Lab Results

My blood test results were all normal except the A1c. The doctor says that they've switched labs and they now have one in which the normal range is very slightly higher than the lab that they previously used. My A1c came in at 6.6% by this new lab, which probably translates to like 6.4% in the old lab or something.

One thing I didn't mention about Friday's visit was that I gave a urine sample. When the doctor gave me the cup to pee in, I felt reluctant, and after I had peed in it, I had an urge to take it and run. Like I was gonna get bad results. I told myself that maybe I was remembering how two years earlier, I got diagnosed with diabetes through a urine test. Or how two years before that, I got diagnosed with a urinary tract infaction with a urine test. But I dunno, I never felt so reluctant before.

The microalbumin levels in my urine came in elevated. The doctor says it's just a slight elevation, probably nothing and certainly not urgent, and we'll recheck when I'm next in, in two to four months. I started crying anyhow.

Guardian

A box of four sensors arrived on Tuesday, the first day of sukkot. After some discussion with my mother, I decided that I would start up the Guardian and insert a sensor on the second day of sukkot, when the prohibitions have less weight, and are more a matter of tradition. So after sundown, I recharged the transmitter, which took forever, put a battery in the guardian, inserted a sensor (very bloody business), connected the transmitter (green light), hit new sensor. The Guardian claimed to be getting a signal, and all was fine for ten minutes. Then a funny thing happened. The time on the side of the graph started going forward really fast, and soon was way ahead of the time at the top of the graph. Then it went beep beep beep lost sensor. I hit new sensor. It was fine for a few minutes, repeat. And again. My mother said I should call minimed, despite the holiday. I did. Stayed on hold for a long time, thinking about how diabetes distances me from the Jewish people, which extra distance I surely don't need. Person on the phone said she had to talk to the senior technician about it, senior technician said any problem with the timekeeping was with the guardian itself rather than a sensor or transmitter. They sent me a new guardian, which arrived at 10 AM this morning, and said that if they don't get the old one back within 14 days, I'll be charged 3500 dollars. That dollar amount sounded fishy to me since I didn't pay that much for it to start with.

The new model at first glance was exactly like the old one. However, so far it seems to have two improvements. One is that it gets the signal every time, instead of a lot of wacky missed signals. The other is that it displays odd numbers- right now it says 265. The previous model would've either said 264 or 266, but not 265.

My blood sugar has been hideously out of control for two weeks. I'm at my wits' ends.

Soccer Game

I'm in my senior year, and that means that I know most of my classmates. This quarter, I'm taking a course on statistics. Two of my classmates are student athletes- athletes whose tuition is paid for by being on a sports team. One of them in the pitcher of the softball team- she comes in with ice on her shoulder some mornings. She was in my oceanography course last spring, and I've gone to some of her games. The other student student athlete I hadn't had as a classmate before, but she's on the soccer team. Soccer season is now. I figured I'd go to a game.

The game was scheduled for 1 PM. I packed my bag with some library books to return, my diabetes supplies, a notebook for boredom, and lots of food in case of hypos. I went to wait for the bus just past noon, and missed a bus going by. The next one didn't come for forty minutes, and traffic was icky. It started to rain when we were halfway there, and I considered just getting off the bus and going to the library instead. I knew I was going to be late, and I didn't know how long a women's college soccer game would last. But I rode the bus all the way, and then went to the stadium. The rain was coming down harder, and some of the spectators were holding umbrellas. There were about five minutes left in the first half. The score was 0 to 0.

I sat down about two feet from the field, and it rained more. During halftime, the rain came down hard, and I asked somebody how hard it had to rain for the game to get rained out. He went and asked an official, and came back to say that games would only be called if there was lightning. It didn't look like lightning. The game resumed after halftime, and I saw that each half was 45 minutes. Real minutes, no subtracting minutes while waiting for penalty kicks or anything. My classmate is our goalie. I learned that in soccer, the goalie defines the team. The other team's goalie was physically amazing. First off, she was built. Second, she made a lot of amazing saves. A double digit number of saves. The ball was in her court a lot, and she didn't let. Our goalie, my classmate, was of a different style. She did a lot of shouting, directing her teamates. The ball rarely got close to her, and when it did, she ran in and got the ball and then kicked it way far away. Thirty minutes into the second half, she ran for the ball, and she didn't run fast enough. Somebody kicked the ball, and it went in the goal. 1 to 0. No more scoring happened during the rest of the game. Both goalies were amazing, but I bet my classmate is going to still be upset about letting in the one goal tomorrow.

A lot more raining happened though. I eventually stopped minding being wet, and just admired all the rain. The ground was so wet that when the ball skipped accross the field, it splashed and splashed at every bounce. And remember, this is a smooth, perfect, collegiate field. We got wet. After the game, when I got on the train, I took out my meter and found that it was... wet. Uh oh, uh oh, uh oh. I cleaned it out as best I could but couldn't get it to test my bloodsugar. I went to the library, stayed there awhile, and then went home, started reading through my books, thought I might be hypo, reached for my meter.

Stuck in a strip, but it didn't turn on. Tried a different strip, nothing. Pressed on the button, nothing. So I peeled my used test strip artwork off the back of the meter, and called Accu-Chek. Thought I was going to need a new meter, and the guy on the phone sounded like he thought so too. Then he asked me to open the battery cover, and check the battery. I did. Was the battery wet? No. Take it out and put it back in. Now try turning on the meter. It turned on! I told him to stay on the line while I tried to test my blood sugar. It worked! 78, though I didn't tell him that. I felt kind of foolish and hung up. No new meter, but I don't mind.

Today was the Ron Santo Walk to Cure Diabetes, but I didn't go. Did you know that Ron Santo didn't go on insulin until he had been diagnosed for two years? He wasn't even on insulin yet when he was my age, not until his third year in the major leagues did he take insulin. I read his autobiography on Rosh Hashana. He was diagnosed with prandials in the 400s and fastings normal, no symptoms, age 18. He didn't want to admit he was diabetic, refused insulin. Two years later got sick, lost a lot of weight, had leg cramps (probably ketosis), went on insulin. He is currently a radio announcer who announces Cubs games.

Sayings redone

If Poor Richard had been a twentieth century diabetic, do you think that the sayings might have been

A stitch in time saves nine.
A unit in time saves three.

If you will not hear reason she'll surely rap your knuckles.
If you will not heed ketones, he'll hospitalize your ass.

They that won't be counselled can't be helped.
They that won't be counselled can't be helped.

We may give advice but we cannot give conduct.
We may give insulin but we can't stop you eating.

Experience keeps a dear school, but fools will learn in no other, and scarce in that.
Endocrinologists give expensive advice, but fools will heed no other, and scarce that.

Rather go to bed supplerless than rise in debt.
Rather go to bed pumpless than rise in debt.

'Tis easier to build two chimneys than to keep one in fuel.
'Tis easier to cause diabetes than treat it.

Gain may be temporary and uncertain; but ever while you live expense is constant and certain.
Gain may be temporary and uncertain; but it will keep you alive and expenses down.

For age and want, save while you may; No morning sun lasts a whole day.
For sick days and poor days, add up the good days; the dawn phenomenon will rise again.

'Tis hard for an empty bag to stand upright.
'Tis hard for an unfilled scrip to fill a syringe.

Denied

Do I even have to say more? I'm not surprised, since all we did was run it past insurance and mine typically pays for the CGMS only if you make a case about why you need it- I would have a pretty good chance on appeal. But I don't feel like appealing. I think I'm going to pay for one more box of 4 sensors, for 145 dollars, wear them, and consider the CGMS experiment over. Because after the 4 sensors, my transmitter is probably going to go totally bad (it doesn't do so great as is) and warrantee will be over, and I don't want to pay for a new minilink.

100 Medical Things I've Learned

Today marks two years since an IV was stuck into one of my arms, and four bags of fluids started dripping down into veins. The second IV wasn't inserted until the 2nd because the first 6 sticks didn't get a vein. Today marks two years since a doctor promised me that in just a few days, I'd be feeling much better. Today marks two years since I came back to life. My father says that watching me during my first hour on insulin was like watching an inaminate object become animate- that's how different I looked. I was interested in medicine and disability long before diabetes, but diabetes has certainly changed the directions in which I've learned.

This is a list of 100 things I've learned in the last two years. Half of them are things I learned because I have diabetes, directly or indirectly; half of them are things I learned just because I am interested in the ways that bodies work. I can provide sources if you leave a comment wanting to know about a few, but I'm not going to find where I learned each one otherwise. I originally intended to make a list of 200 things, but it was taking too much time. A lot of these could probably be divided into two things though.

*1) Although the kidneys secrete most things proportional to their presence in the blood stream, glucose is the exception.

&1) Hemophiliacs typically have reduced levels of clotting factor, not an absolute deficit.

*2) Glucose is filtered by the kidneys in a piecewise function: f(x)=0 for xa. a is the renal threshhold.

&2) A normal human spine has a slight curvature. Unusual curvature, or scoliosis, can threaten the heart and other internal organs.

*3) Gastroparesis is gastic nerve death, and it causes slow digestion, abdominal stiffness, throwing up, and other gastric woes.

&3) Effective surgical anesthesia was not widely available until the mid-nineteenth century. The anesthetics used had been available for recreation use for forty years prior.

*4) Most mild cases of gastroparesis go undiagnosed. Of diagnosed cases, half are in diabetes. Between a fourth and a fifth of all T1s will be diagnosed with gastroparesis.

&4) Bites precipitate 1% of ER visits in the US. The three most common biters responsible are dogs, cats, and humans.

*5) Of ER visits due to drug reactions, insulin is the drug most often responsible.

&5) Immunotherapy, or measured increases in exposure to promote tolerance of a foreign substance, works for rabies as well as for allergies.

*6) Most autoimmune disease are more prevalent in females. The human autoimmune for of diabetes is the most prominent exception to the rule.

&6) Leukemia kills more adults than it does children. Some forms of leukemia are chronic illnesses.

*7) The only suspected cases of type 1 diabetes transmission involved diabetics donating bone marrow. The marrow recipients developed T1 diabetes.

&7) Allergies are always an IgE response to proteins. No protein, no true allergy.

*8) Injections typically fall into four categories: transdermal (into skin), subcutaneous (into fat), intravenous (into vein), and intramuscular (into muscle).

&8) Service dogs can help people with short term memory loss by prompting them and by warning them of danger. Less than half of service dogs serve the blind.

*9) Some dogs and cats can smell hypo and hyper glycemia.

&9) Imprinted genes are ones where which allele comes from which parent makes a difference in how the gene is expressed.

*10) The genes implicated in type 1 diabetes are paternally imprinted. That's why having a father with T1 confers 4x the diabetes risk that a mother with T1 does.

&10) Viruses become more mutagenic when passed through the blood of multiple people, as when blood recipients donate blood. This may be how SIV turned into HIV.

*11) Celiac Sprue is most common in people who have at least one R3 allele. 60% of T1 diabetics are homozygous R3/R4. T1s and their siblings have a 5% chance of developing celiac.

&11) People with Down Syndrome have a 5% risk of developing diabetes. They also have a 5% risk of developing celiac sprue.

*12) The primary function of the pancreas is to produce digestive enzymes. Early attempts at isolating insulin failed because the pancreatic extracts digested themselves.

&12) Fluctuations in testosterone level are responsible for some mood swings, but absolute testosterone level rarely is.

*13) Fluctuations in blood sugar level are much easier to feel than absolute blood sugar level. They are also probably more dangerous to the body.

&13) People typically have an increase in growth hormone production in the early morning.

*14) Growth hormone causes insulin resistance, and the early morning insulin resistance from growth hormone is called the Dawn Phenomenon.

&14) The cost to inject growth hormone in one person for one year is typically 20,000- 30,000 dollars. Children in the bottom 1% of height, as well as anybody with an absolute deficiency, is legally eligible to take growth hormone.

*15) After carbohydrates are digested, about half of them are stored in the level, for continuous slow release.

&15) Prolactin is a hormone whose levels are controlled by the pituitary gland. Tumors of the pituitary, which are fairly common, can result in high levels of prolactin.

*16) Bodies can convert some protein into glucose.

&16) For HIV positive men who want to have children, there exists a procedure called washing, in which the sperm are isolated from the semen. Sperm are not contagious.

*17) An acidic compound called a ketone is the waste product when people burn fat. A build up of these acids is ketoacidosis, and the most common causes are lack of insulin, and alcohol withdrawal.

&17) Most schizophrenics smoke cigarettes, but they don't get lung cancer. They do get other health problems from smoking.

*18) Being overweight is a good sign if you happen to have Type 1 diabetes. It means you're getting enough insulin. Overweight T1s live longer.

&18) Human weight is supposed to peak between the ages of about 55-60. People who are skinny at 60 may have difficulty living through the strains that age places on bodies.

*19) Even mild vitamin D deficiency in children is a strong risk factor in the development of type 1 diabetes- though whether the deficiency is the cause or effect has not been proven.

&19) Vitamin D deficiency sometimes happens to people who spend all of their time indoors/ wearing lots of clothes, and who don't eat diets rich in vitamin D.

*20) Veins are larger when people are hydrated; it is very painful to have blood drawn during severe dehydration.

&20) Drinking a lot of water can flush important stuff from the body (see *1).

*21) Diabetes can cause blindness in multiple ways. 13% of new cases of blindness in adults in the United States are from diabetes. More than 90% of diabetics have eye damage from diabetes after 20 years.

&21) Rheumatoid arthritis can cause sudden blindness. One of the first people to go around the world, James Holman went blind from arthritis at the age of 25.

*22) Rheumatoid arthritis is an autoimmune disease. Juvenile Rheumatoid Arthritis has onset exclusively in children, while 5% of people with the adult form are diagnosed before the age of 18.

&22) Rosacea is a condition in which the skin and/or eyes become flushed, chronically. It is only dangerous when it happens in the eyes.

*23) Heart Failure means that the heart isn't pumping out enough blood with each beat. People can live in heart failure for a long time.

&23) Stomache cancer is usually a form of food poisoning.

*24) Insulin is slightly carcinogenic. Insulin resistant people are at higher risk of cancer because they use more insulin. The only commercial insulin known to be more carcinogenic than Toronto is Lantus.

&24) The Yellow Fever Epidemic of 1793, which took place in Philadelphia, was the prompt for the first published criticism of racism in the United States.

*25) Diabetic neuropathy can affect the sexual function of both men and women. Many men with diabetes also have abnormal sperm production.

&25) Cystic Fibrosis is the most common reason for people to need double lung transplants. If a CF patient gets only one new lung, the CF destroys the new one; with a double lung transplant, no cystic fibrosis occurs in the new lungs.

*26) Almost 100,000 people are waiting for new kidneys. 3,000 are waiting for kidney-pancreas transplants.

&26) Breast size continues to be dependent on estrogen levels after puberty- a fall in estrogen levels will reduce breast size. It'll also reduce breast cancer risk.

*27) The first American to benefit from insulin injections was diagnosed with diabetes at the age of 15; put on insulin at 22; died at 61 from prostate cancer.

&27) Making the exhalation longer than the inhalation is calming. Calms me down enough to sleep through dentist visits.

*28) Dogs with diabetes are often eager for shots because they know that a shot means that food is coming soon. Wouldn't it be nice if humans were so trainable?

&28) Seizures typically result from too much electricity in one part of the brain (partial onset) or the entire brain.

*29) Hypoglycemic seizures typically start below 45 mg/dl. The seizure itself tends to raise blood sugar.

&29) Some people don't mind having seizures, or even enjoy them. Others experience terrible pain and/or anxiety.

*30) Most adults experience fluctuation in insulin sensitivity based on monthly fluctuations in sex hormone levels - even men!

&30) Acne breakouts are often precipitated by changes in testosterone levels. The dramatic cycles women experience explain why men are more likely than women to outgrow acne.

*31) People need insulin even when they're not eating. See *15.

&31) Metabolism slows down as people age. Renal threshhold increases.

*32) During DKA, potassium leaves the cells, goes into the blood stream, and gets filtered out by the kidneys. Dangerous potassium depletion results.

&32) Having a balance of sodium and potassium levels is usually, but not always, more important than absolute levels of sodium and potassium.

*33) Potassium is one of the most bitter substances necessary for survival. YUCK!

&33) Tardic Dyskinesia is the name of a side effect of many psychotropic medications, including lithium. It is an inability to control, or to promptly control, many small muscles at first, and others later, and is what many people think of when they think of the mentally ill.

*34) Sugar is not more dangerous to diabetics than other carbohydrates are. For me, sugar is easier with insulin than protein is.

&34) People who regain sight or hearing after long periods of blindness or deafness have sensory integration problems that improve with time, even though those of us born with sensory integration disorder tend not to improve much after reaching about puberty.

*35) Injections are least painful when they go into subcutaneous tissue (ie fat).

&35) The term shot, used to mean an injection, began to be used towards the end of the first half of the twentieth century, and was still considered slang in 1960.

*36) Autoimmune diseases are more common in lefties.

&36) The children of two left handed parents have a 50% chance of being left handed.

*37) The only vaccination that makes a difference in the long term likelihood of a person being diagnosed with type 1 diabetes is the TB vaccine.

&37) The usual TB test is an intradermal injection (although sometimes messed up and made a subcutaneous injection) that provokes a skin reaction in people with TB antibodies as well as those who are allergic to the ingredients in the shot.

*38) The first insulin intended to last longer than regular and commercially sold was PZI insulin, or protamine zinc insulin. Almost all insulin mixes since have contained zinc.

&38) NPH insulin is sold on the steroid black market (even though you buy it over the counter) as a weight gain tool. Way too dangerous, in my opinion.

*39) Going bald is an itchy proposition. Ugh. I was balding from malnutrition when I was diagnosed with diabetes.

&39) The brain can't process both deep pressure and pain sensations at the same time, which is why rubbing makes owies all better.

*40) A low fiber diet is one of the more effective dietary treatments for gastroparesis.

&40) Absolutely 0 gluten is the most effective dietary treatment for celiac sprue.

*41) Although most autoantibodies only increase risk of developing one disease, GAD 65 is implicated in type 1 diabetes, type 2 diabetes, Stiff Person Syndrome, and a few other neurological conditions.

&41) The flu vaccination is available in both the live and dead forms. The live form is the more common one. The vaccination is even available in nasal spray form.

*42) Risk of almost all infectious diseases is increased for diabetics. Risk is greater with worse blood sugar control, but does not decrease to 0 with intensive therapy (A1c below 6).

&42) Insulin shock therapy was once used like electric shock therapy continues to be used today. It was not effective in treating depression, and was discontinued in the main.

*43) When venous blood sugar levels drop below 45 mg/dl, the difference in brain function is visible on EEGs.

&43) It is illegal to drive in the state of IL with a disorder that your physician believes may give you 1 or more seizures per year.

*44) Glucagon is a hormone produced by alpha cells, in the islets on the pancreas, and it signals the liver to release glucose.

&44) Hormones are either water soluble or oil soluble. Oil soluble hormones are steroids by definition.

*45) Red blood cells are basically bags of hemoglobin. A portion of the hemoglobin is bound to sugar. What portion of the hemoglobin is bound depends on how long the hemoglobin lives for and what the ever blood sugar level is.

&45) Although the normal range for red blood cell counts of men and women overlap, the male range is about 10% above the female range. This is entirely testosterone dependent.

*46) Neuropathy itself is usually not a reason for amputation; it creates a strong vulnerability for infections and accidents. Smoking quadruples diabetics' major limb amputation risk.

&46) The vast majority of deaths in people with end stage renal failure are directly caused by either poisoning, from eating things the kidneys aren't there to clean out of the blood, or infection from the dialysis sites.

*47) Diabetics on dialysis typically have A1cs in the 6s and 5s because they don't eat much.

&47) Hemodialysis patients who have poor tissue health in the conventional dialysis sites can be dialyzed through the neck.

*48) Peritoneal dialysis offers a better prognosis than hemodialysis EXCEPT for diabetics. Peritoneal dialysis patients typically report a higher quality of life.

&48) DHEA is a hormone that stimulates production of sex hormones. It is an over the counter medication in the United States but prescription only in Canada.

*49) The normal blood sugar range of pigs is 20-80 mg/dl.

&49) 5-15% of the general population is stereoblind, meaning that we (I'm stereoblind) lack binocular vision.

*50) The body's ability to hormonally react to hypoglycemia decreases with duration of diabetes treatment regardless of level of blood sugar control.

&50) A gelastic seizure is one that features uncontrollable laughter or crying. They aren't thought to be very common.

Oy, Lantus

Sometimes I forget that Lantus really loses effectiveness over the course of a month. Yesterday morning I woke up with a bloodsugar of about 250, having taken two Novolog shots during the night. I had been going a little high in the mornings after fairly stable nights for about a week. I decided to open a new vial, since I'd been using the previous one for 34 days or something like that. I took the same dose. Last night, I was hypo, snacked, checked in another hour, was 75, ate a plum and a butterscotch candy (together 15-20 carbs) and went to sleep. When my father came by to tell me to get up, my blood sugar was 81 and by the time I actually got up two hours later it was 79. Wow. Lantus, you fiend!

In other news, I reordered my supplies yesterday, and there must have been some snafu, because my insulin and glucagon and test strips arrived today, shipped by overnight mail. Which I hope I'm not paying for. The polar packs were still frozen when they got to my house! That hasn't happened before. The stuff arrived in two boxes. The smaller one is about one cubic foot, and I was startled to find that the only thing inside was styrofoam, two polar packs, and a glucagon. The glucagon could easily have fit with the insulin in the other box. My syringes and needles have not arrived yet. I think I decided not to reorder lancets, since I seem to have enough of those. I am really running low on pen needles- I've been doing an unprecedented number of shots lately.

And in the final stretch of medical news, my testosterone levels were discovered to be way too high. I inject testosterone under medical supervision, and it appears that my dose was about 3x where it ought to have been. Maybe more. I am fantasizing that this means I don't really need to inject it. In the meantime however, my dose has been lowered and I have to get more blood drawn. Ouch! Last time it was drawn from my hand, and my hand looked like I had a mosquito bite. It hurt a lot, but it healed pretty well.

After the 594

That evening, I went hypo. I ate about 30 carbs. Stayed hypo. Ate another 20 carbs, and went to sleep. Woke up with a blood sugar in the 180-210 range. The ISIG on my CGMS wasn't all that high at the time (something like 8), so I pulled the sensor. Less than 24 hours after the 594, in the dentist's office, my blood sugar came in at 36. What a range!

I'm feeling a little less happy about the CGMS. I mean, I said no the IPORT partly because my first day on the IPORT, I had a bad site that resulted in a blood sugar of almost 400, which was the first time in over six months I'd been that high. That I was wearing the CGMS when I had my high score blood sugar makes me frustrated. I mean, it hadn't appeared that the sensor was going bad- the ISIG was something like 10, and it had been less than 2% off both of the earlier times that day that I'd checked.

During my first nine months managing diabetes, I counted every carb. I took a food scale with me wherever I went and I weighed and measured and I memorized the carb percentages by weight for over a hundred beans, grains, fruits and vegetables. I did most of my own cooking (I lived alone) and I measured everything going into the pot. I followed pretty strict carb ratios, which I adjusted on a weekly basis. I acheived A1cs of 6.5 and 6.3. My blood sugar didn't hit 300 for over five months, but it frequently went below forty.
These days, I have a much more relaxed attitude towards diabetes management. I don't have any carb ratios. I keep track like this well yesterday I ate about two thirds of this at this time and I took x amount of Novolog so and I ended up a little hypo so today maybe x+1 units would be right? Maybe? Eh, sure, why not. And the amazing thing is that I'm usually right. My blood sugar has hit 300 more often these days, but not that often, and I'm still in range for most of the day, whether or not I use the CGMS. My last A1c was 6.3.
My blood sugar spikes more now than it used to. I suspect that this is because of both my less attentive attitude (giving rise to more mistakes), and because the last of my beta cell function is done for.

In less than a month, I will have been on insulin for two years. I intend to write a list of 100 ways I've changed then. Right now though, I figure I'm at the best part of the diabetes journey. It's old enough that I really feel that I know what I'm doing and I'm comfortable doing it, and it's new enough that I don't have any major complications.

High Score of 594

I've been feeling high all day. Drinking lots of water, really sweaty, using the bathroom a lot. Later in the day, a little stomache ache. I checked my blood sugar a few times this morning, and it was within five points of the CGMS all three times. All three readings were below 100. So I trusted the CGMS this evening and took insulin for supper, which the CGMS showed as a very mild spike, and then continued eating as the CGMS showed my blood sugar fluctuating in the 80-110 range. I was about to go to bed, a bit past midnight, when I tested my blood sugar at 594. I was like, WTF?! NO! And I washed my hands and rechecked at 588. This may mean that my sensor has gone bad- if it doesn't agree with my morning reading, I'll take it out. The ISIG has been 6-12 the last two days, which is lowish but ought to viable, though not with a blood sugar of almost 600. I can't even enter that number as a calibration.

I took twenty units of Novolog as correction, and decided to stay awake a while longer to stay on the ball, because this is the highest I've ever tested and 20 is a very large correction for me. When I was diagnosed with diabetes, it was with a fasting blood sugar of 425 by meter, 453 by blood draw. With those fasting numbers, it seems highly probable that my postprandial numbers were in the 600-1000 range, but I never found out and had had no further readings above 400, and very few above 300 since the day I was diagnosed with diabetes. Today's readings are more than 100 points above any other reading I've had. You'd think I'd feel terrible, but frankly I feel fine. Just a little thirsty, and with 90 degree Fahrenheit weather, I think most people are feeling a little thirsty.

Right now, thankfully, my CGMS is showing my blood sugar climbing rather dramatically, so maybe it is just delayed.

I just tested my urine ketones, and they are negative. My number 1 diabetes goal is to avoid ever going into DKA again. I was diagnosed in DKA and when I came out of it, it was like having a long term pain removed- you almost don't realize how much pain you're in, until suddenly you are in dramatically less pain and you can think again and talk and walk and eat and drink and you're alive, like you only sort of were before. I believe that I spent at least three weeks in DKA before I was diagnosed with diabetes. I know that I wasn't in terribly severe DKA (7.25 with reference range of 7.35-7.45), and that it took over a week for my ketone strips to show negative ketones. I've had small ketones on two occasions since September 2006, both when I'd thrown up, unaccompanied by high blood sugars.

Post script: an hour and a half later, my blood sugar is down to 176. In general, I would consider this a slightly high reading. At the moment though, it strikes me as way too low, because I bet it's dropping quickly, yeah? Argh. I don't know what I'm going to do. Eat, I guess. Humph.

Stupid Care Link

Every now and then, I use the Carelink (yes, I got the free USB one now- thanks for the tip). And then I get my reports. And then I get mad.

For one thing, the "target range" on the reports is always 70-140. Which has never, ever, been my target range. So while the Guardian itself on its screen shows me that I spent the day 95% in my target range of 65-155, the carelink report says that I spent a mere 77% of the day in their stupid target range of 70-140.
It also rounds numbers incorrectly, doesn't give me a useable data download, won't overlay more than two weeks' numbers, doesn't give any interactive data, and won't put the insulin, exercise, food or other marker onto the actual graph. I don't care when I was alarmed; I care about what I did.