Monday's Diabetes February 24th

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

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

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

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

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

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

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

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

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

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

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

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

At 1000 hours CGM read 95

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

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

At 1300 hours CGM read 94.

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

At 1500 hours CGM read 123

At 1600 hours CGM read 125

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

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

At 1900 hours CGM read "WARM UP"

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

At 2100 hours, CGM read 273.

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

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

The day ended with CGM reading 121

Monday's Diabetes February 17th

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

So here is Monday, February 17th.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

At 1300 hours the CGM read 107.

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

At 1500 hours the CGM read 141.

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

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

At 1800 hours the CGM read 74.

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

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

At 2100 hours the CGM read 152.

At 2200 hours the CGM read 159.

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

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


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

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

Another One Bites The Dust

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

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

Dear Medtronic, PLEASE NOTE, YOUR BACKLIGHT IS NOT FOOLPROOF

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

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

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

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

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

Labs Mostly Normal

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

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

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

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

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

My albumin was slightly high, probably from mild dehydration.

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

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

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

Hodgepodge Post

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

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

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

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

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

Things I Have Liked About Pumping

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

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

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

And the previous one was so nice too.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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