Tuesday, February 17, 2015

Waking up Low

I've had more morning lows than I care to count.

When I have a low in the middle of the night it usually wakes me up.  I don't know what it is that wakes me but I'm so grateful that my body recognizes the low enough to rouse consciousness and alert me to the situation.  I stumble around in the dark and get some glucose in then usually just crash back into bed.

When I wake up with a low I immediately have a headache.  Sometimes I get this strange feeling that a low is pulling me deeper into sleep.  That kind of scares me.  If I don't wake up... how low will my blood sugar drop?  Sometimes I get migraine like symptoms with a low.  Bright spots in my vision, bright spots when I close my eyes in the shower.  That makes the headache start to pound.

Morning lows put me in a bad mood.  After having kids, I've become less of a morning person anyway.  Add a low to the morning routine and I'm basically an angry bear in the morning.  Sigh.

Lows always suck.  But lows in the morning... those are the worst!

Sunday, November 2, 2014

A year later

It's been roughly a year since I received a whole lot of bad news, blogged here. 

In the 11 months since that time, I've had quite a LONG year in my diabetes (and overall health) care. However, I am happy to say that I just had my blood work repeated and everything came back within normal ranges with the exception of thyroid to which my doctor has made a very small change.  When I received this news yesterday I was ecstatic.  The past year has been such a struggle and I am so happy to learn that all of my hard work is paying off and I'm once again kicking diabetes to the curb.  That's a really good feeling.  

The major thing which has changed for me this year is gluten.  Last year when my doctor saw my numbers he said I fall within the range that could be considered a Celaic diagnosis.  I took him seriously and slowly began removing wheat and gluten from my diet.  It was a struggle.  really, really difficult at times.  I am STILL not perfect at it and it is still very difficult here in Singapore but I am doing so much better and I FEEL so much better too.  And now, my blood work shows that it's working for me too.  

There's so much more to be said about what has happened in the last 12 months and what's yet to come for me and my care but I'll leave it at this for now.

Sunday, October 12, 2014

Insulin Pump Set Change Process

Been a long while since I've blogged.  There's a lot behind that and I'm not sure how to get back "in to" it except for to just jump right in.  I may have written this before but I just don't like to focus on my diabetes all of the time.  I'm glad that there are diabetes blogs out there for others to read should they do so but I don't always have the head space to make it MORE a part of my day than it already is.  I'd rather focus on living my life as the normal person that I feel I am.  That isn't to say that I don't focus on taking care of myself because I certainly spend plenty of effort doing that, I just don't care to blog about it (or even talk about it) constantly.  You won't see much about diabetes on my Facebook page or on my family blog.  There is MORE to ME than just diabetes, diabetes news, diabetes articles, diabetes research... I am so much more interesting than all of that.. and again I don't mean that in a negative way.

ANYWAY, I have realized recently that there are some people who are interested, possibly curious, about my life with diabetes.  And that, I don't mind sharing.  I have lived in my new location for just about a year and many of the people I now associate with, my friends, don't know a whole lot about diabetes like some of my friends whom I've been associated with longer have already learned from me about my condition.  So, for their benefit I've been posting little snippets on my Instagram and Facebook.  When the reaction is positive, I tend to be more willing to share more... a little.

SO... Here's what I've recently shared.  It's nothing new.  It's stuff people who wear insulin pumps already know, but for some of my new friends, they were fascinated. They had no idea I could chose where I want to put my site, that I could move it every three days, and that I could wear my pump in any place I want to.  I wear my insulin pump on the belt clip and apparently in the same location on my waistband that one of my friends thought it was permanently in that spot at about four o'clock on my belt.

Without further ado, I give you the process of changing out the insulin pump set in a step by step post.

Going from right to left, top to bottom here are the steps of changing out my site- or my pump.

1. (not pictured) I rewind my pump, remove my old site and throw away the tubing, reservoir, and infusion set.
2. (top left) fill the reservoir with enough insulin for three days (300mL for me)
3. (top middle) attach the reservoir to the tubing (the little blue thing that's on top of the insulin vial in photo 1 is thrown away
4. (top right) I insert the full reservoir (now attached to the tubing) into the pump... I should have taken a different photo.
5. (bottom left) Fill  or prime the tubing by holding down the ACT button.  In this photo you can see 2.6 units being primed into the tubing.  I hold that down until it reaches about 14 units and then I see drops coming out of the needle and no air bubbles in my tubing.  Sometimes it takes more units and sometimes it takes less.  I like the longer tubing ( I think it is 42 centimeters long or something) so it takes a few more units of insulin than the shorter tubing but that length just works better for me.
6. at this point I attach the insulin pump- see next photo

7. This needle goes into
8. my arm, hip, or stomach (let's be honest, I NEVER use tummy sites- bad experience)
9. I pull the needle (blue piece and attached metal needle) out and the plastic cannula 6mm long stays inside of my body for the next three days.

Just as a bonus here's a BRIEF explanation on  how pumping insulin works.

I use fast acting insulin only mine is called Humalog but there are a few other brands and names.  I have programmed my pump with the help of my doctors and logging my blood sugars to meet the needs of my body without food or exercise throughout the day.  This type of insulin delivery is called BASAL insulin.  It is like my baseline.  So hypothetically if I am fasting all day long this is the amount of insulin I need throughout the day and night.
The second way I give insulin is through BOLUSING or a BOLUS.  I give a bolus of one unit of insulin for every gram of carbohydrate I eat.  So, if I eat a meal of 30g. of carbohydrates I need a bolus of 4.2 units.
To take it a step further, my pump and my glucometer (blood tester) communicate with each other wirelessly (blue tooth) so at a meal time I will test my blood sugar and the value gets beamed to my pump.  Then I count the carbs in my meal and enter my bolus.  If my blood sugar is high I need one unit of insulin for every 25 points over 100 mg/dl that my sugar is.  So... if I were eating a meal of 30 carbs and my blood sugar was 125 I would need 5.2 units instead of 4.2.
Conversley, if my blood sugar is low then I need a little less insulin.  So if I tested and my blood sugar were like, 65 then I would take about 2.2 units instead of 4.2.

Wow!  It's a good thing I know how to do a little math!  But don't worry because really my insulin pump has all of my own calculations entered and it really does all of the math for me!  ;) Maybe I'll do some screen captures and photographs of insulin deliver for my next series of Instagram photos.

PS: If you're still way down here reading this entire post you can look up on this blog for my tag "a day in the life" and see the series of posts I did back in 2007 for a more comprehensive look at my daily diabetes routine.  Not much has changed even though it's been 7 years, diabetically speaking.

Wednesday, January 29, 2014

Busted Pump

Went to take my lunch bolus the other day when my pump just up and broke.  The most ironic thing about that was on my to-do list for that very day was to call Medtronic and see if I needed to replace my pump due to a crack in the battery chamber that had been there for over a month.  I was probably going to make that call about an hour after my pump just quit working on me.

So, I went to take my bolus for lunch and my pump wouldn't deliver the insulin.  This is the error I received.

The crumbs on the table give it a special touch, don't you think?

So, I did what any reasonable diabetic would, and commenced to FREAK out.  I rewound the pump and reloaded the reservoir (after disconnecting) and came upon the Motor Error again.  A good friend was helping me through the freak out and suggested I try new tubing and reservoir.  I did that and still got the same error.  I tried it with a new battery and still got the Motor Error.

I called Medtronic in Singapore after searching for their number.  Left a frantic voice mail and continued freaking out.  I was pretty well panicked but somewhere in the mix I took an injection to cover my lunch.  I called my husband and he was able to dial internationally and connect me with Medtronic in the US.  

Thank goodness, because I hadn't heard back from the "local office" at all.  

I went through with support at Medtronic and they confirmed that my pump was indeed busted.  They told me that my pump is covered under its' warranty until June of 2015 so they would send me a new pump.  THAT'S when I told them that I don't actually live in the United States and that I in fact live 9,000 miles away in Singapore.  The customer service representative wasn't really quite sure what she should do but she said they'd send me a pump through their global office and that "global" would be contacting me soon.  

I searched through my diabetes cabinets for my back up pump and couldn't find it.  I guess I gave it to Hurricane Sandy victims?  I can't remember.

With the help of a friend, I was able to calm down enough to figure out a reasonable number for a Lantus dose and take that (about an hour after my pump died).  I called my local doctor and left a voice mail for him to call me back so that I could make sure I'd taken that Lantus shot correctly, to let him know that I was taking injections, and to tell him that my pump was broken.

Busted Pump aftermath 

By the way, if your pump breaks, it's good to have a back up pump.  But if you don't have that, it's a wise idea to have some long-acting insulin on hand.  I'd also suggest having your basal rates, correction doses, and carbohydrate ratios written down.  Luckily, I had a Lantus pen in my refrigerator so I was able to switch over to Multiple Daily Injections (MDI) until a new pump arrived.   I didn't have Humalog (or anything similar) in pen form, which kind of sucks, but I had syringes and plenty of bottles of Humalog so for boluses and corrections, I just used that method.  

I'm not sure if it was just by coincidence or what but later that day, the Medtronic rep was at my doctors office and after I called them back a second time, the two of them returned my call.  My doc told me that I was taking my Lantus the way I was supposed to and that the Medtronic rep had a loaner pump I could use until my new pump came from the states.

Here's how I figured out how much Lantus I should take.  I added up all of my basal rates to find my daily basal total.  I took that amount divided by two every 12 hours.  Technically, you could take the whole thing in one shot every 24 hours but Lantus doesn't quite work as well as fast-acting insulin so if I only took an injection every 12 hours, then I could adjust that amount in 12 hours instead of waiting an entire day to do so.    

It wasn't until the end of the next day that the Singapore office received word that the US team had received a report on my pump being broken and that a new one was en-route.  They figured it would take about a week.  Something I hadn't realized before was that ALL Medtronic pumps come out of California.  Asian, European, Australian, and American pumps all come from the same place.  Huh.  Guess that just hadn't occurred to me before.  At least, I'm pretty sure that's how it works.  

Anyway, about a day and a half later, the Medtronic rep came to my house with a loaner pump.  I was sure relieved to go off of MDI even though it had only been about 36 hours.  I hooked that sucker up and was off and running.  

The next day, in a moment of clarity, I suddenly remembered where I'd stored my back-up pump.  I felt like an idiot for not remembering, but was still comforted by the fact that I did indeed have a back-up should I ever need it.  Since I was already using the loaner pump, I didn't bother getting my own back-up pump out. While thinking I had donated it to the Red Cross was a lovely idea, I'm glad I have a back up.  Especially now that I know a replacement is going to take a week to get here.

It was exactly one week to the day that my replacement pump arrived.  The rep was nice enough to come out to my house again and deliver it.  I gave him back the loaner pump and hooked in to my new pump.  It's been working well since then.

When I tweeted, posted on Facebook and Instagram a picture of my "Motor Error" I was really surprised to hear from many Medtronic users that they'd experienced the same thing.  One follower told me he's had SIX pumps with errors needing to be replaced.  With the exception of my 508 having an unfortunate run-in with the banister thus cracking the screen, I've never had to have a pump replaced until the Revel.  This is now my third Revel pump.  I'm really curious if they'll be a recall on this pump due to the motor error sometime in the near future, but I suppose time will tell.  

Monday, December 16, 2013

Part 2: New Doctor, lots of Tests

So my new Doc, Dr. Lee, decided to have me get a full panel of blood work.  I was to be fasting and have all of the blood in my body drained out for testing.  Not really, but this list was LONG!  I was actually really glad though, because I've been wondering about some things and feeling like others weren't properly treated.

Anywho, I got a taxi after 40 minutes of waiting in the rain and headed down to the medical center for labs.  Little did I know, the results were gonna be scarier than that dang needle.

The same day that I had my labs done, I went to my doctors office to have a CGM inserted for my blind trial.  Again, he wanted a blind trial so that I wouldn't be interacting with the CGM but rather to collect the data and make adjustments to my insulin regimen.

One week later, I went back to the doc to upload the CGM data, review that, and talk about my labs.

The week that I was wearing my CGM, my doc wanted me to be recording all of my blood sugars, meals, and insulin doses.  Introducing the mySugr app.  Very cool, highly recommend it!  It was a great little app on the iOs and I found it was easy to use and maybe even a little entertaining.  I logged everything really well for seven days and haven't used it since. What can I say?  I gave up on logging a LONG time ago!  Plus I log all of my calories on MyFitnessPal so that's just way too much time on logging!

I digress.  So, I went back to see Dr. Lee.  First we went over all of my labs.

Testosterone & Estrogen tests were normal: no PCOS (whew!)
Lipids (Cholesterol): bad (CRAP!)
Hashimotos (thyroid): still uncontrolled even though I take thyroid meds (SIGH)
Uric Acid (proteins in urine detecting kidney function): high (SHIT!)
Celiac (allergy to wheat): Positive (double SHIT!)

Then we went over my CGM and it was fine.

So, basically, my blood sugars are under control and I don't have PCOS but other than that I'm a complete mess.

This was REALLY HARD news for me to swallow.  Really.  Hard.

I'd seen a doctor about my thyroid and possibly having Celiac previously but I was never actually tested for Celaic.  I played around with gluten free for about a month and then I decided to move across the globe and basically forgot about all of it.

This time though, it's time to face the facts and realize what I already thought I knew.  Celiac. Positive.  And no more wheat for me! That SUCKS!

As for the Cholesterol, I'm just gonna go ahead and say that I had already had a high cholesterol come back and this one wasn't really a surprise.  In the states though, my beloved Dr. Day told me I could wait until I was 35 before starting on any medications.  Not this Doc.  He wants me on a low dose of Statins.  It took me almost a week to take that first pill.  So far no bad side effects so I think I"m good there.  And if it protects my heart, then I'll do what I gotta do.

Hashimotos.  or hypothyroid.  So I've got that.  I have been taking thyroid meds for quite some time and I knew they weren't enough.  I saw some whack job at the beginning of last summer and he wasn't doing it for me so I quit him and ignored it.  Until now.  I'm on double my dose from before and finally able to wake up in the morning!  Hooray for that!

As for the Uric Acid, I got to do the ever so enjoyable 24 hour urine collection.  I never heard back from them so I'm assuming that test was fine.  Geez!  I don't want to find out that my kidneys aren't working well.  Guess I gotta stay vigilant and do everything I know to keep this dreaded diabetes under control.

Celaic.  Damn. I can't believe I have Celaic.

Switching over to gluten free has been difficult.  I think that's compounded with the fact that I live in a freakin expensive country and it's hard to pay for regular groceries let alone switch it all up and eat a different way.  I had some really good go-tos back in the states when I tried this before.  Some of those things just aren't available here and I've resorted to eating eggs all the time.  Not really, but... really!  I am so bored and need some good gluten free meal ideas.  Particularly lunch.

I guess after a few months of focusing on the big move, and home-schooling my oldest due to some unforeseen circumstances, it is time to focus on me and my health again.  It's hard when you're a mom and have another life outside of taking care of diabetes 24/7.  But it's wake up calls like this that kick your butt into gear.

I didn't reach out to many in the DOC about all this, but it's time I put this story out there.

Update on my progress to follow.

Friday, November 15, 2013

New Country, New Doctor (part 1)

I've totally neglected this blog.  And at this point I'm sure no one is reading it.  I'm not sure if I should just delete it or... try to keep it up better.  I think the stories I tell (about Diabetes) are important and valuable for some to read and I really love it when someone has a question about something specific and I realize that I've written a nice long post on the topic.  The only problem I have with consistently blogging about diabetes is that I HAVE ANOTHER LIFE.  I mean, Diabetes is my life, but it's NOT my life and I don't want to spend ALL of my time talking about it, or writing about it.  So.  Yeah.  That's why I don't blog here much.

HOWEVER, there have been a few things recently that I should really put out there.

So most of you know that I recently moved to the other side of the world and now live in Asia; one degree above the equator, in the tropics, on a tiny little island, city, country called Singapore (no, not Japan or China or the Philippines).  Anyway, there are a lot of things about diabetes which were affected by my diabetes, or maybe it's the other way around.

First of all, I had to find a new doctor.  I asked some really great resources for help on referring me to a doctor here in Singapore.  Several people suggested this one doctor in particular so I figured he would be a good one.

I basically waited until the last minute to book an appointment.  I'm not sure why I was dragging my feet.  Maybe because I had plenty of other things to adjust to what with living in a new country or whatever, maybe it's because I REALLY like my old doctor and didn't want to face the fact that I am going to be seeing someone new for the next two or three years.  Dr. Day, if you retire before I get back, so help me!

Getting ready to go see my doctor.  I was so nervous! 

He was.  or... is, or whatever.

The first appointment I had with him went REALLY well.  I was very pleased with the experience and found him to be VERY thorough in getting to know me, my diabetes, and my health history.  He took my HbA1c and looked at my blood glucose data. He decided that he'd like more data and asked me to do a week on a blind CGM so that he could use the information to adjust my basal and bolus rates.  He also ordered a FULL panel of blood work.

I wasn't really pleased with my a1c but given the disruptions to my life the previous three months, I decided to give myself a break about it and aim for better next time.

Stay tuned for part two.

Friday, November 8, 2013

Making Friends

Met a new friend.  Decided to go on a hike with this friend.  The hike was intended to be a long one.  About 3 or 4 hours.  So, naturally, being diabetic, I had to think about ways to prepare for low blood sugars along the way.  My sugars were doing really well, staying within the normal ranges so I decided to lower my basals by 50% like I would during any exercise and carry three packages of mentos with me.  That's more than enough to cover any lows I may have had on the trail, as well as share some with the boys, and their new buddy.
It's really awkward, you know, meeting someone new and having to jump right in with, "so, I'm diabetic and..." But... I feel like, when doing this kind of activity, it's probably better to bring it up right away rather than, you know, try to explain while having a low or something.  
New friend has a kid.  This kid is basically a big fat brat.  He's asking for my stash of candy pretty much right away.  I tell friend that it is hard to have candy in front of kids when, you know, they're gonna want you to share, but that I always explain to my classes (substitute teacher) that they'd much rather NOT have the disease than share my candy, or juice, or orange or whatever it may be that I'm treating with.  And, I don't go out of my way to openly eat it in FRONT of the kids, but sometimes you have to, especially in my profession.  
So she says to me, "yeah, and I guess if they eat too much candy they can get diabetes too" UGH!  Really?  So I politely say, "no, not really, actually you're more prone to get it by genetic predisposition than by eating too much sugar"  "Oh, I guess I don't know that much about diabetes anyway".  
Right, I hadn't noticed.

Had tea with another friend and when I explained to her that I wear an insulin pump because I have diabetes her reaction was, "Oh, you have it THAT BAD?"  "yeah", I said.  

I mean, I don't expect everyone to know everything about diabetes, not by a long shot.  But since moving, I've noticed this kind of becoming an issue for me.  

I'm usually one to meet friends pretty easily.  I'm outgoing, friendly, talkative, and usually that ends in me rapidly making good friends with a lot of people. I'm usually really open about diabetes.  Don't mind telling poeple about it, don't mind people asking about it.  Until recently.  

I've had kind of a hard time adjusting to my new life here, in Asia, thousands and thousands of miles away from home.  For some reason, well, I know what the main ones are, but anyway, it's just been... difficult.  Add to that the fact that making new friends means they don't already know about diabetes like my friends back home already know about it... it's just added to the stress of it all.  

I mean, how do you just go up to a person and explain that you have this chronic condition?  It's so damned awkward.  I'd take the silly questions my OLD friends had over explaining it new for the first time any day.