Monday, April 14, 2014

Day Three of Podding

My third day of using the OmniPod didn't go so well. This is mainly due to my having trouble working out how the extended bolus works.

When I eat food that is high in fat, it keeps my blood sugar from rising for awhile. The extended bolus is meant to help with that by holding back some or all of the insulin bolus for however long the user specifies. My big problem has been in figuring out how long that is. On Saturday morning I ate a banana muffin with peanut butter, and when I took a bolus for it my blood sugar dropped right away and then increased significantly a couple of hours later.

On both Saturday and Sunday I ate a burger and fries for lunch. On Saturday I programmed my extend bolus for two hours, only to have a high blood sugar by the time the pod gave me the bolus. The next day, Sunday, I programmed it for an hour and a half, and again I had high blood sugar by the time of the bolus.

Because of the high blood sugar, I did something stupid. I had a high fat coffee drink at Starbucks but I gave myself the bolus right away -- at the same time the pod gave me the extended bolus from lunch. This resulted in my blood sugar crashing in the middle of Wal Mart -- not surprising, really. I temporarily suspended insulin delivery and ate some candy that I keep in my bag for emergencies.

The rest of day three was uneventful until a couple of hours before bedtime, when the pod suddenly emitted an alarm. Turns out that the insulin reservoir was low. I probably would have had enough to last the night, but I didn't want to risk either going into ketoacidosis overnight or being rudely awakened by another alarm. I decided to change my pod early.

I was nervous about doing everything on my own, since the first time I applied a pod I'd done it under the watchful eye of Nicola the pump trainer, but I had a handy "quick start" guide that was easy to follow. Changing the pod wasn't as difficult as I had feared.

Today I am going to try to find food that isn't as high in fat if I happen to be downtown at lunch time, but I am going to have to figure out that extended bolus eventually if I want to eat pizza ever again.

Saturday, April 12, 2014

Day 2 as a Pod Person

My first day as a pod person had its ups and downs, or at least my blood sugar did. After my blood sugar had been high all morning, the PDM finally suggested a correction bolus to bring it down.

When I was finally down to a blood sugar in the single digits I ate a chocolate bar. The PDM then suggested a bolus for the chocolate that was a bit more than I thought I needed, but I accepted the bolus. That was a mistake, as I wound up with hypoglycemia at a blood sugar of 2.4.

However, a glass of Coke and another chocolate bar brought it back to normal. I then had to figure out how to keep it up. At first I thought I would reduce my basal rate, but I soon found the "suspend" function, and I suspended all insulin delivery for the next 90 minutes, until I had supper.

I spent most of my evening working on my new house, and I noticed my blood sugar was dropping quite quickly. Time to suspend basal insulin again. Another hour and my blood sugar had increased, so I turned on the basal once more.

I slept like the proverbial log last night, completely unaware of the pod on my arm, even when I was lying on it. The biggest change I noticed was eating without doing an injection. For more than 40 years I have done an injection at breakfast time, and this morning all I had to do was push a couple of buttons on my PDM -- fewer buttons than you would push to send a text message.

Obviously I am still getting used to setting my insulin dose on the PDM. I think my peaks and crashes on day one were due to a combination of miscalculation of carbohydrates and more activity than I was anticipating, along with the learning curve on the pump. I think I'm getting there, though, and soon I will be an expert pod person.

Friday, April 11, 2014

First Day on the Pod

Today is my first day using an OmniPod. I was very excited and found it hard to sleep last night, or maybe I couldn't sleep because my endocrinologist had instructed me to not take my Lantus long-acting insulin last night, so high blood sugar kept me awake all night. At about three in the morning I checked my blood sugar and took two units of fast-acting NovoRapid. Those were gone by the time I got up at seven and had a blood sugar of 15. I met my pump trainer, Nicola, at a local restaurant. She's very nice. She showed me how to activate my PDM (personal device manager) and program in my basal rate and my carbohydrate-to-insulin ratio, which is now 10 to 1. (My endo had originally set it at 12, but Nicola and I decided to take the middle ground between 8 to 1, which I had been using, and 12 to 1, which Dr. Miller said to use, and set it at 10 to 1.) I input all the information, filled the pod, activated it and stuck it on my left arm. When I put on the pod for the first time it felt very similar to an injection, but as I've been doing injections for 40-plus years, that's not a problem. I'm fine with going from four injections a day to one injection every three days. Unfortunately my blood sugar has been high all day. I think it's a combination of the lack of long-acting insulin in my system and probably miscalculating the carbohydrates in my breakfast. (A breakfast wrap with a side of hashbrown potatoes.) It's coming down, but very slowly. I've had to resist the temptation to just grab my insulin pen and inject a bolus to bring down my blood sugar. I skipped lunch because I had breakfast very late and because my blood sugar was so high. For supper I intend to eat something for which I know the carbohydrate count for certain so that I know how much insulin to tell the pod to give me. Maybe I can avoid getting high blood sugar again (or avoid keeping it high.)

Sunday, March 16, 2014

Reviving the Diabeteblog: learning to carb count

I haven't posted in this blog for years, but I've decided to try giving it another go. I am about to acquire an OmniPod insulin pump, and I want a place to record my experiences. I am trying to find a way to change the name of this blog from "Diabeteblog" to "Diary of Pod Person" but I haven't found a way to do so, so far.

Because I am getting an insulin pump I decided it was finally time to learn how to count carbs. I'd tried it once before, but I gave up before I got very far. I generally guess-timated the amount of insulin needed for the food I ate; I was pretty good at judging this for things I ate every day, but not so much for things that I ate only once in a while. I was determined to learn carb-counting once and for all, though, because I would need it for the Omnipod. I started out with breakfast: muffins from the bakery at Save-On-Foods. The package gave me all the information I needed. Each muffin contained 48 grams of carbs. I tried four units of insulin one day, six the next and eight the next. Six turned out to be just the right number.

My next food was cereal. I measured one cup of Cheerios and half a cup of blueberries. The carb count for the cereal was on the box, but I had to look up the blueberries. Since the muffins had worked out at six units for 48 grams of carbs, I decided to take one unit of NovoRapid for every eight grams of carbs. Success!

These days every time I go to a restaurant I ask for nutritional information for the food. I've started asking my boyfriend to take me to Milestones for special occasions because they have a special card that contains the carb count, calorie count, fat grams etc. for all of their dishes. I found that A & W has something similar posted on the wall of their store at the Bay Centre. Starbucks drinks and menu items can be easily found with a Google search on my smart phone, so I know exactly how much insulin I need to take for my tall cinnamon dolcé latte (four units, by the way.)

Some foods are more difficult to judge. I failed badly when I had sushi because I had no idea how many cups of rice came with my meal, nor did I know how much sugar was in the sauce that was added to the rice or how much sauce was used. I have no clue how to measure cooked pasta. I definitely still have much to learn.

I'm noticing differences already, though. I'm not having lows nearly as often because I now don't have to guess how much insulin I need to cover that sandwich or this glass of juice. Also, now that I know the carb counts of the foods I eat most often, I'm making an effort to eat more lower-carbohydrate foods.

I definitely appreciate that the bakery at Save-On Foods labels all their products with carbohydrate counts. I now know how many grams of carbs are in one-eighth of a cake, and when I want some, I will cut the cake in half, then cut it into quarters, and then slice one of the quarters in half so that I have one-eighth of a cake. Before I counted carbs I'd have had a bigger piece.

My OmniPod arrives tomorrow, and then I have to get a pump trainer to teach me how to use it. I hope to chart my progress here. Wish me luck in becoming a pod person!

Sunday, August 7, 2011

Diabetes history

I was diagnosed with juvenile diabetes in 1973. I was five years old. There were no blood glucose meters. There was no A1C test. There were urine tests before every meal, and there was a fasting blood sugar done at the hospital every few months. Injections were done with a syringe, once a day, using Toronto insulin and Lente insulin. (I think I switched to two injections a day when I was 16.) The word "carbohydrate" was never mentioned; instead, we had food exchanges. Half a banana was one fruit exchange. (Half of what size of banana? Well, that was guesswork.) Half a cup of milk was a milk exchange. A certain amount of cereal -- not a lot of choice there, either -- was a starch exchange. The exact measurement was found in a book with some original title like "The Diabetic Diet." It had a blue and yellow cover and was spiral-bound.

There was some "diet" food available. I could drink Tab, Fresca or Bubble Up. There were a few sugarless candies available. That was until the Canadian government decided to ban saccharin. Suddenly there was no diet pop, no sugarless gum, no sugarless candy. I drank Kool-Aid prepared with Sugar Twin, which was cyclamate. There was no Equal or aspartame, no Splenda or sucralose.

I went to summer camp four times, sponsored by the Canadian Diabetes Association. There were three or four other diabetic kids my age in my hometown, and we all had the same doctor, who made an effort to get us together every so often, and we all travelled to camp together. Diabetes camp was really just like any other summer camp, with the exception that we all had diabetes and the counsellors had to carry emergency sugar supplies with them. We went swimming and boating, hiking and camping, made arts and crafts and had dances.

When I was 13, which would have been in 1981, I saw a blood glucose meter for the first time. It was about the size of a hardcover book, took a large amount of blood from your finger, and had a pointer on a dial that showed approximately what range your blood sugar was in. At that point we were still all doing urine tests, and four times a day there would be two campers assigned to do the tests for each group. Take two drops of urine, add ten drops of water, drop in a Clinitest tablet and watch the chemical reaction take place.

By my third time at camp, when I was 15, we were all using blood glucose meters -- Glucoscan or Glucometer. These were sophisticated machines for their time! They were now about the size of a paperback book instead of a hardcover. The lancing device was a nasty little thing called an Autolet. (See a picture of it here.) The drop of blood was still pretty big, and you had to wait 60 seconds (the machine would sound a buzzer) and rinse off the strip with a special bottle of water before putting it in the machine. It then gave you a digital readout. This was a big improvement over urine tests. Aspartame became available around this time too, and we now had sugar-free pop again, including Diet Coke. For the first few years, though, products made with aspartame were more expensive than their sugar-containing counterparts.

When I was in my teens I had to spend some time in the hospital. I got my tonsils out, was admitted for nausea and vomiting because I couldn't keep my blood sugar under control when I couldn't eat, and had dental surgery. Each time I was admitted, I wound up teaching the nursing staff how to use the blood glucose monitor and how to mix two types of insulin in one syringe so that I didn't have to take extra needles.

By the time I was in university I was taking two shots a day -- still Lente and Toronto -- and the blood glucose monitor was now the Glucoscan II (image) and no longer required rinsing. Now it used a slightly smaller drop of blood. It still required a countdown, but now you had to blot the blood on a special pad before inserting into the machine. It was still about as big as a paperback book.

When I finished university in the early 1990s my insulin changed from beef-pork insulin to synthetic "human" insulin, or Humulin. I now took Humulin R and Humulin L, and a newer blood test machine that now read in mmol/l instead of mg/dl and required neither rinsing nor blotting of the strips. (Sadly, I can't remember the name.) Unfortunately, it was around this time that I became unemployed and had to go on welfare. Due to a poorly informed case worker and my being so shy and timid that I didn't dare speak up for myself or contest what I was told, I was left with the impression that my diabetes supplies would not be paid for by the welfare program, and I wound up reusing my syringes, taking as little insulin as I could get away with, and never testing my blood sugar. To make things worse, the company making my blood glucose meter discontinued it, and the strips were soon impossible to find.

Fortunately, in the mid-90s I discovered the diabetes clinic at the Royal Jubilee Hospital, and I also got a better caseworker for the welfare benefits. The diabetes clinic supplied me with my first One Touch blood glucose meter (image), and the caseworker got my medical supplies paid for.

One day around 1995 or so, I went to the pharmacy to pick up my prescriptions as usual, and the pharmacist asked me if I would like to try an insulin pen made by the Novolin company. I was intrigued by this new device. Sadly, there wasn't one for Lente insulin, but I started using it for my Toronto insulin. In 1997 I went on disability, which guaranteed that my medical benefits would stay in place.

It was in 1999 that I changed insulin for the first time since 1973. I switched from Lente to NPH insulin. Now I could use an insulin pen for that insulin too. A few years after that, in the early 21st century, I changed from using Toronto (Regular) insulin to NovoRapid. A few years after that, I went on Lantus insulin. My cat was also diagnosed with diabetes, of the feline variety, and now we both take Lantus -- me once a day, and my cat twice a day. I also went through a few more glucose meters, all from Lifescan -- the Fast Take, the Ultra and the Ultra Smart.

Today I am no longer on welfare or disability. I have a job now. I still use insulin pens, and now I use a One Touch Ultra Smart for my glucose meter, alternating with an Ultra Mini that I carry in my purse for convenience. I've tried almost every diabetes gadget under the sun except for the insulin pump and the continuous glucose monitor, both of which are out of my price range and neither of which is covered by public medical insurance and the medical benefits I get from my job only go up to $500 a year.

Monday, November 29, 2010

The problem of blame

We diabetic people are pretty familiar with the blame game. People like to blame us for our disease. "You ate too much sugar." "If you lost weight, your diabetes would go away." "Well, that's what you get for being fat and lazy."

None of this applies to people with Type 1 diabetes, of course, though we get lumped into this all the time. But it doesn't always apply to people with Type 2 diabetes, either. Not everyone with a diagnosis of Type 2 got it from being fat or lazy. For many people it was just the luck of the genetic draw. If your grandparent and/or parent had Type 2 diabetes, there's a good chance you'll get it eventually ,too, regardless of your weight or physical fitness level. There are also people who get Type 2 diabetes as a side effect of having another medical condition, such as polycystic ovarian syndrome, or whose weight gain was caused by a particular medication they were on. Many antidepressants and other psychiatric medications have weight gain as a side effect.

Even if a person did get Type 2 diabetes because of their weight, it's not helpful or supportive to keep blaming the person. I'm sure they didn't wake up one day and say, "Hey, I think I'm going to be fat now. I love being ridiculed by the general public and blamed for everything that's wrong with the health care system and demonized by the media." Telling a person that he or she got diabetes from being overweight isn't going to make their weight magically drop overnight, nor will telling them that their diabetes will go away if they lose it. (It won't, by the way. The person may be asymptomatic, but the diabetes will always be there, regardless of what Drew Carey or the latest celebrity with diabetes says.)

I mentioned the media. They're the ones who are largely to blame for this. Some 99 percent of the news stories about diabetes mention weight. I follow lots of diabetes "news" sources on Twitter and almost all of them are full of articles about diabetes and weight. The media just eats up stories about fat people, for some reason. Obesity + diabetes makes a good sound byte, I guess. News stories are limited for time (TV and radio) and space (newspapers and websites) so they can't go in to the very complex causes of diabetes. I doubt many of them have ever heard the term "autoimmune disease" or even know that there is more than one type of diabetes, let alone several types.

While diabetes seems to be the favourite target of the blame game, some other diseases get it too. Lung cancer is another popular target. I remember when some minor celebrity died of lung cancer. I mentioned on an online discussion forum that this person was not a smoker, so therefore we can't blame all cases of lung cancer on cigarettes. Well, I was immediately pounced on by people who told me that obviously, shne must have smoked at SOME point in her life; either that, or she had lived with smokers long enough to be exposed to enough secondhand smoke to develop lung cancer.

Why do people like to play the blame game? Well, I think for many it comes down to fear. If I'm afraid I'll get a particular disease, I can look around and say, "Well, I don't smoke," or "I'm not overweight," or "I don't eat junk food," or "I exercise regularly," therefore I won't get that disease, unlike the people who do smoke or who are overweight or who eat junk food or who don't exercise. It's probably reassuring in a way.

Then again, some people just like to make themselves look better than other people. I have encountered some people with Type 1 diabetes who consider themselves superior to those with Type 2 because we didn't get our disease from being fat.

I think in the end we all want the same thing: a cure for all types of diabetes. Unfortunately, the "blame game" stands in the way of that by making the general public think that if people just lost weight, their diabetes would be "cured" and that getting diabetes is our own fault, and if we just lived healthier lives we wouldn't get sick in the first place. So why donate money to research a disease that can be "cured" so easily?

Sunday, November 14, 2010

World Diabetes Day & Me

Today, November 14, was World Diabetes Day. I was aware of it, but I didn't do anything to mark it. There wasn't anything happening in my community to mark WDD, perhaps because it was a Sunday. There were no walks, no rides, no buildings or monuments being lit up. (One of the ways that many places mark World Diabetes Day is by lighting up specific buildings or monuments in blue, because blue is the colour of World Diabetes Day.)

Sundays are usually pretty quiet days for me. I seldom go out. So I didn't even have a chance to wear blue today.

I tried to take part in the "Big Blue Test" but I didn't manage even that. For the Big Blue Test you were supposed to test your blood sugar at 2 p.m. your time, then do 15 minutes of exercise and test again. I tested at about 1:55 and found that my blood sugar was 3.7. That's too low for exercise, so I didn't do any.

Some people were doing a diabetes scavenger hunt, with the idea being that you organize a team, take pictures of specific items and then post them to a certain web page. But I found out about this only the night before, which was too late to organize a team, even if I knew enough fellow people with diabetes to do so. The only diabetic people I know are the ones on Twitter. My boyfriend didn't want to go out today.

Next year I'm going to try to get a jump on World Diabetes Day. I don't know how yet, but I'm going to do some research to find out if there is a way to organize people to do something to mark the day and get something lit up in blue. Unfortunately it's a work day next year, being on a Monday, so that will limit my options.