Mostly Wordless Monday

I’m tired of high blood sugars. I need to get this *insert curse word here* figured out.

Dexcom goes live tomorrow.

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What I’ve Decided about Dexcom

(First of all, shout out to the Dexcom employee who is currently reading this. HI!).

So I’ve been using my continuous glucose monitor for about a year now. In fact, just four days short of a year. Well, that’s kind of a lie. Because, see, I have not actually used the thing for the last couple months. I actually had a few reasons for this, as follows:

1. When I first got to Utah, I was spending a lot of time on a hiking trail giving tours. It was hot. I was sweaty. Sweaty Sarah significantly shortens sensor life. (Say that five times fast).

2. I had a bad batch of sensors right when I came out here. One didn’t work from the start and one ???’d on day 3. Dexcom shipped me a replacement for the former, but, even though I gave the guy my new address, they shipped it to my parent’s house.

3. Something was up with my payment. The credit card I usually use wasn’t working. My parents are trying to get out of debt, so this didn’t surprise me. And because of how expensive the darn things are, even with insurance, I felt bad about asking my parents for money for them when I owe them money. Besides, my dad’s opinion of continuous glucose monitoring is “it’s just another piece of technology that is going to fail.” Well, not quite, he kind of understands, but that was a line he fed me during a heated debate with my two younger brothers present, and now they quote it every time I am having issues with my pump or cgm.

4. I am beginning to detest the scarring that happens when I wear the sensors. After seven days, not only is the insertion site scarred but all the tissue around it is red and puffy and leaves scars. I have enough issues with scar tissue as it is, and after ten months of straight sensor usage I was pretty fed up with the way my stomach was looking. Not only that, but my abdomen is still the best place for infusion sites. Lower back, rear, thighs, and arms work sometimes but usually cause absorption problems. Arms are the best alternate site, but sometimes I do have problems with them. The sensors work OK on my arms but I usually wind up bumping them. Any other site for sensors doesn’t work very well. The sensors are too big and just don’t sit right on my skin. So upper abdomen real estate is highly coveted. Finally I just gave up.

But now I’ve been having this little issue. It doesn’t matter what my sugar is when I go to bed. It could be 300, 150, or 80. When I wake up, I’m somewhere between 200 and 300. It’s been constant for weeks no matter what I do. Which brings me to my first conclusion: I’m dealing with Dawn Phenomenon here, something I thought I had taken care of (cue background music and accent a la The Godfather). Sometime between 1am and 7am, my blood sugar is making a huge jump. Maybe it’s antsy. Maybe it is getting pushed by it’s little brother. Maybe it wants me to wake up and play (Hi Mommy!). But I need to figure it out, Stat, because already I am not a morning person and waking up with a 250 blood sugar only does bad things to my mood. I call it “Morning Grrrr Syndrome.”

I have a beef with overnight basal testing for lots of reasons. One, Sleepy Sarah (more alliteration, did you  like that?) can’t seem to actually wake up and test, she just turns off the alarm and goes back to sleep. Two, I don’t think waking yourself up every hour or two gives an accurate picture of the way your blood sugar functions when you get a solid 8 hours of sleep and actually experience sleep cycles. But I’m not a scientist or a doctor, so that’s just my opinion. I just don’t like it.

This brings me to my second conclusion: Needz Dexcomz Again (in LolSpeak). I at least need to wear the thing for a few days to figure out what’s going on in the mornings. My blood sugar was always much better when I wore it, which means I probably need to wear it all the time. I should probably place my November order. And also my December order. I mean, I only have two months left before I have to re-deductible it up. Which means 3 months of paying full price for the darned things.

I guess I can’t wait until CGMS technology becomes cheaper and less invasive. It will make every single diabetic’s life a whole lot easier. CGM already does, but it would be nice if the small bugs could be worked out.

The Up Arrow is the Unholiest of Arrows.

Please excuse my diabetes related rant.

I had cereal all figured out. Really, I did. Kashi Go Lean Honey Almond Flax has enough protein in it to prevent blood sugar spikes, and when paired with low-carb soy or almond milk I was rarely, if ever, spiking after eating it. But yesterday after my morning bowl of cereal with 1/2 cup of organic, unsweetened soy milk I became infuriated by the almost unholiest of arrows: the straight up arrow, second only to the double straight up arrow:

I have never been so infuriated. Okay this totally isn’t true. I have been this infuriated, and I wasn’t that infuriated. Annoyed is more like it. I was annoyed that my blood sugar wasn’t cooperating with such a routine meal. I was annoyed that I had to visit the darn Vampires yesterday morning. When I left the doctor’s office, I was annoyed at the pain in my arm from the needle and the giant rubber bandy thinger that the phlebotomist put on too tight this time. (I mean, I know it needs to be tight, but should I be wanting to cry from pain because of how tight it is? I never have before.) I was annoyed that I have this stupid disease where I mark my life by doctor’s visits every three months like clockwork and that unless a cure is discovered, I will never be able to stop, not if I want any reasonable control over this monster and not if I don’t want to lose any limbs or any sight or any kidney function.

I know why my blood sugar rose so drastically yesterday morning. It’s because I didn’t take my symlin shot. Why didn’t I take it, you ask? Because I was out, and because at my last appointment my doctor only gave me one three month script and it was only enough for 30 mcg/ meal, and since I self adjusted to 45 mcg/meal I ran out about a week before the appointment and rather than calling her and asking for more, thought I would just wait. I guess that was dumb because now I can’t eat high carb things like cereal without expecting the unholiest of arrows.

I know it will get easier. It will get easier in a few weeks, when I settle into the routine of school. It will get easier in a few years, when my schedule doesn’t change every four months. It will be easier then because my body will be in a repetitive state, whereas now every day is different. I take 3 units of insulin upon waking unless my blood sugar is below 100, and even then I wait til it’s above 100 and then take 3 units. Last appointment, my doctor told me that I should be integrating that bolus into my basal rates in the morning. I told her no, because I get up at a different time every day it’s best if I just take it as a bolus. I’d rather have it as a basal. I’d rather wake up and stumble around and not worry about bolusing. Heck, I’d rather not worry about testing, but that’s not going to happen.

I’m not upset about this no routine thing. I’m really not. I love being in college, and while I am getting a little sick of it after five years (starting my 11th semester this fall – wow) I wouldn’t trade the things I am learning for all the degrees in the world (except maybe a law degree, but only so I could be awesome like my best friend). But it makes living with this monster disease a little harder. So am I expecting an A1c below 7 at today’s doctor’s appointment? As I said yesterday, absolutely not. But I will be OK with the 7’s for now. Because for now, in this crazy awesome time in my life where I get to freeload off my parents and learn cool things, routine just isn’t going to happen. It’s not my style, anyway.

The Choices

There are lots of choices when it comes to diabetes care. Choosing a treatment plan. What kind of insulin should I take? Should I pump or use MDI? Oral medications or insulin (for type 2’s)? Symlin or Metformin? But for me, the choice I’ve been having to make lately is a quintessential question every person with diabetes must face: Lower your A1c aggressively and deal with the lows that come with it, or remain in the high 7’s and 8’s with blood sugars consistently between 150 and 250, but avoid lows?

I think that this is why I ran in the 8’s in my childhood. It was easier on my parents and on me to run a little high than to risk hypoglycemia.

Lately I’ve been aggressively trying to get my A1C below 7. My last A1c was 7.5. That is excellent, the lowest I’ve ever  been! It was after three months on both the pump and using a continuous glucose monitoring system. But I’ve been having quite a few troubles with lows. I have dropped below 50 a few times, and this is a rare occasion for me. To top it off, running lower means that I don’t feel the lows til I get into the 50’s! It’s craziness. I am really glad that I have my Dexcom 7 Plus to help me catch the lows before I wind up on the floor. To this day I still haven’t been in the hospital due to lows, been disoriented due to lows, or had any real bad experiences with lows. I know the day is coming though. I’m doing everything I can to avoid it.

Several factors have been playing into this. Of course, being more aggressive with meal boluses and experimenting with combo bolus (Combo bolus is what Animas calls it when you take part of your insulin now, and part later, using a setting on the pump) effect my blood sugars. I started taking Symlin again, a synthetic form of a hormone that aids in the digestive process. It helps insulin work faster and better with carbs and helps avoid spikes after meals. I was using Symlin semi-effectively when I was taking multiple daily injections, but when I started the pump I decided to see if I really needed it or not. My conclusion, after analyzing pump and Dexcom post-meal data, was that I needed to try it again, because I was spiking over 200 after almost every meal. Unfortunately, it means recalculating insulin to carb ratios when you start taking it. And I am stubborn. It takes two or three lows before I know I’m not over bolusing and am ready to change the ratio.

Another thing that i need to figure out is my basal rates. I know my basals are off due to messed up night numbers from my Dexcom. But I have this nagging cold, and I want it to be gone before I basal test, just so that I don’t increase the rate too much (infections often make me run higher).

And then there is the exercise. Exercise, for me, generally effects me for at least a couple days afterward so long as I work out at least 30 minutes. And, hopefully, if I keep up my exercise routine, weight loss will result. And that will result in lower basal rates and more low blood sugars.

The overall goal is not to reduce insulin necessarily, but to gain better control. I felt good when I went to the doctor’s office in January and was happy with my A1c results. But I have been feeling more out of control lately, so the goal is to control the things that I can control (exercise, how many carbs I eat at once, taking medicine prescribed to me in order to avoid after meal spikes), and hopefully this will result in overall better control. If that means lower insulin dosage, that’s great. But if not, if my insulin rates stay the same or increase, and my A1c still goes down, then that is perfectly fine too.

Weekend Adventures

I’m a bit of a weekend traveler. I like going places and doing things, even if it’s just something local. So this segment of Sarahndipity will be called Saradventures and will typically be featured on Mondays.

This weekend I traveled to Louisiana to visit my boyfriend’s brother, who plays baseball for a university in America’s Wetlands.

I’ve been to the state before. I went with a school group in 2005 just six weeks after hurricane Katrina hit New Orléans and helped with relief work. But to get there, we drove through the night. This time, I was able to see the bayou for its true beauty. I was just in awe of the random water sitting everywhere and the trees growing literally right up out of it. Telephone poles, billboards, and even houses sit right in the water like this is normal! The only time I’ve seen anything like it is during a Missouri flood. I absolutely love cool nature things like the bayou!

So we stopped at a nature preserve and took a nice little hike on Sunday afternoon on our way home. Now, I use a Dexcom Seven Plus continuous glucose monitor, and normally it’s pretty handy for catching rapid lows and highs. For example, right now it says 91 with an arrow diagonally downward, which means I should probably stop writing and test and eat something soon. But on Saturday night, I had rolled the sensor literally right out of my arm. Since it still had 2 days left on it, I hadn’t packed an extra. I don’t really consider it an “essential,” so based on my track record with losing things, I decided to leave the extras at home instead of risking breaking or losing the expensive sensors.

Now I was stuck on a hiking trail with no glucose and no Dexcom. It wasn’t that long of a trail, so I didn’t figure I would be in any dire emergency while hiking. Besides, I tested before we left, and was in the 140’s. But it’s never a safe assumption.

We decided to head towards the visitors center, in the opposite direction of the car, when I began to feel low. I didn’t want to send the boyfriend back to the car and be by myself, so I pushed myself to walk towards the car, holding onto his arm. I made it, but I was 42 when I got there. 42 is very rare for me. I have seen a few 4o’s since I started pumping, but they still seldom occur, especially with Dexcom.

So what was a sightseeing mission turned into a very scary hypo episode. Now, it’s not that diabetics can’t go hiking or do things like that. It’s that I made a poor decision to leave both my monitor and my fast acting sugar in the car when I knew I would be walking around for more than 20 minutes. It’s small decisions like these that can make or break living with diabetes. I was simply tired of carrying my very large purse around. Now, I need the large purse for all my supplies, but perhaps what I can do is place a smaller clutch in the bag and take that out when I want to leave the big purse.

Despite the scary lows and the lessons leanred, we had a lot of fun at the nature preserve. Though it was January I prefer the lack of greenery and the 60 degree weather to the humid Southern summers (Missouri gets humid enough!).   But, I’d love to go boating on a bayou sometime.