Sometimes it's easy to weigh the pros and cons of medical choices we have to make.
Should I take insulin?
It's a synthetic hormone that, if taken at the wrong dose, can be lethal.
Well when you weigh that information against the knowledge that not taking insulin has a 100% chance of killing me, I'm all for it.
Bring on the insulin!
And thank you Doctors Banting and Best for giving me the choice.
Other health decisions are a little less cut and dry.
Should I take calcium?
Pros - it will help reduce the risk of bone density loss, something I am at high risk for and have already shown early signs of.
Cons - the are health risks associated with calcium supplements, include cardiovascular disease risks which, as someone with T1, I am also at risk for.
Should I take a low dose statin?
Pros - it will help reduce the risk of cardiovascular disease and stroke, things I am at risk for as a person with T1.
Cons - there are all sorts of side effects that come with taking statins including, I recently discovered, memory loss. For some reason that one I find particularly disturbing...but I can't remember why.
Should I take iron? Should I take digestive enzymes? Should I take vitamin D? Vitamin K? A multi-vitamin? Low-dose aspirin? A pill whose name I can no longer remember that is supposed to help protect my kidneys? Birth control?
All of the above have been prescribed or strongly recommended by a doctor at some point in my diabetes care. Some I have said yes to, many I have said no. All I have agonized over and still second guess as I pop open the daily pill bottles.
Despite all of the no's, I take three pills when I wake up, one with breakfast, one mid-day and one before bed.
I can only hope that they are doing more good than harm.
Showing posts with label insulin. Show all posts
Showing posts with label insulin. Show all posts
Wednesday, May 27, 2015
Tuesday, March 17, 2015
Just Some Numbers
A few numbers, for the record.
- I've been using the FlexBar for 12 days. My elbow no longer hurts when I grasp things with my right hand and it no longer hurts when I lift things with my right arm. The only time it hurts now is right after I use the FlexBar.
- I have been using My Fitness Pal for 80 days. I have not missed a day of logging my food intake or my activity, not even during our two week holiday.
- I typically meet my daily fibre goal before lunch and I haven't come anywhere near my sodium limit in weeks yet I'm still struggling most days to get all of my calcium and all of my protein. Despite what feels to me like a lot of nuts and a lot of yogurt. Maybe if I top my yogurt with some grilled chicken?
- I've dropped 4 pounds. Not a ton but I wasn't going for a ton. I just wanted to get back to the weight I was a few years ago and I'm almost there.
- The weight loss is fine and all but the best part of it all are the other things I've changed. I hardly drink alcohol at all anymore and I hardly miss it. I still have my after curling glass of red wine but I have not opened a bottle of wine in my own home in six weeks. The 8 bottles sitting the cupboard aren't even calling my name.
- I no longer buy chocolate bars to stash in the cupboard for after dinner treats. I find it easy now to turn down treats when they are brought into the office and my serving sizes have been cut in half. I rarely feel hungry but I also rarely feel full. I just feel good.
- I use almost 20 fewer units of insulin per day than I did a year ago. I've gone from the high 40s and low 50s to the low 30s.
- I chopped my hair a few months ago which resulted in some unexpected savings. I save several minutes in the shower every morning since I have much less hair to wash and rinse. On the other hand I spend much more time drying it now that I can't get away with letting it dry on its own. I am saving a lot of shampoo since I have much less hair to lather. On the other hand I am spending more on haircuts since I now go every 6 weeks rather than every 8-9. I'm guessing if I crunch the numbers it was cheaper and easier to have longer hair but I like it short so short it will stay. For now at least.
Wednesday, February 4, 2015
I Was Never Told
I remember when I was first diagnosed with diabetes and trying to come to terms with what it all meant. Trying to figure things out. Trying to sort through the information that I was given by supportive, well-meaning diabetes educators who, more often than not, did not have diabetes themselves.
I learned a bit from the people who were there to teach me. But I learned the most from just living the experience. I learned. I adopted that knowledge into my new reality and then forgot that I didn't always know it.
Like learning what a low feels like.
I was told that low blood sugars feel like this:
I was not told a bunch of other stuff and ended up having to figure it out on my own:
I was told how to count carbs and inject insulin and treat lows. I was not told that doing all of the stuff they told me to the absolute best of my ability would not produce results anywhere near what they actually wanted to see. That there is a difference between textbook diabetes and real life diabetes.
I was not told that there were other people like me out there. And that it might be a good idea to find some. Because they will understand all of the above.
I learned all of this on my own. In hindsight, that is probably best. I do better when I learn from experience. And I've certainly done better with every year that has gone by as I add more and more to my real-life experience purse.
But I do know that there are many people out there who may not figure this stuff out for themselves. Who may do everything they are told to do and then not understand that it is not their fault when the wheels still fall off the cart on a regular basis. Who may feel personally responsible for every low. For every high. For every up and down.
Those are the things that make me feel like we really need to take a good look at how support is provided to people.
Because while there are times when I think I am doing well because of the support I have received, more often I think I am doing well in spite of it.
I learned a bit from the people who were there to teach me. But I learned the most from just living the experience. I learned. I adopted that knowledge into my new reality and then forgot that I didn't always know it.
Like learning what a low feels like.
I was told that low blood sugars feel like this:
- I was not told that low blood sugars can happen when you're full from dinner. And you will have to gag down food when you really don't want to.
- I was not told that they often happen at the worst time. I was not told that I might have a dramatic low while in the shower and would have to get out with shampoo still in my hair, stumble to the bedroom for juice and then sit on the side of the bath dripping wet for ten minutes before I could stop shaking enough to rinse my hair. I was not told that lows can happen in the middle of presentations at work. While making love. In the middle of eating lunch (I'm already eating for heaven's sake! Piss off!)
- I was not told that those fast-acting carbs that you need during a low are rarely healthy and that, if you have too many lows you could actually put on weight because of all the empty calories you take in. I mean really, no weight maintenance program in the world says you should have 2-3 juice boxes per day.
- I was not told that all the doctors and nurses I met would put the fear of having complications first and foremost in my mind. And that this new-found fear would make it seem like a good idea to have lots of lows if it meant avoiding highs. And that lows are really not good either.
- I was not told that lows can happen no matter how hard you try not to have them - and that you are not a bad person or an incompetent diabetic if you have them.
I was told how to count carbs and inject insulin and treat lows. I was not told that doing all of the stuff they told me to the absolute best of my ability would not produce results anywhere near what they actually wanted to see. That there is a difference between textbook diabetes and real life diabetes.
I was not told that there were other people like me out there. And that it might be a good idea to find some. Because they will understand all of the above.
I learned all of this on my own. In hindsight, that is probably best. I do better when I learn from experience. And I've certainly done better with every year that has gone by as I add more and more to my real-life experience purse.
But I do know that there are many people out there who may not figure this stuff out for themselves. Who may do everything they are told to do and then not understand that it is not their fault when the wheels still fall off the cart on a regular basis. Who may feel personally responsible for every low. For every high. For every up and down.
Those are the things that make me feel like we really need to take a good look at how support is provided to people.
Because while there are times when I think I am doing well because of the support I have received, more often I think I am doing well in spite of it.
Monday, January 19, 2015
The Wrong Line of Work
I was having lunch the other day with a few ladies that I know through work.
One of them mentioned that she had type 2 diabetes and then I mentioned I had type 1 diabetes and we got down to chatting.
She said that she was really struggling with keeping her blood sugars in check, particularly in the mornings. She said that her doctor was not happy with her numbers and was saying that, if she didn't get a better handle on then, she would have to go on insulin.
"I really don't want to end up on insulin" she said to me, with a hint of fear in her eyes.
"Stop right there!" I said holding my hand up.
"Let me guess" I said. "I'm going to guess that, every time you go to your doctor, you are told about all the awful things that will happen to you if you don't get things under 'under control'."
"I'm also going to guess that you leave there terrified of all the predictions, the fear helps motivate you for a week or two but then you go back to the life you always live because it just feels so overwhelming."
"And I'm also going to guess that you think 'ending up' on insulin means that you failed. That you were not able to 'control' diabetes on your own and this is a sign to the world that you failed."
"Everything you said is true" she said, her eyes filled with tears.
"Listen" I said. "Taking insulin is not a sign of failure. If that is the best way for you to lower your blood sugar safely and effectively, then what's the problem with that? You would feel better and it's better for your overall health. I would much rather be on insulin and have good blood sugars than resist it and have higher numbers. Wouldn't you?"
"Yes!" she said brightening.
"And don't let your doctor use scare tactics to try to get you to do what they want you to do. They don't work, they end up making people feel worse and you'll go back there again in six months and hear the same speech all over again. You need to find people like you who get it, who can support you and who can inspire you to make positive changes in your life."
"You're right" she said. "I feel better just talking to you."
"And I also want you to remember that diabetes has a bad rap. People are judged immediately by the term and the stereotype is that you brought it on yourself by poor diet and lack of exercise. There are so many other factors involved that people just don't understand. You're pretty new at this too and you probably believe a lot of those stereotypes yourself and then feel bad because you think that you 'fit' that and you deserve what you get. That's not true. You have diabetes so figure out how best to deal with it, how best to take care of yourself but don't you dare feel guilty about it."
"Thank you" she said with a smile.
And the three of us carried on with our lunch in friendly conversation.
I told Doug about the conversation when I get home.
"You know baby" he said, "you are in the wrong line of work."
One of them mentioned that she had type 2 diabetes and then I mentioned I had type 1 diabetes and we got down to chatting.
She said that she was really struggling with keeping her blood sugars in check, particularly in the mornings. She said that her doctor was not happy with her numbers and was saying that, if she didn't get a better handle on then, she would have to go on insulin.
"I really don't want to end up on insulin" she said to me, with a hint of fear in her eyes.
"Stop right there!" I said holding my hand up.
"Let me guess" I said. "I'm going to guess that, every time you go to your doctor, you are told about all the awful things that will happen to you if you don't get things under 'under control'."
"I'm also going to guess that you leave there terrified of all the predictions, the fear helps motivate you for a week or two but then you go back to the life you always live because it just feels so overwhelming."
"And I'm also going to guess that you think 'ending up' on insulin means that you failed. That you were not able to 'control' diabetes on your own and this is a sign to the world that you failed."
"Everything you said is true" she said, her eyes filled with tears.
"Listen" I said. "Taking insulin is not a sign of failure. If that is the best way for you to lower your blood sugar safely and effectively, then what's the problem with that? You would feel better and it's better for your overall health. I would much rather be on insulin and have good blood sugars than resist it and have higher numbers. Wouldn't you?"
"Yes!" she said brightening.
"And don't let your doctor use scare tactics to try to get you to do what they want you to do. They don't work, they end up making people feel worse and you'll go back there again in six months and hear the same speech all over again. You need to find people like you who get it, who can support you and who can inspire you to make positive changes in your life."
"You're right" she said. "I feel better just talking to you."
"And I also want you to remember that diabetes has a bad rap. People are judged immediately by the term and the stereotype is that you brought it on yourself by poor diet and lack of exercise. There are so many other factors involved that people just don't understand. You're pretty new at this too and you probably believe a lot of those stereotypes yourself and then feel bad because you think that you 'fit' that and you deserve what you get. That's not true. You have diabetes so figure out how best to deal with it, how best to take care of yourself but don't you dare feel guilty about it."
"Thank you" she said with a smile.
And the three of us carried on with our lunch in friendly conversation.
I told Doug about the conversation when I get home.
"You know baby" he said, "you are in the wrong line of work."
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!
Friday, April 4, 2014
Insulin Works!
It's so very easy to forget how essential insulin is. How much of an impact it really does have. How we are one missed bolus away from big problems.
When things are going well and my blood sugar is doing what I expect it to do, taking insulin feels kinda like taking vitamins. You are pretty sure they're important but you don't really know if they are doing anything. You know you should take them so you do but you don't really feel any different for it.
Then there are those other days. The ones that teach you, without a doubt, that insulin ranks up there with oxygen and water in terms of importance.
Like yesterday. When I woke up to a lovely blood sugar of 6.4. When I had a date and then ran my fastest 8k in months. When I got home to a blood sugar of 8.0. When I bolused for breakfast, waited fifteen minutes and ate. When I showered, dressed and headed to work.
Here is what yesterday looked like.
When things are going well and my blood sugar is doing what I expect it to do, taking insulin feels kinda like taking vitamins. You are pretty sure they're important but you don't really know if they are doing anything. You know you should take them so you do but you don't really feel any different for it.
Then there are those other days. The ones that teach you, without a doubt, that insulin ranks up there with oxygen and water in terms of importance.
Like yesterday. When I woke up to a lovely blood sugar of 6.4. When I had a date and then ran my fastest 8k in months. When I got home to a blood sugar of 8.0. When I bolused for breakfast, waited fifteen minutes and ate. When I showered, dressed and headed to work.
Here is what yesterday looked like.
I'll let you guess what which point I realized the importance of insulin.
If you look at the graph you'll notice a little gap towards the left. That's when I left Dexter at home while I went running. I came home, bolused, ate and all hell broke loose.
After breakfast I climbed quickly and steadily upwards. In less than an hour I was 17. Usually after a run and my regular breakfast, I'm pretty steady. I knew something was up and guessed that my infusion site was not exactly infusing. So I bolused two units and held my fingers against the site as the insulin went in. I pulled them away and they were wet and smelled like insulin.
Yep, faulty site.
Most or all of my breakfast insulin never went in and, in my sweaty clothes, I didn't notice the extra moisture on my skin.
I headed home for a quick site change, bolused again and you can see for yourself how nicely I dropped down and how steady things were after that.
Insulin.
Looks like I do need it after all.
Thursday, March 6, 2014
What are YOU Afraid of?
I'm not afraid of flying.
I'm not afraid of spiders - unless getting the heebie-jeebies counts as being afraid.
I'm not afraid to go running alone in the morning before the sun rises.
I'm not afraid of standing up to make a speech and realizing that I forgot to put my pants on.
I am afraid every time I set foot in an elevator. Just for a second as the doors close. I always wonder if I have enough food, water and insulin with me to keep myself alive if I get stuck in there for a few days.
I am afraid to bolus before driving, no matter how much it makes sense to do so. For example: on mornings when I'm high after a swim. Ideally I should take my breakfast bolus and give it a 15 minute head start. That means bolusing, getting in the car, driving the ten minutes home, and then eating breakfast. But I never ever do that. Why? Because I'm afraid. What if that's the morning I get into an accident? What if I'm knocked out, my sugar drops and no one around knows what's happening?
I am afraid of ending up in the hospital for one reason or another and having my pump removed because the medical team feels that using a sliding scale makes things easier to manage.
I am afraid, down the road, of no longer being able to manage my own care and having to rely on others to recognize that I'm high or low and deal with it properly.
I am not afraid of public speaking.
I am not afraid of traveling halfway around the planet by myself.
I am not afraid to be home alone at night.
I am afraid of being kidnapped and having no hope of survival because I only have a day of insulin left in my pump.
I am afraid of being caught in a natural disaster and not being able to get insulin.
I am not afraid of the things that many people are afraid of.
Why?
Because I face the scary realities of diabetes every single day. And that has made me much braver than I have any business being.
So I trade one set of fears for another. All of my fears now involve highs and lows and the inability to fix them.
Pretty messed up isn't it?
I'm not afraid of spiders - unless getting the heebie-jeebies counts as being afraid.
I'm not afraid to go running alone in the morning before the sun rises.
I'm not afraid of standing up to make a speech and realizing that I forgot to put my pants on.
I am afraid every time I set foot in an elevator. Just for a second as the doors close. I always wonder if I have enough food, water and insulin with me to keep myself alive if I get stuck in there for a few days.
I am afraid to bolus before driving, no matter how much it makes sense to do so. For example: on mornings when I'm high after a swim. Ideally I should take my breakfast bolus and give it a 15 minute head start. That means bolusing, getting in the car, driving the ten minutes home, and then eating breakfast. But I never ever do that. Why? Because I'm afraid. What if that's the morning I get into an accident? What if I'm knocked out, my sugar drops and no one around knows what's happening?
I am afraid of ending up in the hospital for one reason or another and having my pump removed because the medical team feels that using a sliding scale makes things easier to manage.
I am afraid, down the road, of no longer being able to manage my own care and having to rely on others to recognize that I'm high or low and deal with it properly.
I am not afraid of public speaking.
I am not afraid of traveling halfway around the planet by myself.
I am not afraid to be home alone at night.
I am afraid of being kidnapped and having no hope of survival because I only have a day of insulin left in my pump.
I am afraid of being caught in a natural disaster and not being able to get insulin.
I am not afraid of the things that many people are afraid of.
Why?
Because I face the scary realities of diabetes every single day. And that has made me much braver than I have any business being.
So I trade one set of fears for another. All of my fears now involve highs and lows and the inability to fix them.
Pretty messed up isn't it?
Wednesday, January 29, 2014
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?
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?
Thursday, January 16, 2014
Don't Shoot the Messenger
I love Dexter. He takes great care of me and warns me of any variety of impending doom. He's my sidekick in more ways that I can count on one hand.
On the other hand however, he's good at what he does and he's not good at what he doesn't do. If that makes any sense at all.
Dexter warns me when bad weather is approaching but he has no skills whatsoever to guide me safely to shore. Or, for that matter, to even tell me what the cause of the bad weather might be, what direction it's coming from or where it's headed.
He just knows that it's not good.
The other day, I woke up with a blood sugar higher than normal (10.0) but not horrible. That's fine, I figured, I'm going for a run anyway and that will bring it back down. I ran 8k and came home to a blood sugar of 6.0.
Perfect.
I bolused, as I usually do, and had the breakfast that I usually have.
I showered and went to work. I kept checking Dexter and kept expecting to see a relatively flat line but, every time I checked, he had climbed another few notches. By 8:45am, I was 16 and climbing. Very odd.
I bolused and headed into a two-hour meeting.
During the meeting I kept checking like a hawk. I was high and still getting higher. I kept bolusing small doses (1-2) units every fifteen minutes, and finally got down to 12.0. By that point I was starving so I bolused twice the usual amount and then ate a Larabar.
I spiked to 20 within 30 minutes. I kept bolusing during the meeting and, by the time I was back in my office, I was down to 17.
I had 45 minutes until I had to head into yet another meeting. I did some math and decided to take a huge bolus (10 units) for lunch hoping it would knock me back into range. I entered that into my pump, hit go and listened to the sound of the insulin being delivered. As I listened, I began to smell the unmistakable smell of insulin.
Dammit!!
There was something wrong with my infusion site. Insulin wasn't getting in as it should. In fact, it was leaking all over my shirt! When I had been bolusing 1 unit at a time, it wasn't enough to notice, but a huge amount like 10 units was obvious. We had a faulty site and I was smelling rather gross.
Thankfully, I live two minutes from the office so I drove home, changed my site, replaced my insulin and headed back to work. I bolused a careful 4 units, not knowing how much from my original dose actually made it into my system, gulped down my lunch and headed to my next meeting.
Of course, I spiked again after having eaten but then began a slow but steady free fall over the course of three hours. No scary drops but a steady decline that had me going low just as I arrived home after work.
Dexter, who could do nothing about it, just beeped, buzzed and downright carried on for most of the afternoon.
Here's what the three hours after lunch looked like:
Thanks Dex, for letting me know what was going on. Too bad there wasn't a damn thing you could do about it.
On the other hand however, he's good at what he does and he's not good at what he doesn't do. If that makes any sense at all.
Dexter warns me when bad weather is approaching but he has no skills whatsoever to guide me safely to shore. Or, for that matter, to even tell me what the cause of the bad weather might be, what direction it's coming from or where it's headed.
He just knows that it's not good.
The other day, I woke up with a blood sugar higher than normal (10.0) but not horrible. That's fine, I figured, I'm going for a run anyway and that will bring it back down. I ran 8k and came home to a blood sugar of 6.0.
Perfect.
I bolused, as I usually do, and had the breakfast that I usually have.
I showered and went to work. I kept checking Dexter and kept expecting to see a relatively flat line but, every time I checked, he had climbed another few notches. By 8:45am, I was 16 and climbing. Very odd.
I bolused and headed into a two-hour meeting.
During the meeting I kept checking like a hawk. I was high and still getting higher. I kept bolusing small doses (1-2) units every fifteen minutes, and finally got down to 12.0. By that point I was starving so I bolused twice the usual amount and then ate a Larabar.
I spiked to 20 within 30 minutes. I kept bolusing during the meeting and, by the time I was back in my office, I was down to 17.
I had 45 minutes until I had to head into yet another meeting. I did some math and decided to take a huge bolus (10 units) for lunch hoping it would knock me back into range. I entered that into my pump, hit go and listened to the sound of the insulin being delivered. As I listened, I began to smell the unmistakable smell of insulin.
Dammit!!
There was something wrong with my infusion site. Insulin wasn't getting in as it should. In fact, it was leaking all over my shirt! When I had been bolusing 1 unit at a time, it wasn't enough to notice, but a huge amount like 10 units was obvious. We had a faulty site and I was smelling rather gross.
Thankfully, I live two minutes from the office so I drove home, changed my site, replaced my insulin and headed back to work. I bolused a careful 4 units, not knowing how much from my original dose actually made it into my system, gulped down my lunch and headed to my next meeting.
Of course, I spiked again after having eaten but then began a slow but steady free fall over the course of three hours. No scary drops but a steady decline that had me going low just as I arrived home after work.
Dexter, who could do nothing about it, just beeped, buzzed and downright carried on for most of the afternoon.
Here's what the three hours after lunch looked like:
I almost went from one corner to the opposite corner. Pretty crazy.
Even crazier, here is what the day looked like. I started off a little high, ran (notice the missing dots when I left Dex at home), had breakfast and then all hell broke loose.
Worse thing of all was that this happened on the first day of my period. The day when I'm notoriously low all day. I arrived to a day of meetings armed with dates, Larabars and other snacks to keep me going. I left smelling of insulin, bleary-eyed and headachy from hours of high blood sugars.
Friday, January 10, 2014
Life's Lessons
Lessons learned this week:
Lesson One
- do not, I repeat, do not almost but not quite yank your infusion site out right before a four-hour meeting, leaving it barely holding on
- should you do that despite my warning, do not, and I mean it this time, go to your office and tape it back on with masking tape
- if you've ignored me to this point, do not, when you get home, decide to remove the masking tape and replace it with something a little more 'comfortable' to secure the site for a few more days until you run out of insulin and actually need to change it.
- masking tape, as it turns out, seals itself very effectively to your skin and it's a challenge not to remove said skin as you peel it off hours later. On the other hand, I do have a few strips on my stomach that are completely devoid of any form of body hair.
- masking tape, as it turns out, also bonds very nicely with your infusion site, and the only way you're going to get it off is to completely destroy the site, yank the cannula out of your body and rip that too
- masking tape saved me during the meeting and avoided an emergency trip home but I had to change the site two days before I should have because of the destruction it caused
Lesson Two
- insulin does freeze when you run outside
- I had heard stories but never, despite some pretty chilly runs, experienced it
- Thursday morning, after a rather bone-chilling 8k run, I bolused for breakfast and alarms started ringing.
- I waited a few minutes, primed my pump to make sure things were moving, and tried again. No problem. And my numbers were within range all day so the flash freeze didn't seem to harm the potency
Lesson Three
- despite the cold - running is almost always better than not running
- despite the early morning wakeup call - swimming is almost always better than not swimming
- despite the dreary basement, spiders and lack of fresh air and sunshine - cycling is almost always better than not cycling
- people complain about the dark, cold winter. Heck I do too. I've learned over the years that running, swimming and cycling every day makes the days feel a little less cold, dark and dreary. Ive also learned that the early morning winter runners are the ones who smell the first hints of spring in the air. And the early morning swimmers are the ones who first notice the sun coming up a little bit earlier every day.
- as for early morning cycling on the trainer - all I can say is I do it because it keeps me fit and ready for the day when it's finally warm enough to take the bike outside and hit the streets again. Soon enough my friends. Soon enough.
Lesson One
- do not, I repeat, do not almost but not quite yank your infusion site out right before a four-hour meeting, leaving it barely holding on
- should you do that despite my warning, do not, and I mean it this time, go to your office and tape it back on with masking tape
- if you've ignored me to this point, do not, when you get home, decide to remove the masking tape and replace it with something a little more 'comfortable' to secure the site for a few more days until you run out of insulin and actually need to change it.
- masking tape, as it turns out, seals itself very effectively to your skin and it's a challenge not to remove said skin as you peel it off hours later. On the other hand, I do have a few strips on my stomach that are completely devoid of any form of body hair.
- masking tape, as it turns out, also bonds very nicely with your infusion site, and the only way you're going to get it off is to completely destroy the site, yank the cannula out of your body and rip that too
- masking tape saved me during the meeting and avoided an emergency trip home but I had to change the site two days before I should have because of the destruction it caused
Lesson Two
- insulin does freeze when you run outside
- I had heard stories but never, despite some pretty chilly runs, experienced it
- Thursday morning, after a rather bone-chilling 8k run, I bolused for breakfast and alarms started ringing.
- I waited a few minutes, primed my pump to make sure things were moving, and tried again. No problem. And my numbers were within range all day so the flash freeze didn't seem to harm the potency
Lesson Three
- despite the cold - running is almost always better than not running
- despite the early morning wakeup call - swimming is almost always better than not swimming
- despite the dreary basement, spiders and lack of fresh air and sunshine - cycling is almost always better than not cycling
- people complain about the dark, cold winter. Heck I do too. I've learned over the years that running, swimming and cycling every day makes the days feel a little less cold, dark and dreary. Ive also learned that the early morning winter runners are the ones who smell the first hints of spring in the air. And the early morning swimmers are the ones who first notice the sun coming up a little bit earlier every day.
- as for early morning cycling on the trainer - all I can say is I do it because it keeps me fit and ready for the day when it's finally warm enough to take the bike outside and hit the streets again. Soon enough my friends. Soon enough.
Wednesday, October 16, 2013
Breaking the Chains
Last Friday morning, I went to the pool and did something I have never done before.
I told my coach that my blood sugar may be problematic and said that I may have to stop or leave if things get bad.
I had gone to bed the night before with a blood sugar of 10.2 and some insulin on board. I read for a bit and then checked again before going to sleep to make sure I hadn't dropped too low.
I was 16.2.
I bolused for the high plus another unit for the bizarre climb.
I went to sleep and woke up at 2am. I checked and I was 13.4.
I took twice the recommended bolus and drank a lot of water.
I woke up at 4:50am for the pool and I was 14.4. Dehydrated, exhausted and feeling like there was oatmeal running through my veins.
I weighed my options. Insulin wasn't doing much. Perhaps a swim workout would help.
I took an extremely conservative bolus of 0.4 units to help the exercise do its job and I headed for the pool. I warned my coach that I was high. Which meant that no amount of 'pushing through' would help me go fast if I was swimming slowly. I said that the swim might cause my blood sugar to go down or it might actually cause it to climb higher and I might end up with ketones. If I had to stop or leave, I would. She agreed.
We warmed up and then swam 10x200m. I had no hope of keeping up with the two speedies I normally chase around the pool. One girl, however, was recovering from a cold so she and I were slowpokes together. I slogged my way through and my times were 10-15 seconds slower than normal despite feeling like I was working just as hard.
We relaxed for a few minutes after we finished the 200m set and then headed into 20x25m. The 25m were in sets of five. Cruise, build, fast, fast, easy. Repeat four times.
I cruised. I built. I sprinted and found myself keeping up with the speedies. Keeping up and challenging them. With every stroke I felt better, stronger, faster.
On one end of the pool I felt tired and sluggish. By the other end, I was bouncing and grinning. I was suddenly full of energy and raring to go.
What happened?
I had lowered my blood sugar enough that I passed through that invisible layer that separates feeling crappy from feeling good.
I roared through the rest of the 25s and felt better and bettter. By the time I climbed out, my blood sugar had dropped from 14.4 to 9.2 and I was almost back to normal.
It's not often that the difference between high and happy is quite that noticeable. It felt like I had been tied up in chains and finally broken free. Pretty amazing stuff exercise.
I told my coach that my blood sugar may be problematic and said that I may have to stop or leave if things get bad.
I had gone to bed the night before with a blood sugar of 10.2 and some insulin on board. I read for a bit and then checked again before going to sleep to make sure I hadn't dropped too low.
I was 16.2.
I bolused for the high plus another unit for the bizarre climb.
I went to sleep and woke up at 2am. I checked and I was 13.4.
I took twice the recommended bolus and drank a lot of water.
I woke up at 4:50am for the pool and I was 14.4. Dehydrated, exhausted and feeling like there was oatmeal running through my veins.
I weighed my options. Insulin wasn't doing much. Perhaps a swim workout would help.
I took an extremely conservative bolus of 0.4 units to help the exercise do its job and I headed for the pool. I warned my coach that I was high. Which meant that no amount of 'pushing through' would help me go fast if I was swimming slowly. I said that the swim might cause my blood sugar to go down or it might actually cause it to climb higher and I might end up with ketones. If I had to stop or leave, I would. She agreed.
We warmed up and then swam 10x200m. I had no hope of keeping up with the two speedies I normally chase around the pool. One girl, however, was recovering from a cold so she and I were slowpokes together. I slogged my way through and my times were 10-15 seconds slower than normal despite feeling like I was working just as hard.
We relaxed for a few minutes after we finished the 200m set and then headed into 20x25m. The 25m were in sets of five. Cruise, build, fast, fast, easy. Repeat four times.
I cruised. I built. I sprinted and found myself keeping up with the speedies. Keeping up and challenging them. With every stroke I felt better, stronger, faster.
On one end of the pool I felt tired and sluggish. By the other end, I was bouncing and grinning. I was suddenly full of energy and raring to go.
What happened?
I had lowered my blood sugar enough that I passed through that invisible layer that separates feeling crappy from feeling good.
I roared through the rest of the 25s and felt better and bettter. By the time I climbed out, my blood sugar had dropped from 14.4 to 9.2 and I was almost back to normal.
It's not often that the difference between high and happy is quite that noticeable. It felt like I had been tied up in chains and finally broken free. Pretty amazing stuff exercise.
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, July 18, 2013
Heat + Insulin = ??
I mentioned in my Gravenhurst race recap post on Monday that my blood sugars in the wee hours before the race were pretty horrific - hovering above 13 for hours and hours.
I changed my pump and popped in some fresh insulin and everything seemed to return to normal.
On Tuesday, we drove home from Gravenhurst after breakfast. I was feeling pretty rotten in the car so I checked my blood sugar. It was 20.4. Bah! I bolused and rechecked an hour later. 17.5. I repeated this cycle for a few hours and drank three huge bottles of water. I got it down to 10, took a double bolus for a protein bar because I was starving, ate it, and spiked again.
We got home, unpacked, did groceries and laundry and I fought to bring my blood sugar back under control again.
Then it dawned on me. We had spent most of Monday outside. In the shade and on a boat with the wind whipping by but still outside. It was 35 degrees.
Did I cook my insulin?
Sick on feeling high, I changed my site and my insulin for the second time in three days. We had dinner and I settled nicely down to a more normal number.
There are lots of other logical reasons for my pre-race high (jitters being a big one). There are also other possible explanations for my Tuesday high. I hadn't exercised in three days. I was probably a little dehydrated after the day before.
Or both days of highs could have been caused from the heat wave we were in the middle of. Did I cook my insulin twice in four days simply by being outside?
The thing is that my insulin rarely, ever, does that. Even when I've done 2-3 training runs in the heat of summer, the insulin remained effective.
What's the difference this time?
I haven't changed the type of insulin I use but I have changed my pump.
Could different pumps be insulated differently? Do different pumps react differently to heat? It is the reservoir? Do they react differently in the heat?
I don't know but I will definitely be more vigilant as this heat wave continues. It's turned into a pretty expensive diabetes supply week.
I changed my pump and popped in some fresh insulin and everything seemed to return to normal.
On Tuesday, we drove home from Gravenhurst after breakfast. I was feeling pretty rotten in the car so I checked my blood sugar. It was 20.4. Bah! I bolused and rechecked an hour later. 17.5. I repeated this cycle for a few hours and drank three huge bottles of water. I got it down to 10, took a double bolus for a protein bar because I was starving, ate it, and spiked again.
We got home, unpacked, did groceries and laundry and I fought to bring my blood sugar back under control again.
Then it dawned on me. We had spent most of Monday outside. In the shade and on a boat with the wind whipping by but still outside. It was 35 degrees.
Did I cook my insulin?
Sick on feeling high, I changed my site and my insulin for the second time in three days. We had dinner and I settled nicely down to a more normal number.
There are lots of other logical reasons for my pre-race high (jitters being a big one). There are also other possible explanations for my Tuesday high. I hadn't exercised in three days. I was probably a little dehydrated after the day before.
Or both days of highs could have been caused from the heat wave we were in the middle of. Did I cook my insulin twice in four days simply by being outside?
The thing is that my insulin rarely, ever, does that. Even when I've done 2-3 training runs in the heat of summer, the insulin remained effective.
What's the difference this time?
I haven't changed the type of insulin I use but I have changed my pump.
Could different pumps be insulated differently? Do different pumps react differently to heat? It is the reservoir? Do they react differently in the heat?
I don't know but I will definitely be more vigilant as this heat wave continues. It's turned into a pretty expensive diabetes supply week.
Wednesday, June 26, 2013
The Cost of Living
My quarterly cheque arrived on Monday for insulin pump supplies. Happily, the infusion sets that Animas gave me to try lasted just long enough for me to wait for the cheque before placing my first big order. The charge goes on my credit card and, thanks to my quarterly cheque, immediately goes off my credit card. Which is exactly the way I like it.
I studied the Animas order form. I needed three things:
1. a battery cover (I'm supposed to change it every three months since I swim so much. My plan is to order one every time I order supplies which should work out to every three months).
2. cartridges (those little plastic vial thingies that hold the insulin)
3. infusion sets (the tubing and the part that gets inserted into me so that the insulin can enter my body. I didn't word that very well but you know what I mean right?)
On my new pump I'm changing my infusion set every 4 to 5 days. A box of 10 infusion sets costs $195.00.
If I change every 5 days,one box will last 50 days and two boxes will last 100 days or just over three months (when I get my next cheque).
If I change every 4 days, one box will last 40 days and two boxes will last 80 days. Not three months.
Two boxes of cartridges, two boxes of infusion sets and one battery cover = $540.92
Two boxes of cartridges, three boxes of infusion sets and one battery cover = $735.92
My quarterly cheque is $600.00
So I decided to order two boxes and see how far I can stretch them. If I run out, I'll place my next order early. If not, then perfect. And heck, the thought of running out early is enough to make me second guess a chocolate bar or extra helping of pasta which probably doesn't hurt either.
So in two minutes I just spent $540.92 for three months of pump supplies. And that doesn't even include insulin or test strips.
Or the calcium I take now. Nor the vitamin D I take with it. Or the cholesterol meds I'm on.
Diabetes is a lot of things.
Some good, some bad.
Always expensive.
(psst! Jeff. Hey, Scott! - I decided to order the infusion sets with the harpoon launcher. You've convinced me to give them another go.)
(psst! Jeff. Hey, Scott! - I decided to order the infusion sets with the harpoon launcher. You've convinced me to give them another go.)
Thursday, June 20, 2013
Sprint Triathlon Basal Profile - Draft
Alright folks, I've worked out a rough draft for my race day basal profile. I have never tackled a race day like this before and I'm excited to see how it works out.
First, the logic behind the numbers.
1. I want to eat breakfast 3 hours before the race so that most of the bolus insulin is out of my system by race time.
2. I want to be able to have a GU gel (20 carbs) without bolusing before the swim and again before the run.
3. I want to avoid lows at all cost but I also want to avoid the highs I was plagued with during each triathlon last summer.
I am planning to create a race day basal profile that I will start on race day and my basal rates will change at preset times so I don't have to remember to do it myself in the heat of the moment.
Here is the race day timeline based on estimated finish times of the swim, bike and run:
5:30am breakfast
8:30am swim start (have a GU right before the swim)
9:00am bike start
10:15am run start (have second GU in transition zone before the run)
11:00am race finished
Here's the proposed basal profile and rationale
7:00am 60% basal rate - to prevent lows during the swim and the bike
8:30am - have a GU gel immediately before the start of the swim
8:45am 120% basal rate (to counteract the GU and the high that I would most likely have after the short swim)
9:00am 60% basal rate (to prepare for the run)
10:15am second GU gel
10:45am 120% basal rate - to prevent the post-race spike in blood sugar and to help deal with the GU
11:30am 50% basal rate - to prevent the lows I have in the hours after the race
2:30pm 100% basal rate - return to my regular basal profile
I may tweak this a bit more before race day. I want to factor in the delicious chocolate milk that they serve at the finish line but I'm not sure if I should adjust my basal rate in anticipation or just bolus for it.
I have no idea if this plan will make for a perfect BG race or make for three hours of this guy:
First, the logic behind the numbers.
1. I want to eat breakfast 3 hours before the race so that most of the bolus insulin is out of my system by race time.
2. I want to be able to have a GU gel (20 carbs) without bolusing before the swim and again before the run.
3. I want to avoid lows at all cost but I also want to avoid the highs I was plagued with during each triathlon last summer.
I am planning to create a race day basal profile that I will start on race day and my basal rates will change at preset times so I don't have to remember to do it myself in the heat of the moment.
Here is the race day timeline based on estimated finish times of the swim, bike and run:
5:30am breakfast
8:30am swim start (have a GU right before the swim)
9:00am bike start
10:15am run start (have second GU in transition zone before the run)
11:00am race finished
Here's the proposed basal profile and rationale
7:00am 60% basal rate - to prevent lows during the swim and the bike
8:30am - have a GU gel immediately before the start of the swim
8:45am 120% basal rate (to counteract the GU and the high that I would most likely have after the short swim)
9:00am 60% basal rate (to prepare for the run)
10:15am second GU gel
10:45am 120% basal rate - to prevent the post-race spike in blood sugar and to help deal with the GU
11:30am 50% basal rate - to prevent the lows I have in the hours after the race
2:30pm 100% basal rate - return to my regular basal profile
I may tweak this a bit more before race day. I want to factor in the delicious chocolate milk that they serve at the finish line but I'm not sure if I should adjust my basal rate in anticipation or just bolus for it.
I have no idea if this plan will make for a perfect BG race or make for three hours of this guy:
Meet the crazy diabetes rabbit
The only way to know is to try it. I promise that I'll check my blood sugar before, during and after. I promise that I'll carry plenty of emergency carbs with me and I won't have the GUs if I'm high.
And I promise to keep you all posted on how it went so we can all continue to learn from each other.
Warning: your diabetes may vary and I am not a doctor. Play with your basal profiles at your own risk.
Wednesday, June 5, 2013
One Month of Lucky
Well, I've had Lucky now since May 6th.
I've gotten used to his little quirks. Like the fact that he is sometimes noisier than my Medtronic pump was and sometimes quieter. I can actually hear him deliver little basal drips of insulin when I'm sitting at my desk. It's kinda cool because it is comforting to hear him working away, keeping me alive.
Other times I expect the boop-beep-boop noises that my old pump makes and Lucky just sits silently waiting for me to tell him what to do. Like when I'm changing my site and I rewind the pump so it's ready to take a new cartridge of insulin. After all the whirring noises are finished, I expect to hear boop-beep-boop but I hear nothing.
Being someone who dislikes loud noises of any kind, I'm grateful for the little things like peace and quiet.
On the other hand, I had gotten used to Medtronic's double warning system when my pump was running out of insulin. It would boop-beep-boop when I was down to 20 units and again when I was down to 10.
Lucky plays Fur Elise (which I still haven't learned to recognize as a warning sound and usually glance around looking for the source of the music) when I'm down to 20 units. There is only a single warning. On Monday afternoon, I got the warning. I acknowledged it and went about my business. I had dinner. I had a bedtime snack. I took a little bolus during the night to correct my 8.7. On Tuesday morning I woke up, went for my 30 minute run/walk, made breakfast, showered and dressed. As I was hooking back up again I suddenly remembered that I was supposed to change my pump. I look and saw that I was down to 2 units. Oops. That was close.
I'm also adjusting to having 100 less units of insulin in my pump. Which means I can only go about 4 1/2 days now instead of 6 between site changes. It's actually less annoying than I thought it would be but I am still finding myself surprised when I get the 'it's time to change your pump soon' warning. Already?!?
Lucky's sidekick glucometer is pretty cool and I often remote bolus with it even when Lucky is sitting right out in the open on my belt. That being said, I switched back to my Verio metre to use up some of the test strips I had bought for it and am finding that I don't miss the remote bolus feature at all when it's not an option. So I guess I can take it or leave it.
The bestest difference, hands down, that Lucky has made is at the pool. I knew that would be the case but I'm still so thrilled every time I get ready for my swim and I clip my pump to my suit rather than unhook it. It makes everything so much easier and for that reason alone I am grateful I made the switch to Animas.
I've gotten used to his little quirks. Like the fact that he is sometimes noisier than my Medtronic pump was and sometimes quieter. I can actually hear him deliver little basal drips of insulin when I'm sitting at my desk. It's kinda cool because it is comforting to hear him working away, keeping me alive.
Other times I expect the boop-beep-boop noises that my old pump makes and Lucky just sits silently waiting for me to tell him what to do. Like when I'm changing my site and I rewind the pump so it's ready to take a new cartridge of insulin. After all the whirring noises are finished, I expect to hear boop-beep-boop but I hear nothing.
Being someone who dislikes loud noises of any kind, I'm grateful for the little things like peace and quiet.
On the other hand, I had gotten used to Medtronic's double warning system when my pump was running out of insulin. It would boop-beep-boop when I was down to 20 units and again when I was down to 10.
Lucky plays Fur Elise (which I still haven't learned to recognize as a warning sound and usually glance around looking for the source of the music) when I'm down to 20 units. There is only a single warning. On Monday afternoon, I got the warning. I acknowledged it and went about my business. I had dinner. I had a bedtime snack. I took a little bolus during the night to correct my 8.7. On Tuesday morning I woke up, went for my 30 minute run/walk, made breakfast, showered and dressed. As I was hooking back up again I suddenly remembered that I was supposed to change my pump. I look and saw that I was down to 2 units. Oops. That was close.
I'm also adjusting to having 100 less units of insulin in my pump. Which means I can only go about 4 1/2 days now instead of 6 between site changes. It's actually less annoying than I thought it would be but I am still finding myself surprised when I get the 'it's time to change your pump soon' warning. Already?!?
Lucky's sidekick glucometer is pretty cool and I often remote bolus with it even when Lucky is sitting right out in the open on my belt. That being said, I switched back to my Verio metre to use up some of the test strips I had bought for it and am finding that I don't miss the remote bolus feature at all when it's not an option. So I guess I can take it or leave it.
The bestest difference, hands down, that Lucky has made is at the pool. I knew that would be the case but I'm still so thrilled every time I get ready for my swim and I clip my pump to my suit rather than unhook it. It makes everything so much easier and for that reason alone I am grateful I made the switch to Animas.
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!!
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