Audrey Update Part II: Medical tech

I posted a short intro about starting an insulin pump/continuous glucose monitor (CGM) trial last month. On April 6 I went to meet the Medtronic rep and get hooked up to the pump. As I was leaving the appointment we learned Acer had cancer, so my focus had to be split for those following two weeks.

You may remember this photo.

It took me a while to warm up to the pump. That's not to say it was hard to use, it was actually pretty simple. It was harder to adapt to being attached to something all the time. Finding sites that didn't get in the way of waistbands or risk being unstuck by motion has taken some practice. I haven't really moved from my stomach much (I did try my right thigh for a while, but that proved a problem when I went to the bathroom).

All in all, the pump has been okay. I know those two or three weeks of having it actually made an impact on my A1C, which was a 6.9, the lowest it had been in my last five blood draws.

This is an A1C to blood sugar comparison chart from www.diabetesdaily.com, for reference sake. 

I've always struggled with being on the high side of my BG levels, so getting down to 6.9 after just three weeks was amazing (most of the more recent results were between around 7.3 and 7.8). 

Then I got hooked up to the CGM about two weeks ago.

First, the country song of my life continued on my way to that appointment. See, the previous week I realized I couldn't make it to the original CGM setup appointment due to work, so I went online to cancel. I'm on my way to what was going to be a combination appointment  to see my endocrinologist, then meet with the educator and Medtronic rep, which - keep in mind - is about an hour away from where I live and I've taken an extended lunch break, but haven't eaten, to make it that day. I'd spent most of the drive talking to my insurance about the wreck the last week and am driving a zippy rental car I'm still not entirely comfortable with. When I get a call from the clinic. "Did you cancel your appointment today?" the lady asks. 

"What? No, I cancelled the one last week and they rescheduled me for today after my appointment with the doctor."

"Well we have your Medtronic lady here, but the computer said you cancelled." She went on to read my notes, stating my availability Wednesday for a reschedule, the Wednesday I'd had off the previous week.

"No, oh my gosh, I must have cancelled the wrong one. But I'm almost there right now."

"It's okay, just come on in, we'll figure it out."

Immediately following I get a text from the Medtronic rep, who was apparently at the check in desk, as confused as the rest of us. 

So I arrive, learned I'd inadvertently cancelled my endo appointment, but could get in for the CGM setup in about 30 minutes. They would reschedule my doctor appointment for two weeks from then (today) and apologize for the confusion. 

The current setup, as I'm writing, for visual. The CGM (middle thingy all taped to skin) takes BG readings every five minutes and sends them to the pump (purple thing hooked to pocket). The pump can suspend delivery of insulin (through infusion at top) if BGs get too low for too long.

After all that mess, I had to get used to a little pod stuck to my body that beeped seemingly constantly all night and all the next morning telling me I was low or high. I hated the thing. All the attempts to remedy what was wrong just led to opposite problems later. I ignored the low alerts at night (shame shame, I know) because I knew I always wake up high. Sure enough, I woke up at 160-something without ever having remedied the lows at 3, 4 and 6 a.m. 

Then I went and had breakfast, some kind of bun and coffee, and dealt with it constantly ringing that I was over 250 all morning, even though I'd given the bolus and the pump kept saying there was still "active insulin" in my system. Of course I crashed before I hit my lunch break because I kept trying to fix the highs and it ended up overcorrecting. 

Just two days on the stupid CGM and my beautiful track record of glucose readings staying mostly in the low 100s was wrecked. 

In the time since, it has started to even out a bit. I still spike a little after breakfast, but I try to figure the bolus to better match what I'm eating to avoid the stupid beeping alerts. 

Now, I have about 30 minutes until it's time to leave for my rescheduled doctor appointment, and the CGM has told me it's time to let it recharge and put it somewhere else on my body. I've done this one other time and it took me about 20 minutes to figure out. I'm not sure if I can make it happen, but I guess I need to try. 

Overall review? Pump: would probably opt for later, when I have more funds available to make the payments, but shots were much easier to juggle with aikido.

CGM: only if I have to. I hate don't really like it. 

When you're torn between two big developments

Yesterday I went to training for my insulin pump trial. On my way home, I learned my dog has cancer on his liver and is looking at a maximum of two months left to live.

How else do you introduce two stories that inspire such opposing emotions?

On the one hand, I'm still not sure how to feel about the pump. It's a small weight attached to me at all times, and has already gotten on my nerves by preventing me from rolling after aikido.
On the other hand, I feel sad and distracted about Acer and trying to decide if and at what point to put him down. It's a constant psychological weight in the back of my mind.

I want to go into a discussion about both of these, but in focusing on one I feel like I'm not doing the emotions and gravity of the other situation justice. With the lack of photos to share, I'll just leave it with this:

• I have two weeks until I learn to use the CGM. In the meantime I'm going to try my darndest to really acclimate to this little purple pump. 
• I don't know how long I have with Acer, but we are planning to spoil him with car rides and treats this weekend, culminating in a small barbecue for him on Sunday, where he will get his own helping of steak and watermelon (I've never seen a dog like watermelon so much). 

Sorry for the lack of meat in this post. I wanted to say something about it while it was on my mind, but I'm having a hard time focusing.

In which I become a cyborg

I don't talk about diabetes very often here. Every now and then it comes up, but even in my every day life I don't bring it up a whole lot.

But tomorrow I start an experiment in my own care.

Tomorrow I go in for training on how to use a pump I've signed up to do a six-week trial of.

My doctor has wanted me to consider a pump almost as long as I've been seeing her (so two or three years now). A couple months ago I was poking around the Medtronic website and found a signup for the trial. Fast forward a month or so, montage a bunch of missed phone calls and voicemails and discussions, and here we are.

Oh goodness...

I finished the booklet reviewing the basics of pump therapy that came in the package I got Monday, and am taking a quick reflection break before I move on to the "Getting Started with the MiniMed 530G Insulin Pump" booklet.

It would be a lie to say I wasn't a little overwhelmed when I unpacked the boxes. I knew precious little about pumps, much less this one. From the discussions with the Medtronic rep, I knew it had been designed to be user-friendly to first-time pumpers and incorporates a continuous glucose monitor (CGM) in the setup.

It's PURPLE!

Past that, I didn't know how to load the insulin, how to correct for highs, what button does what, or anything. But going through the overview I learned some interesting things.

For instance, they have a Bolus Wizard in the pump that calculates a correction for high blood sugar or a given number of carbs consumed based on rates you put into the machine (which can be adjusted).

Equations. Long time no see.

The calculations aren't difficult to do, but having a machine do it for you saves the awkwardness of pulling a calculator out at each meal.

*silences judgmental Audrey*

So, as I head to the Getting Started booklet at almost 11 p.m. (hello Procrastination, my old friend), I decided to reflect on what may or may not be a positive change in a big part of my life I often pretend is not a big deal at all. I have a lot to learn to tomorrow, as well as questions about what to do with it during aikido, but I hope to update with the ins and outs I learn with my first experience on insulin pump therapy.

A few diabetic thoughts

Today is Friday, but it's the Sunday of my mid-week weekend. Tomorrow I'm back to work for Saturday and Sunday, so I'm trying to enjoy this day off with nothing to do. I did the grocery shopping and even made a big dinner yesterday, so there are leftovers in the fridge to get me through quite a few lunches and don't-feel-like-making-a-mess dinners.

I was making a cup of the new French Vanilla coffee I got yesterday and somehow started contemplating my current frustrations with my diabetes. Most of the people reading this blog are aware that I am Type 1 diabetic and I have been since I was 8 years old. Lately (meaning for the last couple of years, but this year in particular) I've been working to try and get back into checking my blood sugar regularly. I'm getting a lot better, especially using this phone app, Diabetes+, that lets me log everything from my glucose and insulin to activity and carb intake.

When I first started using it, I did log EVERYTHING.

It's becoming more of a habit for me, which is good, even though it's still only sporadic that I actually get to test four times a day like I should -- generally I only make it to two or three times.

But the more awareness I have of what my blood sugar is actually doing, the more frustrated I get about it, particularly the morning highs that have apparently been getting me for a lot longer than I've been aware.

Morning is usually the time I don't forget to test. It runs high at that time, so there are a lot of purple/high readings. It almost makes me start to hate purple. Almost.

For example, last night I went to bed with my glucose at 117, which is right in line with the 80-120 goal. All I did was take my Lantus (the long-acting insulin) and go to sleep. When I woke up today, my blood sugar was 177. Up sixty points after just sleeping?

It's not an isolated thing. The night before my glucose rose 38 points, and the night before it shot up by 80.

It's why most of the line graphs the app generates look like the world's worst roller coaster.

I am aware of the "dawn phenomena," where the liver will dump glucose into the blood during the night. Theories on why vary, but the one I remember is the body thinking that the blood sugar is dropping, so the liver dumps its store into the blood to bring it up. Regardless of why, it's a bitch to control.

Aside of rises in blood glucose beyond my own control, I'm also learning that I probably have less of an idea of how many carbs are in what I eat than I thought I did. This has led me to just take insulin for what I think is in something, plus a couple extra units depending on what that food did to me in the past. Some horrible offenders are pizza and coffee. The fat in pizza causes a delay in the processing of the carbs in it, resulting in a delayed spike in blood sugar. I don't know what it is about coffee, but even when I drink it with just half and half and Splenda, I have to correct for 25-30 carbs worth, even though I probably only ingested less than 10. Members of some of the diabetic Facebook groups I'm in have reported similar spikes, even when drinking coffee black, so my theory is that it's something to do with the caffeine content.

Yet I just keep coming back...

In general though, getting back to monitoring myself has been frustrating but will be worth it. I feel more in control when I KNOW what my glucose is doing, not when I just make a vague guess. It's costing some time and definitely some money to keep all the supplies in stock, but all necessary evil.

I have to commend my doctor, also. She gave me the kick in the rear that got me to actually try taking care of myself again. She hasn't ever really lectured or belittled me, either, but she works with me to try and figure out carb ratios and correction scales that will actually help keep things in check. Honestly, I'd forgotten about her suggestion to use a 1:8 ratio in the mornings and 1:10 the rest of the day until maybe a couple of weeks ago, and it really brought my lunchtime readings back down.

Yes, the number of readings per day is still under-par, but there's much fewer purple/high readings in the last couple of days, which makes me happy.

In case anyone thought diabetes was an easy thing to deal with, hopefully this will make you ask some questions and be interested to learn more about what's involved with controlling this disease. I'm free to take a crack at any questions you may have. :-)