Two Life Hacks and a Story

Laddie_Head SquareGoing Home with an Animas Ping/Vibe:  I have been using an Animas Ping pump for over two years and still go crazy with the convoluted menu system. One of the most frustrating things is the lack of an Escape or Back button and I have b*tched about that more than once, twice, ten times, a hundred times. Many bloggers reviewing the just-released Animas Vibe complained about the same thing.

in the Animas Users Group at TuDiabetes, a Norwegian Vibe user with the screen name of Siri (not my iPhone Siri) told me about a shortcut to escape the endless menus of Animas pumps and return to the home screen. Just press the Audio Bolus button on the right side of the pump. Then press the OK button or any key on the front of the pump. You will be returned to the home screen. Siri learned this from her Animas Rep.

With this trick, I will probably save an inconsequential 5 minutes a year, but I will save myself oodles of frustration. Honestly I have to admit that in the last couple of months, I have become so adept with my Ping that I really don’t hate it anymore…. I am definitely looking forward to receiving my Vibe:-)

iPhone trick:  Younger readers of this blog who have grown up texting probably know about keyboard shortcuts. Even I knew about them and had seen the “omg” already programmed into my iPhone and iPad. Because I text like an “old person” and type out exactly what I want to say, I never bothered using shortcuts and never programmed any into my phone. A couple months ago after being annoyed about having to type my email address into so many online forms, it dawned on me that I could use a keyboard shortcut for my email address. Therefore I programmed “mgm” into my phone as a keyboard shortcut for my gmail account.  I set up “mcm” for an alternative Comcast email account. “tgg” enters my blog web address. These shortcuts work on most websites and blogs and save me a lot of error-filled typing.

To set up a keyboard shortcut, go to Settings/General/Keyboard/Shortcuts. Click on the + in the upper right hand corner. Enter your email address as the phrase and a series of letters for your shortcut. One glitch is that a space is automatically entered after your email address when you press the space bar to use your shortcut. That is great for emails and texts, but most website forms interpret this space as meaningful and will reject your address. So after the email populates itself, you may have to backspace before entering your password. Keyboard shortcuts entered on one device automatically show up on your other Apple devices.

If you decide to give this a try and like it, just remember that you learned this from a 62-year old woman. It is never too late for this old dog to learn new tricks!

A Story:  Last Wednesday I hiked in the morning with a group of friends. I came home, cleaned up a bit, and had lunch. The refrigerator was empty so I went to “town” to shop. In the winter I live in the boondocks of Arizona and have a 20+ minute drive to the grocery store. Although I had drunk a lot of water on my hike, I was still thirsty and grabbed a can of carbonated water for the road.

I went to the hardware store, took Abby the Black Lab to the dog park for tennis ball retrieving on grass, and went to Safeway to buy food (low carb of course!). I was still thirsty so stopped by the adjacent convenience store to buy an unsweetened iced tea to carry me through the afternoon.Bud Light Box I grabbed the almost empty can of carbonated water to throw away and gasped as I saw it was a can of Bud Light! I had been driving around town drinking beer. Arizona has no-tolerance laws for alcohol and driving and I think that I would have been thrown in jail had a policeman seen me chugging beer as I completed my errands.

Bud Light in cans is not our beer of choice. I think this can was 3-4 years old and a remnant of the last time my husband entertained Minnesota golfing buddies in our winter paradise. Because I try to avoid Diet Coke, I drink enough weirdly-flavored carbonated water and iced tea drinks that a flat, tasteless beer didn’t register as something I shouldn’t be drinking.

I’ve told this story to many of my local friends. Everyone proclaimed that I was the last person that they would have envisioned drinking and driving at lunchtime. They also swore that they would have visited me in jail. It is a funny story that is actually quite terrifying.

When I got home, I checked my refrigerator’s “canned water” bin and there were no other cans of beer. I wish that I had checked the date on the beer can to see how old it was. At the same time I am glad that this is just a funny story told from the safety of my living room. Because I was totally unaware of what was going on, I have no idea how I would have tried to explain this to a policeman.

Summary: One diabetes hint, one iPhone hint, and a story about drinking and driving. Sounds like a great blogpost to me:-)

The Lantus Experiment Part 2

Laddie_Head SquareMy previous blogpost about my Lantus experiment ended with a hint that the story was not over when I returned to a pump-only regimen. So what happened?

A week and a half after quitting Lantus, I had one of those middle-of-the-night diabetes fiascoes that we all hate. My Dexcom CGM buzzed me at about midnight and I corrected a high that seemed odd but not unprecedented. 3 hours later Dex screamed that my BG was 381. After confirming the number with my meter, I gave a correction bolus by syringe. Exhausted and nauseous, I filled a new reservoir and inserted a new infusion set. Mind you, this was all happening at 3:00AM.Dex_Dec14

Upon priming the tubing, I saw insulin flood out of the plastic connector piece rather than drip from the metal needle. I had accidentally attached the old tubing and immediately understood my sky-high BG. I attached the correct tubing, primed, and went back to sleep. As is typical after correcting Himalayan highs, I woke up to a low of 51 at 7:00AM.

I was mad. I was frustrated. I was angry at myself and exasperated with the devil that we call Type 1 diabetes. I decided to go back to the untethered regimen. Big deal if I was stressed by cell phone alarms. It was time to suck it up and use an insulin regimen that would protect me from “not my fault” pump problems.

I reactivated the cell phone alarms for 7:30AM and 8:30PM. To correct the problems that I had with only infusing 0.1 units per hour by pump, I doubled the pump basal rate to an average of 0.2 units per hour. Using the original Lantus doses from late November, I was taking a much larger amount of basal than in recent years. Because it was holiday time with lots of food, alcohol, and stress, the higher basal worked fine. Some people believe that there is one “nirvana” basal rate. My opinion is that it just needs to be in the ballpark because every day is different and my ideal insulin dose is always a moving target.

So I was back on Lantus. Blood sugars were fine, but not spectacular. I tend to do really great at first whenever I make a major change in my insulin regimen. If I switch insulin brands, I often go low as though the new insulin is magically potent. Then after a week or two, things get back to normal. Similarly the addition of Lantus initially made my morning numbers incredibly stable, but during this second experiment I began seeing the return of a few unpredictable BG excursions.

I always wonder if my body actually reacts to changes in insulin or hardware in a physical, measurable way. Or is it all psychological and I just get better results because I pay more attention to my diabetes and make better choices on food and other controllable factors? Either way I will always be optimistic that there is something better out there and I will always keep trying new things. If nothing else, these experiments alleviate some of the daily boredom of living with diabetes.

Ten days ago I ditched Lantus again. I hated the cell phone alarms and was actually waking up in the night concerned that I would miss the morning alarm. After pumping for ten years, I had no confidence that I would remember two injections a day without reminders. In general on Lantus I had pretty good numbers except for poor food/drink decisions and a couple of “WTF” BG excursions. But in the end it wasn’t hugely different from a pump regimen.

Summary: I am back on my pump 100%. As outlined in My Lantus Experiment Part 1, there are many advantages to using Lantus or Levemir with a pump. However, at the moment I just can’t live in that world. That doesn’t mean that I won’t try it again someday. I will definitely continue to use Lantus as a pump supplement on beach and lake vacations as I have in the past. But for now the mental stress and “diabetes burden” of using Lantus are just not worth the slight improvement in my BG numbers.

*****

Disclaimer: Nothing I say here should be construed as medical advice and please do not change your insulin regimen without consulting your medical team. At the same time remember that diabetes is a life-long science experiment (Thank-you Ginger Viera!). When things aren’t going well, take some time to investigate different diet plans and alternative ways of dosing your insulin. And no matter what, test your blood sugar often and always carry glucose tabs:-)

The Lantus Experiment Part 1

Laddie_Head SquareIn a recent blogpost I wrote about my plans to experiment with using Lantus along with my pump. Although unusual, this is not a novel idea and is described by Dr. Steve Edelman in a 2004 article as the untethered regimen.

Starting in late November I used Lantus in tandem with my pump for two weeks. Although there were measurable benefits to injecting part of my basal, there were some definite negatives that were specific to my insulin requirements and the type of pump that I use. There were also a few things such as ease of use and expense that demanded consideration.

I started the trial by giving about 75% of my total basal split between two injections of Lantus: one at 7:00AM and the other at 8:30PM. There was nothing scientific about that except those were convenient times and I wanted any Lantus overlap to be first thing in the morning which is a problematic time for me. The balance of my basal was programmed into my pump with a little less through the night and a little more in the morning and evenings.

Let’s start with the positives. For the first couple of days I felt that my blood sugar between meals and overnight was more stable than it had been in ages. The most noticeable effect was in the mornings before breakfast. I often struggle with my BG starting to rise the second I get out of bed. It is not an easy basal fix because I tend to go low in the dawn hours before getting up. Sometimes I take a bolus right after getting up and that helps. But sometimes that bolus makes me go low. And other times I have already started to go high and struggle to get back on track even with boatloads of insulin. With the slight overlap of Lantus at this time, my BG remained stable almost every day until I chose to eat. It was a wonderful result.

The addition of Lantus also minimized BG rises after changing infusion sets. Set changes tend to be a problem for me even though I’ve tried lots of the tricks of the trade to avoid that: extra prime, never change sets in the morning, leave old site in, put new site in a few hours before using, and increase basal rates for several hours. I have never found anything that works every time. Of course nothing works every time with diabetes….

Now for some negatives.

At this stage in my life my basal rates are extremely low. After taking 75% of my basal by injection, I was left with only an average of 0.1 units per hour to be delivered by pump. The total of Lantus and Novolog ended up being a slight basal increase for me and maybe that is the reason I felt as though my BG levels were more stable.

The first problem I had with the untethered regimen was with temporary basal rates which I use on a regular basis. Unlike my previous Medtronic pumps where you can set temp basals either to a specific amount or by a percentage change, the Animas Ping only allows percentage adjustments. With a 0.1 hourly rate, it was difficult to make meaningful changes to my total basal. As I thought of insulin adjustments for my winter hiking excursions, even if I set my pump basal to Off, a reduction of 0.1 per hour might not be sufficient.

Another result of the extremely low basal rates on the pump was that it lost prime three times during the two week period. (Losing prime is an extremely annoying problem with Animas pumps and results in no insulin delivery until you correct the problem.)  If you are in the middle of Target, you don’t really want to reach down your pants to unhook your tubing to re-prime the pump. And that is if you’re lucky enough to hear the musical chime that the pump is no longer delivering insulin. Technically some children use basal rates as low as 0.1/hour and the pump shouldn’t have lost its prime. But it did with both of the reservoirs that I used.

My Lantus Experiment_1

After a few days I began to have daytime lows probably because of the increased basals. So I reduced the Lantus by one unit. Then a few days later I tried another reduction and decided to take it all at night and none in the morning. I increased my pump rates to compensate for the reduction in Lantus. Very quickly I lost the benefits that had been provided by two injections of Lantus. Frankly that means that I didn’t have a clue what was going on anymore.

Although I do not have insurance problems buying both Lantus and pump supplies, it is certainly a more expensive regimen and could be considered to be “double dipping.” Many people justify a pump purchase by indicating that long-acting insulin can’t be customized to fit their basal needs. So here I am saying that the pump by itself isn’t doing the job and I need to add Lantus to the mix….

I also got to the point that the addition of two Lantus injections and the corresponding cell phone alarms added too much complexity and regimentation to my life. Diabetes takes up a huge chunk of my brain power already and I don’t need more nagging demands from it.

So I decided to go back on the pump full-time after the 2-week experiment. I was back to where I was before the experiment. But not exactly. I suspect that increased basal rates were part of the reason I benefited early on and my basal rates are set slightly higher than before. But not a lot because I am trying to avoid lows.

Try not to go too high. Try not to go too low. That’s Type 1 diabetes in a nutshell. Not much has changed, I guess….

This should be the end of the story, but it is not. Please stay tuned for the next installment of the Lantus experiment.

*****

Disclaimer: Nothing I say here should be construed as medical advice and please do not change your insulin regimen without consulting your medical team. At the same time remember that diabetes is a life-long science experiment (Thank-you Ginger Viera!). When things aren’t going well, take some time to investigate different diet plans and alternative ways of dosing your insulin. And no matter what, test your blood sugar often and always carry glucose tabs:-)

Flat Tires and Diabetes

Laddie_Head SquareI had a great day planned for December 31.

I started the day by meeting my oldest son and his three children at McDonald’s. The kids ate a breakfast of varying portions of scrambled eggs, sausage, and pancakes. (Health Alert!!! I bought the fruit cup once and no one would eat it, including me. I now save my money and leave vegetables and fruit to lunch and dinner.) The kids had a fabulous time playing on the indoor playground and I got a rare opportunity to catch up with my son one-on-one. After almost two hours we headed to their house so that I could see the wondrous things that Santa had brought.

Next on my agenda was lunch with a couple of D-friends. One of the attendees was Ann W. accompanied by her diabetes alert dog (DAD) Lily. I wrote a blogpost about Ann in July 2014. Also coming was Kathy P. who used to write a blog called Purple Haze but now mostly hangs out on Facebook and TuDiabetes. And drumroll please! This was going to be my first opportunity to meet Molly K. and her new DAD, Hope, who were in town from Wisconsin.

At 11:30 I went out to my car to drive to the restaurant in the Uptown area of Minneapolis and unfortunately was greeted with a flat tire. (I had heard a bang on the highway back from McDonalds but didn’t think anything of it.) Because the temperature was in the single digits, I knew that AAA would be backed up. I made the call and hoped for the best. The whole experience ended up being a comedy of errors when they couldn’t get the wheel off the car and then the air compressor didn’t work to fill the spare. It took a couple of guys with various trucks 3-1/2 hours to get me back on the road. At least I was stranded at my son’s house rather than by the side of the highway.

At lunch I wanted to be here (thanks to Kathy and Molly for the photos):

Ann_Kathy_Molly

But I was here:

Flat Tire_Square

Once I was safely home, I decided to skip the New Year’s Eve party on my agenda. My husband was out of town and I had an airport taxi showing up at my house at 5:15 the next morning. Although there were two cars in the garage, I didn’t trust either of them to get me safely home at midnight. One was wearing the donut spare tire and the other one doesn’t like to start in cold weather….

Later in the day, Ann sent me a text that summed up the entire day.

Text Flat Tire

Yeah, that pretty much says it all.

Making Memories

Sue B_Head SquareMy husband Marc is a Type 1 diabetic with hypoglycemia and hyperglycemia unawareness. Before going on Medicare in June of 2012, he had been using a Continuous Glucose Monitor (CGM) with full coverage by private insurance. As most of you know, Medicare does not cover the CGM. We spent almost two years going through the Medicare Appeals process and lost at every level. As we were deciding whether or not to go further (Federal Court), a night in shining amour came through for Marc in the form of the Veterans Administration. He had applied for VA benefits two years ago and that’s how long it took to get his application processed. Once it was processed, things moved quickly and in less then a month after his initial meeting with an endocrinologist, Marc was notified that a CGM and sensors were on their way. Since that day, the VA has sent all the supplies free of charge and for that we are very grateful. I use the word “we” throughout the blogs that I’ve done on our two year journey to get the CGM because I became Marc’s advocate and did all the blogging, letters to everyone I thought could help us, and made many connections with other people with diabetes. Although I do not have diabetes, I immersed myself into the cause to get Medicare to change their guideline for the CGM and will continue to do so.

The intention of this blog is not to be about diabetes. It’s about making memories. On Friday, December 19, Marc and I will leave for Florida. On Saturday, the 20th, our children and grandchild will meet us in Florida and on the 21st, we are going to board the Carnival Conquest for a 7-day cruise. This is in celebration of Marc’s and my Making Memories45th wedding anniversary. Marc and I did the same thing for our 40th anniversary and the memories we made during that cruise were invaluable. My daughter Robin, her husband Greg and our granddaughter Bailey live in Atlanta, as does our son Jason.  Marc and I live in Pennsylvania. There are over 800 miles between us and we don’t get to see our Atlanta family as often as we would like. When we did our 40th anniversary cruise, Bailey was only 5 and it was priceless seeing her delight during the entire cruise. She, as well as all of us except Greg, did a zip line. Together with her parents she went on a riverboat ride, and we all enjoyed the beaches in all the ports we went to and life aboard the ship. Bailey had ice cream for breakfast, lunch and dinner which is something that would never be allowed at home. Marc and Jason snorkeled and Jason jet skied. We all had new and adventurous experiences and had a great time being together. Now that Bailey is 10 and we are so looking forward to her new experiences and ours as well.

In the past few years, we have lost many friends to various diseases. One passed away from ALS and another died after a major heart attack. A few friends died from various types of cancer or have cancer presently and are going through treatment. My brother has had health issues and recently had two surgeries. And of course, for us, living with diabetes is always a presence in our lives. It’s a blessing when we have the opportunity to do things with our family and create memories that we can always pull out when times get rough.

At the age that Marc and I are at now, we want to make memories with our children and granddaughter that we can all cherish for many years to come. We know they also feel the same way. This is what is really important in life. The love you have for your family. The love they feel for you and all the happy moments that can be captured. It’s what makes life worth living.

A Twofer

Laddie_Head SquareToday’s post is a twofer. Two topics for the price of one. Short and sweet so we can concentrate on more fun activities during this week of Christmas.

Diabetes complications come in many forms. Some problems are serious and even life-threatening. Some are minor but annoying. Today I am looking for sympathy for a crack in my thumb that is sore and resistant to healing. The cold weather in Minnesota and the lack of humidity in Arizona make me vulnerable to skin cracks like this especially since I have horrible fingernails that do not protect my fingertips.

And why am I calling this a complication of diabetes? Am I usually slow to heal? No. Do I have neuropathy in my hands? No. Is my circulation impaired from diabetes? No. Is my Hand Roundskin dry because of erratic blood sugars? Not really. This stupid crack is related to diabetes because I keep using this thumb to squeeze drops of blood from my cold Minnesota fingers which tend to be stingy in the cold weather.

I put bandaids and Aquaphor on the thumb and it starts to improve. And then boom! I forget about the almost-healed crack and squeeze a frigid finger on my left hand. If I didn’t have to test my BG, this thumb would be perfectly fine. Darn you, diabetes!

My current solution as seen in the photo is a trimmed gel toe protector. (These little stretchy gizmos are great for hiking and help minimize injuries to vulnerable toes from long hikes on rocky trails with lots of ups and downs.) It has more cushioning than a bandaid and stays on well. Plus you can take it off to wash your hands. Since I just thought of this today, we’ll see how it works:-)

The second topic of this post is to wish you a Merry Christmas, a Happy Hanukkah, or just a good day depending on your beliefs and traditions. I am looking forward to a visit from my New York son and his family and to spending time with my Minnesota son and his family. On Christmas Eve we will celebrate with four grandchildren aged six and under and life will be busy and chaotic. I can’t wait!

As you celebrate (or try to survive) this holiday season, may your blood sugars be stable and your days filled with joy!Happy Holidays 2014

Eight Days of Hanukkah

Sue B_Head SquareSince I celebrate Hanukkah, I decided to take each day of our eight day celebration and write what I am most grateful for.

On the 1st day of Hanukkah, I am very, very grateful for my husband Marc.  He is my rock and has been for over 45 years.

On the 2nd day of Hanukkah, I am grateful for my children: my son Jason, my daughter Robin and her husband Greg and my granddaughter Bailey.  They are the loves of my life.

On the 3rd day of Hanukkah, I am grateful for my friends.  Most of them have been in my life for over 35 years and since most of us live away from our immediate families, we have become family to each other.

On the 4th day of Hanukkah, I am grateful for my love of doing things with my hands.  I Menorah2014love crafting especially knitting and beadwork.  I especially love knitting afghans for our friends’ children who are getting married and for the babies when they come.

On the 5th day of Hanukkah, I am grateful for my love of reading.  I have traveled to different places and learned so much because I love to read everything and anything and have always, since early childhood loved the written word.

On the 6th day of Hanukkah, I am very grateful that we have a wonderful Hanukkah gift of a cruise for our entire family.  Since we haven’t seen sun here for the past five days (Harrisburg, PA), it will be wonderful to be in the sunshine and warmth of the Caribbean.

On the 7th day of Hanukkah, I am extremely grateful to the Veterans Administration for supplying a Continuous Glucose Monitor  (CGM) to my Type 1 diabetic husband Marc.  After a 2 year fight with Medicare that was frustrating and going nowhere, the VA is supplying the monitor and sensors free of charge.

On the 8th day of Hanukkah, I am very grateful to myself for having the tenacity to decide to fight for the CGM.  I learned so much about myself during this journey.  I never knew I had it in me to blog, to do a Podcast, to speak to so many people across the United States who were in the same predicament as Marc and make so many new friends.

So to everyone who reads my blogs, I wish you all a Merry Christmas (or Hanukkah) and a very Happy and Healthy New Year.