Category Archives: General Diabetes

Stepping Out with Diabetes and a Fitbit

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Laddie_Head SquareThis is one of those posts where I need to state that I am not a medical professional and nothing I write should be considered medical advice. My aim is to share some ideas about how a Fitbit activity tracker fits into my life with diabetes.

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In the last couple of weeks there has been chatter around the DOC about Fitbit and other activity trackers. Some of the talk has been about Fitbit challenges which are well-described in Kerri’s post at Six Until Me. I also wrote a post about one specific challenge.

Although I have enjoyed recent challenges, I owned a Fitbit for almost 2-1/2 years without linking it to social media. Even without friends and challenges, I found a Fitbit to be very motivating in an un-nagging sort of way. Although no one was monitoring whether I reached my daily goals, seeing the numbers tended to encourage me to take the dog for another walk or start using the upstairs bathroom to get extra steps (doin’ the Karen Graffeo).

I am a big fan of activity trackers when it comes to diabetes. Most of the things we PWDPump and Fitbit-001 are told to manage fall into the following areas:  diet, medication, exercise, BG monitoring, and psychosocial support. It is impossible to be perfect in any of these areas, but in my opinion the better I can do “on average,” the better I feel and the better my diabetes numbers are. For me there is no doubt that my Fitbit helps with the exercise component of my diabetes care.

Some of the reasons are:

Consistency:  Diabetes like consistency. By trying to reach my Fitbit step goal every day, my activity level is steadier than it would be without the device. Over time I believe that consistent exercise has resulted in lower and more predictable insulin requirements and I have fewer severe lows when I work out. At age 63 I can arrange my schedule to walk a few miles every day after breakfast and that exercise is reflected in my basal rates. If I skip the walk, I often set an increased temporary basal rate for a couple of hours.

Many of you are not be at a stage in life where you can exercise at the same time every day because jobs, children, weather, etc. demand your attention. At the same time you can work to be more active every day as you try to reach your step goal. Park your car at the far edge of the parking lot, take a longer route to the water cooler, walk around the house when you are on the phone, take a lunchtime walk. The advantage of an activity tracker is that you have data to monitor changes in your daily activity.

Motivation:  By starting with reasonable goals, I was able to achieve success right away. I have always enjoyed the weekly email I receive titled “Fitbit Weekly Stats.” This report gives me information on how many steps I walked the week before as well as total distance, averages, weight change if I choose to enter it into the website, and so on. Not every week is an improvement over the previous one, but in general my average daily steps have increased during the time that I have owned a Fitbit.

I am a believer that starting slow is fine and knowing your limitations is important. Some people have no problem achieving 10,000 steps per day. Others will work hard to reach 2,000 steps and their success is as admirable as those running marathons. Over time as you become more active, you can increase your goal if that makes sense for you. Or maybe your goal will stay the same and you can take pride is meeting that step count most days.

Easy to use:  Fitbits are simple to use. The Zip uses a disc battery which lasts for about 3-6 months. I have the One which is rechargeable with a USB cord. You can check out other models at the Fitbit website.

What is most fabulous is that the data from each tracker downloads automatically to the Fitbit website. When I open the app on my smartphone, it syncs automatically. I also have a USB wireless dongle connected to my desktop PC and the Fitbit syncs whenever I am within 15-20 feet of the computer. I don’t have to do a thing. (This is of course what I wish would happen with all of my diabetes devices….)

Fun:  I enjoy seeing my Fitbit stats whether or not I compare them with others. Challenges can motivate me to take more steps than usual, but at the same time I rarely win the challenges or even expect to. One thing I like about the challenge called Goal Day is that it is based on how each competitor does compared to his/her daily step goal. If my goal is 10,000 steps and yours is 2,000 and we each walk an extra 500 steps, you will crush me because you are at 125% of goal and I am only at 105%.

I have found everything about Fitbit reports and challenges to be positive. When I hit personal milestones, Fitbit rewards me with silly badges like the Penguin March for having cumulatively walked 70 miles or the Happy Hill for climbing 10 flights of stairs in a day. My experience with challenges has been that everyone is positive and supportive. I am awed at my personal stats on the Fitbit dashboard. FYI I have taken over 9,300,000 steps (4,200 miles) since I purchased my first Fitbit. My “best” day was April 5, 2013 when I walked 32,095 steps (a very long Arizona hike).

Diasend:  Diasend is an online system for uploading most diabetes devices except Medtronic products. It is a free service and all you need to do is set up a personal account. I use an Animas Vibe pump, a Dexcom G4, and several Freestyle meters. All can be uploaded to Diasend and there is Compilation report that displays all of this data in one report.

A new development is that I can link my Fitbit account to Diasend. (Other compatible activity trackers are the Moves App, Runkeeper, Jawbone Up, and Nike+.) Because my BG levels and insulin doses are highly dependent on activity level, it’s nice to see them in one report. Below you will see part of a two week report. (I have blocked out some of the data for personal reasons.) But you can see the potential for starting to track the effect of exercise on your diabetes numbers.

Diasend Compilation with Fitbit_1

If you currently use Diasend and don’t know how to link your activity tracker, click on the Account Admin tab and then select the tab that says “Browse & connect activity tracker.”

One caveat. When you first link your Fitbit, it starts with current data and includes no historical data. If you normally look at 2 weeks of data for your diabetes devices, the Activity data will not be correct until the link with Fitbit has been active for two weeks. But from then on your data will show up automatically. No download cables required.

Summary:  I am very happy with my Fitbit. If you are in the market for an activity tracker, you should probably check out all the brands. Some cell phones, including the iPhone 5S and 6-series, have activity trackers built into them. For the budget conscious, a basic pedometer is adequate to monitor your activity level and allow you to keep track of stats that interest and motivate you. Use whatever works for you.

If you can’t stand the idea of more numbers in your life, just ignore everything I wrote today. Put on your sneakers and take a walk. Take time to smell the roses and enjoy your day while secretly thinking that people like me are crazy.…

Fitbit: A Challenging Week

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Laddie_Head SquareI’ve been using a Fitbit for over two years. I originally purchased it to track hiking mileage but quickly started wearing it every day. Although I have enjoyed the weekly stat updates from Fitbit and definitely watched my steps on a daily basis, I have rarely used the social media aspects of the device. I had a couple of Fitbit Friends, but not too many interactions with them.

Last week I was invited to participate in my first Fitbit challenge called a Workweek Hustle. Total steps — Five days — Monday to Friday. Usually I say no to things like this because I don’t want to bother and am mostly self-motivated when it comes to reaching my fitness targets. But I figured I might as well give it a try even if I wasn’t sure what my goals were for participating. Cherise of DCAF/DSMA was the organizer and most of the participants were diabetes types. When the challenge started, I was still in Arizona where I am a step-monster walking the dog, hiking, biking, playing golf, and enjoying easy access to the outdoors. I flew back to Minnesota mid-week and although I keep the same goal of 10,000+ steps/day here, it sometimes take more planning to get to my target.

Because there is always social media trash-talk when you get into contests like this, I had fun from the beginning. On the first day I learned from Kerri that Ben (whom I didn’t know previously) was very “steppy” and she wasn’t kidding. From the beginning his step count was in the stratosphere and he ended up winning the challenge with a 5-day total of 176,727 steps (35,345/day). I don’t know whether he is a runner or walker fanatic, but using my steps/mileage ratio, he clocked in at least 16 miles a day (probably more because his stride might be longer than mine). Kerri was not too shabby with a 5-day total of 143,457 steps (28,691 steps /~13 miles) per day). She was focused on beating Ben up until the end.

Kerri and Ben were so far ahead of the pack that I didn’t compete with them; I just marveled at their statistics. The group itself had a big range of results, but we were all winners as the ten of us totaled 768,205 steps (~350 miles) for the week.

I had a firm lock on 3rd place moving into Friday afternoon. Thus began my favorite part of the challenge. The story is shared in the timeline below:

Fitbit Challenge Timeline

At the end of the day, I lost 3rd place in the Workweek Hustle. No, I won because I got to watch Cherise be a champion. She refused to rest until she clocked 23,000! steps on Friday and rocketed from 4th place to 3rd. One stubborn and competitive lady, that Cherise:-)

I won. I lost. But I won.

Here is a link to Cherise’s video. I don’t know whether you have to be a member of Twitter or a follower of @SweeterCherise to view it, but give it a try. On my laptop and desktop, the link works fine. On my iPad, I have to click the Tweet below the photo and then on the next screen, click on the arrow/TV icon on the upper right of the screen.

One of my next blogposts will be my views on how Fitbit and other step/fitness trackers can be a helpful, fun, and motivating part of your diabetes/general health regimen. That sentence sounds awfully preachy, but I promise (hope!) that the post will be better than that….

Postcards from the Diabetes UnConference

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Laddie_Head SquareLast Friday I drove from Arizona to Las Vegas to participate in the Diabetes UnConference. It is trite to say that words can’t describe the experience, but Words Can Not Describe My Experience. Three days later I am still exhausted. But three days later I am invigorated with images of new friends, old friends, smiles, tears, hand claps, Diet Pepsi, red wine served by charming bartenders, hugs, lows, highs, and flamingos. I don’t want to start listing names because I know that I will mess up and forget my most cherished friends. But I do want to thank Christel Marchand Aprigliano of The Perfect D for following her vision of “The only peer-to-peer support conference for adults with Type 1 and Type 2 diabetes.”

As I struggled to find a way to express my impressions of a magical weekend, I stumbled upon a pile of postcards ready to tell their story:

Postcards_All_2

Midnight Two and Five

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Laddie_Head SquareThe big thing around the DOC these days is the NY Times Op-Docs feature titled “Midnight Three & Six.” This twelve minute video was filmed by Joe Callander and funded by the Sundance Institute. In remarks accompanying the film, Callander begins the story as follows:

For the past eight years, the Chamberlain family in Fort Worth, Tex., has been coping with a nightmare all parents fear: In 2006, their daughter, Grace, was given a diagnosis of a life-threatening disease. Grace has Type 1 diabetes, for which there is no cure. Now 15 years old, she has endured approximately 34,000 blood tests, 5,550 shots and 1,660 medical tubing injections to keep her alive.

Later he writes:

But I was most struck by the realities of the family’s daily routine. Grace’s mother …. told me about nights punctuated by alarms to get up and check her daughter’s blood sugar, at “midnight, 3 and 6.” That timetable became my structuring device for making this film.

By Sunday afternoon there were 165 comments on the documentary. Some claimed that the Chamberlain’s family mirrored their life perfectly. Others labeled it as an overly melodramatic depiction of Type 1 diabetes and criticized the parents for how they care for their daughter. My guess is that all of the comments have some merit and mirror fragments of life with Type 1. To put it all in perspective, you should read the comment by Grace’s father who defends/explains his family’s experience and concludes that the film is an artistic peek at one family’s life with diabetes, not a factual textbook. He writes:

finally, please remember that a very talented, creative film maker asked us for a behind the scenes look at our family situation with T1D; then , he crafted a 12 minute film to encapsulate his subject matter in an artistic way. The film is getting a huge response, and we are happy about that…including the disagreements!

If you haven’t seen the film, watch it here. Be prepared to be disturbed whether or not you agree with the depiction of Type 1 diabetes. If you have time, read the comments.

The purpose of this blogpost is not to give my views of the documentary, but rather to use the title “Midnight Three & Six” as a starting point to discuss how often Type 1 diabetes and a good night’s sleep are incompatible.

I have had Type 1 since 1976—diagnosed at age 24. Parents were never involved in my T1 life and no alarms were ever set to test my blood sugar. Of course I had many years of diabetes before I even had a home BG meter. I also lived with diabetes before the Internet and as a somewhat ignorant young adult never considered that I might not wake up in the morning.

Although they were not an every night occurrence, I have vivd memories of horrific lows in the middle of the night. Waking up sweaty, shaky, and disoriented. Staggering downstairs for orange juice followed by multiple bowls of Frosted Flakes and milk. When I was lucky, I was able to find a dry nightgown before returning to bed, but it was always a struggle to avoid the sweat-drenched tangle of sheets where I had previously slept. I remember the freezing cold that permeated my bones and the inability to get warm even with the electric blanket on high. I can still appreciate the buzz as sugar raced through my body reviving my numb limbs, lips and brain. Although I probably woke the next morning with crazy high numbers, I have no memories of that.

As I aged, it became rare to sleep through the night without at least one trip to the bathroom. I began testing my BG when I got up. If it was low, I’d go back to bed with a couple of Werther’s candies in my mouth. It was many years before it became part of my Sleepy Dwarfwheelhouse to take an injection to bring down a high. I never woke at night without diabetes being the first thing on my mind.

I now live with a CGM. You would think that this watchdog would enable me to sleep soundly, but sometimes I think it is the exact opposite. There are many nights that the Dexcom is on the Midnight 3 & 6 schedule along with Grace’s parents, or more accurately for me, the Midnight 2 & 5 shift. I struggle with eating too many snacks through the evening. Sometimes it’s junk food. Other times by trying to avoid carbs, I eat things like nuts and cheese. It doesn’t matter which. The pattern is to go low early in the night from too much insulin and then go high at 2:00AM. Although I try to be conservative with corrections, usually the highs are followed by lows in the predawn hours. My G4 definitely earns it keep by alerting me to each one of these out-of-range numbers. Since I am confessing my sins, I might as well admit that I eat glucose tabs and dose insulin based on Dex numbers all night long.

On Friday after being frustrated with the current sensor, I ripped it off at bedtime and decided to splurge with an uninterrupted night of sleep. I had eaten nothing since an early supper, had no IOB, and felt confident that nothing too disastrous would happen. I think that it was the first night in two years that I had gone to bed without a functioning CGM (except for a few times when my transmitter died and I had to wait for a replacement).

I slept marvelously. No, I slept marvelously until 5:56AM when my Animas Ping starting singing Für Elise signaling a pump alarm. It turned out that I had not pushed any buttons for 12 hours and had triggered the Auto Off safety feature. A button push or two and insulin delivery resumed. Back to sleep. Back to sleep until 6:12AM when a twinkle alert indicated that my pump had lost prime. (Losing prime is an extremely annoying problem with Animas pumps and requires that you unhook your infusion set and prime a few units of insulin to restore pressure in the insulin delivery system.) A trip to the bathroom, bright lights, my infusion set reattached, and I was awake for the day.

Although my diabetes control is “good,” the fact that I rarely have a night without Dexcom alarms would indicate that I have problems that need to be addressed. I have a list of things that could be improved. In the meantime, if there are any parents who would like to take the Midnight 2 & 5 shift and start testing my BG, dosing insulin and giving juice as needed, I’m taking applications….

Two Life Hacks and a Story

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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

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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.

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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

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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.

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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

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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.

A Twofer

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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

Why I Don’t Download

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Laddie_Head SquareThere are many discussions around the DOC about data interoperability and ownership of data. There are also survey results that indicate how rarely most people with diabetes download their devices.

Last week I had an endocrinologist appointment. I know that I am guilty-as-charged about not downloading my devices very often. But I always do it prior to endo appointments. I consider data extraction a tedious process and it seems to take forever. To figure out if the download time is a legitimate excuse or whether I am just a slacker, I decided to chart my experience.

10:38  I gather up the necessary cords and my two Freestyle meters. My pump and CGM are of course close by in my pockets.

10:40  I prepare my Animas Ping pump for the download. I change the Display Timeout from 15 seconds to 1 minute. If I don’t do this, the pump will sometimes turn off before the Diasend Uploader can start reading its data. Then I suspend the pump and unhook it from the infusion set. I open the Diasend Uploader and attach the wireless upload device to my computer.  I start the download which is always a slow process. After the pump is downloaded, the Diasend uploader asks for my login info and I type it in.

10:47  I have finished the download of my pump and I download Freestyle Lite Meter #1 to Diasend. Quick and and easy.

10:48  I download Freestyle Lite Meter #2 to Diasend. Once again, quick and easy.

10:49  I plug in my Dexcom G4 receiver. The download to Diasend is simple and finished within a minute.

10:50  I follow the Uploader prompt to go to the Diasend website and sign in.

10:51  While the Dexcom receiver is attached to the computer, I open Dexcom Studio and download the CGM data to the Dexcom program.

10:53  All of my devices are downloaded and I cram the cords back into my “Diabetes Download” handy-dandy storage box.

I have invested 15 minutes in my diabetes download project. If I didn’t have an endo appointment and just wanted to view the reports on the computer, the bulk of the work would be done. Both Diasend and Dexcom Studio do a good job of displaying reports clearly and quickly.

But I want to save some of the reports to my “Medical Reports” folder and print them out for my doctor to review.

10:54  In Dexcom Studio I open the Summary Report in Microsoft Word using the last 14 days of data and save it to my computer. Then I print it for my endo. I have felt that I have really been struggling lately with my diabetes, but the reports look quite good. When you’re stuck in the trees, life can look bad although the forest view is quite respectable.

10:57  I go to the Diasend website to print reports. The Compilation Report is the most useful summary because it merges data from my pump, meters, and CGM. I also like one of the CGM reports. I save both to PDF.

I am going to digress here and talk about how some endocrinologists hate Diasend reports. They look fabulous on the computer and many doctors view them that way. But when they are printed, the charts are so small that they are almost unreadable. HEY DIASEND! NOW THAT YOU FINALLY DOWNLOAD ALL OF MY DEVICES, PLEASE PRINT THE REPORTS SO THAT MY DOCTOR CAN READ THEM!  

We own a full version of Adobe Acrobat (a different program than the free Adobe Reader) and I am able to crop the Diasend reports and enlarge them. They are still small but better than the standard reports. My endo will be able to read them. I print the reports and save them to my computer.

11:08  My pump and CGM are back in my pocket. Freestyle Meter #1 is in my purse and Freestyle Meter #2 is on the floor by the stairs to be returned to the master bathroom on my next trip upstairs. (I never put anything on the stairs because my first frozen shoulder developed after a fall from stepping on shoes left on the stairs.)

So here’s a summary:

15 Minutes: That’s what it takes to download my diabetes devices to Diasend and Dexcom Studio. If I didn’t want to print anything, various reports are immediately available.

30 Minutes: That was the total time to download my devices, print several reports for my doctor, and save those same reports to my computer. Obviously I spent more time than other people might.

15 minutes. 30 minutes. That is why I don’t download all of my diabetes devices very often.Download Time

Okay, now it is time to stop making excuses. The data from my Dexcom G4 is by far the most useful information I have when it comes to evaluating blood sugars. I can download the receiver to Dexcom Studio in one minute. It takes another minute to download to Diasend. And maybe another minute to find the download cord and open the computer programs. So from start to finish it’s two or three minutes. I can even save a minute by downloading to only one program instead of two.

So what have I learned from my time study? I have learned that it would make sense to start downloading my Dex G4 on a more regular basis. It’s super quick unlike the time and effort that it takes to download four devices. I can download my G4 to Diasend (unfortunately not yet to Dexcom Studio) on my MacBook and that is even faster and more convenient than with my Windows desktop.

Will I change? I actually think I might. (Just for my Dexcom, not the other devices)

One last question: If I download my data, am I supposed to look at it?