The summer of 2013 was a big summer in terms of triathlons. We did four of them. And I learned all sorts of things about triathlons and blood sugar management. So much so that I hardly thought about it by the end of the season. Kinda like how I handle long runs. After having done so many of them, I just know what I need to do.
Well after a summer off, I'm feeling decidedly out of practice in the triathlon department.
Thank heaven's I have a little book where I write things down. Like basal rate settings for every triathlon I did in 2013. I have a schedule that is broken up into 30 minute segments from 5am until 2pm, that includes timing for breakfast and snacks and bolus percentages for each, basal rates (by percentage and actual amounts), and a summary of how well it worked in case I forgot (which I did).
It's kinda like trying to read Spanish. I know enough to make out the message but wonder if I'm missing any of the subtleties.
So I guess I'll be programming my pump tonight with a race day basal profile. I'll be trusting my report from two years ago because I have nothing better to go on. I must admit that I'm feeling decidedly out of practice. I've only been back in the pool for a few weeks, I have only had one long bike ride and I just ran a half-marathon 5 days ago and my body is tired.
The good news is that I have a continuous glucose monitor (CGM). Two years ago, I had nothing of the sort so I had to rely on blood sugar checks in the transition zone. Now, other than during the swim where the CGM doesn't work, I'll be able to see what is happening before, during and after and Rose will warn me if I'm high or low. There is a comfort in that.
Come back on Monday and you can hear how it went. I don't expect to have many, if any, photos because Doug won't be out there supporting me this time. He'll be out there swimming, cycling and running with me. But I'm sure I'll have some stories to share and some lessons that we can all learn from.
Showing posts with label bolus. Show all posts
Showing posts with label bolus. Show all posts
Friday, June 12, 2015
Tuesday, May 26, 2015
Operation Combo Bolus
Sunday was a rather bizarre day where everything ended up taking longer than it was supposed to take. We had a nice day but, by 6pm, we had only just arrived home and we were both too hot and tired to care much about cooking.
We decided to order sushi but, after picking our favourite sushi items from our take out menu, we discovered that our favourite sushi restaurant was closed on Sundays.
Plan B involved getting back in the car, still sweaty and sunscreen-covered, and driving to another sushi place downtown that was one of those all you can eat kinds.
"You sure you want to do this?" Doug asked. "Sushi usually messes up your blood sugar".
"Yes, I do want to do this" I replied "and I have a plan".
The code name of this plan was Operation Combo Bolus and I was about to take it out for it's first dry run.
I have been using an insulin pump for 6 years now and have known about the Combo Bolus since the beginning. Yet I have never used it. Not once.
Why?
Because it's always been described as a good tool for dealing with high fat high carb meals like pizza and I don't tend to eat too many of those types of meals. The concept makes sense - take insulin over an extended period of time so that it can work in harmony with the food that is digesting over a long period of time, avoiding post-meal highs hours after eating.
I decided to try it for all you can eat sushi night.
So we ordered our first few sushi rolls and I dialed in 6 units of insulin and a duration of one hour.
Every five minutes I could hear the pump gears whirling as I received another small dose of the 6 units of insulin.
I started my dinner with a blood sugar of about 7. We ended dinner and I was 8.0. We went home, did a few things, sat down to watch an episode of Bloodline and I continued to hover between 8.0-8.5. We went to bed three hours after finishing dinner and my blood sugar was holding steady.
No extra insulin needed to combat skyrocketing blood sugars.
No pre-bed snacks do deal with rage bolus-induced lows.
No midnight pump alarms ruining our sleep.
Operation Combo Bolus was a resounding success.
Monday, May 4, 2015
A Bit of Faith
Diabetes is just enough of an a$$hole sometimes that it makes it impossible to have faith in the system.
Even when those devilish diabetes gods behave themselves and do the same thing 15 times in a row I I have trouble believing they will do the same thing on the 16th time. Why? Because, in the past, when they have lulled me into a state of compliance and I lowered my guard a tiny bit, that's when they like to throw a curveball (or a hand grenade) my way to shake things up.
Which is why it made it very difficult for me to have faith last Friday when we headed out to the golf course.
It was my first 18-hole game of the season. Eighteen holes means four hours of walking. We cover about 10k at a fairly leisurely but non-stop pace. We walk up hills and down valleys and back up again.
I learned a lot last summer during our rounds of golf and one key lesson I learned was that the only way to survive 18 holes was to play with my basal rates. Trying to do it by eating a few extra carbs was a recipe for disaster and I ended up eating way more than I wanted to.
Last summer I learned to lower my basal rates down to 40-50% for four hours, starting an hour before the game. At some point during the front 9 I would eat a Clif bar without bolusing any insulin for it. Seems pretty simple but it worked fairly well.
So on Friday, I lowered by basal insulin as planned. My blood sugar started dropping around the 4th hole so I ate my Clif bar. By the 6th hole, Rose is vibrating to say that my blood sugar was climbing quickly. By the 7th hole, I was above 10.0 and by the 8th hole, I was over 12 and still climbing.
I bolused 2 units to stop the climb.
By the 9th hole, I had stopped climbing and by the 10th hole, I was beginning to drop.
The insulin I had just taken kicked in and, combined with the 2+ hours of walking, I started dropping...fast.
By the 13th hole I was below four, despite having eaten two packages of fruit chews.
The fruit chews finally kicked in and by the 15th hole I was climbing again. Rose alarmed - two arrows up. By 18, I'm over 10.0 again.
A bit of a roller-coaster ride that left me slightly nauseated and feeling sheepish for not trusting my system.
Sunday, I decided to have faith in the system that I developed last year.
I lowered my basal rate. At the 4th hole I ate my Clif bar. By the 7th hole I was climbing. I reached 12.0 by the 9th hole. Despite desperately wanting to, I refused to bolus.
By the 10th hole I was 11. By the 13th hole I was 10. I slowly drifted downward and, by the time we shook hands at the 18th hole, I was 8.5.
It worked!
Four hours of golf are much more pleasant when I'm walking up and down hills and valleys but my blood sugar is holding steady. One Clif bar and a bit of faith is all it takes.
Even when those devilish diabetes gods behave themselves and do the same thing 15 times in a row I I have trouble believing they will do the same thing on the 16th time. Why? Because, in the past, when they have lulled me into a state of compliance and I lowered my guard a tiny bit, that's when they like to throw a curveball (or a hand grenade) my way to shake things up.
Which is why it made it very difficult for me to have faith last Friday when we headed out to the golf course.
It was my first 18-hole game of the season. Eighteen holes means four hours of walking. We cover about 10k at a fairly leisurely but non-stop pace. We walk up hills and down valleys and back up again.
I learned a lot last summer during our rounds of golf and one key lesson I learned was that the only way to survive 18 holes was to play with my basal rates. Trying to do it by eating a few extra carbs was a recipe for disaster and I ended up eating way more than I wanted to.
Last summer I learned to lower my basal rates down to 40-50% for four hours, starting an hour before the game. At some point during the front 9 I would eat a Clif bar without bolusing any insulin for it. Seems pretty simple but it worked fairly well.
So on Friday, I lowered by basal insulin as planned. My blood sugar started dropping around the 4th hole so I ate my Clif bar. By the 6th hole, Rose is vibrating to say that my blood sugar was climbing quickly. By the 7th hole, I was above 10.0 and by the 8th hole, I was over 12 and still climbing.
I bolused 2 units to stop the climb.
By the 9th hole, I had stopped climbing and by the 10th hole, I was beginning to drop.
The insulin I had just taken kicked in and, combined with the 2+ hours of walking, I started dropping...fast.
By the 13th hole I was below four, despite having eaten two packages of fruit chews.
The fruit chews finally kicked in and by the 15th hole I was climbing again. Rose alarmed - two arrows up. By 18, I'm over 10.0 again.
A bit of a roller-coaster ride that left me slightly nauseated and feeling sheepish for not trusting my system.
Sunday, I decided to have faith in the system that I developed last year.
I lowered my basal rate. At the 4th hole I ate my Clif bar. By the 7th hole I was climbing. I reached 12.0 by the 9th hole. Despite desperately wanting to, I refused to bolus.
By the 10th hole I was 11. By the 13th hole I was 10. I slowly drifted downward and, by the time we shook hands at the 18th hole, I was 8.5.
It worked!
Four hours of golf are much more pleasant when I'm walking up and down hills and valleys but my blood sugar is holding steady. One Clif bar and a bit of faith is all it takes.
Wednesday, December 10, 2014
Bolusing for Baklava
"Need anything out of the kitchen?" Doug asked.
"I'm hoping I can have baklava but not yet" I replied after a glance at my pump.
I had bolused a little earlier but no sign that I was dropping yet so there was no way I was touching that high carb treat.
Evenings are a juggling act on my side of the couch.
I like a little post-dinner treat but I've learned a few important lessons over the years.
1. Bolus early and do not eat the snack until it's very clear that blood sugar is dropping as it should.
2. Eat early enough so that I know if I'm in a good spot before going to bed - otherwise Rose will wait until I'm sound asleep and then start alarming like a madwomen. I may be high. I may be low. But I'll be something. And no one wants to eat four fig newtons at midnight after already having a high calorie treat before bed.
3. Do not have a post-dinner treat if dinner was a high carb meal. Otherwise there won't be enough time to know what the blood sugar dinner gods will do before I call in the blood sugar snacks gods. Usually they have a big ol' fight in the middle of the night. See number 2 for more details.
4. Do not rage bolus after 7pm unless absolutely necessary. Without fail I will be eating a snack that I do not want to eat at 3am. Guarantee.
There are nights when I have bolused for chocolate, put it on a plate, studiously ignored it for an hour and then put it back in the cupboard with a sigh because, by 9:00pm, I still wasn't low enough to eat it.
There are night when I have bolused for chocolate, enjoyed the chocolate without waiting for my dinner numbers to drop, gone to bed high, bolused extra and then had to eat two more snacks during the night because of lows.
"Need anything out of the kitchen?" is always tempting but I'm slowly learning to say yes when the stars align and to say no when they don't.
I value my sleep too much to jeopardize it unnecessarily for a piece of baklava - as delicious as it is.
"I'm hoping I can have baklava but not yet" I replied after a glance at my pump.
I had bolused a little earlier but no sign that I was dropping yet so there was no way I was touching that high carb treat.
Evenings are a juggling act on my side of the couch.
I like a little post-dinner treat but I've learned a few important lessons over the years.
1. Bolus early and do not eat the snack until it's very clear that blood sugar is dropping as it should.
2. Eat early enough so that I know if I'm in a good spot before going to bed - otherwise Rose will wait until I'm sound asleep and then start alarming like a madwomen. I may be high. I may be low. But I'll be something. And no one wants to eat four fig newtons at midnight after already having a high calorie treat before bed.
3. Do not have a post-dinner treat if dinner was a high carb meal. Otherwise there won't be enough time to know what the blood sugar dinner gods will do before I call in the blood sugar snacks gods. Usually they have a big ol' fight in the middle of the night. See number 2 for more details.
4. Do not rage bolus after 7pm unless absolutely necessary. Without fail I will be eating a snack that I do not want to eat at 3am. Guarantee.
There are nights when I have bolused for chocolate, put it on a plate, studiously ignored it for an hour and then put it back in the cupboard with a sigh because, by 9:00pm, I still wasn't low enough to eat it.
There are night when I have bolused for chocolate, enjoyed the chocolate without waiting for my dinner numbers to drop, gone to bed high, bolused extra and then had to eat two more snacks during the night because of lows.
"Need anything out of the kitchen?" is always tempting but I'm slowly learning to say yes when the stars align and to say no when they don't.
I value my sleep too much to jeopardize it unnecessarily for a piece of baklava - as delicious as it is.
Monday, August 11, 2014
Green Curry
I adore Thai food. Years ago my family and I went on a two-week adventure in Thailand and, ever since then, I am a huge fan of Thai food of any kind. The flavours. The freshness. The fact that the minute I smell good Thai food I am brought back to Bangkok, Ko Samui, Chaing Mai and all the other places we explored. It's like a portal to another country.
One of my favourite Thai dishes is green curry. The veggies combined with the grapes and pineapple pieces mixed in that delicious green curry sauce and then poured over jasmine rice is one of my preferred ways to spend a meal.
I don't have it often. In fact, there is just enough time between green curries for me to forget what happens before I have it again.
One of my favourite Thai dishes is green curry. The veggies combined with the grapes and pineapple pieces mixed in that delicious green curry sauce and then poured over jasmine rice is one of my preferred ways to spend a meal.
I don't have it often. In fact, there is just enough time between green curries for me to forget what happens before I have it again.
This, my friends is what happens when I eat green curry.
I met a friend for lunch at our favourite Thai restaurant. I ordered my green curry and bolused 3.5 units 15 minutes before I ate it. I started eating and a small voice in my head told me that I had not taken enough insulin. So I took two more units. Before I was even finished eating, Rose was alarming that I was climbing too quickly.
Within an hour I was 20. Between 2pm, when I got home, and 3:30pm, I bolused six more units of insulin in increments of 2. I'd wait 30 minutes, see that I was not moving, and bolus two more. At 3:30pm I was 22 and holding and had been there for almost two hours. I had guzzled about 2 litres of water in an attempt to dilute things. Nothing seemed to work and I was feeling about as bad as it is possible to feel when it comes to diabetes.
Did I mention that we were meeting friends at 4pm for 9 holes of golf followed by dinner?
I put on my best 'suck it up princess' look, changed, and we headed over. My body felt stiff. Almost like my blood was so thick that my joints were not moving properly. I was dehydrated despite all the water, my mouth was desperately dry and I had a pounding headache. At 4:15pm, we teed off. The walking seemed to help a bit and I was feeling marginally better even though my numbers still weren't budging.
By the third hole I had dropped from 22 to 18 and was much happier than I should ever be to see that number. I then climbed back to 20 by the fourth hole. Bloody hell! Despite the fact that I was in the middle of a 2-hour walk, I bolused another two units. That last bolus, plus the low level of activity finally seemed to do it.
As we played, I filled my water bottle every second hole and drained it again. I slowly dropped to 18, 17, 16, 15. By the time we started the last hole I was down to 9. Single digits!! By the time we finished it, I was down to 6. By the time I got to the locker room, I was 4.6. I double checked on my glucometer and it confirmed 4.6. I had a pack of fruit chews and headed in to dinner.
I went below 4 for a few minutes but nothing scary and it righted itself as soon as I started each my dinner.
I felt 100% better than I had two hours earlier.
I went from 7.5 to 22 and back down to 4 within 6 hours. Four of those hours were spent between 20-22. I took 13 units of insulin which is more than half the amount of insulin I usually take for breakfast, lunch AND dinner combined. All because I had a lunch-sized portion of green curry and a cup worth of jasmine rice.
Some people have a hard time eating pizza. Others it's sushi. My diabetes nemesis seems to be green curry.
I would like to say that I will never have green curry again. I really would. But I love it so much that I can't make any promises.
Funnily enough, despite the physical challenges my body was going though, I got a personal best on my golf game that night.
Go figure.
Thursday, June 26, 2014
(Driving Range + Weeding) x d'oh = Double Down
I don't usually have the chance to run the insulin in my pump down to fumes. Usually, due to timing, work or the desire to sleep through the night, I will change my pump when there are still 10-15 units left.
I won't go to work with less than 20 units and I won't go to bed with less then 15.
I don't always need all that but I do if I'm high and I'll be damned if I'm getting up at 4am to refill my insulin pump because I was high in the night and drained it.
I'm sure one day I will find myself in the kitchen at 2am, refilling my pump with one eye open, hoping that the neighbours don't look in and get a bit more of a view than they bargained for. I just have no interest in adding that to my ridiculous diabetes moments list so I always change my pump before bed if I'm down to 15 units or less.
Yesterday morning I had 20 units left after breakfast. Enough to get through an 8-hour work day if nothing went wrong.
I risked it.
My blood sugar was fine after breakfast so no extra boluses needed. I had a good lunch that happened to be a bit lower in carbs than usual so that worked out well too. No post-lunch highs so, again, no extra insulin needed.
After work I had a 4:15pm rendezvous at the driving range and still had a few units left. I knew I would be home around 5pm so I figured I was still good to go.
I got home after the driving range and noticed that the weeds in the front garden were more noticeable than they should have been so I dumped my stuff in the kitchen and headed back out with the yard waste bag. I was happily puttering away when my Rose buzzed to tell me that I was 10.5 and climbing.
Odd. I don't usually climb in the afternoon without eating and I had just hit a big bucket of balls which has to count as some form of exercise non?
Oh well, I bolused 2 units (without doing a blood test to verify the pump's number first. I know I know I'm going to hell) and bent over to continue weeding. Rose immediately alarmed again to say that I was out of insulin. Oh right! I forgot about that.
I quickly finished weeding the section I was working on and headed in. I refilled Rose and then bolused the 2 units again.
Yep. I actually did it. Just like that.
Didn't even think to check how much of the first two units were injected before the pump was empty.
Turns out I got the entire first dose. Plus the entire second dose. So now I have four units in my body and my dinner plans are a big huge salad with some carbs (black beans) but not enough to cover all the insulin I had just taken. I had two small pieces of baklava I was saving for dessert and there was no way I was eating those to deal with the low I knew would happen. I wanted to savour them, not use them as medicine.
I ate a banana (20 carbs) and started making dinner. I checked Rose every few minutes to see what was happening. I dropped slowly from 10 to 8 and then the nice green arrow changed from one arrow pointing at 135 degrees to two green arrows pointing straight down. I had a date and continued chopping. At 4.8 I was still showing the double down arrows so I caved and had an oatmeal cookie. I was now up to about 50 carbs. Enough to deal with the four units of insulin I took.
I ate my dinner (which was absolutely delicious by the way) and Rose informed me that I dropped to 3.9 before heading back up to 7 and settling there. Not bad considering.
Lesson for today: if you go to work with only 20 units of insulin in your pump do not decide to weed the garden after a trip to the driving range. Even if you hit a couple of pretty good balls. It will cause you to get so annoyed at the weeds that you double bolus for a mild high and end up eating cookies so that you don't eat baklava. Or something like that.
Anyway, I have to go. I have some baklava to savour.
I won't go to work with less than 20 units and I won't go to bed with less then 15.
I don't always need all that but I do if I'm high and I'll be damned if I'm getting up at 4am to refill my insulin pump because I was high in the night and drained it.
I'm sure one day I will find myself in the kitchen at 2am, refilling my pump with one eye open, hoping that the neighbours don't look in and get a bit more of a view than they bargained for. I just have no interest in adding that to my ridiculous diabetes moments list so I always change my pump before bed if I'm down to 15 units or less.
Yesterday morning I had 20 units left after breakfast. Enough to get through an 8-hour work day if nothing went wrong.
I risked it.
My blood sugar was fine after breakfast so no extra boluses needed. I had a good lunch that happened to be a bit lower in carbs than usual so that worked out well too. No post-lunch highs so, again, no extra insulin needed.
After work I had a 4:15pm rendezvous at the driving range and still had a few units left. I knew I would be home around 5pm so I figured I was still good to go.
I got home after the driving range and noticed that the weeds in the front garden were more noticeable than they should have been so I dumped my stuff in the kitchen and headed back out with the yard waste bag. I was happily puttering away when my Rose buzzed to tell me that I was 10.5 and climbing.
Odd. I don't usually climb in the afternoon without eating and I had just hit a big bucket of balls which has to count as some form of exercise non?
Oh well, I bolused 2 units (without doing a blood test to verify the pump's number first. I know I know I'm going to hell) and bent over to continue weeding. Rose immediately alarmed again to say that I was out of insulin. Oh right! I forgot about that.
I quickly finished weeding the section I was working on and headed in. I refilled Rose and then bolused the 2 units again.
Yep. I actually did it. Just like that.
Didn't even think to check how much of the first two units were injected before the pump was empty.
Turns out I got the entire first dose. Plus the entire second dose. So now I have four units in my body and my dinner plans are a big huge salad with some carbs (black beans) but not enough to cover all the insulin I had just taken. I had two small pieces of baklava I was saving for dessert and there was no way I was eating those to deal with the low I knew would happen. I wanted to savour them, not use them as medicine.
I ate a banana (20 carbs) and started making dinner. I checked Rose every few minutes to see what was happening. I dropped slowly from 10 to 8 and then the nice green arrow changed from one arrow pointing at 135 degrees to two green arrows pointing straight down. I had a date and continued chopping. At 4.8 I was still showing the double down arrows so I caved and had an oatmeal cookie. I was now up to about 50 carbs. Enough to deal with the four units of insulin I took.
I ate my dinner (which was absolutely delicious by the way) and Rose informed me that I dropped to 3.9 before heading back up to 7 and settling there. Not bad considering.
Lesson for today: if you go to work with only 20 units of insulin in your pump do not decide to weed the garden after a trip to the driving range. Even if you hit a couple of pretty good balls. It will cause you to get so annoyed at the weeds that you double bolus for a mild high and end up eating cookies so that you don't eat baklava. Or something like that.
Anyway, I have to go. I have some baklava to savour.
Wednesday, June 25, 2014
Site Patterns
I'm beginning to notice a pattern.
Every Tuesday. Or Thursday. Never both but always one. My infusion site leaks insulin.
Only when it's hot out.
And only when I've gone for a run before work.
This was not a problem last fall. Nor was it an issue over the winter. And, trust me, I do sweat when I run in February. A lot.
It is a problem in the summer. Ever since I've switched from long pants and jackets to shorts and a t-shirt, my site leaks.
Here's how things go.
I go for a run. I come back dripping wet. I check my blood sugar and I bolus for breakfast. I keep one finger lightly on the infusion site and, once the insulin is bolused, I do the finger sniff test. If it's wet and smells of insulin - we have a problem. If it isn't, we might still have a problem but I don't know for sure.
No insulin smell means the breakfast bolus most likely worked but it increases the odds that the lunch bolus won't.
Yesterday, Tuesday, breakfast went well. My site passed the sniff test and my blood sugars did what they normally do after a run and breakfast. Lunch time came around and I bolused. The insulin was still going in when I felt wetness on my site. Damn!!
How much got in? Will I have to go home to change it? Does my entire office have that dreaded insulin smell now? I hope not.
I waited a while to eat to see if my sugar would drop. It did. I ate and ended up around 11 two hours later. Not bad but it never came back down again. I hovered at 11 until 4pm. Not high enough to warrant going home but high enough to be mildly annoyed. I did a test bolus around 3pm and could smell insulin. So after work, before heading to my parents' for dinner, I rushed home, changed the site and then hopped on the highway. Problem solved.
This only happens on Tuesday or Thursday. Not Tuesday and Thursday. I think it's because one of those days is usually a pretty new site and one of them is usually a site that is almost due for a change. I also think that wearing a loose t-shirt instead of a tight base layer top is a problem. The loose shirt, combined with sweat and humidity, rubs back and forth against the site while I run, causing problems. And a wee bit of chaffing.
The problem is that the site looks fine even when it's not. It's not like the tiny tube is sticking out or the adhesive came off. It's still securely attached and everything seems good. It's only when I bolus a large amount (5-6 units) that it seems to pool on my skin rather than go in. I have thought about doing 5 one unit boluses over a few minutes. It might solve the immediate problem but it does sort of take away from the 'convenience factor' of a pump. I've also thought about tossing my needle in my purse after runs and bolusing with that instead. Because I think the basal insulin is getting in just fine. It's the bolus that's a problem.
I'm going to try wearing my tight tank top on Thursday to see if that reduces the movement and helps the site survive the run.
Oh, and I'm putting this out there so that I actually do it. On Thursday I will also be doing 800m interval repeats in my neighbourhood. For the first time in about three years. I'm excited and more than a little nauseated at the thought.
I'll keep you posted on how both experiments go.
Wish me luck!
Every Tuesday. Or Thursday. Never both but always one. My infusion site leaks insulin.
Only when it's hot out.
And only when I've gone for a run before work.
This was not a problem last fall. Nor was it an issue over the winter. And, trust me, I do sweat when I run in February. A lot.
It is a problem in the summer. Ever since I've switched from long pants and jackets to shorts and a t-shirt, my site leaks.
Here's how things go.
I go for a run. I come back dripping wet. I check my blood sugar and I bolus for breakfast. I keep one finger lightly on the infusion site and, once the insulin is bolused, I do the finger sniff test. If it's wet and smells of insulin - we have a problem. If it isn't, we might still have a problem but I don't know for sure.
No insulin smell means the breakfast bolus most likely worked but it increases the odds that the lunch bolus won't.
Yesterday, Tuesday, breakfast went well. My site passed the sniff test and my blood sugars did what they normally do after a run and breakfast. Lunch time came around and I bolused. The insulin was still going in when I felt wetness on my site. Damn!!
How much got in? Will I have to go home to change it? Does my entire office have that dreaded insulin smell now? I hope not.
I waited a while to eat to see if my sugar would drop. It did. I ate and ended up around 11 two hours later. Not bad but it never came back down again. I hovered at 11 until 4pm. Not high enough to warrant going home but high enough to be mildly annoyed. I did a test bolus around 3pm and could smell insulin. So after work, before heading to my parents' for dinner, I rushed home, changed the site and then hopped on the highway. Problem solved.
This only happens on Tuesday or Thursday. Not Tuesday and Thursday. I think it's because one of those days is usually a pretty new site and one of them is usually a site that is almost due for a change. I also think that wearing a loose t-shirt instead of a tight base layer top is a problem. The loose shirt, combined with sweat and humidity, rubs back and forth against the site while I run, causing problems. And a wee bit of chaffing.
The problem is that the site looks fine even when it's not. It's not like the tiny tube is sticking out or the adhesive came off. It's still securely attached and everything seems good. It's only when I bolus a large amount (5-6 units) that it seems to pool on my skin rather than go in. I have thought about doing 5 one unit boluses over a few minutes. It might solve the immediate problem but it does sort of take away from the 'convenience factor' of a pump. I've also thought about tossing my needle in my purse after runs and bolusing with that instead. Because I think the basal insulin is getting in just fine. It's the bolus that's a problem.
I'm going to try wearing my tight tank top on Thursday to see if that reduces the movement and helps the site survive the run.
Oh, and I'm putting this out there so that I actually do it. On Thursday I will also be doing 800m interval repeats in my neighbourhood. For the first time in about three years. I'm excited and more than a little nauseated at the thought.
I'll keep you posted on how both experiments go.
Wish me luck!
Tuesday, October 8, 2013
I Hate Blood Sugar Brain
Diabetics: the only people who take drugs so that they don't get high.
Funny eh?
I thought so too.
Until I spent the better part of last weekend taking drugs...to no avail. It didn't seem to matter what I tried - I was stubbornly high.
Like 18+ for five hours straight on Friday night. Despite numerous rage boluses. Despite at one point having enough insulin to kill me raging through my system and only dropping to 11 before climbing back up again.
Like going to bed on Saturday night with a perfect number and waking up three hours later to find a 14.5 staring back at me.
Like Sunday when I woke up to a perfectly wonderful 5.1, had my regular breakfast with my regular bolus, and was 13.5 a few hours later. Then 15.6. I rage bolused once, waited 30 minutes, saw no change, rage bolused again, waited 30 minutes, no change, rage bolused again. No change. By the time I dropped to 12.3 - that number looked almost heavenly.
I chugged my water. I changed my infusion site and put fresh insulin into a new insulin cartridge. I was not sick nor did I feel like I was getting sick. No infections that I am aware of. No stress worth mentioning...unless the stress of being high leads to my being high. How's that for a vicious circle?
It is not the week before my period.
I had a tough swim workout on Friday which should have had me fighting to prevent lows all day.
I ran 20k on Saturday and did not lower my basal insulin before, during or after the run. I should have fought lows all afternoon. Nope.
This happens sometimes. A few days of unexplained highs. I can change my insulin rates but that tends to just lead to lows a few days later once everything settles. So I don't - unless it goes on for too long and then I do. Because I'm just plain fed up with the whole thing.
In the meantime though, my blood sugar-addled brain starts thinking things it probably shouldn't think. Like maybe I'm becoming immune to insulin. Is that even possible? What if I am and that there will be no way to lower my blood sugar? And it just keeps climbing higher and higher...? Do I float away?
What if all the insulin in my fridge has gone bad? All two boxes of it? Do I toss it all out? And buy more? Maybe I got a bad batch of pump supplies? Is that possible? They looked fine but who really knows if they are?
What if my glucometer isn't working properly and I'm really not that high? What if I took too much insulin based on a false number and I'm going to go horribly low? I should double check my number. Yep, still 18. Oh wait. What if the glucometer got it wrong again?
Then my blood sugar finally comes down enough for me to start thinking a little more rationally. And remind myself that this happens sometimes. And that diabetes sucks. And it's unpredictable. And annoying. And mean. And I'm not going to die because I randomly developed an immunity to insulin.
And my numbers settle back into their kinda predictable pattern and life resumes it's kinda predictable routine.
And Blood Sugar Brain goes back into his box until the next time...
Monday, September 16, 2013
IOB - It Actually Does Make a Difference
I really like a lot of things about insulin pumps.
I love some of them.
I really really love Insulin on Board. It's one of those things that doesn't just claim to make my life easier...
...it actually does.
Insulin lasts in the body for a certain amount of time. It varies with the type of insulin, the person and, because we're talking about diabetes, a million other variables including the number of dragons flying overhead, the weather, who won Le Tour de France and the number of children Brangelina have.
For me, Humalog (the insulin I use in my pump) typically lasts about three hours in my system. So if I take six units at noon, I will (theoretically) have four units left by 1pm, two units by 2pm and my lunch bolus should be out of my system by 3pm.
Insulin on Board refers to the amount of insulin left in my system and Lucky, my pump, calculates it for me.
"This is great because...?" you ask.
Well, here is one example. Let's pretend that I had lunch at noon and bolused for it. Two hours later, I'm 9.0. Nine is a high number that, normally, I wouldn't want to see. So I'll tell Lucky that my blood sugar is 9.0. Lucky will do his math thing and he might tell me that I should take 1.5 units of insulin to correct the high.
But wait!! Lucky says. You have 1.5 units of insulin on board from lunch so you don't need to take anything.
Before my pump I used to have to remember how much insulin I took with my lunch, do some math in my head to figure out how much I'd need to bring my BG down from 9.0, guesstimate out whether I had that amount left in my system, hope that Brangelina hadn't adopted any children over the weekend and bolus accordingly.
Last weekend Doug and I had a busy Saturday. We ran 10k in the morning, had breakfast, showered and then hopped in the car for a 2-hour drive to a family event. My blood sugar was high when I woke up but it dropped nicely down to 7.2 after my run. I bolused for breakfast (minus a bit because I had just run) and then I changed my pump. I also changed my battery since it was getting low. I showered and we left.
About 30 minutes into our drive, I felt pretty awful. A quick BG check showed that I was 15.5. My pump told me that I needed 2.5 units to correct the high so I took it.
Right after the insulin was delivered, my brain said "but what about insulin on board?".
Omigod!
Lucky said that I didn't have any but I had taken five units with breakfast only 1 1/2 hours earlier. So I should still have almost 3 units lefts. I double checked that I actually did bolus for breakfast (I did). I double-checked my insulin on board. The bolus I just took was there but nothing from breakfast.
That's scary.
I tried to figure out what might have happened. I haven't changed any settings on my pump. But I did change my battery. Is that it? Does changing a battery wipe out recent IOB memory? If so, that's a little disconcerting.
As it so happens, my BG was really high all day so the extra bolus I accidentally took didn't do much damage but it could have.
I'll have to be attentive the next time I change the battery to see if it happens again.
If so, I'm thinking I need to have a chat with Animas to let them know.
I love some of them.
I really really love Insulin on Board. It's one of those things that doesn't just claim to make my life easier...
like this handy-dandy spaghetti measurer / pasta scooper / cheese grater
...it actually does.
Insulin lasts in the body for a certain amount of time. It varies with the type of insulin, the person and, because we're talking about diabetes, a million other variables including the number of dragons flying overhead, the weather, who won Le Tour de France and the number of children Brangelina have.
For me, Humalog (the insulin I use in my pump) typically lasts about three hours in my system. So if I take six units at noon, I will (theoretically) have four units left by 1pm, two units by 2pm and my lunch bolus should be out of my system by 3pm.
Insulin on Board refers to the amount of insulin left in my system and Lucky, my pump, calculates it for me.
"This is great because...?" you ask.
Well, here is one example. Let's pretend that I had lunch at noon and bolused for it. Two hours later, I'm 9.0. Nine is a high number that, normally, I wouldn't want to see. So I'll tell Lucky that my blood sugar is 9.0. Lucky will do his math thing and he might tell me that I should take 1.5 units of insulin to correct the high.
But wait!! Lucky says. You have 1.5 units of insulin on board from lunch so you don't need to take anything.
Before my pump I used to have to remember how much insulin I took with my lunch, do some math in my head to figure out how much I'd need to bring my BG down from 9.0, guesstimate out whether I had that amount left in my system, hope that Brangelina hadn't adopted any children over the weekend and bolus accordingly.
Last weekend Doug and I had a busy Saturday. We ran 10k in the morning, had breakfast, showered and then hopped in the car for a 2-hour drive to a family event. My blood sugar was high when I woke up but it dropped nicely down to 7.2 after my run. I bolused for breakfast (minus a bit because I had just run) and then I changed my pump. I also changed my battery since it was getting low. I showered and we left.
About 30 minutes into our drive, I felt pretty awful. A quick BG check showed that I was 15.5. My pump told me that I needed 2.5 units to correct the high so I took it.
Right after the insulin was delivered, my brain said "but what about insulin on board?".
Omigod!
Lucky said that I didn't have any but I had taken five units with breakfast only 1 1/2 hours earlier. So I should still have almost 3 units lefts. I double checked that I actually did bolus for breakfast (I did). I double-checked my insulin on board. The bolus I just took was there but nothing from breakfast.
That's scary.
I tried to figure out what might have happened. I haven't changed any settings on my pump. But I did change my battery. Is that it? Does changing a battery wipe out recent IOB memory? If so, that's a little disconcerting.
As it so happens, my BG was really high all day so the extra bolus I accidentally took didn't do much damage but it could have.
I'll have to be attentive the next time I change the battery to see if it happens again.
If so, I'm thinking I need to have a chat with Animas to let them know.
Thursday, September 5, 2013
Diabetes Centre Visit - The Results
Yesterday I had my six-month appointment at the Diabetes Centre.
You might remember last week when I wrote about my two-week log of food, exercise, blood glucose readings and insulin doses. I mentioned that I had been experiencing one low per day, pretty much every day, for two weeks. Without much of a pattern to it. Sometimes at 3am. Sometimes after breakfast. Sometimes before dinner. Or after dinner.
I had a nice chat with my diabetes doctor and here is what I learned.
I'm having too many lows.
We both agree on that.
She reminded me of the general rule of thumb when it comes to lows:
- If I'm low within two hours of eating, I need to reduce my bolus amount.
- If I'm low before a meal, or in the middle of the night, I need to adjust my basal rates.
I told her that I had reduced my basal rates across the board because the lows seemed all over the place. She said that was fine. I also said that I was just (and I mean just as in five minutes ago) reduce my dinner bolus calculation to avoid the pre-bed second dinners I've had to eat to avoid 3am lows.
Within seconds of flipping through my information she noticed that I was low or under 5.0 every day at lunch time. She recommend that mornings are probably a good place to start. Since I was low by lunch, not after breakfast, my basal rates are probably too high, especially considering I exercise most mornings. So I'm dropping those down and we'll see if that helps with the before lunch stuff. Once those are better I'll be looking for after lunch and before dinner patterns.
She was really helpful. No judging. No lectures. Just another pair of eyes to pour over the numbers and try to make sense of them.
She also suggested that I try uploading the information from my pump which I have yet to try. She said it will help me identify patterns there too. Looks like I need to pull out my big bag of Animas stuff that I have tucked away in the closet and figure out how to do that this weekend.
End result?
My A1C was 6.6 which, as she put it, is fabulous if I can achieve it without too many lows. I'm experiencing too many lows so she wants me to fix that and aim for closer to 7.0 for my next appointment in February.
Yes ma'am.
You might remember last week when I wrote about my two-week log of food, exercise, blood glucose readings and insulin doses. I mentioned that I had been experiencing one low per day, pretty much every day, for two weeks. Without much of a pattern to it. Sometimes at 3am. Sometimes after breakfast. Sometimes before dinner. Or after dinner.
I had a nice chat with my diabetes doctor and here is what I learned.
I'm having too many lows.
We both agree on that.
She reminded me of the general rule of thumb when it comes to lows:
- If I'm low within two hours of eating, I need to reduce my bolus amount.
- If I'm low before a meal, or in the middle of the night, I need to adjust my basal rates.
I told her that I had reduced my basal rates across the board because the lows seemed all over the place. She said that was fine. I also said that I was just (and I mean just as in five minutes ago) reduce my dinner bolus calculation to avoid the pre-bed second dinners I've had to eat to avoid 3am lows.
Within seconds of flipping through my information she noticed that I was low or under 5.0 every day at lunch time. She recommend that mornings are probably a good place to start. Since I was low by lunch, not after breakfast, my basal rates are probably too high, especially considering I exercise most mornings. So I'm dropping those down and we'll see if that helps with the before lunch stuff. Once those are better I'll be looking for after lunch and before dinner patterns.
She was really helpful. No judging. No lectures. Just another pair of eyes to pour over the numbers and try to make sense of them.
She also suggested that I try uploading the information from my pump which I have yet to try. She said it will help me identify patterns there too. Looks like I need to pull out my big bag of Animas stuff that I have tucked away in the closet and figure out how to do that this weekend.
End result?
My A1C was 6.6 which, as she put it, is fabulous if I can achieve it without too many lows. I'm experiencing too many lows so she wants me to fix that and aim for closer to 7.0 for my next appointment in February.
Yes ma'am.
Wednesday, August 21, 2013
Math Tests
It's that time again.
The two weeks where I cart around a pack of paper and a pen with me and I write down everything I eat, every blood sugar reading, every basal adjustment, every site change and all my exercise. In a few weeks I'm heading back to the Diabetes Centre from another appointment with my doctor.
I don't really mind keeping a log for two weeks.
I like doing it because it forces me to document things and then look at the patterns that may, or may not, emerge.
I like doing it because I don't wear a CGM (not an option in Canada yet) so it's hard to spot patterns unless they are staring me in the face. And unless I write them down, they don't stare me in the face.
I like doing it because it keeps me accountable and it makes me second guess what I eat. It's easier to turn down a handful of swedish berries if I know I have to write them down.
I hate doing it because I feel the need to justify every high and low I write down. I write extra notes to explain why I'm high or low. I plan my response to the questions I know I am going to be asked. I force down the feelings of guilt that, irrational as they are, bubble to the surface.
Diabetes isn't like high school math - despite the fact that numbers are involved in both. In high school, if I studied hard enough, I could sometimes pull off 100% on a math test. Or close to it anyway. If I didn't do well on a test, there weren't too many excuses to fall back on other than 'I should have worked harder'.
Diabetes isn't like that.
No matter how hard you work, you will NEVER get 100% on the test.
Ever.
You will always mess up. You will bolus too much or not enough sometimes. You will always have highs or lows that don't make sense. You will always have highs or lows that are entirely preventable yet they happen anyway.
When I am just living my life, it's pretty easy to treat, correct and move on.
When I am documenting my life for two weeks, it feels a little more like I keep failing my math tests.
Bleh.
The two weeks where I cart around a pack of paper and a pen with me and I write down everything I eat, every blood sugar reading, every basal adjustment, every site change and all my exercise. In a few weeks I'm heading back to the Diabetes Centre from another appointment with my doctor.
I don't really mind keeping a log for two weeks.
I like doing it because it forces me to document things and then look at the patterns that may, or may not, emerge.
I like doing it because I don't wear a CGM (not an option in Canada yet) so it's hard to spot patterns unless they are staring me in the face. And unless I write them down, they don't stare me in the face.
I like doing it because it keeps me accountable and it makes me second guess what I eat. It's easier to turn down a handful of swedish berries if I know I have to write them down.
I hate doing it because I feel the need to justify every high and low I write down. I write extra notes to explain why I'm high or low. I plan my response to the questions I know I am going to be asked. I force down the feelings of guilt that, irrational as they are, bubble to the surface.
Diabetes isn't like high school math - despite the fact that numbers are involved in both. In high school, if I studied hard enough, I could sometimes pull off 100% on a math test. Or close to it anyway. If I didn't do well on a test, there weren't too many excuses to fall back on other than 'I should have worked harder'.
Diabetes isn't like that.
No matter how hard you work, you will NEVER get 100% on the test.
Ever.
You will always mess up. You will bolus too much or not enough sometimes. You will always have highs or lows that don't make sense. You will always have highs or lows that are entirely preventable yet they happen anyway.
When I am just living my life, it's pretty easy to treat, correct and move on.
When I am documenting my life for two weeks, it feels a little more like I keep failing my math tests.
Bleh.
Monday, August 12, 2013
I Heard You the First Time
Last Friday, I was down to 19 units of insulin in my pump when I headed to work. I know it would be close but I figured I'd have just enough insulin left to get me through my workday. I hate wasting insulin if I can avoid it. I've been known to bring my needle to work with me for days when I have enough insulin left in the pump to take care of my basal but not enough for meals or snacks.
That being said, I have never actually run Lucky down to zero. He's been close but there was always at least one unit left when I changed him.
On Friday, I left work at 2:00pm. I had three quick errands to run on the way home. I drove to the first one and, as I was backing in to the parking spot, my pump alarmed. No insulin left it said. Lucky asked me to confirm the message. I did.
Thanks Lucky! We'll be home in less than 30 minutes and I'll change you right away. I promise.
I headed into the store and grabbed the three items I needed. I walked up to the counter to pay and my pump alarmed again.
Maybe I didn't actually confirm the alarm the first time. I double-checked to confirm that I was indeed confirming the message and proceeded to pay and head back to my car.
Thanks for the reminder Lucky. I'll change you as soon as I get home.
I tossed the items in the car, did up my seat belt and prepared to pull out.
Lucky alarmed again.
Are you kidding me? Same message. Same confirmation on my part.
Lucky - enough already. I get it. You want me to change you NOW. Well, I'm not home NOW but I'll be home in 20 minutes so relax!
I made two more quick stops. He continued to alarm like a misbehaving child every few minutes. He went off twice when I was checking out of grocery store. Twice when I was walking to my car and loading the groceries and twice when I was driving the short trip home.
I debated taking out the battery to shut him up but it would be out for too long and I'd have to re-entre all my settings. I debating looking through the menus to see if there was a way to reduce the irritating alarm but I was too annoyed by the obnoxious alarms to do anything other than rush home.
I got home, dragged my haul into the house and tossed it on the counter. Doug came down to say hello and happy weekend. I tried not to make my irritation too evident and told him through gritted teeth that I had to change my pump...NOW!
He unloaded the groceries, I changed Lucky and a fabulous sense of peace descended on the house.
Lucky - you know I love you. But holy hannah you're an annoying little dude when you're unhappy.
Wednesday, May 8, 2013
What do the Numbers Mean?
Every once in a while, someone on one of the type 1 diabetes blogs that I read will post their basal rates. Or their daily bolus amounts. Or their insulin:carb sensitivity factors.
I'm usually surprised by the numbers they post.
Probably because I am used to my numbers and, because my numbers and I spend so much quality time together, they become the norm.
It has me wondering though. Is there a norm when it comes to insulin usage? Is it like body mass index or hip:waist circumference where there is an ideal range to be in? Is insulin sensitivity of any importance to a type 1? Is it something to try to improve the way we work on our A1C?
In the interest of full disclosure, here are a few of my numbers.
My basal rates are, using the 24-hour clock:
00:00-03:00 0.75 units/hour
03:00-07:00 0.80 units/hour
07:00-11:30 0.90 units/hour
11:30-17:00 0.95 units/hour
17:00-00:00 0.80 units/hour
My bolus rates are:
00:00-06:30 1 unit of insulin for every 10 grams of carbs (or 1:10)
06:30-11:00 1:8
11:00-16:00 1:6
16:00-00:00 1:8
My correction factor is: 1 unit of insulin will drop my blood glucose by 4.8.
On a typical day, I use about 40-45 units of insulin. Twenty units of that is my basal, the other 20-25 is my bolus for food and for correcting high blood sugar.
Some people I know use 20-25 units of insulin per day. Total.
Others use 60 or 80 units.
I'm sure that there are people out there who use less than 20 units and those that use 100 units or more.
I'm just trying to figure out if insulin usage is just like every other part of diabetes - completely random and completely personal. Or is there a magic range, like the A1C range, that we are supposed to strive for?
Not that I need anything else to worry about. Just curious is all.
I'm usually surprised by the numbers they post.
Probably because I am used to my numbers and, because my numbers and I spend so much quality time together, they become the norm.
It has me wondering though. Is there a norm when it comes to insulin usage? Is it like body mass index or hip:waist circumference where there is an ideal range to be in? Is insulin sensitivity of any importance to a type 1? Is it something to try to improve the way we work on our A1C?
In the interest of full disclosure, here are a few of my numbers.
My basal rates are, using the 24-hour clock:
00:00-03:00 0.75 units/hour
03:00-07:00 0.80 units/hour
07:00-11:30 0.90 units/hour
11:30-17:00 0.95 units/hour
17:00-00:00 0.80 units/hour
My bolus rates are:
00:00-06:30 1 unit of insulin for every 10 grams of carbs (or 1:10)
06:30-11:00 1:8
11:00-16:00 1:6
16:00-00:00 1:8
My correction factor is: 1 unit of insulin will drop my blood glucose by 4.8.
On a typical day, I use about 40-45 units of insulin. Twenty units of that is my basal, the other 20-25 is my bolus for food and for correcting high blood sugar.
Some people I know use 20-25 units of insulin per day. Total.
Others use 60 or 80 units.
I'm sure that there are people out there who use less than 20 units and those that use 100 units or more.
I'm just trying to figure out if insulin usage is just like every other part of diabetes - completely random and completely personal. Or is there a magic range, like the A1C range, that we are supposed to strive for?
Not that I need anything else to worry about. Just curious is all.
Thursday, May 2, 2013
Diabetes and Exercise
On Monday night, Doug and I drove twenty minutes down the highway to listen to a presentation on Diabetes and Exercise put on by Animas. The speaker was Sébastien Sasseville who, I quickly discovered, is a pretty impressive dude.
He is 33 years old and has had type 1 diabetes for 11 years. He pumps. And he takes his pump to places like the top of Mount Everest, the Sahara and five (soon to be seven) Ironman races.
He is my kind of diabetic!
At the beginning of the presentation, I put my hand up and asked him to please share any tips he had for triathlons, particularly things he learned about diabetes management while doing three very different sports.
Sébastien had a lot of really interesting and motivational things to say during his two hour talk. I was impressed with his accomplishments but I am active enough in my own life that I didn't need any more motivation. I have lots of that. I was looking for information. And he gave me plenty of things to think about.
Two things in particular really struck home. It's funny how we sometimes need people to point out the simplest things.
Sébastien talked about his approach to eating during races and long workouts. He used to, like me, focus on keeping his blood sugar in range (as much as possible) and would only eat to avoid lows. Meaning that he, like me, would often struggle with not eating enough during long tough workouts to keep energy levels high. He has since tried a different approach that makes a whole lot of sense. He starts off by deciding how much food he wants to eat during a race or long workout. He then figures out the insulin he needs in order to accommodate the carb intake.
Figure out the food first, then factor in the diabetes.
Makes so much sense.
The second thing he shared that really impressed me was his basal settings for an Ironman. He used to, like me, reduce his basal rate before the race. He would, like me, struggle to remember to change his basal an hour and a half before the start. He would, like me, often forget in the pre-race craziness. He would then, like me, struggle to know how to deal with the fact that he had too much insulin in his body before the race.
So he changed his tactic completely. He now programs a basal profile for race day into his pump. His basal rates change based on his predicted times in the swim, bike and run. I won't give you his numbers because everyone's diabetes is different. It's not the numbers that matter anyway, it's the logic behind it.
This summer I am hoping to compete in an olympic triathlon. Let's assume that it starts at 9am. I would probably swim for about 30 minutes, cycle for 1 hour and 20 minutes and then run for 1 hour and ten minutes. I know my blood sugar climbs when I swim, drops a bit when I cycle and drops a lot when I run. Based on that, here is what my triathlon basal profile might look like
7:30am - reduce basal rate to 60% (don't want a low while swimming)
9:00am - swim starts
9:30am - increase basal rate to 150% (to make up for the fact that my BG climbs when I swim)
10:00am - bike starts
10:00am - reduce basal rate to 50% (to prepare for the run and the fact that I drop quickly on the run)
11:00 am - run starts
11:30am - increase basal to 120% (to prepare for the post-race spike I usually experience)
12:00 pm - race over
12:30pm - reduce basal to 40% (keep it there for 3-4 hours to prevent post race lows)
I don't know if this is exactly what I will do on race day but it's a good first attempt at planning. What I really love about this way of doing it is that eliminates or reduces a lot of the variables on race day. I still can't forget for one second the I have diabetes. But by creating a basal program I wouldn't have to remember to change my basal before the race, bolus after the swim, change basal after the race etc.
Having a waterproof pump will also help a heck of a lot.
Four more days!!
He is 33 years old and has had type 1 diabetes for 11 years. He pumps. And he takes his pump to places like the top of Mount Everest, the Sahara and five (soon to be seven) Ironman races.
He is my kind of diabetic!
At the beginning of the presentation, I put my hand up and asked him to please share any tips he had for triathlons, particularly things he learned about diabetes management while doing three very different sports.
Sébastien had a lot of really interesting and motivational things to say during his two hour talk. I was impressed with his accomplishments but I am active enough in my own life that I didn't need any more motivation. I have lots of that. I was looking for information. And he gave me plenty of things to think about.
Two things in particular really struck home. It's funny how we sometimes need people to point out the simplest things.
Sébastien talked about his approach to eating during races and long workouts. He used to, like me, focus on keeping his blood sugar in range (as much as possible) and would only eat to avoid lows. Meaning that he, like me, would often struggle with not eating enough during long tough workouts to keep energy levels high. He has since tried a different approach that makes a whole lot of sense. He starts off by deciding how much food he wants to eat during a race or long workout. He then figures out the insulin he needs in order to accommodate the carb intake.
Figure out the food first, then factor in the diabetes.
Makes so much sense.
The second thing he shared that really impressed me was his basal settings for an Ironman. He used to, like me, reduce his basal rate before the race. He would, like me, struggle to remember to change his basal an hour and a half before the start. He would, like me, often forget in the pre-race craziness. He would then, like me, struggle to know how to deal with the fact that he had too much insulin in his body before the race.
So he changed his tactic completely. He now programs a basal profile for race day into his pump. His basal rates change based on his predicted times in the swim, bike and run. I won't give you his numbers because everyone's diabetes is different. It's not the numbers that matter anyway, it's the logic behind it.
This summer I am hoping to compete in an olympic triathlon. Let's assume that it starts at 9am. I would probably swim for about 30 minutes, cycle for 1 hour and 20 minutes and then run for 1 hour and ten minutes. I know my blood sugar climbs when I swim, drops a bit when I cycle and drops a lot when I run. Based on that, here is what my triathlon basal profile might look like
7:30am - reduce basal rate to 60% (don't want a low while swimming)
9:00am - swim starts
9:30am - increase basal rate to 150% (to make up for the fact that my BG climbs when I swim)
10:00am - bike starts
10:00am - reduce basal rate to 50% (to prepare for the run and the fact that I drop quickly on the run)
11:00 am - run starts
11:30am - increase basal to 120% (to prepare for the post-race spike I usually experience)
12:00 pm - race over
12:30pm - reduce basal to 40% (keep it there for 3-4 hours to prevent post race lows)
I don't know if this is exactly what I will do on race day but it's a good first attempt at planning. What I really love about this way of doing it is that eliminates or reduces a lot of the variables on race day. I still can't forget for one second the I have diabetes. But by creating a basal program I wouldn't have to remember to change my basal before the race, bolus after the swim, change basal after the race etc.
Having a waterproof pump will also help a heck of a lot.
Four more days!!
Thursday, February 28, 2013
Magic Threshold
How many carbs does it take for you to reach for the insulin?
I know, I know. There are so many other variables involved with diabetes that it's impossible to give a definite answer for that. What our blood sugar is at the time. If there is any insulin on board. Just finished a run? Just heading out for a run? Blah blah blah.
I'm not looking for your special formula. I'm talking about whether you would grab a Swedish berry and pop it in your mouth without testing your sugar or taking insulin for it.
According to my extensive research (ahem: Googled it), one Swedish berry = 3.2 carbs. That equals 0.3 units of insulin.
I don't think I would ever bolus for one Swedish berry. The exercise it would take to reach for my pump and punch in the numbers would be enough to burn it off. I also don't think I would bolus for two. Or four.
What about five? That's 16 grams of carbs. That's also 1.5 units of insulin. Which is like a medium-sized apple.
I'd definitely bolus for an apple.
What about those mini chocolate bar pieces you can get in bulk? Like mini Oh Henry bits that are about the size of a Swedish berry. I'm guessing 3-4 carbs? I'll often walk by the bag of them after dinner and grab three. That's 12 carbs but I don't bolus for them.
I would if I took 6 though.
What's the magic number?
Four grapes? Nope. Ten grapes? Probably. Fifteen? For sure.
It makes me sound lackadaisical with my blood sugars but I'm really not. I'm as anal as can be with testing, documenting and bolusing. My numbers are usually reflective of that and I would never grab Swedish berries if my sugar had been high all morning and wasn't coming down.
But I would grab a few on a normal day. When things were moving along as they should. I'd pop a few in my mouth and think nothing of it. And normally, my sugar doesn't move very much at all with that extra bit of sugar.
I'm just wondering where my seemingly random magic threshold comes from though. It's not like the dieticians told me that three mini chocolates = free but five = you had better test and bolus. In fact I'm guessing I'd get the finger wag if I told them.
What about you folks? Anyone else notice that there is a certain number of carbs you will eat without bolusing? What is it? And how did you reach the point where that number became ok?
I know, I know. There are so many other variables involved with diabetes that it's impossible to give a definite answer for that. What our blood sugar is at the time. If there is any insulin on board. Just finished a run? Just heading out for a run? Blah blah blah.
I'm not looking for your special formula. I'm talking about whether you would grab a Swedish berry and pop it in your mouth without testing your sugar or taking insulin for it.
According to my extensive research (ahem: Googled it), one Swedish berry = 3.2 carbs. That equals 0.3 units of insulin.
I don't think I would ever bolus for one Swedish berry. The exercise it would take to reach for my pump and punch in the numbers would be enough to burn it off. I also don't think I would bolus for two. Or four.
What about five? That's 16 grams of carbs. That's also 1.5 units of insulin. Which is like a medium-sized apple.
I'd definitely bolus for an apple.
What about those mini chocolate bar pieces you can get in bulk? Like mini Oh Henry bits that are about the size of a Swedish berry. I'm guessing 3-4 carbs? I'll often walk by the bag of them after dinner and grab three. That's 12 carbs but I don't bolus for them.
I would if I took 6 though.
What's the magic number?
Four grapes? Nope. Ten grapes? Probably. Fifteen? For sure.
It makes me sound lackadaisical with my blood sugars but I'm really not. I'm as anal as can be with testing, documenting and bolusing. My numbers are usually reflective of that and I would never grab Swedish berries if my sugar had been high all morning and wasn't coming down.
But I would grab a few on a normal day. When things were moving along as they should. I'd pop a few in my mouth and think nothing of it. And normally, my sugar doesn't move very much at all with that extra bit of sugar.
I'm just wondering where my seemingly random magic threshold comes from though. It's not like the dieticians told me that three mini chocolates = free but five = you had better test and bolus. In fact I'm guessing I'd get the finger wag if I told them.
What about you folks? Anyone else notice that there is a certain number of carbs you will eat without bolusing? What is it? And how did you reach the point where that number became ok?
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