Off to the Endo I go

I've uploaded the last month's worth of CGM data from Rose.

I've printed a summary of that data. Complete with pretty colours, pie charts and graphs.

I've breathed a sigh of relief after seeing how lovely my average blood glucose stats were. I then proudly saddle up beside Doug to show him so he could express his delight (or at least make supportive sounds as I clicked through the pages of data).

I have my blood pressure log with detailed notes about each pre and post long-run blood pressure fiasco. I also have my blood pressure meter set out on the counter.

I have my list of questions ready.

It's that time again.

Endo appointment time.

Here's hoping it's a little more helpful than my diabetes centre appointment was a few weeks ago.

I'll let you know next week how the A1C turned out and what her thoughts are on the blood pressure drop accompanied by heart rate spike that keeps happening during long runs.

Type A Diabetes

I have an appointment at the Diabetes Centre next week.

It's one of the appointments where I meet with a nurse and a dietician. Not the appointment when I meet with my endocrinologist.

So no blood work is required but I do need to arrive with a two-week food diary that tracks everything I ate.

When I need to keep a food diary I usually just print out a few pages worth of charts and then carry them in my purse for two weeks, dutifully writing down every little thing I put in my mouth.

This time I decided to see if I could print out reports from My Fitness Pal. My Fitness Pal is the food tracking app that I've been using faithfully now since last December. The one that has been keeping me honest and showing me without a doubt that I need more protein in my diet.

Turns out that you can indeed print from My Fitness Pal.

There's a nice little printable report you can generate that allows you to pick a date range, say the last two weeks, and then print all the food you ate (broken down by meals) as well as all the key nutritional info (carbs, protein, fats, sodium, fibre, sugars etc). It also shows any exercise that I did that day.

Sweet.

Add to that the reports I'm going to print from Diasend to show my blood sugar trends and I'm going to show up there with all sorts of fabulous data for us to comb through together.

Oh, and I can't forget my blood pressure data that I've been tracking for the past few weeks (before and after workouts as well as at random times during the day).

They are either going to love me...or put a note in my file that says "Watch out, this girl has Type A diabetes".

A Month of Numbers

I was cleaning up my home office on the weekend and spotted my Diasend box of tricks amongst the piles of documents that I needed to file.

So, while I filed, I uploaded a month's worth of insulin pump data.

Once I finished filing, my treat was that I got to pour over the numbers, cup of tea in hand, to see how things had unfolded in the last month or so.

The number of ways that Diasend lets me look at the data is almost too much. The first few times I did looked at it, I looked at everything and got too bogged down in the details to notice the important stuff.

Now that I'm a little more experienced, I look at the things that are important.

Like this:

A month's worth of Continuos Glucose Monitor (CGM) readings. The green section is my target range (between 4.0 and 10.0). The red dots are my average reading for every hour of the day. The black lines extending up and down from those dots show the highest and lowest reading I had during each hour. 

And this:

This pie graph is my favourite thing to look at. It tells me at a glance what percent of CGM readings were below 4.0, above 10.0 and what percent were within target range (4.0-10.0). According to this I was below 4.0 only 3% of the time and above 10.0 only 16% of the time. The rest fell into the lovely green section. 

The last thing I look at is a tiny little number on the last page that read: average blood glucose reading. 

For the last four weeks, my average blood glucose reading was: 7.5 

So what did I do after checking out all the stats? 

After doing a happy dance I mean. 

I increased my basal rate between 11:00 and 17:00 to try to get those higher afternoon numbers down a bit. I also made a minor increase in my insulin to carb ratio at lunch time to see if that will help too. 

Other than that, I'm not touching anything. No point messing with a good thing. 

Analyzing Diasend Trends

A week and a half ago I wrote about the excitement I felt when I discovered that I could upload data from Rose to a website called Diasend. 

I talked about how I could analyze the data to my heart's content - looking at daily, weekly, bi-weekly, monthly or even 90-day trends in blood glucose data, insulin data etc etc etc. 

I posted a few graphs from my original upload. Like this one: 

This was a graph showing my blood glucose readings over a one-month period. My average (the red dots) at every hour of the day fell in between the high (10.0) and low (4.0) blood glucose ranges I aim to stay within which made me happy. I didn't drop much below 4.0 when I did go low which was good but I was not particularly pleased to see how high I my blood glucose numbers went some days. 

After seeing that graph, I made a few adjustments to my basal rates. I increased them starting at 5:00pm until about 4am. I didn't increase them by much. Just enough, I hoped, to get those highs a little less high without causing more lows as a result. 

On Saturday, I uploaded data from the past 9 days from Rose to Diasend. Here is what the last week looked like. 

If you compare with the first graph you'll see that the red dots are still in a pretty good range (not too high - not too low). The highs I was having late at night and in the early morning have decreased.  

I have gone lower than I would like around the 2am mark as well as around the 5:30pm mark. The afternoon one shouldn't have anything to do with my original basal changes but I'm keeping an eye on it. I may need to lower my afternoon basal rates a bit. 

So I made a few more tweaks and have increased my overnight basal just a bit. Not back to where it was before but probably half way. 

Let's see what this next week holds. 

Diasend and Other Things I Didn't Know

Have you ever felt out of the loop? Like everyone else knows something and you don't?

I've had a few of those moments in my life. Some were minor. Like when I was in high school and everyone was talking about Bee Oh. Or B.O.?  Or Beo? I had no idea what B.O. meant or what it was. The internet did not exist yet so Google was of no assistance. B.O. was not in the dictionary (yes of course I checked). And everyone else seemed to use it regularly in conversation so I felt ridiculous asking.

One day I figured it out. It just popped into my head and I solved it. Kinda like Sherlock would have. I was so excited that I wanted to tell people how pleased I was at solving yet another awkward teenage mystery. Except that, if I told them, they would know that I didn't know. So 20 years later I'm coming clean on my blog.

I, Céline Parent, did not know what B.O. was in high school.

And if you're reading this wondering what B.O. is, I'm not telling. Sometimes it's more fun to figure things out on your own.

Other moments of discovery are a little more major.

When I was in Orlando I asked a few questions about my Animas Vibe pump. When I was using the Dexcom, I had been told that there was a software that would allow me to upload all of my blood sugar readings but that it was not approved for use in Canada yet. So the best I could do was look at what had happened in the last 24 hours.

When Rose arrived, with the continuous glucose monitor built right in, I assumed (silly me) that I still could not upload that data. While in Orlando, I asked when that software was going to be approved because I was really interested in looking at my blood glucose trends. I mean I have a device that measures my blood glucose every five minutes. All day every day. Think of how useful it would be to  see trends over days or weeks. Or different times of the day.

Turns out that I've had the power to upload data from Rose all along. It's a completely different program when uploading from a pump than from the Dexcom. So I came home from Orlando, signed on to the website as instructed, went down to the basement and found the cable I didn't realize I had and, within a few minutes, had the last month's worth of blood glucose data on the screen.

By data I mean all of the readings from my continuous glucose monitor. And all of the insulin I've taken. And the number of carbs I eat at every meal. And every finger prick result. Screen after screen of data that I can look at and sort daily, weekly, biweekly or monthly.

I emailed the Diabetes Centre to ask if they hard heard of this miraculous new tool? To ask if they would be willing to look at those results rather than have me write down all of my numbers for two weeks.

Apparently they had already heard of it (whaaaaat?) and many of their patients have been using it for a while now.

Bloody hell.

I guess it's one of those things that everyone assumed I knew and, since I didn't know, I didn't know enough to ask.

Well now I know. And I can't stop looking at the numbers. They're fascinating.

Here is just one example of how cool this is:

This is a graph of blood glucose readings from the last month. The red dots are the average every hour of the day. The green line is the range I have set as 'acceptable'. I'm pleased to see that my average at every hour of the day falls within the range I've set which is a low of 4.0 and a high of 10.0.

I'm also pleased to see that I haven't fallen too far below my low threshold of 4.0. I'm not so happy about the fact that I have gone pretty far above my high threshold. Particularly before lunch as well as late in the evening.

This is my basal profile. That means how much insulin my pump is programmed to give me every hour of the day. This does not include the insulin I take when I eat or when I'm trying to bring down a high blood sugar.

I looked at the first graph and compared it to the second. I then changed some of my evening basal rates to try to bring down those night time highs I have been struggling with. It's only been two nights so far but I can report that my high alarm did not go off once - nor did my low. So there is the first improvement. I'll work on the pre-lunch highs next.

This is my favourite thing so far. It shows what percentage of my blood glucose readings fell within my 4.0-10.0 range in the last month. Turns out that 77% of them fall in rage. Even better, I have only been low 3% of the time in the last month. I'm not as happy with the highs but am already working to get those down. 

This is such a powerful tool and it tells so much more of the story than my 10 times a day finger pricks used to. Now I have 288 blood glucose checks per day, every day.

My goal in the next month? Get the highs down without increasing the lows. Having a CGM and this wicked software will certainly make that goal a little easier to meet.