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.

Wednesday, March 29, 2006

Positive Feedback vs. Negativity

What gets you going? Positive feedback or the nay sayers? Are you the type that gets serious motivation to do something just because someone says you can't? Or do you get going when you get some positive recognition?

I am the type that gets a real charge out of any positive feedback. It gets me going. Makes me work even harder at whatever it is that I'm doing. Gives me a sense of power - that I can do whatever it is that I'm working on.

Negativity works in just the opposite way for me. It sucks any motivation that might be there right out of me. Makes me just want to escape the situation. It makes me just want to throw it all to the wind and give up on it.

One of the clearest memories for me of the difference between these two approaches to motivating people is the differences between my basketball coaches in high school. I didn't play much at all, I rode the pine for most of both seasons. I gave it all up in my junior year when the varsity coach wanted me to pay for my uniform - which I never wore because I was the guy stuck with camera duty up in the stands during each game. So I gave it up and started working. Since then I've been addicted to a paycheck and haven't ever looked back.

The difference between my freshman and sophomore coaches became very apparent when the team was in trouble during a game. Our freshman coach would pull us into a tight huddle, either during a time out or maybe at halftime. He would let us know what was going wrong, then he would tell us that he knew we could do it - no matter what the obstacles, we could find a way to come back and win. He had such inspiring confidence in us. It got the team just absolutely juiced up. The guys would go out and battle back. We didn't always win, but the efforts put forth were just simply impressive. And the coach was always proud of us. No matter win or lose. He would pull the positive out and focus on the good that happened.

The sophomore coach was just the opposite. In those same type of games, where the team was really having trouble, this coach would pull us together and tell us how utterly disappointed he was in us. Telling us that that he was just going to give up, and that he guessed that we don't have what it would take to get out of that tough spot. The effects of these talks were absolutely devastating. The team just fell apart, totally. It was a very tough transition for all of us. And maybe that was the thing - that it was totally opposite of what we had been exposed to with our freshman coach.

To watch the differences that the two approaches had on the team was very clear to me, even as a young high school kid.

I find that these approaches have similar effects on me in different aspects of my life. Be it at work, or in my diabetes management, or whatever.

I was diagnosed at the age of 5. After some changes in the early years, I ended up seeing the same endo for many, many years. We're talking at least 15 years. He was a Pediatric Endocrinologist. I can remember being 20 years old, walking into the waiting room and having to look for the "big" chairs. Maneuvering around those tables with the painted metal rods, bending every which way, lined with wooden beads of all sorts of colors that you would push up and along the rods. Flipping through the Highlights magazines and other kids reading materials. Feeling strange about driving myself to the appointment and coming into the "kids section".

But this doctor and I had a TON of history. He knew me, and I knew him. He knew that I did not respond well to the scare tactics that are so often used with diabetic patients. Rather, he encouraged me, with friendly conversation and positive feedback about good changes that were being made. Challenging me to rise up to that next level of control, and feeding me information on things I might try using to get to that level. With him I was able to achieve my lowest A1C result ever.

I finally had to leave his office due to insurance changes - otherwise I swear I'd still be going to see him. They would have had to literally throw me out of the office. I am still trying to recover from the devastation that I felt having to start all over with a new endo. I have yet to find one that really does the trick for me.

But where does that positive feedback or negativity come from when you don't have that special connection with someone in your care team? I'm not sure about you, but I have tons of negativity rolling around my brain - much of it coming from myself (worries about not doing good enough, etc.), more of it coming from all the bad stories that people have about "that guy they know who lost his leg, went blind and is on dialysis", and plenty of it coming from the docs that tell me my numbers are not where they need to be.

I do get a lot of positive feedback from my friends and family, which is great - and I rely on it heavily. Can there ever be too much positive feedback though? I don't think so.

The d-blogging community is, for the most part, very empowering for me. Many of the posts I read and comments to those posts and my posts are very positive. I personally find that very helpful. I've said it before, but I'll say it again. Diabetes is a very isolating thing to deal with, and the way we all pull together is very touching for me.

I appreciate each and every one of you - and thank you all for everything you do. Whether that is sharing your own stories on your blogs, or taking the time to drop a comment here or on other blogs, or even just simply reading. It makes a difference.

Where do you get the motivation to keep going? The drive to keep doing all the things you know you must, but seem like such a pain? The resolve to move on through the obstacles and frustrations you face?

Monday, March 27, 2006

I Am Stronger Than You

I am stronger than you Diabetes.

You will not break me.

Through whatever frustrations, confusions, inconveniences, angers or worries that you throw at me, I will prevail.

I will outlast you.

I will beat you.

I will win the fight.

I am stronger than you.

So put that in your pipe and smoke it. Chump.

Friday, March 24, 2006

Test Strip Contest - Winners!!!

What a fun time I had with the test strip contest!

I'm glad that we were able to have some fun with my untidy testing habits!! And we also had a bit of fun with the general (lack of) quality of picture that my camera phone is capable of. 8D

So, you remember from the original post that we had two parts of the contest.

1) How many strips are there?
2) What meter are the strips from?

You will also, no doubt, remember this wonderful, high quality original picture. As mentioned in the original post, this is where all my used test strips land when I test at work. For no good reason, as the garbage is just inches further in the other direction. But as Wil mentioned, that's just too damn far away.

The winner of part 1 of the contest is Kerri of Six Until Me!! Kerri guessed 133 strips, which is, as she said, "Larry Bird plus 100". There were actually 139 strips in the pouch. Very good guess Kerri. You be sure to tell Larry "thank you" when you talk to him next.

The winner of part 2 of the contest is Caro of Diabetes Wise!! Caro guessed that the strips were from my Accu-Chek Compact meter. Very nice! Perhaps she remembered me posting about this meter back in February.

These two wonderful fellow d-bloggers will be receiving some type of real world prize - but I have to wait until I get my allowance from my wife after she's had her way with our tax refund. :-)

I had a lot of fun with this, and will do something similar again in the near future.

Congratulations to our winners, and thanks to everyone who participated!

Thursday, March 23, 2006

More Test Strip Stuff...

A few more things about test strips that have wandered through the vast land of emptiness between my ears.

1) I found a test strip in my basketball sneaker. And it had a very worn look to it. Now I know it had not been there long, because like any "Good Diabetic" of long standing, I check my shoes for foreign objects before I put them on. This strip looked like it had been run through a few wash & dry cycles, and then set out in the Texas sun for a year. All this from what had to have been a single day of basketball. This does not, however, even come close to comparing to Julia's twig in bra episode... On a side note - that was perhaps the funniest post I have read. Ever. Go check it out.

2) I wear my pump, test strips and lancing device in a slightly over sized pouch on my belt. The test strips are the FreeStyle type, and similar to the One Touch strips they have an over sized tab on the lid of the bottle. This is, I suppose, to make the bottle easier to open - something to push against with your thumb. This tab makes it a pain in the ass to fit the bottle into tight spots. Most of the time I put the bottle in my waist pouch upside down, then align the pump next to it on top of the tab. Well I pulled the bottle out of the pouch, and the tab had come open. The strips went every damn where. And do you think it was a mostly used bottle, that had only a few strips in it? Nope, almost brand spankin new. I heard the entire bottle of test strips flitter to the floor. I spent the next few minutes picking up test strips off the floor, painstakingly picking debris from them so I could put them back into the bottle and use them again.

3) This one happened a long time ago, and is very similar to #2 above. I was out for lunch one day at Perkins. Sitting in one of those weird half booth things - where there's only room on each side for one person. I was working to open my vial of test strips. I have no idea how this actually happened, but right as I was applying pressure to the tab to open the vial, I fumbled it and the bottle went flying. Strips went everywhere. I'm talking up in the air, then raining down on me in my little "special person" booth and all accross the floor. It was like that card game you play on with your kids - "52 pickup". Frrrrrrrtttt. Everywhere. I was thankful that they didn't land on anyone, or in their lunch. No, they were just littered all across the busy walkway between my row of funny booths and the regular people booths next to the windows. Again, full bottle. And once again, I spent the next few minutes picking up test strips off the floor, painstakingly picking debris from them so I could put them back into the bottle and use them.

4) The Test Strip Contest is wrapping up. Winners announced tomorrow. I looked at my "diabetes drawer" at home, and am truly embarrassed about the sheer mountainous quantity of used test strips I have in there. I was going to do another contest, with a picture of that drawer - but I'm not so sure about that anymore. It's really scary. Plus I don't know if I can count that high...

5) FreeStyle test strips are packed 50 strips per vial. One Touch strips are packaged 25 per vial. Shame on One Touch for using so much packaging - it's wasteful. But dammit - I can't fit my finger into the FreeStyle vial to get the frickin' strip out!!!! I hate how I have to tip the bottle, dumping the strips partway out in my hand just to get a grip on one to remove it. Very funny how these little things, which you would think should be barely noticeable, drive you crazy. Maybe they should use more plastic and pack 25 strips per vial.

Wednesday, March 22, 2006

Update on my Nutrition Counseling Appointment

I know, I know - I shouldn't have led you on with that title. I know you're all anxiously awaiting my side of the story from my dietician appointment.

Well, it hasn't happened yet.

It was scheduled for the 15th, but that was the day that I was puking my guts out, so I had to cancel. I wondered to myself if it was some kind of subconscious thing that got me sick in order to avoid the appointment. But I dismissed that since I was not just "feeling bad", but indeed had the good old "toss your cookies" kind of morning.

The next day I called back and got back on her schedule. It's set up for March 31st.

I'll report in shortly after the appointment.

Back to your regularly scheduled program.

I would also like to thank everyone for the comments I've received so far on my denial/grief post. It's a very deep thing, and will take a good chunk of time to work through. I just want you all to know that I appreciate your thoughtfulness and feedback. It does help.

Tuesday, March 21, 2006

Facing Denial? The 5 Stages of Grief?

It seems like such a very strange thing to be looking at. I was diagnosed in April of 1980. That would be almost exactly 26 years.

How can one not have completely accepted Diabetes after 26 years? How can that be? Is it even possible?

But it seems that yes, it is very possible.

I had another very good appointment with my therapist last week. It turns out that there are many types of denial. There are the physical types, where you don't test or take your insulin. I'm not there. I do all the testing, and I take my meds.

Then there is emotional denial - as Carol said in my post about nutritional counseling, maybe the diet thing is a "last bastion of rebellion against DM" for me. Also as Theresa has commented a few times in various posts here and there.

I think there may be something there.

The nasty thing about denial, of any sort is, well, denial! I mean, by it's very nature it is something that you do not want to look at, at all.

My assignment for this month is to write a letter to my diabetes. I'm finding that particularly hard to wrap my head around. It sounds very "silly" to me at first, but then couldn't that be denial weaseling it's claws into me again?? I'm sure that I will come up with any and every manner of excuses not to do it - and that is for sure denial. But I am committed to working through those excuses and will do it. I hope that I can be honest with myself about how I really feel, and not doctor the letter up just because I know she'll be reading it.

According to her, it all centers on grief. Grief being described in this case as "a loss of normalcy".

A loss of normalcy.

Man - that says a lot doesn't it?

But what is "normalcy"? If I've been diabetic for 26 years, isn't that "normal"? Or do I see that others don't have to check their blood sugars, deal with highs or lows, eat without counting (for the most part), worry about complications or feel guilty about not controlling their blood sugars?

But under the surface I do know that I have to deal with more than the rest of the people I'm around most of the time.

I was talking with my wife about this. The whole "denial" thing seems strange to both of us, because I do check and I do count (most of the time) and I do take my meds. But, it appears that this is a different form of denial. I love different forms of things. Makes them a real bugger to figure out. Damn.

I also think that it might be something to do with the (new to me) five stages of grief. These stages would be (according to Elizabeth Kubler-Ross) :

1) Denial
2) Anger
3) Bargaining
4) Depression
5) Acceptance

I've not heard of these stages, nor really any information about dealing with grief and it's relation to diabetes.

Is it possible to get stuck in one of these stages for an extended period of time? Or perhaps a cycle between a few, just back and forth and back and forth? My therapist also says that once you reach acceptance, that you don't necessarily stay there - it's not like a "to-do" list, where you check off each stage as you "accomplish" it. Rather you may spend a period of time in acceptance, and something comes along that ticks you off, and you slide into anger for a bit. That thought disturbed me a bit, though I can understand it.

I also don't know if you go through these stages in the order listed either.

If I had to decide which stage I'm in right now, I would say it would be bargaining. You know, like I'll eat this or that just one more time, then I'll be "good". Even when I know the impact on my blood sugar will be not good. But I do it anyway. Why? I don't understand the things I do much of the time.

I really think that this journey through grief and denial will be very beneficial for me, but also very difficult to deal with.

What information do you folks have on the 5 stages of grief, or dealing with denial in terms of diabetes? Any of you gone through this stuff? And how the hell can I have lived for 26 years with diabetes and never dealt with my feelings of grief?? I just don't get it.

Friday, March 17, 2006

The Test Strip Contest!

This picture was taken with the highest quality camera phone (note the heavy sarcasm) available.

We are looking at a very common scene that exists almost anywhere I spend a bit of time. This photo in particular is my desk at work. It is my little test kit pouch that lays open on my desk, and just happens to be where all my used test strips land. We won't mention the fact that the actual garbage can is not but a mere inch or two farther in the opposite direction... so why don't I just get them into the garbage? I do not know.

The contest has two parts, and each will win a real life prize that has yet to be determined.

Part 1: How many test strips are there?

First comment with the closest guess wins first (and only) prize. One guess per person. Contest ends on Friday March 24, 2006. And yes, I do know it's a crappy picture.

Part 2: What meter are these strips from?

First person to make a comment with the correct meter wins. One guess per person. Contest ends on Friday March 24, 2006. And yes, you already told me it is a crappy picture.

For each part of the contest, I must have some way to contact you. Entries must be made as a comment to this post, but if you don't have your e-mail address available in your profile, or don't want it out in the public, you can drop me an e-mail with the name used in the comment and the e-mail address that goes along with it.

Prizes (one for each part) will be rewarded sometime after I get my tax refund. :-) I mean, whenever I get what's left over after my wife gets my (our) tax refund.

I'm having a bit of fun with this, and will do some other contest related things in the future. I'll try to get better pictures next time too.

Yes, I did hear you when you said the picture is pretty bad...

Okay! - I understand the picture sucks! Get over it!


Thursday, March 16, 2006

More Set Change Stuff - Again.

I'm beginning to think that the issue is quantity of insulin infused rather than the amount of time the new site is being used.

For this set change I tried yet another suggestion, which was to take my breakfast bolus on the old set. The idea was to give the new set a longer time to start absorbing.

My blood sugars were pretty good for the morning, with the exception of waking up high. But as you can see it responded well to the correction and I was also pretty accurate for my breakfast bolus. Once I got myself into the target range, I spent most of the morning/early afternoon there.

Where it gets interesting is at 2:00 in the afternoon, which is when I had lunch. This would be the first meal on the new infusion set. I had a box of Amy's Organic Macaroni & Cheese, which clocks in at 47g of carbohydrates and 3 servings of cottage cheese, which clocks in at 15g of carbohydrates. These were both packaged items, leaving little room for error in terms of measuring serving sizes. The mac & cheese has a lot of complex carbs in it and and good dose of protein (16g). The cottage cheese is also a heave protein item. So with the complex carbs and heavy protein, these items don't seem like they should raise my blood sugar very quickly.

But look what happened!! Within 2 hours I had skyrocketed up to 321! Based on no manner of scientific testing whatsoever, I don't think that what I ate warranted a rise up that far.

Though it could be something with my insulin/carb ratio - I just don't think that is the case. I'll have to do more testing. Maybe I need to experiment with some other lower carb options as well.

I worked my way down, not taking any additional corrections. I played basketball later in the evening, and there was some strangeness with another real high spike afterwards. I haven't figured that one out yet.

I get frustrated with these spikes that always seem to happen on the first meal of the new infusion set. I fight with it for the next few hours. Then I will often times crash - either from the serial rage bolusing, or it may be from pooling insulin that is finally catching up to me. I haven't quite nailed it down yet.

I'm still playing around with different ideas, and am confident that I will eventually stumble onto something that works for me. This is yet another example of the old adage "YMMV" or Your Mileage May Vary.

Diabetes is such a personal thing, and there is no "One Thing" that will do the trick. That in itself can be so frustrating.

Wednesday, March 15, 2006

Scary Sick Day!

Well, I had me a scary sick day today.

I woke up for work and as I started getting ready I felt a little off. It wasn't my blood sugar, because I checked that first thing after waking up.

I went and laid back down for a bit, asked my wife to drive our son to school, then called my boss to let her know I was going to be a bit late. Thinking that I would just rest for a bit, then would be back in action.

I also thought I should probably have something to eat, maybe I just needed to get something in my system. I had breakfast, bolused for it, and shortly after my wife & kids left for work it all came back up.

I proceeded to toss about every 30 minutes or so. Like clockwork. I couldn't keep anything down.

Just a little touch of the stomach flu or something like that. What made it scary was that my breakfast bolus was steadily lowering my blood sugar, and I had lost all the food I had eaten.

Ack! What to do?!

I got sincerely scared at this point. I couldn't keep anything down, but desperately needed to get some glucose in my system. And I was home alone. I tried sucking on a glucose tablet, some vague memory that glucose is able to be absorbed right through the cheek membrane. For the record, it made me want to ralph, and after about a half hour I spit the damn thing back out and don't think any of it made it's way into my system.

Do I call my wife and ask her to come home? Do I call her and have her get me to the hospital?

And through all of this I was feeling so completely miserable that the idea of a car/ambulance ride anywhere made me want to puke some more. I just wanted to sleep, more than anything in the world I just wanted to rest.

I started a temp rate for 6 hours at 0% - effectively turning the pump off. I still had 10 units on board from breakfast and my BG was at 88. I figured if I could just get ahead of the curve a bit that I would be Ok.

Well, as Ok as I could be laying around puking my guts out that is.

Figuring that within an hour or so my 0% temp rate will start raising my blood sugar, eating up some of that IOB (Insulin On Board), and if I could get some sprite in there to help be bridge the gap that I would probably be Ok.

You know how after you throw up, you actually feel better for a little bit? Well I took those opportunities to get some sugar sprite in my system. Over the next three or four hours I managed to get down about 16 ounces. Little bits of that coming back up with the next episode.

After a while I was able to sleep through the rough spots and stop vomiting, finally getting some badly needed rest. When I woke up later, I tested 165. I was actually very proud of myself for pulling through that situation and landing at 165. It was a major accomplishment.

But I must say, that it was one of the first times in a long time that I felt really and truly scared, and was afraid that I would not be able to pull through it without some help. The help being the frickin' ambulance or something like that, which we all like to avoid at nearly all costs.

I'm also a bit ashamed to admit that I did not call my wife, or anyone else. I really really should have at least let her know what was going on. She knew I was not feeling good, but did not know about the potentially disastrous low blood sugar that might have happened. And as I think about it, it was no real good reason for not calling. It was mostly just not wanting to get up to get to the phone, not wanting to scare her, and (do you believe this) not wanting to inconvenience anyone. How ridiculous of me, and very dangerous. Do NOT follow this example if the situation should ever happen to you.

Friday, March 10, 2006

PIIP - Part "n" - Junk Food is Addictive...

I am working to pay closer attention to my "unconscious eating habits". Trying to determine certain "trigger" events, and what other circumstances are often involved with my eating.

One thing I have realized is that for me - junk food is addictive.

Maybe addictive is not the right word to use - because if I stay completely away from it I don't necessarily crave it.

It's just that after I have one piece - of anything, I won't stop eating it. It's as if they add something that makes you keep going back for more!

The bad thing is, when it comes to candy or sweets, I don't discriminate too much. There is a limit to what I'll pay for - what I'll buy at the store, or out of the vending machine. But what is most problematic is the office sweets. You know, the lady around the cube wall who has a candy dish, or the leftover cookies from the meeting in the next room, deserts at the office potluck, that kind of thing.

In situations like that, if I can resist the first piece of sweet stuff then I'll be Ok. If I have even one little tiny piece of anything sweet, I'll be craving junk food for the rest of the day. It usually starts the nasty spiral of the sweet/salty cravings. That's where I'll alternate back and forth between anything sweet, and the "itos" family of salty snack chips.

I don't like those damn "itos" fellas too much. They are not very kind to me. It would be Ok if they would just come for a brief visit to my taste buds - instead of the mad rush that doesn't stop until they've long worn out their welcome.

I'm going to just avoid it totally. That doesn't sound right though - it's as if it comes anywhere within 5 feet of me it will automatically jump down my throat. How about "I will exercise my will power and refuse to eat junk food" - there. That sounds better.

My action plan for junk food is "Just Say NO!".

Thursday, March 09, 2006

Because I'm Not Really a Professional Athlete...

At least, not at my day job.

Seriously though. I played basketball last night, hurt leg and all, and on second thought - it was probably not a very good idea.

I stretched, took ibuprofen, warmed up for a long time, and it still just plain hurt, and it hurt the entire night. But, there were only 8 guys total that showed, so I kind of had to play, even if it was just to take up space on the floor. If I would have sat out then they would not have had enough guys to play full court at all.

So, I was a trooper and limped around the court as best I could.

What was not so smart was that by trying to run & play ball, I was putting a lot of undue stress and wear & tear on my good leg, as well as stressing my foot, ankle, knee, hip & whatever else it all attaches to. I just was not running regular, and I could feel that I was really stressing things by trying to compete even though I was hurt. It was a no good situation in terms of potential injury to things above and beyond my sore leg.

I can't fathom how professional athletes do it. During the season, unless they get seriously injured, they don't get a break. Granted, they have a team of sports specialists that are paid to take care of their injuries for them - special treatments, ice downs, stretches & rehabilitation exercises, drug therapy, massages, the whole nine yards. BUT - they still play through pain! Incredible.

I simply could not convince my leg to cooperate, even though I knew there was no serious injury - it was just sore! But for the life of me, I just could not will it to go through the regular motions.

So, I'm calling an injury time out, and will take it a bit easy until the leg feels better. I do plan to be back on the court next Tuesday, and will do some good walking/jogging in the next few days if my leg starts feeling better.

In the meantime, I'll try to do some resistance exercises - maybe some weights or something.

This also makes me think about what the heck I would do if I had some kind of serious injury - broken leg or ankle or something like that. I mean, what can you do to raise your heart rate that doesn't involve your legs somehow?

Yesterday was also a site change day, and I tried a couple more suggestions from my support team (that would be all of you out there!). I'll put something together and give you all an update very soon.

Wednesday, March 08, 2006

Ouch! That Smarts!

I was thinking yesterday about how my basketball days (Tuesday, Wednesday & Thursday) are pretty much automatic for getting my exercise in. The next thought that came into my head was "boy, I sure hope I don't get hurt or anything! That would mess up my game plan...".

Sure enough - I jinxed myself.

Nothing serious enough to keep me off the court tonight and tomorrow, but it will be sore as hell for a few days.

I got hit real hard with a guys hip right in the meaty outside part of my thigh muscle. When it happened my muscle knotted right up and was stuck in a big charlie horse for a couple of minutes, but I was able to shake it loose and kept playing. See, those types of things are Ok while the muscle is nice and loose, but let me tell you - after I was done and cooled down, it tightened up like a vice.

I iced it down for a bit at my desk, then stretched it out real nice before I went to bed. It is actually not as sore as I thought it would be, but it is still very tight, sore and tender.

I think that after I get warmed up and stretched out at tonight's basketball, it will feel better, and will actually be pretty good for it to get worked out again. We'll see how tomorrow goes.

The stretch is alive at 8 days, and after a close call on day 8, tonight will make 9 days straight. (I mis-counted my days on yesterdays post. I've been going straight since 2/28, so yesterday was actually day 8...)

Thanks to all who have asked about my 100 days!

Tuesday, March 07, 2006

Appointments, Appointments and More Appointments

Sometimes I feel like I'm taking time off work every week for some sort of diabetes related appointment. It's not really that frequent, but it just feels that way.

In many ways I'm very fortunate in my work to have a little flexibility. I usually don't have a problem with being able to leave work for a couple hours for whatever appointment I have. I know that not everyone is as fortunate.

What I do get a little angry about sometimes is that it seems like I burn up a large amount of my vacation time just for these appointments. I usually don't have much (any?) left at the end of the year, and usually don't take any time as actual "vacation" (my family outing to Grand Rios Waterpark (aka "The Toilet Bowl Trip") in January was an unusual exception).

And even though people say it doesn't matter, or doesn't affect people's opinion, being gone from work a lot does have an impact on the way your peers and management perceive your "dedication" to your work.

I finally got my appointment scheduled for the dietician (thanks Theresa!). I'm not exactly sure why the hell it took me so long - maybe I'm afraid to face my terrible eating habits or something.

The lady that booked the appointment said it would be a 75 minute appointment. I thought that sounded like a very long appointment, but I guess that is good. Plenty of time to talk about my issues and wrangle up some suggestions. I just hope that it really is 75 minutes with the dietician, and not 60 minutes in the waiting room filling out papers, 10 minutes in the "exam room" waiting for the dietician, and 5 minutes actually with the dietician...

As I sent an e-mail out to my boss and co-workers, I felt a strange feeling of guilt for having to leave for yet another appointment. It's not any "bad vibes" that I'm getting back, and I'm sure it's all in my head, but it just started me thinking. I mean, what if I didn't have any time to take off, or was self employed where time off means lost income, or had a job where it was very difficult to leave work for any period of time, or had a boss who was not understanding? It would add a ton of stress to the situation.

I think that it just sucks to think that there are people out there who have to make a choice between their work and their diabetes. No one should ever be put into that situation. There is no need to add another layer of complexity to things.

I'm thankful that I have it pretty good, but on the same note I recognize the frustrations of others out there who may not.

100 Days

On a completely different note, the 100 Days streak is alive and well at 6 days, with the next three being pretty much automatic basketball days, so that will take me to 9 in a row.

Monday, March 06, 2006

More Set Change Stuff - Or Is It...?

I'm still fighting my set changes. This is something that has been a thorn in my side for a long time, and it's been hard for me to pound out all the variables and get some steady consistent testing figured out.

This is another good example of that.

I woke up around 1:50am last night (this morning?) and did a test. Didn't feel anything weird, but was up to use the bathroom and thought I should just do a test to see where I was at. I was 191. I took a correction bolus of 2.6 units figuring I'd wake up with a nice, close to target blood sugar.

But when I woke up I was 211! I can't think of any real good reason for me to be high. Where would I be if I hadn't taken that correction bolus last night?!

It was a scheduled set change day. I'm trying a combination of suggestions from kind commenter's here. I've left the old site in (to avoid any leakage), and took a bit more extra insulin on the new set than I should have needed. In fact I took a whopping 4.3 extra units right when I did the set change.

Then I had breakfast, which was the following:

- 1 slice whole wheat toast with a bit of butter and jelly (17g & 13g)
- 8oz skim milk (13g)
- 1 serving sugar free nestle quick chocolate powder (7g)

As Wil & Kevin have suggested previously, this is still pretty high GI (glycemic index) stuff, which probably has a lot to do with it - so that's another area that I need to nail down a bit and do some testing.

About 1 hour after all this, my blood sugar was at 399. Off the frickin' charts! Damn. Now I'm down to 287, so it is coming down (so again, I'm confident I'm not having set problems). But boy am I sleepy!

Looking at this, I'm thinking that there may have been something other than just a set change throwing a monkey wrench into the mix today. Especially since I woke up higher this morning than I thought I would - even after a correction. Maybe I had some air bubbles or something (I was near the end of my cartridge) - but I've never had problems with that before (or maybe I just never paid close enough attention?).

I kind of feel like I've been half assing the testing of strategies around set changes. As I've talked about before, it seems that I have trouble keeping track and paying attention to things every third day when I change the set.

Yes, I've tried a few different ideas - but have I really eliminated the variables around those? Did I eat the exact same breakfast those days? Maybe it was something as small as not having the same bread that morning as I did the previous set change? I just don't feel confident that I'm setting up a stable test environment. I think there are still a lot more variables than there should be.

I do think that I need to do something different for my breakfast - but just didn't plan for it very good this morning. The breakfast I had is a pretty habitual breakfast, and seems to be something I fall back on when I don't have anything better planned.

There was also a suggestion from Jay to take my breakfast bolus on my old set prior to changing, followed by an extra unit bolus on the new set after changing.

I think that I started taking my bolus after changing sets based on another suggestion from a diabetes educator I spoke to a while back. I think her philosophy was to give the new site a nice big breakfast bolus to give it a little "kick start" on the absorption.

Again, it really seems like a YMMV thing (Your Mileage May Vary), and I'll have to try it both ways and see what works best for me. It seems like there are many different approaches on similar problems, and a lot like the exercise adjustments, it's trial and error until you find something that works well for you.

I also have to pay attention to whether I've played basketball the night before, because I feel when I play in the evenings that it does have an effect on my mornings much different than when I play in the afternoons.

With all this going on, I'm thinking about keeping a set change journal, where I can detail the different things I try, and the surrounding circumstances.

I would like to stress what I perceive to be a very difficult thing - to pay particular attention every third day. My brain just doesn't work like that. If it was every day, or even every other day, I think it would be easier. This whole every third day thing throws me for a loop! So, I'm hoping keeping the set change journal will help ease that pain. I've been trying to keep good track in my logbook, but I find the "Comments:" section too small - I've got more to say then space to say it!

So, the game plan is this:

- verify my basal rates.
- verify that this same breakfast doesn't spike me so high on non-set change days.
- start a set change journal.
- list the ideas or possible solutions - things to try.
- eliminate variables as best as possible (this is key).
- look at lower carb & lower GI breakfasts.
- diligently record things tried, variables in the mix, and results.
- trial and error my way through until I find something that works for me.

For right now, I'm going to sit here and close my eyes for a precious few seconds. Maybe I'll be lucky enough to avoid any interruptions for a bit...

***edit*** - 7 hours after my set change I was back down to 86. So again, I know it's not a problem with the set. It took a solid 5 hours before I got down under 200, and the rest of the day is sailing along just fine.

Friday, March 03, 2006

So What Really Happened?

Take a look at that nice flat line staying in my target range for hours on end. Doesn't that look nice? I mean, what more could you ask for??

How about an accurate reflection of what really happened with my blood sugar.

As I looked at the second test in that series, I just knew that it was not a very accurate picture of what really happened. I had a large meal shortly after the first test, so I just know that it spiked up shortly after.

I think that this is a perfect example of why finger pokes only catch a small amount of what really happens. Think about the charts that Wil showed from his Guardian RT CGMS system, with the wild up and down all over the place route that our blood sugar takes through the course of it's day, showing how things really are. Or at least a better, more accurate picture of what really happens.

So what did I miss? I colored in a line that might better show what happened, or at least a guess at it. How can I really know with just finger sticks?

Thursday, March 02, 2006

Overnight Number = Very Important

It is always hard to start the day off with a crappy number. Lows I can deal with Ok (most of the time - IF I can avoid the rebound thing), but highs seem to start me off on an especially sucky note - which I fight with for a good portion of the day.

Not to mention being high makes me very sleepy, more prone to snacking and just generally gives me the blues.

Your nighttime BG value is where you are for around 1/3 of a 24 hour period - and it's a pretty easy number to maintain - you're sleeping! Some variables still exist - carryover from your evening activities, but the number of variables is by far much less than during the course of an average day.

What other 8 hour period of the day can you avoid stress, eating, bolusing and exercise?

So another thing I'm going to focus on is going to bed on target and waking up on target.

If your basal rate is good, this should almost be automatic! A problem for me with this is that I'm eating a meal and going to bed pretty close together. I think it was Keith who once said that going to bed with food in his stomach and insulin on board is usually not a good situation for him. With my routine I'm barely an hour into my food before I'm hitting the sack.

I think I'll need to start bringing lunch AND dinner to work on my long days. I just want to try to have everything all flushed out before I go to bed. If I eat earlier (and don't eat once I get home) I think I can pull it off.

Planning is the key.

Wednesday, March 01, 2006

Sloppy, Sloppy, Sloppy

What do you get when you get home from work, scarf down a bunch of leftovers, and take a wild guess at how many carbs you ate?

Yes, you guessed it - what do they say? Garbage In, Garbage Out? But, which was it - high or low?

It was high.

I had a pretty good day. It was one of my long days, where I split my shift and play basketball over lunch. It was also a set change day - but I'll get into that on another post. I was pretty disciplined through the course of the day, and things had gone pretty good. I left work with my blood sugar at 117 (this was at about 7pm). Not too bad.

BUT - That was the L A S T test I did until the next morning. What the hell was I thinking? When I got home there was a bunch of good stuff leftover from dinner. Before I even settled in I had started grabbing stuff off the counter. A few slices of pizza, some crispy crowns and ketchup, a bunch of cookies and milk and who knows what else.

10 minutes later I figured I should probably bolus for this loosely scrapped together "meal". I had no idea how many carbs I had vacuumed in.

I did a LADCS bolus. This term is closely related to Wil's SWAG bolus. Rather than "Scientific Wild Ass Guess" bolus, the LADCS (pronounced LAD-kiss) is "Lazy Ass Didn't Count Shit" bolus. Granted, it doesn't have the same ring to it, but you get the picture.

So I punched in 80g. A conservative guess, but going to bed soon I would rather error a bit on the high side. If I had any idea just how much on the high side I erred, things would have been a little different.

I went to bed nice and early, but had an absolutely crummy nights sleep. Tossing and turning all night. Never really waking up, but just not sleeping good. When I woke up in the morning, I had to pee like a banshee. I knew right then that I was high, and kicked myself for being so sloppy with everything last night. I tested 300 on the nose (no, I didn't use my nose for an "alternate testing site" - it's just a figure of speech), and promptly took my correction.

Starting my day off so high is tough - for one, I'm sleepy as heck, and two, it's a stubborn thing to get it back down to normal. Seems like I fight it for a long time before getting things back in line.

So, lesson learned (again), and I will do better with my evenings moving forward.