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. 

D-Blog Week Day 4 - Changes

Today's topic: changes.

Specifically, changes that we would like to see in the diabetes world or changes that we have been through since we were diagnosed.

Well the first thing that popped into my head when I read the topic was the change in attitude that I have experienced when it comes to insulin pumps.

Like most people, when I was first diagnosed, I started off on multiple daily injections (MDI). I had two different insulin pens (needles). One with long-acting insulin that I took in the morning and again at night. The other with fast-acting insulin that I took every time I ate something with carbs in it or when my blood sugar was high. And heaven help me if I mixed them up.

I did all of the calculations in my head (40 carbs for breakfast, 1 unit of insulin for every 8 grams of carbs = 5 units.  Plus perhaps an extra unit or two because my sugar is high. Or perhaps only 2.5 units because I'm going for a run etc etc).

When I first heard of the insulin pump, I had a visceral reaction to the very idea of it.

No!

My mother and I were having dinner together one night and she asked me why I was so opposed to the insulin pump. She had read about them and said they sounded like a good alternative. I said that I didn't want to have something attached to me all the time. She probed a bit more and, to the surprise and horror of both of us, I started crying. Right there in the restaurant.

See, years ago I had been in a nasty car accident and had to undergo some pretty major surgery that saved my life. I had a temporary colostomy which was successfully reversed a few months later. I thought I was over the ordeal but, when pushed about the pump, I suddenly realized why my reaction to it was so visceral. Having something attached to my body, that was somehow both on the outside and on the inside at the same time, reminded me too much of that really painful, difficult time. It fell into the category of 'colostomy' and I wanted nothing to do with it.

My mother understood and didn't ask again. I went on with my MDI routine.

I had not yet discovered the Diabetes Online Community (DOC). I did not know anyone else with diabetes. I certainly did not know anyone on the pump. Still, it was hard to avoid the information and posters I would see when I went to the Diabetes Centre. It took me a few more years before I would even consider a pump but I slowly opened up to the idea.

When I heard about a pump info session in my community, I took a deep breath and went.

Alone.

I tried on an infusion site. I wore it all day. I lay down on it, I put clothes over it. I bent and twisted and moved around and I realized that it was nothing like I thought it would be.

So I signed up and got a pump.

A pump that does all the insulin to carb calculations for me. And the pump actually remembers when I took my insulin and how many units I took in case I forget. And it tells me how much insulin is left in my system so I don't have to guess. And it lets me fine tune my insulin doses which makes all the sports I do much easier and safer.

It's not perfect and there are days when I curse having to be attached to something. But I don't think I would ever consider going back to MDI.

In fact I am the first person to promote insulin pumps. Anyone I talk to who is considering one gets gushing reviews from me - the girl who once cried in horror at the very thought of wearing one.

D-Blog Week Day 3 - Clean it Out

Today's topic challenges us to look for diabetes-related things that we are holding on to. It might be physical belongings or it might be emotional stuff that we can't seem to let go of. What are these things, why are we hanging on to them and what are we going to do about them?

Yesterday I struggled a bit with the blog topic and today I seem to be doing the same thing. 

In a physical sense, I really don't hang on to too much diabetes stuff. I have my diabetes cupboard where my supplies are stashed and there is usually a pretty good supply stashed. But I use it all and I feel better when there are weeks of back up stuff stashed in there because one just never knows when that pesky zombie apocalypse is going to hit. 

But other than having a good supply of things I use, I really don't have a lot of extra stuff kicking around for no reason. 

Oh wait, that might not be true. 

Actually, when I think about it, I may still have every single glucometer I have ever used tucked away on the bottom shelf of that diabetes cupboard. 

I may also have boxes of lancets for each of these devices that are still 3/4 full because, let's be honest here, you don't go through too many lancets when you only change them one per season. 

Oh dear. Now that I think about it, I may still have all of the start-up information for my Medtronic pump. The pump I used to use before I switched to Animas several years ago. 

And, since we're being honest here, I may also have gotten into the habit of saving the little pump plug thingie that I use when I am unhooking my pump for a shower. I keep one in the bathroom, two in my toiletry bag for when I'm traveling and a few in my swim bag for the pool. And then, for about 5 years, I used to toss every new one I got into a plastic bag in my diabetes cupboard, just in case. And when you consider that I get a new plug thingie every four days when I put in a new site, I have a lot of them. 

I'm proud to stay that, in the last year or so, I have stopped saving them. But I did post this picture a few years ago and it might be worth looking at it again. 

By the way, this is one of those gimmicky wine glasses that holds an entire bottle of wine in it. There are a lot of those plug thingies in there. 

Ok, so maybe I really do need to take a look at my diabetes cupboard and toss a few things out. 

As for emotional baggage that I am dragging around, since we are all being honest here, there is one thing that does make me kinda crazy. 

I am finding it increasingly difficult to respond respectfully to people who say things about diabetes (be it T1 or T2) that are ignorant or hurtful. Most of the time I am able to hold myself back because I know the person and I know that they are not saying these things to be hurtful, they just really don't understand. So instead of snapping at them, I try to patiently educate so that, hopefully, the next time they think something negative about diabetes, they hear my voice in their head saying "don't judge. Just don't. You have no idea and what you just said is very hurtful. If you're curious, ask the person. But for heaven's sake, don't judge." 

But I have to say that, after 12 years of this, there are days when it's really difficult to put on my nice girl pants...because what I really want to do is give them a good smack and say "oh for heaven's sakes, you have no idea what you're talking about, you are spreading negativity and you sound incredibly ignorant. So how about you stop spewing inaccurate information and making things worse for everyone."

Sigh. 

But you and I know that the second response does not make the world a better place. Only the first one does. 

And I'm all about making the world a better place. 

So while I am getting increasingly frustrated by the lack of accurate diabetes knowledge out there, I am also committed to changing that when I can. 

But let me tell you, there are days when I want to toss all of my pump plug thingies out and check to see if that wine glass really does hold an entire bottle. 

When in Doubt, Trust the Feeling

Yesterday I wrote about having faith in diabetes systems, even when they do not always work.

Well, on Saturday, I ended up having to have faith in my ability to feel what my blood sugar is doing rather than relying on technology to keep me safe.

I have been using a Continuous Glucose Monitor now for about 18 months. When I put a new sensor in, the first day readings can be a little wonky and when the sensor starts failing, two or more weeks later, the readings can also be a little bizarre. But from the second day until the second week, it's usually extremely accurate. So much so that I will often  treat highs and lows based on what the readings say

So on Saturday morning, when I headed out for a run with my 3-day old sensor, I had complete faith in the numbers.

I was 6.0 before the run. Since I was only (only!) running 10k, I had one date. That should have been plenty.

At the 5k mark, I did a quick check and discovered that Rose was buzzing to tell me that I was 3.8. I didn't feel 3.8 and I should not have been 3.8 but there it was, flashing on the screen. To be safe, I had a package of fruit chews.

I started running home. A few minutes later, Rose's ear-splitting siren alarm went off. The alarm that goes off when I'm under 3.1. It made no sense. I sure as hell did not feel 3.1 but, because she was telling me I did, I started feeling like I might be 3.1.

I refused to eat another package of fruit chews. I knew that one package should be enough and two packages would send me flying high in no time. So even as she kept alarming to tell me that I was 2.8, then 2.4, then 2.0 and then just plain "low", I kept running.

When I got home, I did a finger prick and discovered that I was 5.6.

I knew it!!

I re-calibrated Rose and, for the next 5-6 hours, she behaved herself.

Then, as we were sitting on the couch after a busy day of yard work, I started feeling low. I checked Rose and she said I was 7.0 and holding steady. And she had been accurate an hour before so she should be fine.

A few minutes later, I couldn't wish that low feeling away. I went to the kitchen and a finger prick told me that I was 3.8. Rose still said I was a lovely 7.0.

I had some maple syrup for the low and I shut down my 3-day old sensor. I waited an hour and then I restarted it. Two hours later, it was ready to go and I calibrated it.

Rose has been fine every since.

Two for One

I try very very hard to synchronize the changing of my infusion site with the refilling of my insulin pump. It’s not critical and I can certainly refill my pump without changing my site or vice versa but, when I do synchronize things it means that I use one of each of the three pump supplies (infusion site to get the insulin into my body, cartridge to hold the insulin and tubing to get the insulin from the pump to my site). That means that my supply of each of these things goes down at the same rate. Again, not essential but it makes it easier to order new ones when I need the same number of each thing.

Sometimes though, things don’t work out as nicely as I’d like.

Life happens.

Every once in a while I walk too close to doors or cupboards and yank out my infusion site when the tubing catches on the handle.

Some weeks I go for too many runs in between site changes, things tug a bit too much and the insulin starts leaking all over my skin rather than under it.

It’s days like these when I have to put in a new site before I need to refill my insulin pump.

Last weekend I noticed that a tiny bit of insulin leaked out of the site when I bolused for my lunch. Not a lot, just enough to notice. I waited it out and my blood sugar behaved after lunch. Perfect. The same thing happened at dinner but my blood sugar still behaved after dinner so most of the insulin was obviously still going in.

I had 57 units left in my insulin pump which means a day and a half left of insulin. I decided to see how long I go stretch out my failing site and wondered if I could make it to insulin refill time so I could do everything at once.

All evening long my blood sugars were in range which meant that the steady trickle of insulin was getting into my body without a hitch. It was just the bigger boluses I was going to have to worry about. Overnight worked well and I woke up in the morning with perfect numbers.

I showered, slathered cream on my winter-dry skin and got dressed. I had a plan. I was going to bolus the 5 units I needed to take for breakfast in 2-unit waves, several minutes apart. I hoped that smaller doses would go in without leaking and that waiting a few minutes would allow it to disperse under my skin and make room for the next dose.

The first dose worked well. The second, not so much. The third, not at all.

Oh well. I had dragged the site out about 16 hours which was better than nothing.

I popped a new site in and carried on with getting ready.

Less than a minute later I felt something strange under my shirt. I checked only to discover that the brand new site I had just put in had come completely unglued and was hanging by a thread.

Bloody hell.

Turns out that putting a brand new site onto skin that has recently had a good dose of skin cream applied is not a good idea. It makes for a completely non-stick surface and, once a site stops sticking, there is no saving it.

I scrubbed a new spot clean and even alcohol-swabbed it for good measure. I inserted the second infusion site in less than ten minutes.

So much for that plan.

A Bizarre Evening with Dear Diabetes

There are plenty of adjectives that can be used to describe diabetes.

It's not often that I would choose the word 'bizarre' but the other night, that's exactly how I would describe what happened. 

I had a very tight window between the end of my workday (5pm) and my CoreFit class (5:30pm). I had to drive home, change and then drive across town in those precious 30 minutes. 

Problem number one: I had gone to work with what I thought was enough insulin but ended up being down to 1 unit in my pump at 5pm. Not enough to get me until 7pm when I would be home again. 

Solution? I turned my basal rate down to 10% for one hour. I figured I was working out anyway so I wouldn't go too high. Plus it was only one hour so I could just take a bit of extra insulin with dinner to make up for that difference. 

It worked. My pump didn't alarm during class to tell me that it was out of insulin. In fact, it waited until I walked into my kitchen before making a peep. Unfortunately, just as I walked into my kitchen, it alarmed for three things, one immediately after the other. 

Alarm 1: pump is out of insulin

Alarm 2: blood sugar is above 10.0

Alarm 3: blood sugar is rising quickly (double arrows up)

Alright, the blood sugar spike was a little dramatic but I figured I'd be fine as soon as I changed my pump and took an extra large dinner dose. 

Problem number two: I removed my infusion site. That's the part of the pump that is stuck to my skin like a bandage and there is a tiny plastic tube inserted under my skin so the insulin has a way to get into my body. Usually I peel back the infusion site and either nothing happens or a small droplet of insulin leaks out. This usually happens if I change my pump too soon after taking a dose of insulin.

Never in my life have I removed the infusion site and seen blood gush out. And by gush I mean a spurt followed by an alarming amount of blood leaking down my abdomen. I grabbed a nearly tissue and pressed it hard against my side. Doug passed me the box and I added about five more to the pile. I soaked through all of them. More tissue. More pressure. It was a good five minutes before the bleeding stopped to a trickle and a few more before I felt confident that I could put a bandage on and not ruin my clothes. 

In the meantime my pump kept alarming. The no insulin alarm and the blood sugar rising too quickly alarm. I was now 14.8 and still double arrows up. 

Once the gushing stopped, I put a bandage on and then proceeded to refill my pump and put in a new infusion site. I bolused 1 unit for dinner (it was pretty low-carb that day) and 5 units for my spiking sugar. 

By the time we were finished dinner I was 20.9 and still climbing.

It took me three more insulin doses and several hours to climb back down below 10.0 resulting in a rough night and a missed morning run. 

None of it makes any sense to me. 

One hour of reduced insulin is not enough to cause that kind of spike. My numbers were fine at 5:30pm so it's not like I was high to begin with. My CoreFit classes usually cause a dramatic drop in sugars, not a spike. 

And what the eff was up with that gusher? It's like I had hit an artery and the only thing holding in the flood was a tiny plastic tube. Remove the tube and, well, it looked like a scene from Dexter. 

At the end of the day I am grateful that my site didn't decide to gush before I pulled it out. Like in the middle of CoreFit class or during my work presentation. How dramatic would that have been as a bright red mark slowly worked its way across my shirt while I stood in front of a group of horrified onlookers completely oblivious?

My Diabetes-Fighting Team

Dexter has been in my life now for 14 months. Rose has been around for 9 months.

Together, the three of us make a great diabetes team. Not that we do actual battle with diabetes but we sure do work together to keep him in his corner.

As soon as he starts acting up, Dexter takes notice and sends out a bat signal.

Rose spots it and starts vibrating to pass along the message and then I step in with my bag of tricks (insulin, emergency carbs, water, exercise and a voodoo doll) and together in our slapstick way we bring things back to the way we like them.

We slay the vampires so to speak.

 I like to pretend we're like this trio - only a little more 2015ish. I keep flip-flopping between whether I want to be Willow or Buffy. I'm leaning towards Willow. And Rose is totally Buffy in her fancy pink coat. 

Anyway, so the three of us make a great team. 

Which made it all the more disconcerting when things started to go wrong last week. I was at day 9 of my sensor and things were fine until I got out from the shower last Wednesday morning. Instead of seeing my blood glucose number on Rose's screen, I saw the dreaded ??? instead. 

I hooked her back up anyway and crossed my fingers. About two hours later, she buzzed to tell me that my blood sugar was 3.9 (which it was) but it took two hours for the ??? to go away. 

The next day, it happened again. Right after my shower. And about two hours later, everything was fine. That night, I changed my CGM sensor hoping that was the problem. 

The following morning the same thing happened. It happened on Wednesday and Thursday with my old sensor and it happened on Friday, Saturday, Sunday and Monday with my new one. Each day was the same pattern. Something was happening in the shower that messed things up. 

Since not showering was not an option, I really needed to figure this out. 

So, on Monday, I called Animas Tech Support and found myself speaking to a nice guy in California. He walked me through some of the things that it could be and none of them seemed to fit. He explained that seeing ??? meant that the sensor was reading my blood glucose but could not make any sense of what it was reading. Which eliminated the possibility that it was a transmitter battery problem. 

He said that it could be a problem with the back of the transmitter getting wet during my shower but we both agreed that was odd considering it never happened before and now it was happening every single day. Plus, I added, when I go swimming for 90 minutes, I never experienced any problems with Dexter finding Rose again afterwards (I didn't actually use their names for the record). 

He finally concluded that I may have simply had two faulty sensors and he agreed to send me two new ones immediately. 

Hopefully he's right. 

I don't like it when Dexter sends a bat signal and Rose isn't able to read it. It kinda freaks me out. 

I spent the first 10 1/2 years with diabetes flying blind. Relying on finger pricks to keep my numbers in check and going to bed every night crossing my fingers that I would wake up if I had a problem. 

I've come to rely on my CMG and the feeling of security that it brings. Missing that for 2 hours every morning, particularly right after breakfast and a run, is really disconcerting. 

CoreFit Challenge

When to folks in the lab coats develop things to make living with diabetes a little easier - like pumps and continuous glucose monitors (also known as Roses and Dexters) - I'm pretty sure they have to run them through a whole barrage of tests.

Like how well the infusion sites stick.

Do they hold on after a shower? After two showers?

Does the CGM receiver receive a signal when the transmitter is on your stomach and you are sleeping face down under a mound of blankets?

How much pulling can the infusion site take before it rips off? Can it survive if you drop the pump and it's dangling at the end of the tubing? Can it survive if the tubing gets caught on a doorknob as you stroll by? As you run by?

How cold can it be before everything stops working right? How hot?

If someone sleeps on top of their insulin pump, while buried under a pile of blankets, for oh, say, 8 hours, is that hot enough to cook the insulin into uselessness?

So many things to test - no wonder it takes so long for new products to reach the consumers.

After the last few weeks, I'm working if I should contact Animas and Dexcom to let them know about a few more tests that I've been running on their products.

I like to call them the CoreFit Challenges.

The Pressure Test: Take a stability ball. Lie on it with all of your weight on your stomach. Ideally, directly on top of the Dexcom transmitter. Bend forward to put as much pressure on the transmitter as possible. Lift up using your back muscles. This will stretch out your stomach and pull the skin as tight as possible. Hope like hell the transmitter does not rip off. Repeat, oh, I don't don't, 10,000 times.

The Pump Clip Test: Clip your pump to your workout shorts. Begin class. Move pump around to the back in order to lie on your side. Then move pump back to the side in order to lie on your back. Move to stomach in order to lie on your side. Move from stomach to back in order to lie on your stomach. Hope clip is strong enough to handle 60 minutes of sweaty-palmed not-so-gentle manipulations. Repeat twice a week until pump clip disintegrates.

The Up and Down Test: I could probably get a job at Dexcom or Animas right now simply based on the knowledge I have re what happens to diabetes products during a long run. Running involves a lot of bouncing up and down but it's an up and down forward motion. I have never tested these things in a purely up and down fashion while waving my arms in various directions. As in while doing jumping jacks. Or while jumping up, spinning 180 degrees and landing. After each set I reach down to check if Dexter is still there because all the bouncing makes it feel like he's ripping off.

The Vibration Test: I dislike beeping noises so I have switched every pump alarm I can on my pump to vibrate. I never miss an alarm when I'm sitting at my desk. I rarely miss one while sleeping (although Doug may argue with that statement). Can the vibrations be felt while madly doing jumping jacks? While doing football runs? And, more importantly, will the vibrations cause me to lose my balance while in a side plank with one arm and one leg in the air?

Dexcom. Animas. If you have any questions about how your products performed during the CoreFit Challenge, please don't hesitate to contact me.

T-shirt Troubles

There is something odd that happens when running in a t-shirt.

Actually, I should probably clarify that a bit.

There is something odd that happens when running in a t-shirt if you have type 1 diabetes, wear an insulin pump and a continuous glucose monitor (CGM).

And you're me.

The t-shirt running season for me is usually fairly short. In the winter I run in winter running clothes that have nothing to do with a t-shirt. In the early spring I switch to shorts but keep a long-sleeved shirt for a few more weeks. Then it's shorts and a t-shirt but only until it's just barely warm enough and then I switch to my tank top that I wear all summer. Then reverse everything I just wrote as winter rolls back in again.

Last spring, I wrote about how running in a t-shirt seems to dislodge my insulin pump site and/or my CGM. I figured it was the back and forth flow of the t-shirt that did it since my tank top and my winter running tops are all snug and don't move. I wrote about how I was having to run home from work to change a leaky infusion site or having to re-tape my CGM back on because it was barely holding on. Then I stopped writing about that during the summer because it stopped happening.

Yesterday morning it was just cold enough that I put on my t-shirt. Not even thinking.

I ran 7k.

By 2.5k, the shirt had rubbed my CGM to the point where it was barely hanging on and no longer saveable. Since it had already lasted 9 days, I was ok with the sacrifice. Anything under 7 feels like a loss but anything over feels like a win. Still though, 15 minutes of running and my CGM, complete with extra adhesive, fell right off? That won't do at all during long runs and races when I rely on that to tell me what my blood sugar is doing.

I got home, tested my blood sugar and prepared to bolus for breakfast. At the last second I remembered that my site would often leak after running in a t-shirt to I lightly pressed a tissue against it while the insulin went it. I pulled it away afterwards and there was a tiny wet spot that smelled suspiciously like bandaids (insert bleh noise here).

I decided to push the infusion site rather than change it too and it did well all day - no unexplained highs but it did leak a bit with each bolus.

Surprising what one 7k run will do when there is a t-shirt involved. It cost me an $80 CGM site and almost another $20 infusion site. I should take that money and see if I can find a t-shirt that fits like my tank top.

Because I've been reminded that the t-shirt thing just doesn't work for this type 1 gal.

Muscle Jabs

It is possible to stick an insulin pump infusion site into muscle rather than into fat? I suppose it is but, in my five plus years of pumping, I've never had a site that felt like it was in muscle before so it never occurred to me that I could actually do that.

Last Wednesday evening I changed my site. I use one of those insertion devices that, at the push of a button, jabs the needle in. As the needle went in, I felt a bit more resistance than usual but nothing odd. It hurt a bit more than usual but, again, nothing odd.

Thursday, every so often, when I moved a certain way, I felt a twinge. I ignored it. It got worse. I ignored it. It started to twinge when I sat down or stood up but not while standing or sitting. It started to hurt when I folded slightly forward but no amount of moving side to side caused the same feeling. I started to wonder if I had somehow struck muscle with my infusion site.

I decided to try to gently wiggle it a bit to see if I could dislodge it from the muscle without causing it to actually dislodge from my body. It helped a bit but didn't solve the problem. It also hurt a lot.

I decided to use my Friday morning swim as a way to either solve the problem or force me into action. I figured the swimming causes me to move my abs in all sorts of ways as well as lengthen my body. I hoped all the movement would 'fix' the problem.

The swim, as it turns out, didn't cause any pain but also didn't solve anything. I felt nothing during the entire workout but, as soon as I went to climb out of the pool, I could feel it again.

Sigh, I hate wasting pump supplies.

I went home and stubbornly refused to change it. I went to work and gingerly moved my way around the office, getting up and sitting down more slowly than usual. I wondered if I could do it for two more days until I was actually due to change the site.

The big test would be my friday night golf game. Would the golf swing movement be a problem? I did one test swing in my kitchen and immediately knew that I had to make a choice. Change my site or skip the golf game.

Of course I changed my site. I'm stubborn but not that stubborn.

Nothing seemed amiss when I removed the site. No bent cannula. No bleeding. One removed, the pain disappeared. Just like that.

Maybe I should have an extra cookie or two, buy more maple fudge, maybe eat more salt and vinegar chips.  You know, to build up that adipose tissue cushion on my abdomen.

Real Estate

I had a visit from the Crazy Rabbit on the weekend.

He showed up on Sunday afternoon and had a new trick up his sleeve.

He sent my blood sugar spiking after every meal. Even low carb ones. Even ones eaten right after exercise. I would take my regular insulin and, instead of happily bobbing along between 7-9 after eating, I would spike straight up to 16+.

It would take three times my regular insulin and 3-4 hours to get me back down.

Once I got down, I stayed down. Even overnight. My blood sugars happily hovered between 4-6 all night long.

Work through it with me. See if you can figure out the problem.

If I spike like that after a meal my first thought is that there is something wrong with my infusion site and I am not getting insulin properly. Then I wonder if it's my insulin. Did it get too hot? Was there a huge air bubble I didn't see in the tube? Did I actually remember to take insulin? (yes, that does happen).

After a few extra boluses of insulin my blood sugar did come down. Ok, so I am getting some insulin. Maybe not all of it but some. Now that I'm down, if I'm not getting all of the insulin I should be getting my blood sugar will start to climb again.

But it didn't. Even after 8-10 hours overnight. I didn't climb at all. So I'm getting all of my basal insulin.

Next breakfast? Bolus extra insulin and wait 20 minutes before eating. Blood sugar starts to drop as expected. Eat. Wait 15 minutes and it starts to climb. Spikes up to 16 despite a few rage boluses. Takes hours to flutter back down but, once down, it stays down until I eat again.

This happened on Sunday and Monday. I decided to test my Tuesday morning breakfast and, if things kept up, I'd change my site. I ran for an hour before breakfast, bolused, waited, ate and went to work. My blood sugar was stellar. It stayed between 5-7, never spiked, never dropped. Sweet!

Crazy Rabbit went home - finally!

At lunch I counted my carbs, bolused, waited 20 minutes just in case, and ate. Thirty minutes later I was 16. It took four hours and a ton of insulin to get it back down again.

Enough!

I went home, changed my site, my tubing, my vial and put in fresh insulin. I also went for real estate that had not been used in months. I don't like putting my pump on my right side for all sorts of reasons. It gets in the way of my golf swing. It gets in the way when I sleep. It gets in the way period.

I put in on my right side in order to properly address each and every variable I could think of.

If things don't improve, I'm making rabbit stew!

The Week in Review

• I played golf on Monday with my lady friends at our favourite 9 hole par 3 course. This time last year I was working hard to break 50 on that course. A month ago I was struggling to get under 46. On Monday I got a 39! 

• At the end of a team meeting this week we were asked to answer the following question: name something in your personal or your work life that you are working on 'letting go'. My answer popped immediately into my head. "I am working on letting go of the instant anger and frustration I feel when someone says something entire asinine and insensitive in response to my saying 'I have diabetes'." My shoulders and neck tensed as I said this which made me admit that perhaps I wasn't as far along the 'letting go' path as I'd like to be. 

• I did my new favourite 6x800m interval run yesterday morning. My neighbour came out just as I was heading around the block for my third 800m. "Going for a run?" she asked. "Yep" I replied. I returned 4 minutes and a few hands full of seconds later. She looked at me and said, as if disappointed, "Oh, that's all you're going to run?". "No" I replied. "I just ran 800m. I've already done it three times and I have three more times to go". Her eyes widened and she said "you're crazy!". I grinned and headed off again for number four. When I got back I asked jokingly if she wanted to join me on number 5. "I don't jog" she said wistfully. "Neither do I" I replied. I don't know if she got the running humour or not but I grinned and she grinned back so we're good. 

• It was a little cooler than is typical for a Thursday in July so, after my intervals, breakfast and shower I pulled on my jeans, compression socks and running shoes with orthotics and headed off to work. I am almost embarrassed to tell you how good my legs felt after a few weeks of sandals. Their sigh of relief at being so spoiled was audible. 

• I changed my pump site and put it higher on my abdomen than I usually do in search of some fresh real estate. In fact it's less on my abdomen and a bit more at the bottom of my rib cage. It felt fine going in and worked just fine but started hurting a few hours after being inserted. I've done this before and the pain was familiar. As was the stubborn response that immediately popped in my head. "Suck it up princess. It's only four days. You just changed it and you're not going to waste $20 changing it again if it's working just fine." Sigh. 

• I made my favourite home alone dinner this week. Quinoa, steamed kale, roasted sweet potato, goat cheese, olive oil and soy sauce. It was so tasty that I was almost entirely ok with the fact that we were out of black beans. I had to buy the world's biggest sweet potato because that was all that they had at the store. I had visions of it taking 2 hours to roast. As I stood at the counter I had the brilliant idea of slicing it into 1/2 inch slices, drizzling olive oil over the slices and roasting it that way. It took 30 minutes and was delicious. That, my friends, took me at least ten years to figure out. Maybe next time I'll do beets too. I was so amazed at the potato discovery that I went completely wild and stirred a bit of sriracha sauce into the quinoa. 

• I went for bloodwork on Tuesday in preparation for my upcoming appointment at the Diabetes Centre on August 7th. I got back to work and my cell phone rang. It was the Diabetes Centre calling to reschedule for October 7th. Fabulous. My bloodwork is going to need to be dusted off by the time I get there. 

• I go through a swim suit every few months thanks to the wonders of chlorine. I am currently wearing a red one that I like very much. I also have a red swim cap that I got from a triathlon last summer. It has my race number on it and I like it very much as well also. I'm not usually that colour coordinated at the pool but I have been wearing red for a while now and feel very 'swimmer' when I do. On Monday, partway through my workout, my swim cap split. Right up the middle of my forehead. I sighed a sigh of sadness and pulled it off in the ten seconds we had between sprints. I used to swim all the time without a swim cap so I figured I'd finish the workout sans problème and dig out an old one for my next workout. Within seconds I realized we had a problem. My hair is all different lengths now and half of it fell out of the elastic in about five seconds and was all over my face, I discovered that water does not flow past my head as smoothly without a cap and it kept churning up my nose which may sound totally bizarre but I swear it's true. I had to lift my head higher to breathe and I was slower as a result. I cannot believe I used to hate swim caps. I also had to spend an extra ten minutes in the shower trying to comb out all the tangles from my hair. Never again she said. Never again. 

(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.

Unplanned Experimentation

So it went down like this:

Monday afternoon I changed my insulin pump site and stocked the pump with fresh insulin.

I should have been good to go for 4-5 days.

Monday night was fine. I was high but that was easily explained so I didn't think anything of it. Tuesday morning I was 8.0 before my 5k run and 8.6 afterwards. That seemed a bit weird since I usually drop a few numbers when I run but I shrugged and carried on with my regular routine. I took breakfast insulin, made my lunch and puttered for 15 minutes, then ate my breakfast.

I headed up for my shower. When I got out of the shower, my pump was buzzing to say that I was over 10.0. That was really odd since I had taken insulin and waited before eating. Add the fact that I ran first and I should be low if anything, not high. I double checked that I actually took the insulin and Rose confirmed that I had.

By the time I dried my hair and got dressed I was 13.4. By the time I was ready to leave I was 15.0.

I should have changed my pump before heading out but my blood sugar was levelling out so I thought I might drop back down again. I grabbed my needle and the remaining half cartridge of insulin from the fridge and headed to work.

My drive is 1.5 minutes. I was 16 by the time I got there, 17 by the time I turned on my laptop and 18 by the time I had unpacked and sat down.

I took out my needle and injected 4 units of insulin. Within 15 minutes I was dropping.

In the meantime, I tried to figure out the problem. There were a few options:

1. the insulin was bad. That didn't seem likely since injecting it by needle seemed to be working.
2. there was a kink in my canula. Maybe but it had been working fine earlier.
3. the site was bad and insulin was leaking out rather than going in. I've learned to always put my finger against the site when I take insulin after a run since it sometimes moves during exercise. If I don't smell insulin, that usually means everything is fine. I didn't smell insulin when I took my breakfast insulin.

I had a full day of meetings ahead of me. The kind that you can't be late for or leave early from. So I headed out with my trusty needle in tow and stalked Rose to see what was happening.

This is what happened. 

The far left was a post dinner high I was fighting on Monday night. I went down to 4.0 by 3am and had a pack of fruit chews. I went up to 8.0 which is where I was when I woke up a 5:15am for my run. I ran, bolused, waited and then had breakfast.

The first spike is from breakfast. I dropped down to 9.0 after taking insulin for the high. But then I spiked back up to 20.5. I took insulin, by needle, for that crazy spike and came right back down again. When I reached 10.0 I took more insulin for my lunch and waited until I hit 7.0 before eating. 

I hung out at 6.0 for a little while but then started climbing back up again. I continued to climb even though, by then, I should no longer be climbing because of my lunch. I think I was climbing because I hadn't received any insulin from my pump all day so the slow basal rate I usually get wasn't there to keep me stable between meals. 

I took insulin and came back down to 8.5. 

When I got home I sucked it up and completely changed my one-day old infusion site and filled the pump with fresh insulin. 

Why? 

Well, I never did find a leak or any kind of huge air bubble in the tubing. The insulin was fine because every time I took a needle I came back down. The fact that I would climb back up again, even when I hadn't eaten anything for a few hours made me think that I wasn't getting any insulin from the pump at all. Yet the pump wasn't sending 'no delivery' alarms. Where had a day's worth of insulin gone if I wasn't going into me and wasn't backing up in the pump? 

When I removed the infusion site there was no sign of kinking or damage of any kind. So I have no idea what the problem was. I just knew that I didn't want to spend any more time hanging out at 20 so   I changed everything at once and crossed my fingers. 

It worked. 

I had dinner and purposely had pasta. I took insulin from Rose rather than the needle and I am happy to report that I never went above 9 despite the carbs. 

Introducing Rose

There is a new kid on the diabetes block. She recently arrived in Canada and, just last Friday, showed up on my doorstop.

Her name is Rose and she is a lovely pink Animas Vibe pump. She been riding around on my belt since Sunday evening. We're still getting used to each other but I think she will be a wonderful addition to my diabetes arsenal.

Let me explain how Rose came to arrive into my life.

Many of you probably know that I usually wear a green Animas Ping pump named Lucky. Lucky arrived on the scene a while ago now and, thanks to his waterproof nature, has made a huge difference to my swimming routine as well as on triathlon days. No longer having to remove my pump when I swim is pretty sweet and very helpful when it comes to blood sugar management.

Here is a picture of Rose (top) and Lucky (bottom). You'll notice from the tubing that Lucky was still attached when this photo was taken. 

Lucky is also pretty cool because he can be remote controlled using my One Touch Ping glucometer. Which means that on weekends like this past weekend when I wore two different dresses over two days, he can be hidden under the dress and there is no need to dig him out when I need to bolus.

Back in November the Dexcom was released. Dexcom is a Continuous Glucose Monitor (CGM) that is separate from Lucky. Mine is named Dexter and, since the moment he arrived, we've been inseparable. He shows me what my blood sugar is doing, he alerts me if I'm high or low or when I'm climbing or dropping too quickly. He has made a huge difference in my diabetes management and, after only six months, I can hardly remember life without him.

Smile for the camera Dex!

So I have a waterproof insulin pump that I can remote control when I need to. I have a Dexcom that keeps me on top of my blood sugars. What more could I possibly need?

Not much, I thought, until the new Animas Vibe pump came out.

The Vibe is different than the Ping and there are pros and cons to each of them. Both of them are waterproof which is critical to my lifestyle. The Ping, or Lucky, has the remote control feature I mentioned which, when I first got it, didn't seem like that big a deal. After having it for a while, I realized how convenient it really is and what a difference it can make when you need to keep the pump tucked away under your clothes.

The Vibe, aka Rose, does not have the remote control feature. But she makes up for it by having the Continuous Glucose Monitor built right in. With her, there is no need for a separate Dexcom device. One touch of a button and you can see one of six different CGM screens. It's pretty sweet.

This is the 3-hour screen. I can also see what my BG is doing over 1 hour, 6 hours, 12 or 24 hours or I can just see the current BG reading, an arrow showing me where it's headed and the amount of insulin on board (IOB) 

So how did I end up with Lucky and Rose? Well, about six weeks ago now, you might remember that I did a presentation for Animas as a conference for diabetes educators. It went really well. One thing led to another, we exchanged a few phone calls and I ended up signing a contract with Animas. I agreed to do more presentations like the one I did, as well as attend local, and not so local, events. In exchange, I would be signed on to their Animas Heroes program and I would receive a new Animas Vibe pump. A pump that would make a big difference in my ability to stay on top of my blood sugars during sporting events. No need to leave Dexter tucked away during a swim because he is not waterproof. No need to add more weight to my running belt by bringing him with me. Now the CGM is build right into the pump and, at any point during a workout or race, I will be able to look down, see what's happening and make decisions as I go.

So Rose arrived on Friday and, after my weekend of fancy dresses, I revved her up and hooked her on. I have three weeks until the next wedding weekend when I'll need to wear Lucky again so I can remote bolus as needed. But, for the moment, Lucky's in the cupboard and Rose is hanging out.

What about Dexter you ask?

Well, I'm guessing I'll be wearing Lucky a lot during the summer months because of all the sundresses I'll be sporting. So he'll get to be my wing man as usual. When Rose takes the stage though, he'll end up in the cupboard with Lucky.

He's not particularly happy about that but I'm hoping he'll learn to see it as a much deserved vacation.

(Almost) Naked Shower

Yesterday I just missed having my second naked shower since November. 

One in six months. That's just sad when I think about it.

Yesterday morning I went out for an 8k run in the cold spring rain. Dexter, who was already 10 days old and holding on by a combination of sheer determination, the fear of my wrath if he let go before day 10, and some well-placed tegaderm, didn't survive. My wet and heavy shirt kept rubbing on him and, by the end, he had come completely unglued. 

When I got home, I dug him out from under my wet layers, placed him on the counter to dry and headed up for my shower. 

After my shower, I noticed that my infusion site was also barely holding on after the rainy run. There was just enough insulin left in my pump to make it until dinner so I taped it in place, crossed my fingers and went to work. 

I fought highs all day. Not high enough to go home and change my site but high enough to make me think that I may have caused some structural damage to the site and not all the insulin was getting in. 

I changed it the minute I got home and that is when I realized that, if I had changed it in the morning when I was doing Dexter (that sounds worse that it should), I would have been able to have a naked shower. 

Dammit. 

Naked showers, for those of you who get to take one every day, are a luxury that I rarely get to enjoy anymore. 

The thought of not having to gingerly wash around my cyborg parts and just being able to enjoy the shower is, well, I can't even think of the right word for what it is but it's a damn nice thought. 

The thought of not having to think about where and how I stand in the shower so that the water doesn't directly hit one of my sites when the edges are already started to come unglued. 

How many of you actually know how to stand to make sure that some parts of your body get wet but never actually get directly sprayed by the water? How many of you care? I'm guessing it falls in the category of 'who the hell does that?'.

And imagine the whole post-shower drying off process. Dry arms vigourously. Dry legs vigourously. Dry abdomen...oh wait, dab, dab, carefully dab so as not to knock any cyborg parts off. 

Sigh. 

I missed my naked shower by a handful of hours. 

With pump site changes every 4-5 days (usually in the evenings) and with Dexter changes every 8-14 days, the odds of both sites coming off on the same day at the same time just before I need to shower are roughly the same as the odds of my taking up figure skating.

Or ballet.

Or anything else that requires a combination of grace and short skirts. 

My Purse

I have a pretty big purse. And it's pretty packed with stuff. All of it stuff that makes sense, at least in my head, to have on hand.

I have hand cream (two hand creams actually but one is almost finished so I'll be down to one again soon) and a handful of lip balms (I like variety). A collapsible shopping bag (ok, two collapsible shopping bags). Sunglasses and, in the off chance I actually need them in the middle of winter, my contact lenses. I have a ziplock bag full of fruit chews, Dex 4s and other emergency carbs. I have my fountain pen(s), my rollerball pen and my clickie pencil. Ink refills for my pen because I write a lot. A hairbrush and a pick (not sure why I need both but they're in there). A CPR pocket mask. My glucometer. Batteries for my pump and my glucometer. Face cream (just a small one). A mirror (just a small one). Hair elastics. Hair clips. A mangled Larabar. My emergency glucagon. My wallet. My change purse that I no longer use since I got my new wallet but it's still floating around at the bottom of my bag anyway. A nail file (ok two nail files). My green moleskin notepad.

What I do not carry on a normal day is a new infusion site for my pump. I also don't normally carry a back-up needle with insulin.

Why?

Because I already carry a ton of stuff.

Because I work two minutes from home and, on most days, can easily leave the office to pick up what I need should I need it.

Because my purse is already packed with stuff, most of which I actually want to carry. I don't want to take any of that stuff out to carry more things that I really don't want to carry.

Because I rarely run into problems that I can't easily fix.

Because.

Because.

Because.

Anyone want to guess what happened?

Yep. I needed some stuff that I didn't have and was nowhere near my home at the time.

It all started on Sunday morning. I woke up to a beautiful flatline on Dexter. I had slept well all night and spent over 8 hours with a blood sugar between 5 and 6. I love waking up to flatlines.

I showered and went downstairs for breakfast. My regular breakfast. Which I bolused my regular insulin for. I ate it, said bye to Doug and hopped in the car to drive to Toronto for a sister-visit.

By the time I hit Burlington, Dex was singing the high notes. I was surprised to see that I was 17 and climbing. I doubled checked on my glucometer and it said I wasn't 17, I was 18. It made no sense. The only thing I could think of was that I hadn't exercised that morning and my sugar was higher than it should have been. I bolused. Dexter sang. I bolused again. He kept singing.

By lunchtime, I had managed to get my sugar down to 11. Still crazy high but at least I was dropping.

We ate. I bolused 20 minutes before we ate and took twice the dose I should have. Within 30 minutes of eating, I was 17 again. We walked around Toronto a bit more but then I said I had to head home. Something was wrong.

I got in the car and I was 18 and climbing. I dialled in a 5-unit megadose and hit 'go'. I immediately felt wetness on my skin and smelled insulin. Fabulous. My site was compromised, I was 75 minutes from home and I had no other insulin-injecting device available. It explained the problem but I had no solution.

There was nothing I could do but drive. Every 15 minutes I checked Dexter and every 15 minutes he confirmed that I was 17.5 and holding steady. Not the kind of flatline I wanted to see.

By the time I got home I was exhausted, dehydrated, headachy and starving. I changed my pump site and took a megadose of insulin. We waited 40 minutes until I dropped back down below 11 before we ate our 100% carb-free dinner.

I should have carried a site change in my purse. I should have had a backup system. I should have at least had something in the car in case I needed it.

I know.

I know.

I know.

I just don't really want to feel any more like a traveling hospital than I already do. I just wanted to spent the day in Toronto with my sisters, pretending we were famous. Walking into stores and looking at the beautiful vintage clothes we can't afford to buy. I just wanted to giggle and tell stories and be the big sister.

Not the sick sister.

If I am Ever Kidnapped...

Sunday morning, I was down to 20 units in my insulin pump. Enough for breakfast and lunch but not enough for dinner.

Being the scrimper that I am, I told myself that I would change my pump right before I headed to my parents' house for dinner.

Then I got busy living my life and plum forgot.

Until they put out a plate of cheese and crackers and I reached down to bolus...and saw 8 units left.

Bah!!

I explained the situation and asked what was for dinner.

Lots of protein and veggies with a few carbs here and there. I did the math and thought "I think I can do it!".

I was going to be there for about 3 hours. My basal rate is just under 1 unit/hour which left me with 5 units for dinner. Not enough to eat what I wanted but enough to keep me, I hoped, from shooting up off the top of Dexter's graph.

I bolused every single one of those units and we headed to the dining room.

I filled up on pork chops and asparagus but still had a few bits of potato, the smallest piece of pie possible, no bread, no crackers and no ice cream.

I climbed to 9. Then 10. Then 11.

When I was down to less than one unit left, I headed home. As I pulled out of the driveway onto the snow-covered roads, I had a moment of horror. What if I drive off the road in the snowstorm? What if it takes five hours for help to arrive? What if anything at all happens on the 20-minute drive home?

I have no insulin left and Dexter was making it very clear that my blood sugar was now 12 and climbing.

Bah!

Nothing happened other than Lucky ran dry on the way home and began his incessant alarming to make sure I was well aware. I walked in to the house, headed straight for the butter compartment and pulled out a fresh vial of insulin. I was good as new in 5 minutes and my blood sugar was on its way down again within 15.

I always feel better when I'm topped up with a four-day supply of insulin on my belt. That way if I drive into a ditch, am kidnapped or stuck in an elevator for the weekend, I have a chance of surviving until help arrives.

Any other T1s out there who hope that, if they are ever kidnapped, it happens on the day when they are fully loaded with insulin? Anybody else do a quick check to make sure they have enough emergency carbs, water and insulin before they get in the elevator...just in case?

Best Day Ever?

On Saturday morning I woke up to balmy temperatures. It was 8C by 9am for heaven's sake! I pulled on my running hat instead of my toque for the first time in over two months. I wore two thin shirts, no jacket, no gloves and I headed out for a 13k run.

Instead of the sound of snow crunching under my shoes, I got to listen to the sound of water rushing down the streets as the mounds of snow melted at an alarming rate.

I spotted all sorts of things that had been buried for weeks in snowbanks. A rusted dog collar. More than a few christmas ribbons. Mitts. Enough Tim Hortons mugs to start my own franchise. Probably a  dollar's worth of dimes, nickels and quarters. I didn't pick any of those up - I was holding out for a $100 bill that I was sure would emerge somewhere during the big melt. If it did, I wasn't the one to find it.

I also managed to pick a route that kept intersecting with city garbage trucks that were out picking up old, discarded Christmas trees. Every time I passed one, I was engulfed in the smell of crushed pine needles. If there is a better smell in the world, I couldn't name it.

So far, the day was going very well.

When I got home, I stretched and had my coffee. Instead of heading up to shower before lunch, I lingered around a bit and then had lunch before my shower. Nothing crazy I know but it's not my typical routine.

Trust me though, there was method to the madness.

I wanted to have lunch first so I could bolus the last few units of insulin and get my pump down to almost empty. Meaning that I would then remove the infusion site before my shower. At the same time, I also removed Dexter as it was getting beyond the time when he needed to be changed too.

And for the first time since the last week of November, guess what I got to do??

NAKED SHOWER!!!!

Best!

Dexter gets changed every 7-14 days. My pump gets changed every 4-5 days. When the stars align for them both to be changed at the same time, this girl does a happy dance. You have no idea how nice it is to shower without having to be aware of where all of your cyborg parts. To just be able to shower is a luxury that cyborgs like me sometimes dream about. I admit it, I may have stayed an extra few minutes in the steam just relishing the moment.

By 1pm on Saturday, I had run 13k, enjoyed a taste of spring, been engulfed in the smell of pine needles, and had my first naked shower in almost two months.

Did I mention that I had grilled cheese with Franks Hot Sauce for lunch?

How's that for the best day ever??

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...

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.