Scott's Diabetes Blog

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Location: Minneapolis, Minnesota, United States

Diagnosed with Type 1 diabetes in April of 1980. I recognize the incredible mental struggle of living with diabetes. I hope to share my struggles, my successes, and everything in between.

Tuesday, July 26, 2005

Is 30 To Young?

Am I too young to be concerned about heart problems?

With long term diabetes it is said that you are at higher risk for heart problems. I think the statistics are somewhere around 6 to 10 times higher risk than a non-diabetic person. Add in my excellent (NOT!) dietary habits and the fact that I'm still a good 40 pounds overweight and I bet it's even higher.

I've never smoked and I don't drink, so I've got that going for me. I try to get regular exercise, but it seems to go in spurts in regards to consistency. I'll do good for a couple months, then something comes up and I fall out of my routine for a while.

I've heard that often times people with diabetes that do experience a heart attack say the symptoms were very mild and hard to notice. That scares me.

I had the opportunity to ask one of the RN's that I work with if I'm too young to be worried about all this, and she thought that I was. However she did offer a suggestion that made me feel better. She suggested that I ask my endo if I am a good candidate for a cardiology workup.

I think that sounds like an excellent idea, and I happen to have an appointment with him in about a month.

Thanks for listening!

Wednesday, July 20, 2005

A Couple of Things

So last night I posted on having to treat an upcoming low right after dinner and being so full I thought I would explode... Well I woke up this morning at 310. What the hell! I did play basketball over lunchtime for a couple hours, and I'm just not used to dealing with that particular exercise/duration/intensity yet.

There are a couple of possible scenarios I thought of for that high this morning:
  1. I still went low last night and the high in the morning was a rebound
  2. I overtreated that upcoming low last night

I am lucky enough to work with a group of RN's that specialize in diabetes. One of the nurses said that if you wake up high in the morning and it is because of a rebound from a low during the night, you will have ketones in your urine. I will keep that in mind for the next time I suspect that. The problem with that is my morning habitual routine. First stop in the morning is the bathroom, then downstairs to test & eat breakfast (usually). By the time I know I'm high and suspect anything, I've got nothing left to, uh, deposit on the ketone test strip. Although I suspect that there would still be ketones present the next time I need to go - you can't flush them all out in a single void (I don't think so anyways).

Another thing that one of the nurses recommended is a formula regarding temporary basal rates before & after exercise. This topic is varies so much for every person, and of course the exercise can vary quite a bit (sometimes I play basketball and am very aggressive, other times I lack off a bit... depends on "stuff" you know?). So, with that being said, YMMV (Your Mileage May Vary). The formula was basically for every 30 minutes of good intensive work, run a 50% basal rate for 4 hours afterwards. So, for 2 hours of basketball I'd want to run my basal rates at 50% of normal for about 16 hours afterwards.

That may have really helped me yesterday because I think I was crashing at dinner because of that good exercise earlier in the day. What happened was that a while after dinner I started feeling kind of "funny". I did a test and I was running in the low 100's (101, 110, something like that). This was immediately recognized as a problem because I still had over 8 units of insulin on board from the recent bolus at dinner! So, I had to scramble to avoid crashing in the near future.

Maybe if I had continued to run a temp rate reduction that afternoon I would not have been crashing at dinner.

It gets complicated though when you start to think about such intensive exercise, burning alternate fuel sources, creating ketones causing insulin resistance driving blood sugars higher.

I'm a master at overcomplicating issues. It really is complex though, the way the bodies metabolism works and having to try to figure it all out (and get it right) while exercising.

Stay tuned...

Tuesday, July 19, 2005

Have You Ever Been...

...really full, but HAD to eat/drink something because your blood sugar is low?

What an uncomfortable feeling! Talk about looking for something that has the most "bang for the buck"!

As strange as it sounds, even glucose tablets feel like they are going to be the calorie that makes the stomach explode.

I imagine that this is what it's like to have gastroparesis, where the insulin is working faster than the food is being digested and affecting the blood sugar.

In my case tonight, I had been fighting some lows late in the afternoon, and must have been crashing during dinner or something like that.

Old Medical Records (Joslins 25 Year Certificate)

I'm a little frustrated. I celebrated my 25 year mark with diabetes this past April. I got interested in getting my 25 year congratulatory certificate from Joslins. I just thought it would be kind of neat to scan it and put it on my blog here. :-)

I started researching what is required to get registered with Joslins, and the best thing is discharge records from diagnosis.

I've lived in Minneapolis my entire life, and there are only a handful of hospitals that I could have gone to. My dad & I can't remember exactly where I went, and my mom passed away recently, so I can't ask her (it's from her that I know it was April of 1980, because I asked her about it a couple years ago). I sent record requests to two of the main candidates (Methodist and Fairview Riverside), but both have returned correspondence indicating that they have no records for me for that time (April of 1980).

I've got a couple other longshot possibilities - Fairview Southdale and Childrens. I think I'll send a records request off to Fairview Southdale first, just because I think I would have remembered Childrens because of it's unique "kid friendly" environment.

There are other options that Joslins will accept, but I would really love to see my discharge records from my original diagnosis, so it's about more than just the certificate now.

For those of you who are "recently" diagnosed, tuck those records away somewhere - you may want to look at them 50 years down the road...

Monday, July 18, 2005

Self Control & Evenings

I've been waking up high a lot lately (say that to a non-diabetic and see what they do...).

I've got an idea as to why, and it doesn't have anything to do with basal rates or the dawn phenomenon or anything like that.

I mentioned in a previous post how managing diabetes requires many "mental visits" through the day. I usually do pretty good with things all day. I seem to have the mental discipline to keep track of things, counting as best I can the things I eat, testing a lot, correcting, etc.

By the time I get home at night I seem to get a little lazy. Eat more than I should, don't count it as close, guestimate my insulin, yadda yadda yadda...

I think it could also have something to do with the fact I seem to be a product of packaged food (usually junk food at that). I get home, don't have stuff in pre-packaged serving sizes, don't feel like measuring and before you know it I've eaten four servings and counted for two.

You'd think I'd be pretty darn good at carb counting after 25 years, but I've always hated it and use any excuse available to fall back into my old bad habits.

Does anyone else recognize that they let their guard down in the evening? It's almost like it has beat me up all day and I just surrender to it at night. What's the deal with that? Any thoughts on what to do to keep my motivation going once I get home?

Friday, July 08, 2005

Why it's important to eat breakfast

I've been very calorie conscious this week, being very careful to not eat more than I burn, working to start losing some weight again (it's been creeping up on me lately...).

I had a big lunch scheduled for this afternoon, where I just knew I'd be taking in a TON of calories. I also woke up with a high blood sugar (overtreated a reaction last night). Those two factors combined were enough to convince me to skip breakfast.

I know that your body needs to burn energy from one source or another. If you have carbs on board it will use those, otherwise it starts looking for alternative sources (fatty acids, etc). In this scenario I hadn't had any carbohydrates since right before bedtime when I overtreated that low.

What else do we know about burning those fatty acids for energy? That's right - ketones! So, theoretically it is possible to be spilling ketones with a normal blood sugar, just because you are burning fat for energy (a process of which ketones is a side effect). Now, spilling ketones TENDS to make you more insulin resistant, driving your blood sugar higher.

You could theoretically keep your BG's normal by increasing your insulin, but you are still spilling ketones because you're burning fat for energy! The insulin will not eliminate the ketones - to get rid of them you need to drink a bunch of water, but it will help manage your blood sugar level.

So, I wake up at 7'ish, not having eaten anything since like 11pm the night before. But, I was high from overtreating a reaction. Here's the breakdown:

7:17 - 357 - 7.35 unit correction bolus
9:05 - 272 - 0.00 unit correction bolus (still had some on board from earlier dose)
12:51 - 252 - Asking myself, "Why the heck am I still so high - I corrected that high this AM, and haven't eaten ANYTHING?!?! ..."

It was precisely then that I had an "Aha!" moment! By skipping breakfast my body did not have any carbs on board for a fuel source, so it turned to alternative sources like burning fat - spilling ketones, therefore making me a bit resistant to my insulin!

I should have been prepared and had some ketostix around - it would have been very interesting to prove my theory! Maybe if I plan on fasting I have to run a slightly higher basal rate? I would like to test this theory when starting with a normal blood sugar rather than such a high one.

Does this theory sound possible? Crazy? Maybe I've got too much glucose in my brain, and I'm just making things up? What do you think?

Update on Set Changes & Timing

In a post a while back I was talking about how I run high for a while right after changing my infusion set.

I mentioned the problem to a couple of educators and clinicians, and they suggested making sure I am inserting the set into a very "fresh" site/location - something that doesn't have much scar tissue or "nodules", and to also do the set change right before breakfast, getting a nice big breakfast bolus delivered right after the set change.

I've been pumping for what I consider to be a "long time", which in numbers works out to be somewhere around 8-10 years (I can't remember exactly when I started). For all of those years I've used my abdomen and lower back (love handle) areas. I've always been very good at changing my sites every 3 days and rotating around each side, etc. So I am a little disturbed to think that my tissue is at the point where I'm having absorption problems.

Trying their suggestions, I have started using my rear end. I was very hesitant, just because it's a new place - I've never jabbed a needle there before and didn't know if it would hurt worse than my "usual" sites. To my delight, it was very comfortable, and I did the change right before breakfast. I had a normal breakfast and took a normal bolus.

My blood sugar did not spike and run high!! It was great! A normal blood sugar after a set change and a meal! How refreshing!

The next experiment will be to let my abdomen heal up for a while (how long will that take?), and then try infusing there again. I'll also have to do some research on alternate infusion sites and see what other options I've got.

Tuesday, July 05, 2005

Flatwater Kayaking!

I'm not much of a "workout in the gym" kind of guy. I mean, I go through spurts, where I'll get on a kick for a while, but it just doesn't hold my interest enough to keep me there long term.

At my last job there was a big fitness center on location, which I did use a lot. I could manage it into my work day, and most of the time the place was dead so I had it all to myself. I don't have that luxury anymore. So, I need to find other ways to get some exercise!

One day I was out walking around Cedar Lake here in Minneapolis, and was crossing a little bridge over a small channel that connects it with Lake of the Isles. As I was walking across the bridge I looked down and saw a couple guys kayaking through the channel and thought it looked really intriguing.

When I got back home I wanted to at least do some research on kayaking lessons in the area. I found a place called Paddle Masters that offers a series of lessons over a couple days for flatwater kayaking. I decided that it would be worth my time and the class fees to try it out and see if it was something I liked enough to invest in.

There were three courses split out over two days. Flatwater 1 & 2 on a Saturday, and Flatwater 3 on a Sunday a few weeks later. The classes ran pretty much all day on both days. I didn't think much of that until it got to be about 2:00pm on that first Saturday, and my body was completely exhausted!! I was (and still am) in pretty poor shape, not doing much of anything on a regular basis, and here I go jumping in a kayak for 8 hours! What the hell was I thinking?!

The first half of the day went well - I capsized (tipped over) a couple times, and can proudly say that I was the first in the class to get wet. The second half of the day was torture. There were only two other people (both triathelets) and the instructor. I felt like I was working my tail off just to keep up with them, and felt kind of bad for slowing them down. I also kept capsizing - I mean like 5 or 6 more times!! I was getting very frustrated, and thinking "man, I don't know if this kayaking stuff is for me!".

I made it to the end of the day, and on shore when the instructor and I picked up the kayak I had been using we almost doubled over because it was so heavy! He got this confused look on his face (I wasn't confused, I thought I was just so damn tired) and we put the boat back down. He opened up the storage hatches in the front and back, and BOTH WERE COMPLETELY FULL OF WATER!!! He said "that explains everything!". Water weighs something like 8 pounds per gallon, and I had at the very least 12-15 gallons of water in those compartments. So here I am paddling around with an extra 100-120 pounds of water in the boat, sloshing around from side to side, front to back.

I tell you what, I was SO relieved to see that there was a reason for me being so tired and unstable! I thought I was just a big puss and was ready to throw the whole kayaking idea down the tubes!

As we were cleaning the boats up and helping the instructor load them onto the trailer, one of the triatheletes, who was also signed up for the next class with me, asked me if I planned on renting a kayak and going out to practice before our next class (in a few weeks). I thought about it, but decided it would be a bad idea. Specifically because we had not learned how to get back in our boat if we capsized out on a lake by ourselves!! And based on how many times I capsized, I thought I might need to know that technique before venturing out on my own...

A few weeks later rolls around and I did the Flatwater 3 class, which again was an all day thing. I was tired, but did a much better job of staying hydrated and feeding my body with a good mix of carbs & proteins to help pull me through (BG's stayed pretty good all day long). I did capsize a couple times, but was not to the point where I was so frustrated with the whole thing. It was very windy and there was a lot of boat traffic (which means lots of big waves!).

I was also able to pull off the single rescue, getting myself back in my boat on my own. That was a huge confidence boost, and to the point where I feel like I could do it on my own if I need to. I also had to keep in mind that on both days I was in boats that may not have been the best for me. They were the official touring kayaks, made for multi-day trips, etc. The ones I had been looking at were more the big giant cockpit size and made for tooling around local lakes, etc.

After going through the classes I decided to buy my own boat, and got a big recreational one. I've had it out a few times since I got it, and it feels very nice and stable. It's got room in the cockpit for me to take the kids with me (one at a time, with proper lifejacket apparel of course!).

It's really interesting to me that my blood sugar really seems to drop while I'm doing it. It's a slow and steady kind of thing, kind of like walking I guess, but more with your arms. Nothing real vigorous, but I do build up a sweat. That alone tells me it must be good exercise! I do have a bottle of glucose tablets stashed right next to my seat as well as a testing kit in a waterproof box.

Hopefully I can go tour some of the beautiful lakes around here, getting wet only if and when I choose...

Stay tuned!


I was just thinking back on something I got a little kick out of a few years back.

I spent a couple years working for the Federal Reserve Bank here in Minneapolis. It was a really neat experience! I got to tour the vault and the cash shipping/receiving area - talk about impressive!!

Before I started working there I had to pass a very thorough background check. This included getting fingerprinted, etc. When they did the fingerprints it was on a completely digital system. As they rolled each of my fingers (and thumbs) across a little digital scanning pad, a high resolution image of my finger appeared on a large monitor in front of us.

My fingers were riddled with (what seemed like) hundreds of these little diamond shaped lancet marks! Very weird to see it on the screen of the monitor! I had to explain to the security guard that I was diabetic and had to poke my finger to test my blood sugars through the day!!

I could also see very clearly which of my fingers were my favorite to poke at the time!

Any diabetic criminals out there that can fill us in on whether all those lancet marks makes it easier or harder to track us down? Hehe!