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!

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.

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.  

adjusting to a new schedule

Keeping good control over diabetes means making frequent adjustments.  A friend of mine, and diabetes podcaster recently asked the question; "How often do you make changes to your basal rates?"  This questions means making adjustments to the amount of insulin your body receives throughout the day.  Basal rates are the amount of insulin your body requires at different times in a 24 hour period.  Each time I visit my Endochronologist, like I did about 2 weeks ago, we look at my blood sugars, analyze my A1c, and examine my basal rates.  Usually, we make some little adjustments.  My doctor has taught me that there needs to be a minimum of a 10% change in basal rate for an effect to take place.  I see my doctor every 3 months.  Occasionally we don't make any changes, most of the time however, we do.  I rarely make adjustments to my carbohydrate ratio (the amount of insulin I take for the amount of carbohydrates I consume) but in the beginning I made those changes more frequently.  I also made carb ratio changes when I was pregnant because EVERYTHING changes and gets really wacky when you're pregnant and diabetic.

Anyway, recently, my weekend schedule has changed.  I wouldn't say that it has changed dramatically but it has changed enough for me to notice a pattern of change- for the worse.  So, I've got to decide what I'm going to do to make some changes and adjust to this new change.

Each year, our church schedule changes.  We attend church for a three hour block of time.  Each "ward" or congregation, is assigned a different start time so that the buildings may be shared by more than one ward.  This year, its our turn to attend the 12:30-3:30 block.  AND I HATE IT!  I absolutely detest this schedule.  It's not good for me, and it's not good for anyone else in my family.  Last year we were lucky enough to attend the 9-12 block.  Yeah, it's nice to sleep in on Sundays but I'd much rather be finished with church by noon.  Also, when do you eat?  Either you sleep in and eat a big, late breakfast; or you wake up early and eat two small meals before attending church.  This is what has been really whacking out my blood sugars.  In the 5 weeks we've attended church in 2012, I've had ONE Sunday where my sugars were under control.  The other weeks, I've had one issue or another.  I've been high, I've been low, I've been quickly rising and falling fast.  Ugh.  I cannot figure out this schedule.

Yesterday, it finally clicked that something had been off for five straight weeks, each and every Sunday.  Yesterday I took the day to sleep in.  I slept until 9:00 am like a total slob (for a mom) and didn't eat breakfast until 9:50am.  At that time, my blood sugar had dropped to 59.  I didn't even feel it.  I almost always feel lows. Not this one.  So I ate.  And I ate.  And I probably did eat too much.  And I didn't take any insulin.  So, 2 hours later, my sugar was like 280.  Then I got to take my naked and free shower (where you aren't wearing a pump site or sensor) and put in a new site after my shower.  I bolused and figured I'd come right on down.  Only no.  1 hour after my bolus I checked my sugar and it was 316.  I felt super dizzy.  And super thirsty.  And it just happened to be the first week of the month which means that everyone is fasting.  So I'm taking down at the water fountain when all the adults around me are fasting from food and drink, including water, for 24 hours.  Ugh.  But you do what you have to to take care of yourself, right?
Eventually my sugar came down and I spent the rest of the day fighting lows.  Which leads me to tomorrow's post.

So, let me get to the point here, I know I've got to make a change.  And I hope it will be an easy one.  I just need to wake up earlier.  No more enjoying the ONE BENEFIT of this stupid late schedule, I've got to get up at my regular time and eat breakfast at my regular time.  As for lunch, I don't know.  I think I'll just go for a little carbohydrate and protein combo snack before church and maybe another portion when I get home and then have dinner at the regular time.  That should do it.

I'll let you know how it goes.

Diabetes Doesn't Care

Diabetes doesn't care if it's 2 hours after you went to bed. Diabetes doesn't care if you just fell into a deep sleep. Diabetes doesn't care if you've counted all your carbs, bolused correctly, had a bedtime snack, did your exercise, and otherwise followed through with all of your normal "diabetic" routines. Diabetes doesn't care if you're sick, or tired, or if you have a big day the next morning. Diabetes doesn't care if you have carefully calculated your basal rates.

When Diabetes wants to strike you with a "low" or a "high" then Diabetes is going to strike. Diabetes is 24/7 - 365. It doesn't break for holidays, sick days, birthdays, or Sundays. It doesn't EVER go away!

Monday night I went to bed at a decent hour. Back to a regular routine in the morning. My blood sugar at 10pm was 130. Just about what it had been all day long. Nice and steady.

I worked out at about 10am that morning, so it had been a good 12 hours since then. I ate my regular 6:00 dinner.

I had NO REASON to believe that my blood sugar would plummet. However, just about an hour into my deep sleep, I woke with the distinct feeling that I was low. When I was first diagnosed with Diabetes, I thought for sure that I'd never wake up with a low blood sugar. Little did I know, I just wasn't experiencing them. Once I did though, I knew they'd always wake me up. I don't know how my body does that. But I'm really glad it does. Sleeping through a low could be very dangerous. I wake up and think, "aw crap, I'm low". I reach over to the bedside table and flip on my light, test my sugar: 53. So I stumble down the stairs to the kitchen on my terribly aching feet and get the rest of the juice out of the fridge. There's only a half cup left and I water it down for the kids so I know it isn't going to be enough. I grab a slice of bread, pour some honey on it and climb back up the stairs to bed.

Then this post starts running through my head until I can finally fall back to sleep. My sugar at 7:30am the next morning: 130. Just what I thought it would be... without the escapades in the middle of the night.

10 Facts about Diabetes

Having to test my blood sugar 4-10 times a day is a real pain.

Having to change my site every three days is annoying.

When the batteries in my pump die, replacing them can be inconvenient.

Dealing with the symptoms of low blood sugars is frustrating.

Hyperglycemia side-effects are nauseating and can be life threatening.

However, the thing that bothers me most about having diabetes is others' ignorance about it. AND, the stupid things they say to us.

I've had people ask me questions about my pump, my blood sugars, my insulin, and even my diet. Most of the time people are just trying to find out more, they're curious, and I REALLY don't mind telling them more about it. But when people throw out their opinion when they're uneducated on the topic, that's when I get mad. Maybe mad isn't the right word. Just frustrated or annoyed.

Probably the worst question I've received is one that I hear quite frequently, "Can you eat that?" or, "Are you allowed to have that?" or, "Should you eat this?"

I've also heard, "You're a diabetic, does that mean you can't have any sugar?"

"I could NEVER give myself a shot"

"Do you always wear your pump?"

"Did you bring your food supply?" (this person was referring to my pump)

"Do you need your medicine?" (when I'm low)

"Do you need something to eat?" (when I'm high)

"Don't you think you'll be able to get rid of your diabetes since you're exercising more?"

"You're not too fat for a diabetic"

"You have diabetes? But you're not overweight."

There are some SIMPLE things that I wish ALL people knew about diabetes. I'll be the first to admit that I knew very little about diabetes before I was diagnosed. I also know that for the most part, people are just curious and that their comments aren't meant to be malicious in any way. However, it's pretty much NEVER socially acceptable to talk about another persons weight. Or diet. And if you don't know the way something works, don't be afraid to ASK a question so that you CAN understand.

1. Your pancreas is the organ in your body that makes insulin which controls the blood sugar levels in your body. A normal pancreas delivers insulin when you need it, and does not when you do not need it.

2. Diabetes means you have too much sugar in your blood- Hyperglycemia.

3. Usually a diabetic's blood sugars are too high. To bring them down, they must take their medication; either insulin or pills.

4. Sometimes a diabetic's blood sugars are too low. To bring them up, they must take in glucose by way of eating or drinking something with sugar in it.

5. Neither low blood sugars or high blood sugars are good. Lows can make a person pass out if extreme. Highs are more dangerous in the long run and cause complications like heart disease.

6. There are 2 different kinds of diabetes.

-Type 1: USED to be referred to as juvenile or childhood diabetes. This type of diabetes means that the person's pancreas no longer works and that to STAY ALIVE they must inject insulin; either through a syringe or a pump.

- Type 2: USED to be called Adult Onset diabetes. This type of diabetes means that the insulin your body makes is no longer effective, or as effective as it should be. This type is usually treated with oral medication but some patients also inject insulin.

7. Adults can be diagnosed as Type 1.

8. Children can be diagnosed as Type 2.

9. Currently, there is no cure for diabetes.

10. You could give yourself shots if you had to do so to survive.

I know this post sounds negative, and I'm sorry for that. I'm really not angry or anything, my purpose is really to get more information out about diabetes.

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.

Thanks!

Jen

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.