Hypoglycemia Unawareness

My control seems like it's been a lot better lately. I'm spending much more time in the mid to low 100's rather than above 200. I credit much of this to my using the more advanced features of my Cozmo pump. The features I've started using more often are the following:

• Bolusing by grams of carbs vs. straight units of insulin. I used to do the calculation in my head and just enter the amount of insulin in units. I would total up all the grams of carbs, then divide by 8 (1:8 ratio) which would give me the amount of insulin needed. Now I just enter in the carbs (the Cozmo has this great "Meal Maker" feature which allows me to enter each item individually and it totals it all up - a fancy calculator) and IT does the necessary calculation for me. I think this also helps keep me honest. I figure there were many scenarios where I didn't want to own up to how many carbs I was eating for a snack or something, and would just "punch in" a handful of units. This would start the rollercoaster effect and I'd be riding it until I was motivated enough to stop it.
• Trusting the pump. The pump has an adjustable "duration of insulin" figure and keeps track of the amount of insulin "on board". If you tell it to, it will factor this amount into any boluses entered while there is insulin "on board". I trust whatever the pump suggests for the most part (unless it is totally ridiculous, which has never happened yet).
• Using the "Correction Bolus" more. Pretty much anytime I test my blood sugar I will enter it into the pump (or use the CoZmonitor which attaches onto the back of my pump) and ask for a correction bolus. If the pump calculates that I don't actually need any insulin it will "suggest" a bolus of 0.00 units. This really helps keep me closer to my target (100). Another way I use this is to avoid lows. If I do a test and come in at say 119, but I still have some insulin on board, I know I need to have a little snack to avoid a reaction in the near future.
• Using the "Combination Bolus" more for my fatty meals. This option splits my meal bolus into a portion that delivers some right away and some over a period of time. Even splitting a high fat or protein meal into a 70%/30% split seems to make a big difference. I certainly don't have it down to a science, but even just experimenting with it more is making a big difference.

Where I'm going with all this is as I spend more time with a BG closer to my target, I've noticed that I'm not feeling my moderate lows as much as I used to. I used to feel symptoms at very close to 70, sometimes even 80'ish. Now I am surprised when I do a test to find myself mid to low 60's or even 50's and not feeling any noticeable symptoms.

As I thought about posting on this topic I wanted to check into some details about it. I have a copy of "Pumping Insulin" by John Walsh and Ruth Roberts at work here, and there is a small chapter dedicated to hypoglycemia unawareness. There is a whole list of situations that can trigger this, and they say the major culprit is frequent low blood sugars. With that in mind, I'm quite sure that I've had more lows lately - which happens as you tighten your control.

Have any of you had problems with this? What have your experiences been? Anyone able to deal with it in a positive way?

On a somewhat related note, I attend a monthly pump group in the area. It's a nice social atmosphere and I've gained a lot from the group. On occasion we have a guest, and last year we were visited by a woman who had severe problems with hypoglycemia unawareness. She has enlisted the help of a service dog! It was the most incredible meeting I've been to! Her service dog was still in training (the tests & training are incredibly thorough) but he had successfully caught a handful of lows that she was not aware of. It was really something special. I do think we'll see more of that type of thing as more people become aware of other services these special dogs can provide. There are also many people that have stories about their cats and dogs helping them wake up at night during a reaction, etc. I think it's pretty neat!

Excercise Physiology?

I've talked my boss into letting me split my late shifts twice a week which allows me to go play basketball at the YMCA over lunch, and I've also taken a couple of flatwater kayaking lessons and I'm planning on doing that a couple times a week. I got my bicycle tires all pumped up and I think I'm ready for a test ride.

As I'm getting more active I am getting increasingly more interested in how the body works in relationship to exercise and what the body needs for fuel, how your blood sugar level affects your performance, and the differences between how a non-diabetic persons body works while exercising and how a diabetic body works while exercising.

The body has such a complex system for balancing the blood sugar level, releasing insulin to lower blood sugar, releasing glycogen to raise blood sugar, dealing with adrenaline and other blood sugar raising hormones, all the while dealing with different sources of energy (glucose, fatty acids, etc.) depending on the intensity, duration, environment, circumstances, etc. It's really mindblowing.

I'm hoping to leverage the exercise to lose some more weight, which is difficult if I keep eating to maintain a high enough blood sugar. You can cut your insulin back a bit, but you still need some on board otherwise your bodies fuel sources can't get the energy into the cells. There is a fine line there, and it's hard to put exercise into a quantifiable number.

I've also had problems with my blood sugar rising because either my body dumping adrenaline causing higher insulin resistance or just not having enough insulin on board.

It's a bit frustrating because while exercising, conditions are usually not ideal for frequent testing (which is necessary to figure this stuff out!!).

I think that the more I learn and understand how my body works, the better I'll be able to anticipate my insulin needs. Any advice on books to read, etc?

Is managing diabetes a full time job?

If only I had nothing else to do... Right? Wrong - but anyways.

I sometimes feel like there are so many things that we deal with that sometimes my diabetes takes a back seat and I don't give it the attention I need to in order to achieve better control. I mean, life gets busy sometimes!!!

I often think that managing diabetes can be a full time job, and at times it can be. But looking at how typical management is done, it's kind of weird. Managing diabetes is not a "task" that you can focus on and "get it done", but rather requires multiple mental "visits" through the course of a day.

I think my biggest problem is maintaining a consistant level of diligence through the course of the day. I might be very motivated at one point of the day, but I have problems maintaining that level of motivation while navigating the course that unravels for the rest of the day.

So, if I didn't work, or do anything else at all, would I be able to manage my diabetes better? I don't think so - just because I don't think any of us can maintain that focus all day every day!

The puzzle is figuring out how to balance everything when taken together. I think that diabetes can be just a small mental part of our normal thought process during the day. Similar to driving - I'm still very careful when driving, but for the most part it is somewhat unconcious. Something I've been doing for so long that it does not require 100% focus like it did when I first drove. Maybe diabetes is a bit like that? Some situations and circumstances requiring more focus and attention, but for the most part occupying a small amount of mental resources...??

Thoughts?

Balancing Responsibilities?

My exercise patterns of late have slowed down a lot. Some due to life changes (new job) and others just due to season changes, etc. With that I've felt a lot of pressure on myself to get moving again. I also recently read somewhere that type 1 diabetics are at 10 times greater risk for heart problems - hell, I thought it was only 6 times greater risk and I thought that was bad!!

I've got a family at home, a wonderful and beautiful wife and two great kids. My kids are 5 and 2, and at that age demand a lot of attention and energy. So where the heck do I find time to exercise? If I stay home and be with the family I feel like I'm neglecting my responsibility to exercise. If I go and exercise I feel like I'm neglecting my family responsibilities. There are some activities that can be done as a family, but the kids don't always appreciate being thrown into a stroller and carted around (plus, my 5 year old is getting BIG for a stroller). However, letting them just walk with me usually doesn't work - they stop and look at every spec of dirt, bug (dead or alive), leaf or any other piece of debris along the way. It takes 10 minutes to walk 10 feet!

Finding that balance is the key. Why is it so damn elusive?