Exercise

My biggest problem as I get older is getting enough exercise. I know that when I am able to get, just a little exercise, it helps stabilize by BG throughout the day. I have had several problems/excuses lately though. 

1) Weather: I hate going to and paying for a gym. I find that walking the dog is usually more than enough for me. She is a puppy and we don't walk slow. The problem is that this winter has been so cold and/or wet I haven't been able to get out for many morning walks.

2) Pain: I have developed a serious pain in the arch of my right foot. Everyone keeps telling me it's plantar fasciitis but the symptoms don't match and the insole I was given by a podiatrist made it worse. It starts to hurt about a half to a quarter mile into walking and doesn't let up until I stop.

3) Low BG. Finally, I still haven't gotten the hang of eating and/or insulin dosing for exercise. I'd love to lose some weight but it seems like every time I do go out and get some work in I end up going low and needing to eat. How do you use up those calories and work them off, if you just end up needing to put them back in?

I guess I'll have to just keep trying. hobbling along on my dog walks as soon as the rain stops. Unless there are other ideas.

Medtronic 670G

I haven't posted here in a while but I thought I'd give you some thoughts on my new pump. Recently I was forced to switch back to Medtronic as a pump supplier because of United Healthcare's exclusive deal with Medtronic. Any other pump would have been considered out of network and the costs would have been prohibitive. I chose to go ahead back to Medtronic. As a disclaimer, I stopped using Medtronic pumps years ago because of being discouraged by their customer service and billing practices. I had really enjoyed and gotten used to the Dexcom sensor and the Tslim pump so this was  a major disappointment to change and it took a lot of getting used to. 

When my Tslim went out of Warranty I switched to the Medtronic 670G. It is their newest pump/CGM combo and has the Automatic mode that allows the pump to make decisions on basal rates of insulin based on history, glucose readings and trends. I had a hard time trusting this pump. On first beginning to use the CGM it didn't seem to (and still doesn't) stay as close to actual BG readings as the Dexcom did. It is also very particular and can fall into a pattern of asking for glucose readings and calibrations over and over again if it falls to far off the actual. I have, several times, just given up and turned the sensor off for an hour or so before turning it back on and resetting the whole thing. The automode makes it even more sensitive to readings being off and again can fall into this seeming loop of asking for blood glucose to stay in auto mode. When I had my Dexcom if it ever became too separated from actual BG readings I would calibrate it would come back into line and move on. This pump/sensor does not seem to be able to do this. It can become maddening at times getting buzzed and beeped over and over again with warnings and asking for BG results. Very frustrating. 

Changing of a reservoir and infusion site is much faster and simpler with the Medtronic pump than the Tslim. It also seems to use the insulin up better. I always felt like I was wasting insulin on the Tslim. 

Changing the CGM sensor with the Medtronic is ridiculously more difficult than the Dexcom. What I could do in a couple of minutes with one hand now takes over a half an hour, (you have to wait to charge and clean the transmitter) and I usually need help from someone else. 

All that being said, my A1c has been much better with the Medtronic. I joked with my family that it is probably for two reasons. 

1. Automode really does help stabilize BG especially overnight. 
2. The CGM built into the pump is so finicky I find myself being really careful not to send my BG to far out of whack so I don't have to deal with the CGM freaking out. 

Just some random quick thoughts on Medtronics latest pump. Let me know if you have any questions. 

Somebody Ran Over My Dexcom

I have to go back to regular blood tests for a while. A few days before Christmas while running errands my Dexcom receiver fell off of me. I had it in it's belt clip and was wearing it on my left side. I guess I jarred it a bit loose getting out of the car and while I was jogging across a parking lot it fell off. I didn't notice it missing until I got back to the car and found it, still in it's leather belt clip in the middle of a traffic lane. Unfortunately it had been run over as it sat there.

Over the past few days I've had to get used to not knowing what my blood sugar is between finger sticks. I gotta tell you it's really weird.

I got so used to glancing down and seeing where I was as far as blood sugar went. Waking in the middle of the night and picking up my receiver to see how I was doing. Trusting that silly thing to wake me up if I dropped too low.

The good news is, wearing it for as long as I did taught me enough about my body and it's reaction to insulin and food that I've been able to keep blood sugars fairly stable without it. Even through the Christmas Holiday and several parties with lots of dangerous grazing food available I didn't get too out of hand. So even wearing a CGM for a while will help.

The other thing I pretty sure I've decided is that I might have been believing I could do far too much with this technology. I was trying to make my blood sugars look, "normal."  I'm fairly positive that is not possible. My body is not normal and no amount of technology and work that I do could even begin to match what a functioning pancreas does on it's own.

My goal now is to control it. To be close to normal. To not be swinging from highs to lows and spending hours and days far too high. My blood sugar may not be normal but I spend far less time above 200 than I used to and I'm going to try and be happy with the occasional spike.

I can't wait to get a new DexCom receiver though.  I hope to ordering a replacement fairly soon.

Sometimes you do everything right and it still doesn't work.

Rough night last night.

Admittedly, I didn't eat great.  Everyone else was out so I just grilled a ham and swiss sandwich added some Cheetos. I had some crackers and dip too because Kristy left some of this wonderful ranch/bacon dip that she took to the ladies Christmas banquet. I might of had some dessert too, a couple of Hershey's kisses. I was fairly sure I accounted for all of that, though, when I set up my bolus. I took almost 20 units of insulin 12 units up front and the rest spread over a two hour period.

Thant was all around 6:30. Around 8 I started seeing my blood sugar go up. By 9 it was above 200 and I took extra insulin. At 9;30 it was above 250 and I took more insulin. Remember I haven't eaten since 6:30 (Ok I  had a pickle and some cheese, maybe a carb) Around 10 it appeared my blood sugar was taking a break from the rise. It had leveled off at 290. I thought, maybe all that insulin was going to start kicking in. It didn't. I started feeling bad and also started asking Mallory, who was watching Oregon  beat up on Arizona with me, If she smelled insulin. I began to look for  leaks  in the tubing or evidence that  there  was  something wrong with the infusion site. While I thought I smelled insulin I couldn't find any  liquid on the tubing or near the site. I told Mallory  that  I would wait till morning and see if my blood sugar ever went back down.

At 11:00 though I looked at my blood sugar one more time; 323 and rising. I thought, "I didn't eat that much. It's gotta be the infusion set." 20 minutes later I had changed all the tubing and changed the site where it was connected to me. I over-rode the pumps safety features and took 15 units of insulin. I figured I hadn't gotten most of what I had taken through the evening. I set my continuous glucose monitor alarms to high set it next to my head and went to sleep. I woke several times overnight and each time checked my CGM. Each time it indicated that my blood sugar was going down but not dangerously. I woke at 6:00 with a blood sugar of 98

A couple of points to make through this story

• Sometimes diabetics do everything right and it still doesn't work. If you have a diabetic friend or family remember please  don't assume that a problem With blood sugars means they aren't doing a good job controlling themselves. And if they get frustrated by this disease, remember you'd rather have them frustrated and fighting it than having them give up and let blood sugars run Crazy because they are too hard to control.
• Another push for CGM's. This entire night could have been a lot messier and a lot more difficult without it.

All about that pump

Found another great diabetes blog site. This video reminded me that all of the stuff I go through: There are millions of kids and their parents fighting the same battle, remember insulin is not a cure!

http://blog.thediabetessite.com/type1girls/

Surprising results in a weekend where I ate out a lot.

I'm wondering what affected these outcomes most

• Good carb estimation? 
• limiting extra carb input? 
• plenty of exercise? 

Kristy and I went to Louisville Kentucky for the weekend for a late celebration of our 27th anniversary. We ate out a lot and since I'm a craft beer fan and Louisville seems to be a center for craft breweries I sampled some craft beer. I didn't go to get drunk but did enjoy a few strong ales and stouts. 

To my surprise my blood sugar stayed well under control all weekend long. Even after the Pretzels and cheese appitizer the first night we were there. The Nacho's at Churchill Downs and the amazing "loaded Kettle Chips" at Troll Pub Under the Bridge. 

Several things I think I did right to help with Blood Sugars on this trip. 

1. I really focused on a good estimation of carbs and didn't hold back on the insulin to deal with it. 
2. If I added carbs in an appitizer (pretzels or chips) I limited carbs with my meal. No sides with my BBQ on the first night and left my fries on the plate at Troll Pub. 
3. We did a lot of walking. Even though it was cold, we walked most everywhere in downtown Louisville. 

the takeaway from the weekend? You can go out and enjoy yourself while controlling you're blood sugar. You just have to be intentional about it. 

On diabetes awareness day

If I had one thing that I wish the public understood about type 1 diabetes it would be understanding how difficult this is to control.

It's like when you interview the opposing team before they play Peyton Manning or Russell Wilson. The reporter will eventually ask the question, "What are you going to do to control that guy?" The answer is always the same. "We have a plan to try and contain him but the truth is you can't control him you just have to try and limit his effects." That's what fighting type 1 diabetes is like.
You  come at it with a plan, sometimes that plan works, sometimes it doesn't. The most frustrating thing about being a type 1 diabetic, as I get older, isn't the diet, the shots or even the blood tests. It's those times when you are doing everything you're supposed to be doing and it's still not working.

That's the thing I wish people understood. That insulin isn't just a medication you take to fix the problem. Taking insulin means a delicate balance of food, insulin and exercise. Stress and infection can affect the way your body processes the insulin you take and the food that you eat. Just about the time you think you have it figured out something changes and nothing seems to work anymore.

I love those days where everything seems to work and my blood sugars stay somewhat normal. The truth is though I spend most of my time trying to figure out what I did wrong and wondering why my blood sugar is either much higher or much lower than I thought it should be.