Thursday, January 18, 2007

Doctor Visit

I saw my diabetes specialist today. The news was pretty good. My weight has remained the same in the last 4 months and my blood presure was great. My HbA1c was at a 7.1, up from 6.8 at my last visit. He did say though, that I am still in good control and that I'll just need to monitor my sugars a little more closely. He reminded me about writing down glucose levels which is something I used to be very faithful at, but haven't done in over 2 years.

One topic of discussion that came up was the continuous glucose monitor (CGM). This is a device which is fairly new to the public market that monitors glucose levels continuously- hence the name. So, this means it is taking a reading subscutaneously (under the skin) without a finger prick. But, this does not eliminate the need for blood testing because this must still be done about 3 times a day to calibrate the monitor.

The crappiest thing about this though, is that insurance is not covering the monitoring
at all yet, so it is very expensive. The monitors range from $300-$1,000 and every three days a $35 site has to be changed. You can see how quickly this could add up. However, it would not necessarily have to be worn all of the time. I guess it would ideally be worn for a 2 week period to study out trends in glucose readings and would not need to be worn again for a few weeks or months. Some people use them to help themselves recognize hypogylcemia (lows) so they might need to wear it on a more regular basis.

Minimed CGM
Dexcom CGM

Anyway, I've also been thinking about upgrading my pump to one with some of the latest features. My pump is currently out of warranty but working fine. As soon as it breaks though, I'd have to buy a new pump. I am not sure what kind of coverage I have on my new insurance, but my last pump cost us $1,000 after insurance. Pretty good for 5 years of 24/7 use. I'd also like to get a glucometer that "talks" to my pump so I'd probably go with the Cosmo or the Minimed.

Mini Med pump and corresponding glucometer
Cosmo pump and attached glucometer

Lots of money in the heath-care industry.

Sunday, January 7, 2007

A Day in the Life

A Day in the Life of a Type 1 Diabetic

January 6, 2007

The following is a series of posts I've created to document one day in my life with diabetes. I hope that you will find them interesting. I’ve enjoyed putting this together and I want to thank my husband, Colin for helping me take these pictures throughout the day. Diabetes is such a huge part of my life, and I guess I just want to share some images and words with you so that you can maybe realize the impact that it has on me each day. I was diagnosed with diabetes in April of 2001, nearly 6 years ago. It has been a struggle at times, and at other times it has been a blessing. I think I’ve become more aware of my eating and exercising habits because of the disease. I’ve also probably become a little more stressed out and perhaps more obsessive-compulsive about other aspects of my life because diabetes is something that is so difficult to control. I am not mad that I have diabetes, but some days I wish I could take a diabetes vacation. The star of most of the images that will follow is my mini med 508. I love my insulin pump and would suggest all type 1 diabetics get the pump. Anyway, I could talk about diabetes all day, but I’ll just let the blog do it for me. I hope you will enjoy it, and I hope that you’ll leave a comment telling me what you think about it. Also, if you know someone who may like to read this, please feel free to forward them the link.



The first thing I do each morning is take out my meter and test my blood sugar. This sort of sets the tone for my day, but I try not to let it bother me if I am off. There was a time when all of my morning tests were very high. I had what is often referred to as "the dawn phenomenon" but, the pump has helped me cure this, and I wake up with much more regular or normal blood sugars.
I have to gently squeeze my finger to get the blood to come out. My hands are shaky and taking pictures is difficult so I know my reading will be low.

I put the drop of blood in the top of the test strip and it will read my blood sugar in 5 seconds time.

Normal blood sugar levels are between 80 and 120 points. This is the amount of glucose in miligrams per deciliter. Low blood sugars, like this one, are the absolute worst part about having diabetes. I hate the way they feel. To explain it to a non-diabetic, would be hard, but I guess if you have ever gone without food for an extended period of time, and you get toward the end where you feel weak, shaky, confused, and tired, it's like that for me. I can't think straight, I get angry, my hands shake, sometimes my tounge goes numb... lots of symptoms can happen. Some people pass-out, others act like they are drunk.This is 2 cups of fruit loops, about 56 grams of carbohydrates. I take 1 unit of insulin for every 7 grams of carbohydrates. Because my blood sugar is low, I can take one less unit to help bring my sugar back into normal range.

To give myself a dose of insulin or bolus for a meal, I have to push the select button. I then have three different types of bolusing optioions, I choose normal then dial up the amount of necessary insulin.
9.0 units for breakfast.

Taking off the pump for my shower. I just leave it on the counter and re-connect as soon as I am done bathing.


A Day in the Life Continued: 01/06/07

My lunch may seem like an ordeal to you, but this is so normal for me. I'm very used to it.

This is my meter in its case. It holds (as you can see below) the meter, the lancet delivery device, the test strips, and whatever I want to put in that little mesh side pocket, usually more lancets and alcohol strips.
The "tester" as I call it, open and ready to use needs a new lancet and bottle of test strips. The official name is "glucometer". Mine is the One Touch Ultra and I love it.

lancet delivery device with cap off, old lancet inside has to be taken out and properly disposed of
empty lancet delivery device, needs a new lancet
new lancet
Lancet delivery device is ready for pokings.

finger prick, left hand ring finger.

milk finger to get blood drop and apply to strip for reading, then wait 5 seconds

PB&J, 2 slices of bread 15 carbs each, 2 Tbs PB= 0 carbs 2 Tbs Jelly 8 carbs. Total 38 carbs.

Deliver 2 units to bring my high blood sugar down, and 5 for the sandwich, the total bolus is 7.0 units. I so rarely deliver in smaller increments than a whole unit, but my pump delivers tenths of units if I need it to, or tell it to.

After bolusing for lunch, I get a "low volume" alarm on my pump. There are only about 30 units left so I'll most likely have to change my site today.

exercise and snack

A Day in the Life Continued: Exercise and Snack

Ryan and I do some Dance Dance Revolution to get some exercise for the day. This wasn't a great session of exercise, however, exercise is an important part of diabetes care and management. This is probably where I can use the most improvement. I just don't do it enough. I find it difficult to fit into my schedule of being a full-time teacher and mother.

A high reading is not what I was expecting, which is why you should always "test, not guess" as they say on dLife. So, I'll take 3 units to bring my blood sugar down to normal range. I take 1:33 for lowering blood sugars above 100. This means, for every 33 points above 100, I have to take 1 unit of insulin to lower it the 33 points. I usually don't take any extra unless my bg is over 160.
excellent reading!
1 regular sized bannana (small) about 20 carbs.
Don't forget to bolus, even if it is just a snack. I can usually tell though if I don't need to bolus for a snack, which can happen like before exercise or if I feel like my sugar is dropping.

Dinner and Evening Snack (Okay, Dessert)

A Day in the Life Continued: dinner and evening snack- okay dessert

Testing on my left hand index finger for dinner.

A normal reading. I will not have to take any extra insulin at this meal, only that needed to "cover" the carbs.
Half of a Cafe Rio grilled chicken salad with rice, pinto beans, tortilla strips, lettuice, tortilla, tomato, and creamy tomatillo dressing. I'd guess about 50 carbs so I took 7.0 units of insulin to cover this meal.
2 oatmeal cookies, about 35 carbs.

Deliver bolus of 5.0 units

Changing the Site

A Day in the Life: Changing the Site

Changing my insulin pump infusion site is probably the diabetic task I dread the most. It is time consuming and can be painful at times. My pump holds up to 300 ml of insulin and when there are only 30 units left it gives me a low volume warning and again at 10 units. When it is compeltely out of insulin and can't give me anymore, I'll receive this "no delivery" alarm.This is my last warning, the pump is no longer delivering insulin and I must change my site.
First I have to fill up the reservoir with 3 days worth of insulin. For me, this is about 210 units. The reservoir holds 300ml or units. This is just like filing up any other syringe except that you have to make sure there are no air bubbles, which can be slightly difficult, but I've got it down!

Then I manually prime the insulin through the tubing. Once it comes out the needle, I know it has gone all the way through the tubing and catheter.

Then the insulin has to be primed through the tubing for 5.0 units. This makes sure there is insulin all the way through and that the new reservoir is working properly. It also helps get out some of the air bubbles.

Inserting the infusion site into my hip. This strange looking blue thing is an infusion site delivery device. This device makes it possible for me to push a button and insert the needle without having to do it by hand. It helps ensure the right angle and depth is achieved when putting in a new site. I am glad for this, although it isn't fool-proof. When a site goes in wrong, it hurts bad, and can cause problems with blood sugars if you aren't getting the insulin right. I like to put my sites in my hips mostly. I can also put them in my stomach and any other fatty part of my body. I've only ever done stomach and hips though. I really don't like it it my stomach. Because my hips are fattier, it doesn't hurt as much. However, most of the time I don't feel it much at all.
The needle is inside that blue part. I'll pull it out and then it will look like below.

Pull out the needle. Then, your site is in. It will stay this way for about three days. I'll then move it to a new site.

Last, prime 0.5 units. This is to push the insulin into the catheter. I am at this point ready to use my pump for regular meals and basals.

How to wear the pump

How to wear the pump: A Day in the Life

1. Hook the pump onto your pants, shorts, or skirt. I even hook it onto my pajamas. When I wear a belt, the pump doesn't get in the way as much because of the belt clip. I didn't take a picture of it on the belt, but you can "get the picture".
2. With a pump cover. I love this black leather cover. It has a hole for the belt clip to slip through and velcos over the front. It has clear plastic through which I can dial the setting buttons easily, and see though well. I have a few other covers, but I rarely use them.
3. To wear the pump inside your pocket, first you have to take off the belt clip, so it's not as bulky.
slip inside pocket
inside the pocket

4. The pump can also be worn when you are wearing a dress, but it is more of a pain. I used to wear it inside the front of my bra, but if the top is tighter, it looks like a strange bulge. So, I've started wearing it inside my pantyhose without the belt clip. They make fancy leg straps and stuff but I've never bought one. Usually, I'll just wear a skirt because it is much easier with the pump.

5. When you go in the water, you have to take the pump off. Like for bathing or swimming. Usually I just stay in the water a short amount of time so I'm not "disconnected" for very long.

It may seem cumbersome, but I've had the pump for almost 5 years now, so it's really no big deal and most of the time I don't even notice it, and it doesn't bother me. A lot of people worry that they'll have a "badge" telling the world they have diabetes when they choose to wear the pump. I don't mind. Most people don't notice it. Others are ignorant and don't know what it is. Those who do know what the pump is usually strike up a conversation with me, "so, how long have you had diabetes?" And I love talking with diabetics and their families. I'm not ashamed of my disease and I could talk about it (as you can see) forever. Maybe someday I'll become an educator- diabetes educator that is.

Diabetes Supplies

Diabetes Supplies: A Day in the Life

When you become diabetic, there are so many supplies that you have to buy. Many of them are extremely expensive. However, if you were to go without them, you're life expetancy would shorten to less than a couple of months. Insulin is, of course, the most vital; and along with that comes many necessary delivery items. Here are the supplies that I use most frequently. I feel as if after my diagnosis, I've become a new person, mostly because of all this baggage that I have to carry, in form of diabetic supplies.Here is an important diabetic supply. It is the Glucagon pen used for emergency hypoglycemia (low blood sugars). Colin would likely be the person to use this, if I ever needed him to. I've luckily never had a low so severe as to be incoherent or unconscious. What he would do is mix up the solution and inject the entire dose into a muscle group. The result would be a dramatic rise in blood sugar. This is actually my first ever prescription for the pen, and as you can see in the next picture, I've never had to use it either.
The inside of the glucagon pen. At the bottom (left side) is the powder wich is mixed with the salene solution inside the syringe.
These are lancets. Notice they aren't in any official box or packaging. I bought a supply of lancets when I was first diagnosed back in 2001 and I think I've only ever bought one or two boxes since then. I guess you are supposed to switch lancets every time you test, but who has time for that? I change my lancet each time I get a new bottle of test strips out, so that is 25 pokes or "lances" per lancet. I've found that they have other uses than poking fingers though, they've come in handy for many things around the house. This amonut of lancets will probably last me a couple of years at least. They are very inexpensive.

These are bottles of test strips that I use to test my blood-glucose levels. Each bottle holds 25 strips and this is my 3 month supply. This will actually last me about 4 and a half months or more, and I do a considerable amount of testing. I usually test at least 4 times per day, sometimes as many as 8. When I was pregnant, the minimum amount of testing per day was 10 times! This is where the pharmaceutical companies make bank, these come in boxes of 2 or 4 bottles (50 or 100 strips) and those run about $65 per box! So, to add it up for you, right there is about $815.00 worth of test strips. Of course, I have health insurance so, I only pay $30.00 for the same amount of strips.
Here are three months worth of tubing/ infusion sites. I keep all of my diabetes supplies in a tuperware drawer in the bathroom. It all comes packaged sterile. The tubes are 43 cm long and they are like a hose with insulin inside them. Then there is a canula part that goes inside my body. I have to switch this out whenever I run out of insulin. They recommend every three days and I do a pretty good job of that. The needle is only 6mm long so it doesn't hurt too bad when it is injected. The needle comes out right after you insert it because then the canula is inside your body.

This is about 3 months worth of insulin (slightly less). I take the brand Humalog, made by the Lilly diabetes company. They rake in the dough! This stuff cost about $30 per bottle retail. This supply only costs me $30 though because I use mail-in prescriptions and have great insurance coverage. Each bottle holds 100 units per ml wich means 1000ml. I use up one in about 9 days. I take about 60-80 units per day.

These are called reservoirs, they hold 300ml of insulin inside my pump, the Medco Mini Med 508. This is three months worth, I just got a shipment.