.
Wednesday, January 21, 2015
And the HbA1c is...
6.9%
I started pumping with an A1c of 6.3%. It was 6.4% after six months on the pump. Now it's been 13 months pumping.
Of course, if the 530G system is responsible for the rise in A1c (and it might not be) I think the sensors are more to blame than the pump.
I wore a sof-sensor from Sunday to this morning along with my Enlite. Because they disagreed so vehemently most of the time, I checked my blood sugar much more often. They were both very far from the meter. Nonetheless, with the Guardian returned to the study, I once again pretend the 530G is telling me truths.
I started pumping with an A1c of 6.3%. It was 6.4% after six months on the pump. Now it's been 13 months pumping.
Of course, if the 530G system is responsible for the rise in A1c (and it might not be) I think the sensors are more to blame than the pump.
I wore a sof-sensor from Sunday to this morning along with my Enlite. Because they disagreed so vehemently most of the time, I checked my blood sugar much more often. They were both very far from the meter. Nonetheless, with the Guardian returned to the study, I once again pretend the 530G is telling me truths.
Wednesday, January 14, 2015
Rough
Last night my sensor failed and I didn't put in a new one.
This morning, I went to see the hand surgeon. I was really nervous about it, and was very jumpy and flappy. I checked my blood sugar prior to the appointment and it was 207; I took half a unit.
The doctor said that it was a ganglion cyst. He was able to transilluminate it. He also says I have a much smaller one on the other wrist. And we're going to just leave those cysts alone unless they either grow a lot or start hurting more (right now the big one hurts somewhat if I move the wrist in various ways).
After the appointment, I walked three quarters of a mile to the bus stop, waited around, took a bus I hadn't taken before. Checked my blood sugar after twenty minutes on the bus. 492. Rechecked. 438. Looked at my site. It looked fine. Checked that I had bolused for breakfast. I had. Bolused 7 units (twice the pump recommendation- I have my ISFs set at 80 to 100 depending on time of day). They went through. When I got home, 50 minutes later, I washed my hands and checked again. 330.
Next week I am participating in a research study that I don't really understand yet. It involves type 1 diabetes, heart disease, and a sleep study. When I asked if they would be telling me some of the heart risk results, they said no because those won't be computed until the end of the study. However, they will be doing an A1c and CBC that they'll be sharing with me. So! I'm having an A1c next week! Hope today's excursion doesn't show up too much.
Numbers like 207 don't tend to surprise me. They just happen. Numbers like 492, OTOH... it's been a long time since I saw a reading so high. And the only cause I can see for it (other than diabetes, of course) is anxiety.
This morning, I went to see the hand surgeon. I was really nervous about it, and was very jumpy and flappy. I checked my blood sugar prior to the appointment and it was 207; I took half a unit.
The doctor said that it was a ganglion cyst. He was able to transilluminate it. He also says I have a much smaller one on the other wrist. And we're going to just leave those cysts alone unless they either grow a lot or start hurting more (right now the big one hurts somewhat if I move the wrist in various ways).
After the appointment, I walked three quarters of a mile to the bus stop, waited around, took a bus I hadn't taken before. Checked my blood sugar after twenty minutes on the bus. 492. Rechecked. 438. Looked at my site. It looked fine. Checked that I had bolused for breakfast. I had. Bolused 7 units (twice the pump recommendation- I have my ISFs set at 80 to 100 depending on time of day). They went through. When I got home, 50 minutes later, I washed my hands and checked again. 330.
Next week I am participating in a research study that I don't really understand yet. It involves type 1 diabetes, heart disease, and a sleep study. When I asked if they would be telling me some of the heart risk results, they said no because those won't be computed until the end of the study. However, they will be doing an A1c and CBC that they'll be sharing with me. So! I'm having an A1c next week! Hope today's excursion doesn't show up too much.
Numbers like 207 don't tend to surprise me. They just happen. Numbers like 492, OTOH... it's been a long time since I saw a reading so high. And the only cause I can see for it (other than diabetes, of course) is anxiety.
Sunday, January 04, 2015
Just Life
1. My brother Globe is in the hospital. He's been extremely sick since October 20th. He cannot walk or eat without lots of help; he can't talk (or sign or nod his head) at all.
P.S. I started this post yesterday. Today he said "mama" once.
2. So who cares about my diabetes anyways?
3. I haven't really carb counted in forever. I'm really sick of pumping. When I called MM about a really bad sensor that failed rapidly, I got chewed out for not calibrating often enough and also for wearing my sensors in locations other than the belly. I tried a belly sensor. It wasn't accurate either. I'm not gonna reorder sensors or pump supplies. I'm contemplating not using sensors at all but I guess I'll go back to dexcom.
4. I think I've only seen my endo twice this year. Only one A1c reading. But then, with lots of sensor wear, who cares about my A1c?
5. My new insurance has not paid for ANYTHING yet. Not even my insulin. WTF? I'm wondering if I got signed up for something other than the plan I thought I picked.
6. I have a lump on my left wrist that's probably just a ganglion cyst, but I have an appointment with a hand surgeon because I want to be sure that it's a ganglion cyst. It's been there since September and it's growing.
P.S. I started this post yesterday. Today he said "mama" once.
2. So who cares about my diabetes anyways?
3. I haven't really carb counted in forever. I'm really sick of pumping. When I called MM about a really bad sensor that failed rapidly, I got chewed out for not calibrating often enough and also for wearing my sensors in locations other than the belly. I tried a belly sensor. It wasn't accurate either. I'm not gonna reorder sensors or pump supplies. I'm contemplating not using sensors at all but I guess I'll go back to dexcom.
4. I think I've only seen my endo twice this year. Only one A1c reading. But then, with lots of sensor wear, who cares about my A1c?
5. My new insurance has not paid for ANYTHING yet. Not even my insulin. WTF? I'm wondering if I got signed up for something other than the plan I thought I picked.
6. I have a lump on my left wrist that's probably just a ganglion cyst, but I have an appointment with a hand surgeon because I want to be sure that it's a ganglion cyst. It's been there since September and it's growing.
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