And This is Why We Struggle

I recently filled out a long diabetes survey where I had to rank the potential benefits of a hybrid artificial pancreas system. One of the choices was a good night’s sleep. I think I rated that as Benefit #2 and I can’t remember what was #1. Probably accuracy of the CGM sensor.

Last night I had proof that a good night’s sleep is hugely important to me and proof that it is occasionally an elusive unicorn.

From the CGM history on my Tandem pump.

7/30/21     12:45am     Out of Range Alert

7/30/21     1:20am       Out of Range Alert

7/30/21     1:20am       Fixed Low Alert

7/30/21     1:20am       Fixed Low Alert

7/30/21     1:45am       Fixed Low Alert

7/30/21     3:40am      Fixed Low Alert

7/30/21     4:35am     Fixed Low Alert

7/30/21     4:40am     Fixed Low Alert

7/30/21      4:45am     Fixed Low Alert

I am not sure how many of those vibrating alerts I slept through and for sure the Out of Range alarms were the result of me sleeping on top of my pump. But I was woken up 7-8 times during the night. My husband probably 3-4 times. At some point I turned off my phone to stop the “Nerd Alert” 55-low alarms.

Last evening we flew from Baltimore, MD to Minneapolis. Several hours waiting at the airport followed by an unpleasant boarding experience and an uncomfortably hot flight. But as always with flying, if you have an equal number of take-offs and landings, it is a good day. But it was still a cr*ppy flying experience with Delta which is normally good for us.

In general Control IQ protects me from most lows and it is rare that I have an overnight like last night. I had several carb-loaded snacks on the plane (there was nothing else to eat) but all of those boluses should have disappeared several hours before I went to bed. At 7:30pm mid-flight I took my 5u nightly Lantus bolus with an insulin pen. (I use the untethered regimen with Control IQ to give my body some insulin that the Tandem pump can’t suspend. It works well. Usually….)  I remember in previous years reading articles indicating that insulin pumps might not deliver insulin correctly while taking off and landing on airplanes. Air pressure issues. Does that affect insulin pens? And my bolus was mid-flight, but probably at 35,000 feet. I have never worried or taken precautions about my pump. Should I have not trusted my pen-bolus?

Our flight landed at 8:30pm and we were home within 30 minutes. A little TV and straight to bed. Here is a photo of my 12-hour pump screen from 10:00pm last night until 10:00am today. The red areas show where my insulin was suspended. As you can see, there were several hours overnight where I was in the 50’s despite hours of getting very little insulin from the pump and eating at least 4 glucose tabs. I actually tested with my meter once to confirm that the CGM was correct and it was. I never soared high after all of these suspensions and that is unusual. So the Lantus must have been super-charged. I don’t think that any of the early-evening Novolog pump boluses could have still been active. I am never someone  who thinks that my body occasionally produces insulin. It doesn’t. So something was definitely awry last night.

The two hours from 8:00am to 10:00am reflect a typical breakfast bolus for 20 carbs (oatmeal, almond milk, and chia seeds) followed by a 3-mile walk. That insulin suspension is expected and common. It is the previous 10 hours that is crazy.

I had a bad night’s sleep and awoke today tired and achy. But when I got up, I was mostly fine and I had a good day with no fatigue. But gosh darn-it! It is horrible to be awakened over and over again by my diabetes devices. Or is it my diabetes devices communicating the craziness of my diabetes? Either way, I hope that future generations of D-tech, improved artificial pancreas algorithms, and faster insulin products can eliminate nights like last night.

I am thinking that I should move “a good night’s sleep” to the #1 position in my diabetes surveys.

6 thoughts on “And This is Why We Struggle

  1. Laddie, thank you for keeping me on your “alert” email list. When we first “met” I read every post and followed your ups & downs of the CGM life.

    Then life got in the way of many things. More important (family) matters came to the front and everything else was pushed aside. I found myself in the middle of a perfect storm of bad things happening to good people.

    But enough about me, thanks for sharing.

    I do have a favor to ask. I publish an (almost) monthly newsletter (electronic) to 600 or so clients and friends who are on Medicare. It is getting harder to come up with fresh material that doesn’t seem like rehashing the same old thing. I feel like the preacher who, having stayed too long at the same church, was greeted with this from one of his parishoners.

    “Sam, that was a really good sermon. Not a great one, but a good one. Much better than most of the 17 times before when you have used the same Bible verse to make us aware of our shortcomings. Keep up the good work. I am sure there is a church out there that is in need of fresh material”

    That being said, would you mind if I link to this post in an upcoming newsletter?

    Take care,

    Bob

  2. I made it number 4. Numbers 1, 2, and 3 had to do with Sheryl not hitting me anymore over low and high alerts. I put one in at 1:45 AM (dont make Sheryl want to hurt me), 2:15 AM (dont make Sheryl want to hurt me), 2:30 AM (dont make Sheryl want to hurt me) and I was about to put in 4:00 AM (dont make Sheryl want to hurt me), but Sheryl had made me leave the room so I put in sleep.

    rick

  3. Pingback: And This is Why We Struggle – Diabetes Today

  4. Pingback: And This is Why We Struggle - Health Guard Medical News

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