Stick With It

Dexcom sensor, Day 6.  You can also see the sticky residue from the last sensor and my pump tube.

This poor little guy doesn't get changed out until tomorrow, and he's barely holding on (especially on the right side, I'm not sure it's technically sticking to me anymore).  I am loving Constance's ability to always know what my blood sugar is doing, but the willingness for the sensor to stay on my body has turned into a sticky situation (PUN!). 

When I first saw the right side wanting to detach a little, I tried putting a single bandage over the lip.  But that didn't really do much because the bandage isn't sticky in the middle, so I still had exposure.  Then, per the DOC and their always helpful tweets, I tried some waterproof first-aid tape.  That worked for about 2 days before it started to peel.  Now, I'm just hoping this thing doesn't come off in the middle of the night or when I happen to run into a wall corner (it's bound to happen). 

I'm contemplating my next placement, because I want this thing to be as secure as possible.  Right now it's in the groove between my love handle and my belly button, which is actually nice and indented but not smooth enough for 7 days worth of tape. 

I'm contemplating my next site.  My love handles work the best, but I try to give them a break once in awhile.  I don't want to do it on my thigh because my clothing would rub on it too much.  The ideal place right now would be my arm because I tend to wear mostly sleeveless shirts during the summer.  But am I ready for that?  To have my diabetes exposed to the world in such a manner?  Not that having a pump or a CGM is discrete, but those are just pieces of technology that I "carry" with me.  This thing will be attached to me underneath my skin for the whole world to see.  I'm not sure I'm ready for that or the random questions, yet. 

So, does anyone have any good experiences with keeping a sensor securely attached to you for 7 days or more?  I'm able to keep my pump site secure for its mandatory 3-4 days with the sticky alcohol wipes from Medtronic, but it's tape size is smaller and its lifetime is shorter.  I'm mainly worried about our beach trip in 2 months (Yay!) with the salt water and sand.  I may just get a cast wrap around the sucker for a week and be done with it.  Sexy!

The Perfect Storm

The title of this post is kind of ironic because I actually sleep the most soundly during a storm.  And there's one passing over us right now, making for a very sleepy Monday morning.  Especially after yesterday morning's "storm".  

It had been a fun night the night before.  I made homemade pizza, and we had some friends over for pizza, beer, and Phase Ten.  We stayed up until 10:30 PM; Trey was the victor in the Phase Ten game.  But it was still fun, one of my favorite ways to spend a Saturday night. 

However, the pizza/beer combination wreaked havoc on my blood sugars as soon as my head hit the pillow.  I'm learning so many things aboug my BG trends with Constance.  For example, the combination of high fat, high carb, and alcohol lingers in my blood stream for not just four hours, but six.  Therefore, my square bolus of 4 hours worked great while we were awake.  But my bolusing ended as soon as our evening did, which meant my BGs began their mountainous climb, blessing me with high alarms every hour starting at midnight.  As I've mentioned before, I'm horrible at actually waking up with the alarms.  I snooze at least once, usually twice, before I finally get up and correct.  This means that I woke up to a nice BZZZZZZZZ every hour until 3:00 AM when my BG was well over 300 mg/dL.  I corrected and tried to savor the 5 hours I had to sleep until we had to get up for late service. 

But not only do I live with a disease that never sleeps, I also live with 4 animals (2 cats and 2 dogs).  Our latest edition, Missy, is a 1-year-old lab/boxer mix.  She's a lovable little thing, but she has her own clock that wakes up everyday at 4:30 AM.  So, after finally sleeping for an hour and a half following my correction, I get up and let both dogs out for their morning potty and play time. 

Back to bed, but not for long until my long-haired tabby Elvis comes into our bedroom meow-screaming his head off.  "Did I give him water last night?"  In the chaotic fun that was our evening, I don't think I filled up his water bowl, which means he was surely letting me know I forgot.  Several attempts to shush him went by the wayside, he kept coming back. 

It's about 6:30 AM now and the dogs have arrived back from their time in the yard, and Roscoe is whining at the back door.  About this time, Constance goes off with a low alarm--can't really snooze on those because a low is a very unpleasant adrenaline rush to wake up to, sweat and all.  *sigh* "I guess I'm up," I groaned. 

After chugging some juice, giving Elvis some water, and letting the dogs in for their breakfast, I made some well-deserved coffee.  I grabbed my sugar-free French vanilla creamer and the biggest mug in our cabinet, filled the cup up to the brim, and shuffled to the couch.  The dogs were already passed out on the couch for their post-breakfast nap, and the cats were content in their tower once again. 

The storm was over, and the house was quiet again, minus the sound of the hubby and I chomping on our cereal.  Still an hour before the scheduled alarm. 

. . . 

Time for a second cup. 

Technology Troubles

On a daily basis, how many pieces of technology do I use?  Let's see:  phone, meter, pump, CGM, computer, and TV.  Not to mention all those shiny appliances in the kitchen that are used to make food.  So, when one or more these gadgets decide to malfunction, it can totally throw off my day. 

Take yesterday, for example.  I had put in a new sensor for my CGM, hoping for another stellar week like before.  Everything began like last time:  put in the new sensor before bedtime, dealt with false highs and "???" most of the night, start getting "real" data around 5:00 AM.  I know that technically the data is supposed to come as soon as the 2-hour calibration is done, but from what I've heard via the DOC and twitterverse it takes the sensor almost a full day to get "wet".  But after 2 hours of "real" data yesterday morning, the "???" began staring back at me . . . for 2 hours!!!  I knew this meant there was something wrong with the sensor.  After consulting with several tweeps, I decided to call Dexcom and see what's up.  The very energetic lady told me that if the sensor continues to give "???" for at least 3 hours, they will ship another sensor as a replacement and told me that I should rip that one out.  I gave it until I got home from work, but after 6 hours of "???" I decided this sensor was toast.  Ripped out said sensor and started a new one. 

I think there may have been some user-error going on ("No, really?  Not you, Holly!"  Yes, reader, I'm quite non-graceful.  Please contain your surprise.).  When I inserted the new sensor, I noticed the insertion was a lot smoother following the two clicks of the insertion plunger.  "Hmmm, did that happen last time?  I don't think it did."  Also, the old, bad sensor experienced some . . . ahem . . . activities between the hubby and I that may or may not have been detrimental to its placement (BTW, this isn't the first TMI post of this week.  Right, Elizabeth?)  So, between a not-so-smooth insertion and some non-purposeful tape pulling, the sensor was a dead man walking . . . on me, anyway. 

So, after a new sensor and the typical 6-10 first hours of "???", I'm a real-time diabetic once again.  But thanks to the always helpful DOC, I'm learning all the secret tricks of the CGM trade.  For example, it typically takes a sensor several hours to get "wet" even after the calibration.  Some folks even let theirs sit for 24 hours before data processing, just so they know they're getting good results.  And isn't that the whole point of this little gizmo?  Also, if the placement of the sensor becomes an issue again *blush*, then I might need to invest in some medical tape.  I tried using some band-aids to hold the lifted edges down, but they don't last past the first shower which would be extremely inefficient and expensive. 

My next technological blunder happened to me this morning when my work computer greeted me with the blue screen of death.  After several attempts to reboot, nothing happened.  A call to computer services, 2 hours of conversing with the world via my BlackBerry, and 30 minutes of troubleshooting and I'm back on!  But how frustrating that I literally didn't get any work done for 2 hours because I had no computer access.  Just goes to show how dependent we've become on using technology just to get on with our daily lives. 

We have a beach trip coming up in September, and I'm debating how we'll survive without some of our technology just to make the vacation memorable.  I mean, if all we do is go down there with our laptops and watch TV the whole time, we might as well save the gas money and stay here!  /soapbox 

Anywho, this post just goes to show how dependent we are on technology.  Especially for us diabetics with our meters, pumps, even CGMs.  Now if I can just find an electronic pancreas with an extension cord . . .

 No kidding, annoying paperclip!

tobybuckeye, I think I love you!

As I was perusing some local news sites during my lunch break, I came across a familiar acronym:  "JDRF opens new Huntsville office." 

"Sweet!  This is great!" I thought.  I was all to excited to begin reading about the new office in my hometown and the subsequent walk to be planned, but then I skimmed down the comments section: 

1st commenter, jarhaid, said, "Teaching the little darlings not to cram food like they're on some mission from God would be a good start." 

"WHAT?!  Are you serious??!!"  I could feel my blood beginning to boil and starting my not-so-rational response, until I read down to the following commenter, tobybuckeye: 

The old saying is: Ignorance is bliss. This country would be in much better shape if folks like jarhaid would get "educated" before spouting off the first thing that comes to their mind. Juvenile Diabetes is also known as "Type 1" Diabetes. A common "MYTH" is that high amounts sugar consumption causes this. Research has NOT found the cause of this "Type 1" diabetes. Although many times it is found in children, even older folks are not immune to this disease. Juvenile diabetes is when the pancreas quits working entirely. Type 2 on the other hand is when the pancreas is working but the body doesn't remember how to distribute this insulin. Which is what YOU or I Jarhaid could end up with. Please get educated before passing a judgment on children. An organ in the body has stopped working and the medical profession still has NO IDEA why. Do something useful and donate to the cause of finding out why.

Followed by:

MORE INFO FOR JARHAID:
Type 1 Diabetes
Type 1 diabetes occurs when the body's own immune system destroys the insulin-producing cells of the pancreas (called beta cells).
Normally, the body's immune system fights off foreign invaders like viruses or bacteria. But for unknown reasons, in people with type 1 diabetes, the immune system attacks various cells in the body. This results in a complete deficiency of the insulin hormone.
Some people develop a type of diabetes – called secondary diabetes -- which is similar to type 1 diabetes, but the beta cells are not destroyed by the immune system but by some other factor, such as cystic fibrosis or pancreatic surgery.
Understanding Insulin and Type 1 Diabetes
Normally the hormone insulin is secreted by the pancreas in low amounts. When you eat a meal, sugar (glucose) from food stimulates the pancreas to release insulin. The amount that is released is proportional to the amount that is required by the size of that particular meal.
Insulin's main role is to help move certain nutrients -- especially sugar -- into the cells of the body's tissues. Cells use sugars and other nutrients from meals as a source of energy to function.
The amount of sugar in the blood decreases once it enters the cells. Normally that signals the beta cells in the pancreas to lower the amount of insulin secreted so that you don't develop low blood sugar levels (hypoglycemia). But the destruction of the beta cells that occurs with type 1 diabetes throws the entire process into disarray.
In people with type 1 diabetes, sugar isn't moved into the cells because insulin is not available. When sugar builds up in the blood instead of going into cells, the body's cells starve for nutrients and other systems in the body must provide energy for many important bodily functions. As a result, high blood sugar develops and can cause:

I realize his 2nd comment was probably copy/paste from a reputable diabetes website, but I was so glad that he/she took the time to do (especially considering he/she isn't diabetic, as alluded to in the first comment).

I normally don't engage in the type 1/type 2 debate.  Mainly because pre-Dx, my family history foreshadowed me to have type 2.  So I tried my darndest to eat well and keep active.  I understand that being type 2 is not always lifestyle, sometimes genetics just mess with us regardless of our eating habits.  Also, my dad is a type 2, so if I start bashing those with pseudo-working pancreii, I would be bashing Dad.  And that's never gonna happen. 

HOWEVER, there should be some, SOME (for the love!) type of education on the difference between type 1 and type 2.  The first commenter, jarhaid, obviously had no idea what juvenile diabetes is, and yet he bashes parents and children for "Teaching the little darlings to cram food like they're on a mission from God."  The only time I'm "eating on a mission" is when I'm coming up from a low with a mission of not passing out.  I realize there is some form of "internet courage" going on here because he can take a stab at children with type 1 with no repercussions (save tobybuckeye's responses), but there should be some common sense politeness if you don't know anything about the subject! 

I know this blog is mainly for connecting with other diabetics, but my hope is that this little rant will inspire other non-D readers of my blog to go out and educate yourselves (that is, if you must comment on a subject you know absolutely nothing about).  But sometimes it just makes me furious the ignorance of the general public about this disease.  And I can be patient with caring questions here and there, "Does it hurt?" "Can you ever just eat and not worry about insulin ever again?" "Are unicorns real?"  OK, the last one is not D-related, but I'd like to think yes.  But the question that I get that makes me turn Hulk-ish is, "What did you do to get this?"  Me?  Well, I was studying for a Dynamics final, so don't ever take Dynamics and you won't get diabetes.  /rant

So, thank you, tobybuckeye, for educating yourself enough to know the difference.  I suspect you are either a medical professional or a type 3, but I'm still grateful all the same.  Now, I will go and eat my 20 g of almond salad and apple "like a mission from God". 

By the way, jarhaid finally responded, "Well, excuuuuuuuuuuuuze me!".  To which someone replied, "It's tough when you expose your ignorance, isn't it?"

Isn't it?   

The More You Know . . . about a CGM

So I'm half-way done with my first Dexcom sensor.  I have learned so much in the past few days about my diabetes and how food affects my numbers.  I couldn't pin-point one particular nugget of knowledge to focus on for a blog post, so I'd thought I'd go bulleting with all my knowledge nuggets: 

• My Novolog takes about 30-45 minutes to actually start affecting my BG.  The first 2 days I noticed that I was spiking to 250 almost 300 mg/dL when I bolus at the same time as I start eating.  So, this weekend I started testing, bolusing, and waiting 30 minutes before eating.  This is really easy to do on the weekend because I can enjoy a cup of coffee while I'm waiting on my insulin to kick in.  But I had to start a new routine this morning before work to give it the same amount of time.  I have begun testing and bolusing before my shower, then after my shower and getting dressed I will eat--giving my insulin at least 30 minutes.  I feel like this change alone will affect my A1c the most. 
• It takes more than 15 grams of carbs and more than 15 minutes to bring me up from a low.  My current low alarm setting is set at the default of 80 mg/dL.  I like this setting because I feel safer catching the lows before they get too bad.  I understand the 15/15 rule is the same for any person experiencing hypoglycemia.  However, when insulin is involved (type 1 or type 2), you're fighting more than just a lack of sugar in the blood.  It's a lack of sugar combined with sugar-fighting insulin on board.  I'm noticing it takes like 30 grams of carbs and 20 minutes before I start to feel normal again.  Everytime I do the standard 15/15 rule (which states, "After 15 minutes, if your BG is still not normal, take 15 g more of carbs."), I always end up taking more. 
• My nighttime numbers are crap.  I've only had one evening where I stayed in range around 140 mg/dL the whole night.  Otherwise, I ususally start out going to bed with a low alarm, correct, and end up high around 3:00 AM (which does not a happy Holly make).  I'm thinking some basal tweaking is in order, but I'm waiting the full week to get a better idea.  
• Speaking of nighttimes, I am not very good at getting up when an alarm goes off.  Everyone hears it--my husband, both dogs, and the cats scatter, but I have already developed the bad habit of grabbing the receiver, hitting "C" for cancel, and going back to sleep.  The ultimate goal is to get my basals down to perfection so these alarms don't happen, but until then I need to get up and correct for the alarms.  Last night, I snoozed 3 high alarms before finally getting up--meaning I was high for 3 hours before finally getting up, not good.  
• I need to also do some more tweaking for bolusing for high fat/high carb meals like lasagna and mexican (which I had for the past 2 nights).  My standard bolusing is to do a dual bolus 40/60 ratio with a 2-hour square bolus.  This usually puts me back at normal 2 hours later, but Constance has shown me that I continue to drop for another 2 hours.  So, I need to extend my square bolus for longer or just do a square bolus throughout the whole duration.  
• Finally, this little device and all its fixin's, is expensive!  See the following:  

 Good thing because . . . 

it's over $1600 out of pocket.  Thanks, insurance!  

This also means between my pump (including tube, reservoir, and insulin), Constance and her sensor, and my phone, I'm easily walking around with close to $10K just on my hips!  Bionic woman, indeed!  Plus, with all these attachments, I feel like I need a toolbelt just to walk around. 

Friday Five: 2 July 2010

Today is a special edition of Friday Five because it's my parent's 39th wedding anniversary.  So today I will give 5 fun facts about my parents, their marriage, and our family.

1. When my parents first met, Dad was actually dating someone else.  They met at a church cookout where Dad asked Mom to make him a hot dog, to which Mom replied, "Why don't you get your girlfriend to make you one!"  Ahhh, I love that story.  
2. My Dad was almost late to their wedding.  He had just started his job at the radio station the day before, and he had to wait for the afternoon guy to come take his place.  I'm not sure how late he left from the radio station, but he obviously made it in time.  I'm sure my mom was sweating.  
3. Shortly after they were married, Mom's engagement ring's band broke.  So she just wore her wedding band for a long while.  For their 25th wedding anniversary, Dad bought her a ROCK!!!  But Mom eventually had her engagement ring fixed, and now she wears that ring instead of her 25th anniversary ROCK, even though her engagement ring was a fraction of the size of her ROCK.  Just goes to show how special that ring was to her.  
4. About 4 years ago, my dad had to have knee surgery.  Mom had to take care of him in more ways than a lot of people have patience for.  Including picking his leg up and off the recliner over and over and over.  At Thanksgiving, Dad made this speech that had everyone in tears about how much he loved my mom and couldn't have made it without her.  This was one month before my D diagnosis, and I learned what it meant to say "in sickness and in health". 
5. After 39 years, 2 kids, 2 kids-in-law, 2 grandsons, and retirement after 30+ years in their careers, they are still very much in love.  It's so rare these days to meet a couple who's been married this long.  But it's even more rare for a couple to still love (and like) each other.  They are enjoying their time alone together camping and boating and spoiling one crazy Shih-tzu.  

 Riding bikes together.  (Yes, that's a dog in a stroller--their 3rd child and my dog-sibling, Bo.)

Happy Anniversary, Mom and Dad!  May you have many, many more.

May your fountain be blessed, and may you rejoice in the wife of your youth. ~Psalm 5:18

First Impressions from a Bionic Woman

Yesterday around 4:00 PM I received an automated email from FedEx telling me that my package, my Dexcom CGM starter kit, had been delivered to my house.  I had already alerted some coworkers that I was going to leave whenever I got this email.  I gathered my things and began my commute home, which seemed twice as long as it normally does. 

When I arrived home, the package was sitting on the doorstep.  "Rather small box," I thought.  I went ahead and requested to have 3 months worth of sensors, and the box was smaller than my Medtronic refills.  I took the box inside and began opening it.  All of the sensor boxes were on top (or bottom, I may have opened it upside down), so I dug down until I found the box holding Constance.  The egg, as Kerri affectionately calls it, was a lot smaller than I had imagined.  I don't know why I expected it to be like a little Nerf ball, but my Blackberry is bigger than this little device. 

I already knew that the receiver needed to be charged for 3 hours before I could use it.  So, I plugged it in next to the coffee pot and proceeded with my daily ritual chores.  I took care of the cats, fed the dogs, emptied out the dishwasher, and took out the trash.  All the while, I'm checking the receiver to see if it was charged (as if it would be fully charged in one hour, but I was kind of hoping).  I then flipped through the User's Guide and Start-up pamphlet.  I had already watched the tutorials online and Kerri's video for several weeks before Constance's arrival.  Now I just had to wait for it to charge (longest 3 hours, ever!).

I had some distractions in the form of going to pick corn and visiting some friends who recently adopted 2 adorable kittens.  Finally, 3.5 hours after I plugged it in, we arrive back home.

Next, I programed the date/time, made sure the transmitter ID was correct, and prepped  myself for the sensor insertion.  I grabbed a sticky alcohol wipe from my pump stash, pulled out a sensor from the FedEx box, and took a deep breath.  Opened the sensor packaging, peeled off the tape (I concur with Kerri, very tricky that sticky tape), and placed the sensor on the left side of my stomach parallel with my belly button.  Pressed down on the tape to make sure it was stuck to my skin, and took off the safety.  Using my right hand, I pressed down with my thumb on the plunger to insert the needle, and pulled up the other plunger with my index and middle fingers removing the piercing needle.  It kind of hurt going in, but I think it hurt because I was nervous about it, making my muscles tense.  After I took out the piercing needle, I barely felt it.  The hardest part for me was putting in the transmitter!  It took me several tries before the latch inserted the transmitter into the sensor.  Go figure, it wasn't the whole inserting a needle into my body thing, it was putting the transmitter in (but I was never that good with Legos, which is what it's like).

Next, I began the sensor calibration which takes 2 hours.  This happened about 9:15 PM, which is typically my bed time these days.  I tried staying awake by watching The Office and Family Guy, but alas, I fell asleep on the couch before the end of the Family Guy's intro.  Luckily, I woke up with 10 minutes left in my calibration.  I started watching the receiver like a hawk anticipating the two blood drop calibration request screen.  BZZZZZZZZZZ!  "Enter two BG readings."

I entered two readings from the same finger (and the same prick, too. yay, a bleeder!):  216 and 201 mg/dL (I'm not sure why I was high because it had been over 6 hours since I ate dinner, but like I've mentioned before, I test at the same every day.  And 11:15 PM is not a typical test for me; therefore, I have no idea what goes on during this time.)  Immediately after I entered the two BG's, the tracking screen came up with 204 mg/dL followed by a High alarm.  "Well, the alarm works."   

Exhausted from it being after 11:00 PM and the general excitement from it all, I headed off to bed.  However, almost as soon as walk to the bedroom, I get the "???" error on the screen.  "Great, what did I screw up?"  I get back up and go look at the starter pamphlet and read the "???" error description.  It said that this error is normal and to just wait.  No problem.  Sleepy time! 

I vaguely remember waking up in the middle of the night to a High alarm:  323 mg/dL.  But since it was just a few readings surrounded by "???", I ignored it.  The sensor came back to life around 3:00 AM and showed a little snake-like action around 250 mg/dL.  I'm not sure how much stock I'd put in the numbers, but it did show a trend where my BG starts to spike (thank you, dawn phenomenon).  This made me happy, and hopeful, that I could eventually conquer this DARN phenomenon!  It went back out again to "???" until about 5:30 AM after I started eating my oatmeal breakfast.  It was kind of perfect timing, because I started seeing a major spike about an hour afterwards around 280 mg/dL and a decrease starting about 30 minutes after that.  "Hmmm, I guess I SHOULD take my insulin a little while before eating." 

 Kind of crappy resolution and glare, but you can see the spike from my oatmeal.

First impressions:  it was a little frustrating when I couldn't even put the transmitter in!  I called my engineering husband over to help me investigate, but immediately when he started walking towards me I got it in.  (He's my force field of positivity. *smile*)  I also didn't anticipate having so many "???" for the first 6 hours or so, but I've heard this is pretty common and the numbers are more accurate after 24 hours (or so I've read via the DOC).  But once it started working this morning, I was giddy.  I was checking it after every step in my routine.  Brush teeth, check Constance, dry hair, check Constance, pack lunch, check Constance.  On the phone with Trey going into work I said, "I am such a nerd right now."  I could hear him rolling his eyes on the other end of the phone.  "Bionic woman, eh?"  "Yep," I exclaimed. 

 The obligatory belly picture:  Dexcom sensor and receiver on the left, insulin site and tube on the right.

Bionic woman!

P.S.  Just did a test.  Meter:  96 mg/dL.  Constance:  121 mg/dL.  I'll take that.  =)