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.

Sunday, April 29, 2007

What's Missing?

I took advantage of the incredible weather we had here this weekend and took my kayak out for the first time of the season.

I found everything I thought I needed, worked a bit to load the kayak on top of my old truck (the work loading it is the price of admission - the cost of enjoying a good time), and hit the road.

A short 15 minute drive down the scenic Wirth Parkway here in Minneapolis, and I was on the shore of Cedar Lake. I parked, unloaded the kayak, stuck all my gear into it and strapped on the wheels.

The what?!

The wheels. See, I can't park right at the shoreline near a good launch point. So, I have these wheels that strap onto the front of the kayak, then I can grab the other end and "wheel" it to the launch point. Works much better than having to pick it up and try to carry it. One of the best inventions around.

Anywho - so I wheel the kayak to the launch point, get all my stuff ready, and crack open the waterproof case that I keep my testing supplies in. I wanted to test before getting behind the paddle. But - I was missing something. Can you spot it?

Meter? Check.
Test Strips? Check.
Chapstick? Check.
A funky orange watch? Check (wtf?).
Glucose Tabs? Check & Check.
What else do I need? Oh yeah - blood. I've got that inside of me, but no way to get to it! No lancing device! Doh!

I do keep an emergency knife on my life vest, but I wasn't quite sure if I wanted to stab myself with that just to do a test. Well, actually I tried a little bit, but wussed out. I just couldn't do it.

I decided that I had plenty of stuff with me (in addition to the glucose tabs in the picture), and that I would just go for it.

Everything worked out fine, I didn't get wet, I saw lots of turtles, and made it back home in one piece. A beautiful day.

Saturday, April 28, 2007

A Picture's Worth ... a Bunch of Carbs!

I have a fairly active imagination.

There are times when I can lose myself in mental adventures. My wife would say it happens most when she's trying to talk to me about something important.

But there is something that I wish my brain was better at. Graphing my blood sugar. I think that in terms of blood sugars, a graph is very powerful. You can see what's happening (or has happened). You can usually get a pretty good picture of where things are going, and whether you need to do something about it.

Many of us are using Kevin's awesome excel spreadsheet. I love it, and use it all the time. I would be lost without it. In fact, if I could have done in my head what Kevin's logbook does for me on the computer, I could have avoided this particular low and subsequent kitchen destruction. Let's take a look:

Overall, a pretty wild day. I have had to make a few changes to my basketball routine, and as you can see here that it hit me pretty hard. Took me until much later in the day to get back down to normal.

Do you see what happened that night?

9:45 pm - 112 mg/dl
11:30 pm - 90 mg/dl

A slow and gradual drop. No single number was cause for alarm, or even alert. I felt fine. Then at 1:15 am - 46 mg/dl. Ouch. Awaken from my slumber, ravenous, shaky, ready to eat whatever I can get my hands on. And I do. A bunch of cereal. A bunch. Which, of course I paid for shortly after with a 216 mg/dl, and the next morning with a 268 mg/dl - even though I tried to bolus for an unknown number of carbs I ate.

As I looked at this graph the next day, I really wished I had been able to see that graph last night when I tested at 11:30 pm, I might have paid more attention to the downward trend of the graph, especially so close to the bottom of the target range. I might have had a little snack to fend off that sneaky low that hit a couple hours later.

But, instead, I just went on to sleep feeling pretty good after seeing such a nice number on my meter.

If I would have known, I could have acted.

Likewise, I would have been on the alert if the numbers had been a little more different. For example, dropping from 190 mg/dl to 90 mg/dl (100 points) in two hours is much, much different than dropping from 112 mg/dl to 90 mg/dl (22 points) in two hours.

It's the slow and sneaky ones that catch us.

I think that things like this will get easier as new CGMS devices are made more affordable, reliable, accessible, and comfortable.

But for now, I'll just have to practice making charts in my head.

Thursday, April 19, 2007

Questions for the Almighty Blogosphere

Please know, that in my mind the OC knows everything.

With that being said, I have a couple questions I would like to ask. This is the kind of stuff that rolls around my brain sometimes.

1) I eat two things. One item is very quick to digest, the other is very slow. What happens? Does it digest at a mixed speed - like the quick is speeding up the slow and the slow is slowing down the quick? Or does it digest in the order it was eaten?

I would think that it kind of all gets mixed up in my stomach. The slow stuff slowing down the digestion of the faster stuff. But what about when you eat something like ice cream, go low, eat some glucose tabs, and have your BG come back up? Shouldn't the ice cream slow the glucose tabs?

2) This question comes from one of my favorite co-workers. What is with having to calibrate your glucose meters? I mean, I have done it for always. As long as I can remember. And I know that if you don't have it calibrated correctly, that the results can be inaccurate.

But why? Is it something about the chemical process? What is it about the process that requires us to put in the code, or the chip, or the calibration strip?

Tuesday, April 17, 2007

Unsteady Ground

The water is about knee-deep in most places. Brown and murky, I'm not able to see the terrain of the riverbed. But I know that it is absolutely littered with debris. Rocks. Downed trees. Holes and pits.

I know this because I've been stumbling along - slamming my feet and legs into things, if I'm lucky the edges are not too sharp or jagged.

Jarring my knees and spine with unexpected drops into holes or off of small ledges. Then tripping back up when the landscape levels off.

Or stepping halfway onto a rounded rock, slippery with the muck and growth. My foot seems to accelerate off the rock as it slips down the surface, pulling me forward into the next obstacle.

I'm not allowed to slow down - it's just simply not allowed!

Try as I might to slow down, the current of life is pushing and pulling me along. I can not be hesitant or careful with my steps. I march forward fully expecting the ground to be solid and stable beneath my feet. Unable to slow down and tentatively feel out the terrain below my next step.

I muster up my confidence and continue to move on. Sure that I'll find my rhythm and routine any step now.

Walking full speed in knee deep, obstacle ridden, brown murky waters. That is what it has been like for me experimenting with Novolog.

I usually pump Humalog insulin. I have for as long as I can remember (does anyone remember when it was first made available?). I had an opportunity to get my hands on a bottle of Novolog, and wanted to try it. For no good reason really. The Humalog was/is working fine (for the most part). It seems a little slow for me at times, but not enough to make me want to get rid of it.

From what I can tell, the Humalog vs. Novolog use is just as individual as we are. For some people one works better than the other, and for other people they can't tell any difference. Some folks have had to switch because of insurance arrangements. Others prefer one over the other.

For me, the out of pocket cost is the same. I have noticed that for meal boluses, the Novolog seems to kick in faster, which I kind of like. Same for correction boluses. I rocket down like some kind of bungee jump ride that doesn't bounce back up. They don't seem to stop when I've reached my target - they keep going and dragging my BG down with them! Resulting in lows, which I'm prone to over treat. I haven't had the time to really dig in and test with it though.

For the most part it has made me unsure of my ratios and calculations. These same ratios and calculations that I have been using for years. It has made me less confident of my moves when I'm bolusing for a meal or for a correction. A little gun shy maybe.

But then I pay for it when I reduce the recommended doses.

I am 100% sure that, given enough time, I could figure it out (we are good at figuring things out). But, without a good reason to change right now, I will probably just add this knowledge to my toolbox and put it away for a while.

Granted, it may not be the best time to make a decision. Somewhat shaky about things and anxious to get back to my clear and shallow swimming pool - clear water and a flat and stable concrete bottom.

I'm also in a position where I don't need to make a decision. If I choose to re-evaluate again in the future, I'll have a better idea what I'm getting into and can maybe better set my expectations. I am deciding not to decide right now.

It sure has been an interesting few days!

Friday, April 13, 2007

Mixing Variables

I have so much on my mind. So many things I want to talk about, think about, write about. But time is what it is, and there's just not enough of it.

I'm behind on all of your latest news. I look at my bloglines "new post" counter for the OC blogs that I try to keep up with. The number is well over 200 (236 to be exact).

I love it.

While seeing that number so high is somewhat intimidating, it is also so very exciting to me to see so many of us expressing what living life with diabetes is all about. This invisible condition has a strong voice now - The Diabetes OC. You all are my heros. I gain so much insight, inspiration, strength, resilience, and courage from all of you. Thank you.

What's on my mind tonight? A few things really, that all come through the story of my day.

I was supposed to change my infusion site this morning, but didn't. Just didn't feel like it. I figured I could get through the day and deal with it later. I'm not a morning person, so mornings are just not a great time for me to make decisions like that.

"Hmmm...let's see. Sleep in an extra TWO MINUTES or get up and change my infusion site?"

So I slept in (for two effing minutes - totally not worth it). I had about 35 units of insulin left, and figured if I could go easy on the food it would get me through the day (I typically use about 75 units a day, with about 25-30 from my basal rate).

But I had a huge lunch (don't ask), and exhausted my insulin supply before 1:00 PM. I had insulin back at my desk, so I figured I would just do a site change at work. I rarely do my site changes at work. Just something about the whole "balanceitallonthetoilet" and "sanitary" not going well together...

Here's where things get interesting, and it also calls for a couple of tangents for background.
  • I use the Medtronic Quick-Sets (old school with the luer lock), and the "Quick Serter". A spring loaded insertion device that (when used properly) slams the needle bearing infusion set into place with (usually) very little pain and (usually) less chance of incorrect insertion. I had one at work that I had never used before, and there was something different about it - the set didn't sit in there quite right and I struggled with it for a while. I think I eventually got it in the device "well enough", but I can't be sure. That was one factor that complicated things.
  • I normally use Humalog insulin. Never tried Novolog. I happened into a bottle of Novolog and I decided that this would be a good weekend to try it. That was another factor.
  • I wanted to try a thigh site. I have NO idea why I was so set on trying something new. I have very little subqq" tissue on my legs. They are strong because they have to carry me & my stomach all over! They are not shapely legs, mind you. Just strong. But I found a spot that I thought might work.
So, here I am in the restroom of work, hiding out in a stall for privacy. I've got my freshly filled cartridge full of Novolog, my infusion set & tubing, my inserter device, and an alcohol swab. All balancing on various parts restroom stall. Some on the toilet paper holder, stuff on the top of the toilet tank lid, and both hands full. All this and with my pants down to my knees for access to where I want to place the site.

As I prep the site, then fight for a couple minutes with the infusion set and inserter device, I sit there with it cocked, locked, and loaded, pressed against my skin. I can feel the needle gently jabbing the surface of my skin. I only need to pull the trigger(s). But I hesitate...

I'm scared. I've never inserted here before. Will it hurt? Is there really 9mm of available soft tissue there, or will the needle and cannula slam into my muscle (which hurts like a sonofabitch to me...).

With this being only one very small example of the "Everyday Courage" we rely on, I pull the trigger. It hurt. The tape got all hung up on the sides of the inserter, so it was pulling the whole thing out as I tried to pry the inserter away from the tape and cannula that is supposed to remain.

"Well", I thought, "This isn't going quite as I had planned".

But I didn't want to give up on the site. I was able to get the tape loose from the inserter and pull the needle out. The cannula was, I thought, halfway in - so I just pushed down on top of the infusion set. Creepy feeling - in the new location. It just didn't feel right.

I connected up to it anyway and started up the rest of my lunch bolus. As the pump was delivering I prepared to remove the old infusion set. I stopped myself and thought I had better leave it in place in case there was a problem with this new leg site. I got a blockage alert on the new site within 30 seconds.

I reconnected back to the old site and finished bolusing. I took out the new leg site, and just my luck - a gusher. Bleeding like all get out. I grabbed some toilet paper and held it tight for a few minutes. It finally stopped bleeding. I was glad that I had not oozed blood all over everything.

So - I clean myself up, clean up my garbage, and head back out to my desk. Now pumping Novolog insulin instead of Humalog, and into my old site instead of this fancy new thigh site I was planning.

Nothing major so far, but something is different. I have been eating a lot today, but my BG's are not low, but a good, mid-100 number, with a bunch of insulin still on board ( I swear the body can sometimes tell when there's just too much insulin for what it needs). I'm not sure if my BG will stay there, or drop because of that insulin on board.

Why is all of this happening?

Is it the Novolog? Can it really make that much of a difference? Enough of a difference that if I were to switch to Novolog (I'm not yet seriously considering) I would have to probably re-evaluate all of my ratios and settings?

Or did I deliver a fair amount of insulin into my leg muscle in the bathroom? I believe that delivering into the muscle "does things" to the insulin absorption and efficiency (giving it a slight "supercharge"). It doesn't seem like that should be the case though, because that was early this afternoon, and now it's 1:00 AM. Plus, the amount of insulin I delivered prior to the blockage was not a significant part of my typical total daily dose. It should not be playing games with me so much later...

So what is it? I'm not sure, and I will probably not know until I do some more controlled experiments. I need to nail down the variables as best I can to isolate what it is that is making things happen.

  • No mid-day site changes (if it can be avoided - I want to change in the AM and at home)
  • No new infusion sites (NOT the best time for me to get crazy with it)
  • No crazy lunches just before (If you program your lunch bolus using the DOWN arrow ONE TIME to enter your carbs, you're eating too much...)
One change at a time Johnson. One change at a time.

Just stick with my typical routine that I am familiar with. I mixed in too many variables at the same time, and because of that I'm not sure what the heck to think. Watching things over this weekend will help me figure it out, but only a little. It will also take more than a single weekend to know if Novolog acts different than Humalog for me.

Moral of the story? Don't mix your vegetables! I mean VARIABLES!

Wednesday, April 11, 2007

What? Who's that? Wil?! Really!?! Sweet...

Alright folks - Wil from LifeAfterDx is back on the map!

Be sure to head on over and read the latest news. A very welcome surpise for him and very good news for the OC (in that we will enjoy reading Wil's work once again!)!

Monday, April 09, 2007

Liberation in a Meal Plan

What are the first few things you think of when you hear the words "meal plan"?

Me? I think of very strict, hard and fast rules about what I can eat. I think of very "old school" words like "2 starches, 2 proteins, 1 dairy, 1 fruit, and 1 fat". I think of nothing other than foods I DON'T like to eat, and am forced to anyway.

I remember back to days at "Camp Needlepoint", long ago when "exchanges" were the way things were done. Not eating meat, I was instructed to replace my "protein exchanges" with something else. You know what it usually was? A whole freaking cup of creamy peanut butter. Literally -- a CUP of creamy peanut butter, with a spoon.

And they wondered why I got sick each and every year I went.

All of this ran through my head when I started to talk with my dietitian about a meal plan.

Was I really uttering those words - the words that meant nothing but guilt and anxiety to me? Words that made me feel "weird" for not liking "normal" foods?

Yes I was.

Because I recognized that lack of a plan got me into trouble every night, I was ready to make some changes.

I get home from work later than the rest of the family. They are well done with dinner by the time I get there. Not being sure of what I wanted to eat, I would just fly by the seat of my pants. I would make something that I thought I wanted, eat it, not feel satisfied, and start making something else! By the time it was all said and done, I would have eaten three or four dinners by the time I felt satisfied or just too damn full to eat anymore (even though I was STILL not satisfied!).

With the sheer quantity of food I was eating, my carb counting got real sloppy. I would over-estimate and run low in the middle of the night - causing a kitchen raid (again), or I would under-estimate and run high all night. Neither one is good for weight management or A1C tests.

So I faced the dreaded "Meal Plan".

I have nothing but great things to say about my dietitian - I've raved about her before. She helped me put together a meal plan that I would actually follow. Eating foods I like, just watching the balance and the quantities.

But I was still scared.

Rules and regulations? Measured quantities? Eating what is planned rather than what I feel like? Can I do it?

What about my Cool Ranch Doritos, or handfuls of M&M's from the work candy jar? What about my ...? What? What about all that crap? Well, it's still there, every once in a while.

I was very worried about feeling confined and trapped by having a meal plan. I was worried about losing the very flexibility that has graced my life with worrisome A1C results. I needed a change, and this was the place to start.

For the first three or four weeks, at least during the weekdays, I was eating the same things every day at about the same times. And I was seeing fantastic results. Mind blowing results. Results that were evidence enough of the power that food choices had in regards to diabetes management.

But I knew I was setting myself up for failure.

The first taste of which happened when I ran out of the dried blueberries I tried (and liked!). I went back to the store to buy more, and was devastated when they didn't have them anymore.

What was I going to do?!

Please remember, I am not the normal eater, and losing this critical item from my limited food menu horizon was a show-stopper. Luckily enough I was able to find them at a different store in the area, but the scare was enough to convince me. I needed to make another appointment (with my dietitian) and come up with options, which I did.

A couple years ago I lost a bunch of weight. I did it by carefully counting calories, and burning more than I consumed (it's simple math folks, it's just that the truth hurts most of the time). I tried going the same route again recently, and found that it was just way too much to keep track of. One would think that if you are already counting carbohydrates, that adding calories to the mix should not be that hard! Try it. I burned out real quick.

One of the surprising things that I have found as a result of following my meal plan - freedom. I plan my meals, and know ahead of time what they contain for calories and carbs. It is surprisingly liberating to not have to count all that stuff! I mean, sure - I still count it, but just not in the heat of the moment. It's all planned.

I know that the menu I put together is good for me, and provides what I need, and usually satisfies me. It is really liberating. Exactly opposite of what I thought it would be.

Sticking with the meal plan is a challenge, but I know that I get immediate and positive feedback when I do. Awesome BG days where the "line" doesn't leave the target zone, great energy and stamina on the basketball court, and just general "feel good" periods!

Now if I could figure out how to resist those cheesy tots at Burger King...

Friday, April 06, 2007

Invisible & Invincible

Diabetes is, for the most part, an invisible condition. Unless you spend a bit of time with me, you may never know that I walk the never ending tightrope of blood glucose management.

Even if you do spend a bit of time with me, you have to pay close attention to notice the seemingly little tasks that make up parts of my day. Checking my blood sugar, manipulating my pump - those are pretty much the only things that you can see from the outside. And like any seasoned veteran, I am good at being discrete when I want to be.

Even when not making a conscious effort at discreteness, these tasks are done quickly. A BG result in less than 10 seconds, a bolus in a matter of a few presses of well known buttons.

Except for extreme situations, where things spiral out of control, I am able to keep it all under wraps. I have not needed help with a high or low blood sugar for many years. And unlike other conditions, where the person struggles physically with symptoms, diabetes does not manifest in external signs for a very long time - possibly not at all, ever.

But this does not mean that I do not struggle a great deal with the management. It’s just all inside. On the outside people see me as a strong, independent, successful person with few worries. But on the inside I am fighting for every second of decent blood sugars, constantly wary of diabetes invading and interrupting whatever activity I am doing, or planning on doing.

It’s like taking shifts on guard duty - except your shift never ends. There is no one to take over for you.

It all weighs on my heavily at times, and eats up more than it’s fair share of my energy. I am tired. Not in a physical sense, and almost not even in a mental sense. As ada said “Tired to my soul”.

As I look out the window. The sun is bright and happy. It looks inviting. Makes me want to be outside. But I step out of the door and am hammered by the sharp cold sting of the wind.
Looks are deceiving. Just as if you were to step into the world of diabetes. Something that many of us make look easy - but living life on a tightrope gets old quickly.