Rage Against the Machine

You ruined my beautiful blood sugar you d*mnned CGM!


It was a beautiful day in Vermont.  Temps in the low 80s, perfect blue sky dotted with fluffy white clouds, dappled sunlight shining through the trees...

picture courtesy of Burlington Hostel

I was mowing the lawn; a job I actually don't mind since it appeals to my need for immediate gratification every once in a while.  We have a huge, uneven, hilly lawn so this little chore usually takes me about 4-5 hrs.  We only go up to VT on the weekends, and by then the grass is knee-high and the weeds are out of control. But, I was enjoying being outside, and knew that I would have a good BG reading pre-dinner because of all the mowing, raking, wheelbarrowing and weed-wacking.


After yard duty, hubs and I decided to grill dinner.  We had a delish summery dinner- lamb chops for him, and fresh corn, grilled zucchini, pasta (Dreamfields) salad and grilled pineapple for dessert.  Heaven for a veggie like me!  May sound a  bit high carb, but suprisingly, corn on the cob isn't too bad on my BG  readings.  I bolused 5.3 units for this meal and my pre-meal bg was 66 (a tiny bit low due to all the exercise, but not bad.)


Two hours after dinner I heard the dreaded "your bg's low" tone coming from my pump.  It's really amazing how four little beeps can inspire so much fury!!


 The ensuing disaster is the problem I've been having recently, trying to figure out how to utilize the CGM in the best way with out driving myself or husband crazy.  Any hints/suggestions/advice/commiseration is appreciated!


I looked at the screen.  Beautiful straightish line hovering between 66-82-70.  Ahh perfect combo of exercise, insulin and food.  However, my CGM is set to go off as "getting low" at any BG 70 or under.  I'm hesitant to mess with that setting because I know the CGM isn't 100% accurate and when it says 70 it may actually be 45.  So,  I checked my bg with the meter. Actually 70. Wow.  Very accurate.  Now what do I do? I sit through another half hour or so of beeping every 5 mins and test my bg a few more times 68 was the lowest.  Ok, I thought, I'll eat 5 chocolate covered almonds to raise the bg a few units- anything around 80 or 90 will stop the CGM from going off all night. Test half an hour later: 70.  Ugh, how come I can't raise my bg when I want to, when I don't want to, its always 200+...?  Beeping continues...Blood sugar not rising, but temper is!!  Check the meter and see I have 1.1 units active insulin left.  Ok, maybe that's why bg is not going up.  I decide to eat a Nonni's biscotti 14g of carbs. My ratio at night is 1:10 so I thought- perfect amt of carbs to override the 1.1 units and boost my bg a little? Right?  Am I making sense or do I completely not know how to calculate I:C ratio?


I decide I can go to bed now and I really really want to because I am tired after all that mowing.  I go to bed and fall immediately asleep.  I fall so soundly asleep as a matter of fact, that I don't hear the doo-doo-doo-doos until the meter starts vibrating, lighting up and shrieking like a police siren.  Ahhh!  Test BG again.  140.  CGM still saying low.  Calibrate you damn thing!  I calibrate it and go back to sleep, totally exhausted.  I must have slept for maybe 3 hours when I hear those f'ing doo-doo-doo-doos going off again, but now in the annoying "your bg's high!" tone.  Oh my god. I can't take it.  Why are you messing with me? Bolus.  Sleep. Beep. Bolus.  Wake up in a very bad mood.  Test BG 109. CGM says 170.  CGM, I. hate. you. right. now. 


Hubs nicely asks about my opinion on concrete floors.  (We are looking for a new apartment and that is an option in one apparently.)  "Concrete floors!?!"  I practically yell.  "What are you talking about? You drive me crazy!  This damn things been going off all night and I've had 3 hours of sleep!  Why are you talking about concrete floors?!"  Hubs nicely asks if I am ready for my coffee now. 


Finally, after coffee when I am feeling more reasonable, I apologize to hubs, and to CGM.  I know the CGM is only doing its best and trying to help me, but I am getting sick of these interrupted nights.  Can anyone else relate to this?

School Daze

I am starting grad school in Health Systems Management in the fall (ideal career is nebulously defined as trying to do something to improve diabetes care and I hope I'll be able to get some clarity on that as I start my program.)

The program requires two pre-reqs and strongly recommends a third, so for the last six weeks I have been doing nothing but studying, taking exams and reading.  These classes are accelerated classes during the summer, so they will be over soon (thank god) but it's been a lot, cause did I mention these three classes are microeconomics, accounting and statistics? Oh, yeah.  F-u-N!

I was not a diabetic in college, didn't get the 'betes until I was 25..  (Which is a very good thing, considering my typical college weekend consisted of beer, pizza, waffles, beer, jungle juice, beer, pizza, bread sticks, beer, Gatorade, cereal and Gatorade.)  

I really had no idea what going back to school was going to be like, diabetes-management-wise.  Funnily enough, its easy to go right back to those eating habits I just described...with maybe not quite so much beer.... I've been in class so much that food shopping for fresh healthy food has gone by the wayside, and bagels, pizza, and big macs-with-no-meat are my new besties.  Not ideal, I know.

Last week, I had lunch with a friend near my school. We had sushi, which is definitely on the I list of "I love carbs but they don't love me" foods, but I eat it every once and a while and (thought) I had worked out a decent bolus.  For me, its actually one unit for every piece of sushi.  We ordered three rolls to split and had some edamame.  I bolused 9 units and only ate 7 pieces, so I thought I was good.  On the way to school, I must have immediately been feeling the carb-high-sluggish-brain coming on, because I wanted coffee but for some reason, ordered a cappuccino (way more carbs than I needed/wanted =high bg brain fog?) so 2 more units for that.

Now onto the homework and studying in the library before class.  Two hours of reading and homework later, I realized, I had not retained A (not one) thing. Fast forward to the next day, when I got the grade on the homework I turned in.  Not even half the questions right (Luckily, I've been doing well on all the other assignments.)  Ugh.  Its easy looking back, with a reasonable blood sugar brain, to see that I should have checked my bg sooner, and corrected it.  But when you're in the throes of high-blood-sugar-blood-is-as-thick-as molasses-and-is-clogging-my brain its not even easy to make the decision to test.  So lesson learned.  And, re-learned, as far as my homework goes. 



This is a normal brain...axon and dendride firing signals... you remember biology...making the brain work. (Picture courtesy of http://en.wikipedia.org/wiki/Synapse)

This is a brain after sushi (or other high carb food is consumed) axon and dendrite clearly unable to function normally.

Freaky Tuesday

Yesterday was my birthday.  I had a great day that started with coffee and presents in bed.  Ahhh.  Promoting my happiness.  (side note: I went to dinner a few months ago a new restaurant, and at the end the waiter asked me if there was anything else he could do to "promote my happiness."  I decided that this phrase needed to be included in my life at least once a day from that point forward.)


Then my meter beeped to tell me my reservoir was low.   (Ok, to be truthful it beeped the night before but I didn't feel like to changing it so I checked to see how many hours of insulin I had left.  Omg, 19 hours!  I'm only gonna sleep for about 7, I don't need to change it now! I rationalized...)  And, luckily, I have always drank (drunken? drinked?) black coffee with one splenda so I don't have to worry about bolusing for coffee in the morning.  But...eventually.... I had to get out of my wonderfully warm and comfy presents-covered bed and change my reservoir. 

I don't know why I said this, as I wasn't really in a morbid mood, but I sighed, "Gotta get up and change this thing so I can live another day."

Later, after lunch and cupcakes! on the roof deck I had class from 6-9 pm (brutal!) Its 20+ miles from my house, and knowing greater Boston traffic, I leave 2 hours early just in case.  Traffic was actually light, so I had an hour to kill before class. I decided to take a walk in a huge cemetery that's on the way to class.   It was a nice day, the cemetery is nicely landscaped and  is not at all freaky...

Well, that is, not at all freaky until this:

Two headstones next to each other: one with my  name, one with my husand's name.

Gah!

Who am I Ebeneezer Scrooge 

with the Ghost of Taking-a-risk-by-not-refilling-your-reservoir-when-you-got-the-warning Future? 

And on my birthday? Man!

(Other than this freaky episode, I really did have a wonderful birthday)

The Diabetic Manual

Right now, I am supposed to be studying for my exam tonight.  What am I doing instead?  Procrastinating big time by reading the "Diabetic Manual: Tenth Edition" written by Dr. Elliot Joslin in 1959.

I found this at an antique store in Maine last summer and have been meaning to read it but haven't got around to it until now, when I'm supposed to study :-)  I'm interested to see what kind of advice was given to PWD in 1959.  I'll be sure to post some good tidbits as I get to them.

Saturday (err Wednesday) Snapshot

I meant to post this on Saturday but got a bit busy so here I am.  I call this masterpiece

"Still Life with Diabetes"

Here is a pic of my two kits.  The blue one is my everyday meter, finger sticker, test strips, lancets, alcohol wipes kit.  Those black bags they give you with your kit are so boring, in my opinion.  The other one is my CGM/backup kit with everything I need to change my infusion or sensor.  I always want something bright and cheerful to keep all my supplies in...and will shamelessly use D as an excuse to buy handbags.

What They Should Know

Diabetes Blog Week Day 5

Diabetes is relentless.  That is what I'd like others to know.  It never stops.  It is not the kind of chronic disease for which you can take a pill in the morning for and forget for the rest of the day.  A PWD can't forget it even for a minute.  I could be fine one minute, and literally sweating, shaking and having a low the next.  It may look like I only deal with my diabetes at meal time- you might see me with my meter or putting numbers into my pump.  But, I am actually dealing with it ALL the time.  Everything must be planned- what I eat, when I eat, where I'm going, what I'm bring with me.

A perfect example of this is the time Hubs and I went away for a long weekend a few years ago.  I was pretty new to diabetes- probably had it for less than 2 years and I was on the flex pens for insulin. We were with a group of friends and had beautiful weather and a great day planned: watching a daffodil day parade, cycling out a picnic area for lunch and then having a big group dinner at a local restaurant.  My DH (dear husband) got us bikes and was excited and ready to go.

Before we could even leave I remember asking him a hundred questions: Where are we going? How long is the ride? Who is bringing the picnic? What kind of food did they make? Should I bring my own food?  Is it too hot to keep my insulin in the bike basket?  What time is dinner? Are we cycling back? Where is the restaurant?  Do I have enough snacks in case I go low? Are there any stores on route in case I need anything?...   DH was very understanding, but I could tell he was surprised at the number and almost-frantic nature of my questions.  I remember being close to tears because I felt so overwhelmed at managing the kind of day that is supposed to fun, spontaneous and relaxing.  In the end, we had a pretty good day.  We talked about all my questions and got stuff figured out but we were late getting to the picnic and I admit I felt a bit embarassed at my break down.

That experience shows the relentlessness of diabetes.  What would be a fun easy day for most people left me in a cold sweat trying to think about manging exericse, picnics and dinner in a restaurant.  I wish people could see and appreciate the constant planning, worry and  thought process and guilt trips that we go through just to do regular every day things.   As soon as I figured out that day on our long weekend trip, I had to get up and start it all over again the next morning....

Fantasy Diabetes Device

Diabetes Blog Week Day 4

So far (fingers crossed/knocking on wood) I really don't mind the infusion set changes or wearing the sensor.  Sure my pump line usually ends up wrapped around my waist at night when I'm sleeping, and having two sites on my body at all times isn't ideal, but I can live with those things.

My fantasy device would be an app for smart phones that immediately and accurately counted the number of carbs in any and every meal.  You know how you can scan one of those bar code box thingies with your iPhone to go to a website or get more info? I would have the same technology look at the food I was about to eat and tell me precisely how many carbs were inside.  The app would take everything into account: condiments, sauces, garnishes etc. No more wondering about serving size, or asking yourself, Is this baseball sized or the size of my palm? the size of my husbands palm?  Does the restaurant consider this to me a S, M, or Large?  All those frustrating ambiguities would vanish and you woud have your carb count with the touch of a button.  Imagine eating pad thai, sushi, pastsa dishes with all kinds of veggies, salads with a hundred ingredients, casseroles... with no worries... and no nasty blood sugar effects... Ahhhhh.....Can someone invent this now please?