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.

Thursday, February 22, 2007

Back on the map!!

I'm so ashamed that I haven't come up with a single diabetic related joke. Pitiful. I'm going to have my license revoked if I don't come up with something funny soon. G-Money has run away with the laughs, and I'm here just totally paralyzed by the pressure.

I spent a good part of today in outer space. You know, above the stratosphere? Up so high that you couldn't see me. An official astronaut I was.

There's that point, if you graph your blood sugar, where it goes so high that it is literally "off the chart!". And there is the point where you are "back on the map" - a point where you can, once again, actually see your blood sugar on the chart (what a relief!).

I left for space somewhere around 1:00 p.m., directly from the YMCA during basketball. I returned somewhere around 3:00 p.m..

How was the trip? Pretty shitty actually. My muscles felt funny, like they just wanted to cramp up. Especially my triceps. A slight nausea, but not too bad. But this was all at the peak of the journey, right before starting my descent back down.

After I was done with basketball, I just wanted to sleep. I sat down against the wall, tested my blood sugar, took a boatload of insulin, and just closed my eyes for a while. It felt so good to just rest my eyes. I could have laid down on the hardwood floor and caught some ZZZ's. I was startled back to reality by a guy coming into the gym and bouncing his ball.

What happened? Well, I'm not exactly sure!

It had something to do with my site change this morning. I've talked about those damn site changes more times than I can remember. The lack of constant behaviour is a huge deterrent in applying myself to figure something out. Sometimes it acts crazy - other times it's smooth sailing.

Scar tissue?


Great - another variable to keep track of.

No. thanks.

Here's the "play-by-play" description of how it all went down (or...up?).

I woke up a bit high - 202 mg/dl. I took a correction bolus and started my day. I changed my infusion set, a day later than scheduled. I finished getting ready and headed off to work. I got to work, settled in, and a while later I tested 124 mg/dl. Nice. Can't ask for much better than that!

Hmm. It's pretty late. 9:45 a.m. or so. I don't want to have breakfast now - I'll be playing basketball soon. That's one of the things the dietitian talked about - eating breakfast early to give my insulin a little more time to do it's thing and be done. 9:45 a.m. is not early.

I figured that I would just delay eating for another hour or so. I figured I would grab a bite to eat right before leaving for ball.

11:00 a.m. - 157 mg/dl. I took that as evidence that my temp basal rate reduction was working perfectly. 11:10 a.m. - I stop by the cafeteria and make a sandwich.

Two slices of whole wheat bread, some mayonnaise on both slices, a slice of swiss cheese and two slices of yellow american.

Yes. I know. Not much of a sandwich for you meat eaters (no, I don't eat meat. no, I don't consider myself a vegetarian (um, due to lack of vegetables mostly...)). A good old fashioned cheese and mayo sandwich. A staple in the Scott Johnson diet.

I step on the court about 25 minutes later, and test 220 mg/dl. Humph. A bit higher than I want, but considering I was out of my normal routine I was not too concerned. I did not bolus for that sandwich. I was also anticipating some great basketball action for the next couple hours, so there was no way I was going to take a correction bolus.

An hour later? 289 mg/dl. My highest test in a long time (a month maybe?). Ok, I'm frustrated now. Not feeling my game, not in my "groove".

Why? Because my damn blood sugar is high. I took what I consider an aggressive correction bolus - remember, exercise super charges your insulin. 1.5 units. I wondered if I should have bolused for that sandwich.

Back to the game. Back to stinking up the court. I dedicated myself to just working hard and at least trying to get a good workout. You know - something that I could feel much later in the day. A fatigue. A "good" tired. And I did work hard the rest of the session.

At the end of basketball, I sat down near my goody bag and tested my blood sugar. 363 mg/dl.

Holy WTF Batman?

A bunch of thoughts race through my mind:
- Something wrong with my infusion set (remember I just changed this morning - it hasn't been proven good yet)?
- Adrenaline rush (not likely, but possible, I guess...)?
- Ketones (I've never had them hit me like this before...)?

Then it hit me. That sandwich was the first thing I had eaten after changing my set. That's when it always hits me. A super high, not after my set change, but after the first meal after that set change.

Looking back on it, even if I would have considered that sandwich being the first "meal" after a set change - I was sure not about to load up on the insulin right before going to play basketball. That would be begging for a nasty low. I probably would not have done anything different.

I would have hoped that my aggressive exercise would counter act that possible rise in my blood sugar. Maybe evening the field so that things would "even out" and make for a day just like a non-set-change day.

No such luck.

I was able to get things back under control a bit later in the afternoon, so I know my infusion site is fine.

Now? Just before bed? 54 mg/dl. Damnit. Test THEN brush...

And testing low right before bed brings up a whole mess of fears and worries - a topic for another night maybe.

I also wondered if writing a post while low is as potentially dangerous as writing after a few drinks? Just kidding Julia - couldn't resist the opportunity. Love ya!

Ok, I'm off to bed now. I'm hoping to dream up a few funny d-jokes in my sleep...

Sunday, February 11, 2007

Weekend Update

A couple of quick updates for the weekend.
  • The latest installment of "Which Way Is Down?" has been posted over at dLife. Go take a look if you would like.
  • I had my endo appointment on Friday. It went very well. My A1C result came back at 7.9, which is the lowest it has been in over 6 years.
What have I been doing different? Well, I upped my basals around the clock a while back. That made a big difference, and I didn't feel like it resulted in around the clock lows.

The other big thing that I've been doing is to really strap down and carefully count my carbs at dinner. A lot of weighing and measuring (which I hate), but I guess at some point you recognize that it is necessary and do what you gotta do.

I've got a good feeling that I can fine tune even more, and get this number down even lower. My goal for the OC New Me Challenge is an A1C of 7.5 or below. If I am able to meet that goal mid-year, that is great - but I've got to keep it there for it to count. Not only for the challenge, but for my long term health and well being. Just like golf, lower is better.

I also had an appointment on Wednesday with my dietitian. That was the first in a series of appointments with which we are hoping to design a game plan for healthy weight loss and good blood sugar control. It was, again, an awesome appointment. Now - I just have to follow through with some of the ideas she gave me.

I feel good about where I am, and better about where I'm going.

Tuesday, February 06, 2007

A Flash of Anger

Not long ago I did a post called "What exactly is it". This post talked a little bit about trying to figure out what exactly it is about living with diabetes that bothers me. There was some really great comments on that post. One of the most valuable group of comments I might have ever gotten.

I had an experience shortly after that post that really helped me to identify one of the things that bothers me.

Many of us find a routine. A set of actions that produce predictable results. We follow that routine, and for the most part are able to expect a certain outcome. Or at least feel pretty confident that the outcome will not be something outrageous.

My typical morning routine is to have an english muffin with butter and peanut butter for breakfast. Along with some Diet Coke. I bolus for 30 grams of carbs, and it usually works out pretty nicely.

I'd like to share my logbook sheet from Friday, January 26th:

I woke up at 163 mg/dl. A little high, but I'm not complaining. Took a correction bolus, changed my site (I was supposed to have changed it the day before) and got ready and went to work.

At work, before breakfast I tested at 107 mg/dl. Perfect!

I enjoyed my breakfast, and started to get busy working. An hour and a half later, I felt like shit. Sleepy, trouble concentrating, restless, just overall crappy. I tested my blood sugar, and it was 275 mg/dl.

There was a very identifiable flash of anger. I just wanted to smash my meter for that split second. I could feel the adrenaline spike, the rapid increase in heartbeat and all that. I was pissed. But just for a few seconds. What the hell happened?

Oh yeah - my site change. I've talked about that many times before. Where I spike up real high after the first meal on a new infusion site. I'm still trying to work through it - but sometimes the variables are overwhelming and I just pull back. It's not consistent, and that makes it a real bear to figure out. But - that's not the point of this post.

The point is - I felt like shit, and didn't do anything wrong.

I did the same thing that I do most mornings, and most mornings it work just fine.

This was a very tangible feeling, that feeling like crap. It made me very angry for a few seconds. That too was a very tangible feeling.

Of course, it didn't last long - the anger. It was a quick flash, then I was able to start figuring out what I needed to do. As you can see, my judgement was affected by my frustration - I piled the insulin on through the morning and for lunch and after lunch, and ended up low late in the day because of it.

I was so frickin' frustrated!! I just wanted my blood sugar back down. Mostly I just wanted to stop feeling so crappy I guess. At the time I figured that I would happily deal with a low just to stop having to deal with the high.

A very clear, real life experience of what exactly it is...

Saturday, February 03, 2007

"No Guns Allowed"

Whoa. Careful there. It's cool - no need to bring out the big ammunition...

Guns like that should be checked at the door! Wait 'til I flex...

Ok. Ok. I'll stop. I know. Not too impressive. I'm not like Kerri's Chris - with biceps jumping out of his shirt at you (you're welcome Chris! :-) ).

Wait - what is that on the bottom of my arm?! Oh yes - the point of this post...

Yes boys & girls, I have officially tried an arm site!

The timing working out just right, my site change day fell on a Friday morning. That meant I had four days before I would be playing basketball again. Four days meant that I would be doing another site change before basketball. This is important.

Where I play basketball, we play shirts & skins. One team keeps their shirts on, the other team takes their shirts off. With the teams changing many times through the session, shirts vs. skins makes it easy to keep track of who is on your team.

With the need to play basketball with my shirt off, I usually need to keep my infusion site very close to my waistline, reducing the amount of tubing that is above my shorts. I don't want it to get snagged and pull my site out.

I would be able to change site locations before my next basketball session, making the next one a little more "basketball friendly".

I took advantage of the opportunity to try something a little different.

I use a 9mm cannula. That means that cannula going below the skin is 9mm long. Going straight in at a 90 degree angle.

So, in theory, you need at least 9mm of subcutaneous tissue for that cannula to occupy comfortably. On my abdomen that is not a problem. But on my arm? I just wasn't sure about that.

But what is the worst that could happen?

It might hurt like a son-of-a-bitch, in which case I would take in out and know never to try it again. Or it might be relatively comfortable, but have trouble delivering the insulin. You know, a bent or kinked cannula? Or it might be one of those sites that hurts sometimes, like when delivering a bolus or when you apply pressure to it. The only way to know would be to go for it.

I got all my stuff together, cocked my Quick-serter, positioned it where I thought I wanted it, took a breath and started squeezing the release buttons.

Those that have used the Quick-serter know that you usually try to apply equal pressure to both buttons (one on each side), getting them to "click" and release the spring at the same time.

Well, it didn't quite happen like that for me. Not sure if it was just the new position, or if I was all scared and shaky. I got the first button pressed, heard a muffled not-quite-right partial click, and nothing. I was pressing with all the might I could muster on the other side, but the damn thing didn't want to release. Finally, with another odd sounding "click", the button released and the spring slowly eased the needle into my arm.

Wait a second - that is not how it's supposed to work!!

The whole reason I use a spring loaded inserter device is because I'm a puss and don't deal well with the "slower is better" mentally flawed logic that I'm usually a victim of.

But - it didn't hurt a bit. I was concerned about the integrity of the site, because of the cockeyed insertion, but it seemed to hold fine and the needle came out nice and easy.

How can you really know though? You can't see the cannula. You can't tell if it's bent or kinked or crimped or whatever.

Wait and see is all you can do.

I tentatively pushed down on top of the exposed site - trying to see if it would hurt when I applied pressure. Nope - it felt fine. Great even. Could hardly tell it was there. I went through the rest of the routine, getting my pump and tubing all set to go.

The next challenge would be "tubing management". I wear my pump in a pouch on my belt, typically having whatever excess tubing there is just live down the leg of my pants. But with this - an arm site, what would I do?

I put my t-shirt on, and had the tubing just going back up my arm through the t-shirt and down across my chest and stomach to the other side where I put my pump. Overall, it's not too bad. But I can feel some pull when I raise my left arm up over my head. Not too much though.

My blood sugars have been pretty much in line - or at least no major stubborn highs that might indicate a problem with the cannula. I'm happy with that.

I have just a little more courage to try new places now. I really didn't think that I had 9mm of spare subcutaneous tissue to spare on my arm - but apparently I do. That might open up some options for me down the line.

What's next for me? A leg site?

It all depends on how I feel the next time my site change falls on a Friday...

P.S. - Special thanks to Beth at In Search of Balance for the spiffy new header image!

P.P.S. - Anyone else out there get a kick out of those caveman commercials?