A: The yo-yo.
(Just a joke- I love yo-yos, actually).
This has been so far the worst 24 hours of blood sugar I've had while wearing the Dexcom and shows no signs of letting up. I suspect it may qualify as my worst blood sugar day in the past year, although maybe that's because other days are not so fresh in my memory.
Last night after supper I had a stomach ache and went hypo. My blood sugar according to the Dexcom spent three hours in the hypo range despite me eating a huge amount of sugary stuff. When I checked on my meter, the Dexcom said 50, meter said 55. I went to bed as the numbers were rising (I was around 100), suspecting I'd go high.
My numbers went up most of the night, and I corrected around 5 AM (270). When I got up a few hours later, I was going hypo (apparently I overshot with the correction). The Dexcom said 73 and the meter said 70. The hypo did not respond quickly and I went to LOW and stayed there for a while. I ate candy an then a muffin, trying to rise a little more quickly because my brother was waiting for me so we could walk to the synagogue together, and figured I'd inject when I came up a little bit. I injected as my blood sugar got up to 100.
A half hour later in the synagogue, the Dex read 199 with two arrows up and I injected a little more.
An hour later, the Dex said HIGH, the first time I've seen it do so. I decided to simply wait.
Soon it began to plummet. By the end of the service, I was dropping rapidly, and on the walk home I was back to LOW. I finished going home, ate, injected a small amount, came up a little, dropped back down. Throughout the afternoon, my blood sugar would come up to about 110 before plummeting. When I checked on my meter while the Dexcom said 58, the meter said 41.
As the Sabbath ended, the numbers suddenly started soaring upwards. I went from 70 to 350 in about an hour. Right now the number is 324 dropping slowly.
To recap: I went from under 40 to over 400 in two hours, and in less than another hour was back down to under 40. The insulin I've been taking has shown itself to be promptly effective, but the food seems to be kicking in with much delay. My stomach has been hurting, my neck is so tender that it hurts to swallow (and it hurts in my neck, not my throat) and I've been told I'm looking flushed.
Differential diagnosis: stomach bug, gallstones, thyroid flare up? Maybe just plain diabetes weirdness.
Anyways, the plan for the next 24 hours is to lower the Lantus dose (from 8 1/2 to 7), be conservative with corrections (I'm going to use a 100 ISF instead of a 60), drink lots of fluids, check ketones (have not done that yet), and eat small meals if I can.
My rationale is that hypos are going to be very hard to treat, so I don't want to go there. Eating large meals that don't digest will set me up for more problems than small meals that don't digest, and maybe I could digest smaller meals better anyways).
If this keeps up, and I check a high number on the Dex and find that I really truly am over 400. I'll call the endo on Monday. I don't remember seeing a number over 400 in the past year. I feel crummy!
I wanted to do a fact on math skills in children with type 1 diabetes but couldn't find my source. Then I got distracted reading about numeracy. Then I read a study with a lower amputation rate than I had expected, looked for more studies, and decided they disagreed with each other too much for me to feel like I have a solid fact about them.
P.S. Whoa, Nelly. My Dexcom was still reading over 300, and it was time to calibrate. The meter said 197. :-/ Not great but way better. Maybe trusting the meter on the higher numbers was the problem.
So here's a fact that is probably already known to most of my readers:
Symptoms of high and low blood sugars are different for different people at different times. The same person may have different symptoms for the same blood sugar on two different days. Symptoms for most people change over the years and threshholds vary.
You may not have symptoms with a high or low blood sugar. Conversely,you cannot be sure of a high or low blood sugar merely because of symptoms.
I get kind of annoyed with people who think they have low blood sugar but have never tested, and I was really put off in a book I read on organ transplants in which the author (who had a liver transplant but no diabetes) claims that diabetics learn to feel their blood sugar levels to the nearest 10%.
No, sorry, it doesn't work that way.
Saturday, November 06, 2010
Friday, November 05, 2010
There's been a lot of people writing, in light of recent news of children dying of diabetes, that diabetes is a terrible horrible thing that should never ever be funny. Or laughed at. Or made art out of.
I don't say anything to them, because they are speaking from the depths of their emotions.
But this is my truth: I have diabetes. Although there are treatments that may make living with diabetes a very different kettle of fish sometime in the next ten years, there is nothing on the horizon that is likely to make it go away.
I did not choose to have diabetes but it is here for the long haul.
I can focus on the worst parts of it. I can decide that every shot is an injustice that I should not have to endure, I can get mad at my brother for being scared of catching diabetes, I can get mad at the world. I could obsess on how horrible it would be to go blind, or die young or any number of complications. I could live angry.
I could also pretend that everything is normal. I could just take my shots 4 times a day, check my blood sugar 4 times a day, make dosage adjustments only at endo visits, and assume that everything is going well.
I could even go into total denial. I could decide that everything is too horrible to be faced, never check my blood sugar, and go in and out of DKA.
I could probably do what most people do and treat it as a frustrating chore.
But this is not what I do. I went into diabetes with the belief that almost all experiences have something of value in them. I struggled mightily with the realization that sometimes I am really bummed and scared of what is to come. But mostly I tried to find the value.
I look for diabetes humor. I look for diabetes art (and occasionally make some). I look for diabetes pride. I look for studies that show that diabetes does something, anything, good (it does- I gotta use some of those studies for facts later this month).
And I face my fears head on. I look at complications and I say, well, okay, if that happens, let's see what that would be like. Because I must be able to find something good in that too. I read about diabetes. A lot. I read about complications, causes, mechanisms. I read stories.
I look for the community. I look for where I fit.
Sometimes I am sad and
sometimes I am mad and
sometimes I am fascinated and
sometimes I am amused and
sometimes I just am and
sometimes I am happy.
I try to dwell on the happy.
Because I will probably be living with diabetes for a long time yet, and I intend to make it the best life I can.
Fact: Insulin does more than act as a channel for glucose to leave the blood stream and go into cells- it serves as signal to alpha cells that they should not be releasing glucagon.
In cystic fibrosis related diabetes as well as in full blown (as opposed to early stage, honeymooning) autoimmune type 1 diabetes, but not in type 2 diabetes, the alpha cells release a larger amount of glucagon most of the time, release a bolus of glucagon at meal times, and do not release glucagon at times of hypoglycemia.
I don't say anything to them, because they are speaking from the depths of their emotions.
But this is my truth: I have diabetes. Although there are treatments that may make living with diabetes a very different kettle of fish sometime in the next ten years, there is nothing on the horizon that is likely to make it go away.
I did not choose to have diabetes but it is here for the long haul.
I can focus on the worst parts of it. I can decide that every shot is an injustice that I should not have to endure, I can get mad at my brother for being scared of catching diabetes, I can get mad at the world. I could obsess on how horrible it would be to go blind, or die young or any number of complications. I could live angry.
I could also pretend that everything is normal. I could just take my shots 4 times a day, check my blood sugar 4 times a day, make dosage adjustments only at endo visits, and assume that everything is going well.
I could even go into total denial. I could decide that everything is too horrible to be faced, never check my blood sugar, and go in and out of DKA.
I could probably do what most people do and treat it as a frustrating chore.
But this is not what I do. I went into diabetes with the belief that almost all experiences have something of value in them. I struggled mightily with the realization that sometimes I am really bummed and scared of what is to come. But mostly I tried to find the value.
I look for diabetes humor. I look for diabetes art (and occasionally make some). I look for diabetes pride. I look for studies that show that diabetes does something, anything, good (it does- I gotta use some of those studies for facts later this month).
And I face my fears head on. I look at complications and I say, well, okay, if that happens, let's see what that would be like. Because I must be able to find something good in that too. I read about diabetes. A lot. I read about complications, causes, mechanisms. I read stories.
I look for the community. I look for where I fit.
Sometimes I am sad and
sometimes I am mad and
sometimes I am fascinated and
sometimes I am amused and
sometimes I just am and
sometimes I am happy.
I try to dwell on the happy.
Because I will probably be living with diabetes for a long time yet, and I intend to make it the best life I can.
Fact: Insulin does more than act as a channel for glucose to leave the blood stream and go into cells- it serves as signal to alpha cells that they should not be releasing glucagon.
In cystic fibrosis related diabetes as well as in full blown (as opposed to early stage, honeymooning) autoimmune type 1 diabetes, but not in type 2 diabetes, the alpha cells release a larger amount of glucagon most of the time, release a bolus of glucagon at meal times, and do not release glucagon at times of hypoglycemia.
Thursday, November 04, 2010
I pulled out the sensor with about 20 minutes to go in the third week. Took a long bath, spent about an hour and a half with no sensor, and then inserted sensor the sixth into my abdomen. It's still in the warm up period.
FACT: Sonia Sotomayor, the newest Supreme Court Justice, was diagnosed with juvenile diabetes at the age of 8. She takes multiple daily injections via syringes.
When I was reading the CDC health statistics for 2009, I was shocked to learn that 1 in 5 American pregnancies that is not miscarried ends in abortion. :(
FACT: Sonia Sotomayor, the newest Supreme Court Justice, was diagnosed with juvenile diabetes at the age of 8. She takes multiple daily injections via syringes.
When I was reading the CDC health statistics for 2009, I was shocked to learn that 1 in 5 American pregnancies that is not miscarried ends in abortion. :(
Wednesday, November 03, 2010
Trying to get myself to wake up from alarms on the CGMS at night drives me nuts. Last night I went to bed with a blood sugar of 75. I ate a small snack at bedtime, and I raised the low alarm threshhold to 80, with a snooze of one hour, thinking I could wake up in an hour if I was still below 80, and treat again, but not wanting to overtreat.
I woke up around 7 AM. It was beeping. It said I was 67, and my meter said 61. The Dexcom showed my blood sugar as having been in the 50-75 range THE ENTIRE NIGHT. Did it wake me up? Nooooo. The Guardian wasn't very good at it either. I know I should get some sort of amplifier. Blech.
Fact:
1 international unit of insulin is equivalent of 1/22 mg of pure cyrstaline insulin. In the United States, you can buy insulin at a strength of 100 units in one mL (U-100 insulin) or at a strength of 500 units in one mL (U-500) insulin. You can also buy a dilutant to be used with some insulins and make insulin at any lower concentration.
Historically, U-30, U-40 and U-80 insulin were prevalent on the US market.
Using a higher concentration helps with absorption of larger doses (U-500 is recommended for those with a sustained need for more than 200 units per day), and a lower concentration helps with measuring lower doses (particularly for those who frequently need doses under 1/2 unit), but having different concentrations has sometimes caused dangerous mix-ups.
Historically the lower concentrations were due to the difficulty of concentrating the insulin.
I woke up around 7 AM. It was beeping. It said I was 67, and my meter said 61. The Dexcom showed my blood sugar as having been in the 50-75 range THE ENTIRE NIGHT. Did it wake me up? Nooooo. The Guardian wasn't very good at it either. I know I should get some sort of amplifier. Blech.
Fact:
1 international unit of insulin is equivalent of 1/22 mg of pure cyrstaline insulin. In the United States, you can buy insulin at a strength of 100 units in one mL (U-100 insulin) or at a strength of 500 units in one mL (U-500) insulin. You can also buy a dilutant to be used with some insulins and make insulin at any lower concentration.
Historically, U-30, U-40 and U-80 insulin were prevalent on the US market.
Using a higher concentration helps with absorption of larger doses (U-500 is recommended for those with a sustained need for more than 200 units per day), and a lower concentration helps with measuring lower doses (particularly for those who frequently need doses under 1/2 unit), but having different concentrations has sometimes caused dangerous mix-ups.
Historically the lower concentrations were due to the difficulty of concentrating the insulin.
Tuesday, November 02, 2010
My sensor is still in, and it's now in its twentieth day. It's been reasonably reliable; no ??? in the past day and only an hour or so of ??? at a time, twice on Monday and twice on Sunday.
Fact: More than thirty thousand pancreas transplants have been performed in the United States. Most were performed at the same time as a kidney transplant, some were performed after a kidney transplant, and a few hundred were done in diabetics whose kidneys had not failed.
Most pancreas transplants come from dead people; a few partial pancreas transplants have been done from relatives.
Fact: More than thirty thousand pancreas transplants have been performed in the United States. Most were performed at the same time as a kidney transplant, some were performed after a kidney transplant, and a few hundred were done in diabetics whose kidneys had not failed.
Most pancreas transplants come from dead people; a few partial pancreas transplants have been done from relatives.
Monday, November 01, 2010
Band-Aids
I put a band-aid on my butt today because the Lantus shot lead to bleeding (hope that doesn't mess up my numbers for the next 24 hours). The band-aid was partially pulled off when I went to the bathroom a little later and I had a panicky, did-I-pull-my-sensor-off moment. Fortunately not.
In honor of November being diabetes month, I'm gonna give you a post with a fun fact every day. I promise none of them will be anything other than facts.
Fact 1: Jackie Robinson, the first African American to play in Major League Baseball, was diagnosed with type 1 diabetes at the age of 38, which was his final year in the majors (I have not been able to find out whether he was diagnosed shortly before or shortly after retiring).
He died of diabetes (heart attack) fifteen years later at the age of 53. By that time he had also lost a lot of his vision, also from diabetes.
His brothers Mack and Edgar were diagnosed with diabetes before he was; Mack died of diabetes related causes at age 88, and I can't find data on Edgar.
In honor of November being diabetes month, I'm gonna give you a post with a fun fact every day. I promise none of them will be anything other than facts.
Fact 1: Jackie Robinson, the first African American to play in Major League Baseball, was diagnosed with type 1 diabetes at the age of 38, which was his final year in the majors (I have not been able to find out whether he was diagnosed shortly before or shortly after retiring).
He died of diabetes (heart attack) fifteen years later at the age of 53. By that time he had also lost a lot of his vision, also from diabetes.
His brothers Mack and Edgar were diagnosed with diabetes before he was; Mack died of diabetes related causes at age 88, and I can't find data on Edgar.
Friday, October 29, 2010
I got a new box of sensors fifteen days ago, about a day after I had finished with my last sensor on the previous box. I put the sensor in my arm, and am so far having the best sensor experience since the first one. Yeps, I said so far. I am now on the third week with it - restarted it for a second time yesterday. It is being held on by band-aids, since the adhesive hasn't been cutting it for about a week now. I haven't seen ??? in about a week, which is way better than the leg or tummy sensor did. I'm still going to give the stomach and leg another go with my next two sensors, but it really seems like arm sites are superior. I am getting fairly frequent out of range blips, but not usually more than for one reading in a row, and maybe it's because of the band-aids. I don't know. I'm also having the problem that it goes from three bars on the battery sign to one flashing one in just over 24 hours. I haven't uploaded data since my last data post and am really impatient to find out how the month of October will have gone by the time I do upload (probably in six days).
My digestion has noticeably improved over the last two months. I haven't had a single meal in over a month in which I was unable to continue eating, and only a few meals in which I made food choices based on my stomach hurting. I'm hoping this heralds great things on the weight front.
My thyroid ultrasound came back with a uniform looking thyroid, which is excellent news. Unfortunately the ultrasound probe really pushed down on my thyroid and it is now even more painfully tender and visibly enlarged.
P.S. I was about to hit the "Publish Post" button when I noticed ??? DRAT!
My digestion has noticeably improved over the last two months. I haven't had a single meal in over a month in which I was unable to continue eating, and only a few meals in which I made food choices based on my stomach hurting. I'm hoping this heralds great things on the weight front.
My thyroid ultrasound came back with a uniform looking thyroid, which is excellent news. Unfortunately the ultrasound probe really pushed down on my thyroid and it is now even more painfully tender and visibly enlarged.
P.S. I was about to hit the "Publish Post" button when I noticed ??? DRAT!
Tuesday, October 26, 2010
Naked Pancreas Meme
1. What kind on insulin management mode do you use?
Shots, shots, lots and lots of shots. Syringes and NovoPen Jr.
2. How often do you inject/change pump sites? One Lantus shot per day, 2-10 Novolog shots per day. I guess I average about 6 shots per day.
3. What type (s) of insulin do you use? Novolog and Lantus. I was really tempted by Exubera but insurance wouldn't cover it and now it's off the market.
4. What are your basal settings ?
One shot of Lantus. I took 8 1/2 units a couple hours ago. I get about 25 free carbs out of it most afternoons.
5. What are your correction factors ?
Right now I'm using a 1:40 most of the time, but it should be more like 1:35 in the mornings, 1:60 in the evenings.
6. What are your meal ratios ?
I was just thinking about that. 1:7 for breakfast. 15 free carbs, then 1:8 for lunch. 1:8 for supper.
7. What do you do for activity and/or PE?
I play it by ear. Mostly I try to make sure my blood sugar is above 120 and/or rising if I'm not going to be able to deal with it for a while or if I'm about to do some exercise. But sometimes I just go and eat and hope.
8. How do you manage Pizza, Macaroni and Cheese, or any other "difficult to manage" foods?
I'm a vegan (since 6th grade) so those particular foods are not an issue. I try to avoid foods that take a long time to digest when it's near bedtime because otherwise I spend the night high. I have some difficulty with fat due to pancreatitis. But if I can, I try to eat high fat foods when high. If I'm not high, I prebolus about half and then wait at least an hour, 'til I see a new rise, to inject again, based on the slope. I may do a third or fourth shot if the slope is not to my satisfaction.
I try eating foods that make me spike when I've got other things tying up my digestion and know that there won't be any spike for a long time.
9. How do you prefer to manage your logs/data?
I always record Lantus dosage, 'cause I play with it a lot. I upload Dexcom data and enter into it what's what. Every now and then (maybe twice a month) I'll count my carbs very precisely for a few meals in a row (maybe two days' worth) and see how my ratios are looking. I also write about one sentence per day about if anything weird was happening.
I used to log a lot more but I just don't feel like it anymore.
Shots, shots, lots and lots of shots. Syringes and NovoPen Jr.
2. How often do you inject/change pump sites? One Lantus shot per day, 2-10 Novolog shots per day. I guess I average about 6 shots per day.
3. What type (s) of insulin do you use? Novolog and Lantus. I was really tempted by Exubera but insurance wouldn't cover it and now it's off the market.
4. What are your basal settings ?
One shot of Lantus. I took 8 1/2 units a couple hours ago. I get about 25 free carbs out of it most afternoons.
5. What are your correction factors ?
Right now I'm using a 1:40 most of the time, but it should be more like 1:35 in the mornings, 1:60 in the evenings.
6. What are your meal ratios ?
I was just thinking about that. 1:7 for breakfast. 15 free carbs, then 1:8 for lunch. 1:8 for supper.
7. What do you do for activity and/or PE?
I play it by ear. Mostly I try to make sure my blood sugar is above 120 and/or rising if I'm not going to be able to deal with it for a while or if I'm about to do some exercise. But sometimes I just go and eat and hope.
8. How do you manage Pizza, Macaroni and Cheese, or any other "difficult to manage" foods?
I'm a vegan (since 6th grade) so those particular foods are not an issue. I try to avoid foods that take a long time to digest when it's near bedtime because otherwise I spend the night high. I have some difficulty with fat due to pancreatitis. But if I can, I try to eat high fat foods when high. If I'm not high, I prebolus about half and then wait at least an hour, 'til I see a new rise, to inject again, based on the slope. I may do a third or fourth shot if the slope is not to my satisfaction.
I try eating foods that make me spike when I've got other things tying up my digestion and know that there won't be any spike for a long time.
9. How do you prefer to manage your logs/data?
I always record Lantus dosage, 'cause I play with it a lot. I upload Dexcom data and enter into it what's what. Every now and then (maybe twice a month) I'll count my carbs very precisely for a few meals in a row (maybe two days' worth) and see how my ratios are looking. I also write about one sentence per day about if anything weird was happening.
I used to log a lot more but I just don't feel like it anymore.
Thursday, October 21, 2010
Monday, October 11, 2010
Probelms with This Blog
As you may notice, this blog often displays posts overlayn with my profile or side links.
Do you know of any way to prevent that? The ones that change my blog appearance least will be most appreciated; otherwise I'll switch templates entirely.
Do you know of any way to prevent that? The ones that change my blog appearance least will be most appreciated; otherwise I'll switch templates entirely.
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