My life lately

I don't have one cohesive topic to discuss, so here's my lazy bullet point list:

• After nearly a month of pumping, I've discovered that Socrates was right: "The wisest is she who knows that she does not know." Basically I've decided to forget everything I knew about controlling my diabetes with injections and let the pump teach me how it works. Three times in the last week I had heavy dinners with a good about of fat, carbs and protein. Had perfect blood sugars upon going to bed and woke up in the night super HIGH! Oh, that's what a combo bolus is for... duly noted. I'm still learning a lot.
• On Sunday I saw an old high school friend at church. This is kinda cool because I live 800 miles away from where I went to high school, and my old classmate lives in Los Angeles (he went to college at UCSD, so he visits frequently). Anyway, this is also cool because he has type 1 diabetes too! We dated (you know the "going out" kind of dating) our freshman year of high school when I had diabetes and he didn't. We weren't very close during our sophomore and junior years, but then senior we started chatting again in Physics class. Just before Christmas that year, he was diagnosed with type 1. I visited him in the hospital and we've shared that "diabetic bond" ever since. He's been pumping forever, and I always felt sort of embarrassed for not being on the pump, so I was REALLY excited to see him last week. I showed him my pump proudly. Turns out he's got the Minimed CGMS with the upgraded pump... very cool.
• I just turned in my rough draft of about half my thesis to my committee chair. Keeping my fingers crossed that his comments are constructive, and that he's basically pleased with it!!
• I've been listening to my friend's CD on repeat for the last couple weeks. Another friend from my hometown, she's currently finalizing her first studio album from Epic records. She's phenomenal!! I was so excited to see her live in San Diego a few weeks ago. It's very cool to see someone you've known as a child, succeed in something they're so gifted at. In junior high we lined up next to one another in gym class- her last name is Bareilles and mine was Barnum- so we were paired up a lot. I remember asking her to sing me "Total Eclipse of the Heart" all the time, she's always had a gorgeous voice. Well, now she's got the voice and an amazing song writing talent. She graduated from UCLA with a degree in communications and she uses words in her lyrics that you'd never imagine being in a song... and it works beautifully. Anyway, her name is Sara Bareilles and hopefully you'll be hearing of her soon :)
• My sister's dog is having puppies around Thanksgiving. She and her fiance bred their two German Shorthair Pointers, really great dogs. I want one of the puppies, but we live on the 6th floor of a highrise building downtown, not a great dog place. Time to start thinking about settling somewhere bigger... and more permanent.
• To end this brain dump on a diabetic note... after all the trouble with dinner boluses last week, I really focused and had a great result last night. We had meat loaf and baby red potatoes, I did a combo bolus 50/50 over 2 and 1/2 hours. At bedtime I was 124 mg/dl, at 3 a.m. 98 mg/dl, had 2 oz O.J. and woke up at 6:30 a.m. at 113 mg/dl. WOW, I love this pump!! :)

Sometimes you just have to laugh at yourself...

The last 18 or so hours of my life have been humerous (in hind-sight). Here's the rundown:

Yesterday was a typical crazy day at work. I was running around, finalizing financial statements all day and finally got to take a breath at about 4:45 p.m. My plan was to do a basal test overnight last night. Per the instruction in Pumping Insulin, I figured I'd eat dinner at 5 p.m., so I'd have a solid 5 hours between my dinner bolus and bedtime. So, on my drive to pick up my husband, I downed a PB&J sandwich on whole wheat. I bolused for 57 carbs, after calculating the carbs the night before (I even used a tablespoon to measure the jelly!) I had a haircut at 6 p.m. Came home and enviously witnessed my husband watching the NLCS game while drinking Sierra Nevada Pale Ale's (MY favorite!) Tried to hide my resentment at him enjoy the beers while I was fasting for my basal test.

I tested my blood at 7:30 p.m. and was met with 213 mg/dl. NO!! So, I did a small correction (had IOB already). At 9 p.m. I was 195 mg/dl. Frustrated, I did another correction. Went to bed at 9:15 p.m. Woke up at 2 a.m. with my blood sugar at 48 mg/dl. Nice. Basal test out the window at this point. Rather than have my typical O.J. for a low, since I was starving, I dug into the peanut butter and chocolate chips with two glasses of non-fat milk. (I like peanut butter, can you tell?!) I set an extended bolus for my obvious overcorrection for the low. Got back into bed... can't sleep. I've had this happen before, when my body starts digesting all that protein and fat, it doesn't sleep. WHY, OH WHY didn't I just have some juice?!? Lay awake for over two hours. Annoyed at my husband from breathing, or touching me, or doing anything!

My blood sugar stayed in the low 200s throughout the rest of the night, regardless of my repeated corrections. Woke up at 230 mg/dl and corrected. (Finally was 119 mg/dl by 8:45).

Got dressed in a hurry this morning in order to get to work early so I can leave at 4 p.m. to work on my thesis. (Yes, I have WAY too much on my plate right now!) I'm tired and hungry and VERY irritable. My very helpful husband got up early to move furniture because we're having the carpets cleaned today.

As I'm leaving, weighed down with all my bags, my husband calls to me "Can you move your books real quick?" I have books for my thesis stacked all over the living room.

I sighed, "Babe, I'm exhausted, can't you move them?"

He replies, "You know what order they're in."

I snap, "They're not in any ORDER!" while I start stacking them on the kitchen table.

As I finish moving the books, my husband enters the living room, "How am I going to move the table since it's covered with books? Can you put them on the couch?"

"Fine!" I start tossing the books on the couch. While my husband moves the table into the kitchen.

"Bye!" I yell as I pick up my bags to leave.

Wait, the table is now blocking the front door. I struggle to edge the table ever so slightly so I can squeeze out the door. Not working.

I drop all my bags and yell, "Damnit Dennis, the table is blocking the door!"

He comes out and yells back, "Don't yell at me! Just move it!"

So I shove the table back, grab my bags and march out the door. I can hear my husband muttering, "You better not have broken a leg of the table!"

An hour later I called my husband and sheepishly apologized for being so irritable. I also reminded him that I NEED him to help me if I'm going to work full time, write a thesis, be a wife, get my diabetes in perfect control for our upcoming pregnancy, etc. He's totally on board.

The reason this is so funny is that it's completely atypical for us. I'm pretty easy going, and my husband even more so. We don't really fight or even have many disagreements. Wow, was I in a mood this morning.

I was so frustrated with the pump. I'd tried hard to do what I was supposed to in testing my basal rate, and it totally blew up in my face. Obviously I didn't bolus enough for the sandwich and then made a poor choice in correcting the low... but man! So frustrating.

I think I'm going to test my nighttime basal by trying to eat an earlier dinner, so that my dinner bolus is pretty much out of my system by 10 p.m. Eating as early as 5 p.m., however, doesn't seem like the best way to test, since it's not at all my habit. Wouldn't it be better to see how my basal works on a typical night?

Ironically, my overnight blood sugars Monday night were superb! I was 113 mg/dl at bedtime, had 4 oz of milk and woke up at 6:30 a.m. with my blood sugar at 98 mg/dl.

Maybe I didn't need to test my basal rate at all!

Frustrations

Yesterday I had one of my few "I HATE diabetes" days!

Here's what happened:

Work has been crazy lately! I just switched positions in my department and now I provide administrative support to 50 people, instead of 7. I'm busy ALL day! Plus, there's a bit of a learning curve, so I'm dealing with goof-ups a few times a day. Plus, I'm PMSing, which always makes things better!

On Monday night I have a bedtime snack, thought I'd covered it with insulin and had a 350 mg/dl at about 3 a.m. Great. I proceeded to be "high-ish" all day yesterday. Hmmm. I was too busy at work to think much about it. At 4:30 p.m. I tested: 397 mg/dl. WTF?!?! Okay, time to check the pump which indicates that there is still 40 units of insulin in the reservoir. I try a "Fill Pump" and get a "blockage detected" alert. I call Smiths Medical. Got a very helpful rep on the phone. He walks me through opening the reservoir and trying a "Fill Pump" without the tubing attached. Got the same blockage message. I remove the reservior and comment to the rep, "It sure looks like its empty." I turned it upside down... it was completely dry!

Apparently my faulty pump set-up skills made the reservoir count off. Great.

I drove home from work (since I'd worked through lunch, I'd already put in 8 hours anyway) and called my husband and my mom crying. So frustrated!

I love my pump, really I do. I'm just going through all the growing pains of starting out. It wasn't that I was frustrated with the pump, I was just frustrated with diabetes. I had planned to do some thesis writing after work, which I couldn't do because I didn't bring any insulin to work with me (aside from in the pump). I HATE when diabetes interferes with my life.

Anyway, I'm over it now and my pump is happily pumping along. So, here's another potentially frustrating diabetes moment, that was kinda funny too:

On Sunday my husband and I took a walk down to Seaport Village. This is one of our favorite places in San Diego, and luckily walking distance from our apartment. I was at 190 mg/dl before we left, so I did a correction bolus and brought my meter and some raisins along. A couple miles into our stroll, I decided to test: 283 mg/dl! What?!? HOW?! Totally frustrated and thinking my pump must be malfunctioning, I did a correction of almost 2 units. We kept walking a bit, and suddenly I remembered: when I put some raisins in a small baggie, I had raisin gunk on my fingers... I even recalled licking my finger afterwards. Which finger did I just test?! So, I tested again: 130 mg/dl. Oh boy! Since the correction bolus had already completed, I did a temporary basal rate of zero and we headed to the cookie cart!

My sweet husband patted me on the back for being so quick to remember the sticky fingers, so that I caught the potential low before it happened. Yeah, well not quick enough, I thought.

Well, at least it was an excuse for a delicious cookie :)

Pump Successes and Failures

Yesterday I expereienced both the good and the bad of pump therapy.

I got to work yesterday and realized I only had two test strips with me. I've been incredibly sleepy lately (have I mentioned I'm writing a thesis and working full time?!) and have been pretty forgetful. Case in point: I realized at 4:30 p.m. the other day that I had two completely different earrings on!!

Anyway, I had two strips, when I usually use 4 or more during a typical day of work followed by thesis writing at Starbucks. Hmm. I had to trust the pump and just see how I felt. I tested at 11 a.m. 107 mg/dl. Had a bagel with cream cheese (such a no-no before the pump!) bolused for 75 carbs. At around 2:30 I had a small soup and a few Doritos; bolused for 30 carbs. Used my last test strip at 4:00 p.m.: 110 mg/dl. I still had almost 1 full unit on board, so when I had my nonfat, sugar-free vanilla latte at 4:45, I didn't bolus. When I got home at 7:00 I came in at 111 mg/dl. WOW! I love my pump :)

Before dinner I did a site change because I was down to 18 units in my reservoir. I didn't like my first site... so I pulled it around 9 p.m. and entered a new one. After a light dinner, at 9:30 p.m. my blood sugar was 244 mg/dl. Hmmm. A half hour later it was 282 mg/dl. I gave myself 2 units of insulin by syringe. Okay, I'll spare you the play by play of testing, bolusing and injecting... but at 11:30 I'd had it and called the support line at Smiths Medical.

Here's the thing, these highs after site changes have happened during my last three changes. Last Friday night I hit 400 mg/dl and felt TERRIBLE! I scared my husband, who'd never really seen me "sick" with diabetes. But, then the pump would kick in and be fine.

So, I talk to the support person and come to find out, I haven't been priming the pump correctly. I was basically doing all the right steps, but bubbles were obviously forming and thus I was getting air, not insulin, during the first 8-10 hours of each site change. This morning I remembered the post and comments on Jen's blog about bubbles in tubing. I was doing EVERYTHING wrong. Due to my hectic schedule, I wasn't often home long before I did a change, thus I was using very cold insulin straight out of the refridgerator. Also, I've also forgotten to fill the vial with air before drawing up insulin, I did it with my syringes too.

Well, I've learned a valuable lesson about pump set up now! I'll cut myself some slack, today makes exactly 2 weeks on the pump... I'm expected to have some start-up challenges, right?!

Question for the O.C.

I'm new to pumping and am realizing that my old insulin to carb ratios don't apply anymore. Thus, my new approach is to "trust the process" of the pump to see what new rules apply now.

Today my lunch was a Progresso Lentils bowl. The package said it contained "about" 2 servings. Each serving had 24 grams of carbohydrates with 3 grams of those as fiber.

My blood glucose was 101 mg/dl before lunch with 0.30 units on board from my post breakfast correction. My trusty pump factored all of that in, of course.

I programmed in a 48 carb meal and set an extended bolus over 30 minutes because of the slow response of the high fiber meal. The bolus came to 3.70 units.

Here I am, 2 hours later at 49 mg/dl with 1.85 units still on board!

I've already gobbled down half a Whatchmacallit bar before I posted this, so I'm on the upswing now... but what happened?!

Hmmm... I exercised this morning, so that might have helped me use my insulin more efficiently. I haven't determined a different basal rate for days I work out yet. But, this doesn't seem to be a basal issue... definitely an overdose on the meal bolus.

Here's the question: Should I have compensated for the high fiber content of my meal by lowering the total carb count? (I think I've heard this is the case for pumpers... but I haven't come across it myself yet.) OR Was the "about" 2 servings an inaccurate figured and I should have rethought my count? OR should I have set my extended bolus for a bit longer? I'm sure I'd still have gone low, but maybe not so quickly?

Thanks for any insight you might have guys!! Today I ordered the book "Pumping Insulin"- so help is on it's way!