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.
Sunday, November 02, 2014
Saturday, November 01, 2014
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.
Monday, September 08, 2014
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.
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.
Tuesday, July 22, 2014
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.
She also says this kind of tendinitis is much more common in rheumatoid arthritis.
Sunday, July 20, 2014
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.
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.
Wednesday, June 18, 2014
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.
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.
Friday, June 13, 2014
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.
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.
Wednesday, June 11, 2014
Sunday, May 25, 2014
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.
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?
Friday, April 18, 2014
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.
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.
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