I Blame Christmas

I’m having one of those weeks; one where D is behaving like a unsupervised 2 year old on an airplane.  Infusion sites are turning into giant purple bruises on my stomach, or becoming strange unabsorptive lumps on my thigh, or failing to stick properly and falling off within hours.  Meals are being bolused for 5 minutes late and I’m paying for it for 12 hours after.  Insulin has been behaving more like saline, requiring me to bolus at least 1.5x what I think I need to cover anything; I’ve been stacking insulin on insulin, drinking my weight in water, and keeping a constant eye out for ketones (none, thankfully!) but my BG hasn’t been under 150 for more than an hour or two in the last three days!

I’m sure the sushi buffet for Christmas, combined with the stocking full of Reese’s cups and almond Kisses, then the Indian buffet yesterday, and the complete upside down schedule involving way more TV than normal haven’t helped but I’m choosing to blame Christmas.  Christmas was the motivation for the majority of those aforementioned food choices.  Christmas is the reason I’ve had time off work to spend too many hours sitting in front of the television.  With Christmas comes cold weather and with cold weather (and no car) comes a lot more staying home to stay warm. 

I'm ready to quit!

I’m ready to quit!

That average daily dose is about 20 units higher than my normal daily dose.  You’re probably looking at the picture above (of the worst summary screen shot of my adult life) and thinking that it must not be a very realistic summary of the last 3 days, maybe I failed to enter lower numbers into my pump that didn’t require a correction?  While that’s somewhat true, the next screen shot from Dex proves my point:

Worst 3 days in history

Worst 3 days in history

That’s right. You’re looking at 3 full days with an average of 79% above target! Typically I can at least manage to reign in the beast overnight; but not at Christmas!

I am not a Grinch.  Really.  I’ve had my Christmas tree trimmed for a couple weeks and the stockings have been hung with care.  I sent out my homemade Christmas cards and decorated my fridge with the cards and pictures sent by my friends and family.  Christmas is the one holiday M even remotely gets into and I love how opinionated he is about the tree needing to be decorated only with red, the twinkle lights can only be white, and the tree isn’t complete until topped with a star.  Christmas means hot chocolate and singing and mittens and warm tidings (whatever the hell those are).  What’s not to love?

Despite all that, this year I’m thisclose to giving up on Christmas.  If it’s just going to return my love with sticky high blood sugars and teeth sweaters and an increased A1c, then I’m going to boycott.

But then today, the day after the day after the day after Christmas, I wake up with a BG of 65 and level off to 135 after breakfast and I remember that Christmas is over.  I can use the weekend to return to my regularly scheduled food/activity routine, and my blood sugars will return to normal.  I suppose this is what New Years resolutions are for, huh?

I guess Christmas can stay...

I guess Christmas can stay…

Advertisements

Hello, Goodbye

Apidra week from Hell - normally these range bars are short and close(ish) to the green happy-zone. 😦

First a little background as to why I decided to try out Apidra:
I’ve mentioned before that I participated in Joslin’s Why WAIT? program. It was accomplished through a combination of increased exercise, decreased food intake, and the addition of Symlin to my D-regimen. These things combined to cut my total daily dose of insulin in half, and then some. Originally the team had wanted to switch me from Humalog to Apidra because it peaks faster and would theoretically have made blousing with Symlin a bit easier. But, I had 10 vials of Humalog in my fridge, no real job, and switching just wasn’t an option.

Fast forward to last month, about 4 or 5 months post Why WAIT?, to my endo appointment. I approached my endo about switching to Apidra since my humalog supply had dwindled, and, although she wasn’t sure the benefit would be significant, she didn’t see any reason not to try it. So, I walked away with a prescription for a three months supply of Apidra.

After some trouble getting things straightened out with my new online pharmacy, I finally received the Apidra two weeks ago and began using it last week, on Feb 28 at 7pm. And then it began.

Day 1: Hello Apidra. My BG is running high all day; I wake up with a BG of 120, eat nothing and by the time I’m at work an hour later my BG has jumped to over 250. I do correction bolus after correction bolus to no avail and spend the entire work day over 250, even after eating a carb-free salad for lunch. Promptly at 5pm, when I normally head home from work, all of the boluses finally catch up to me and I drop almost instantly to about 55. I correct and make it home with a BG hovering around 100. Dinner is chicken and brown rice. My BG stays flat until bedtime but as soon as I fell asleep, Dex begins to wail. I probably test and correct 5 times overnight and my BG stays flat around 200 all night until an hour or so before dawn when it levels off around 100.

Day 2: Site change in AM. Repeat of day one.

Day 3: After the last 2 days of BG hell , I increase all rates and ratios by about 10% (except the post work/before bed ones) and shorten the IOB time on my pump so I can bolus more aggressively. I also add Symlin to most meals. My BGs level off a bit but they still sit well above my happy zone all day and require frequent corrections that seem to have no effect. I go low overnight.

Day 4: It is like Day 3 never happened and is a repeat of Day 1, again. (Only I have a low-carb, high fiber dinner that send my BG up to over 400!) In the middle of the night I have a low that requires 3 juice boxes and I still wake up the next day with a BG of only 75.

Day 5: Increase all rates again. No change. At this point I realized that I should be monitoring for ketones and luckily find none.

Day 6: Realize that I can’t fix this problem on my own and call Joslin for help. I upload my pump and Dex data from the last week and send it after work. At this point the 5+ days of highs have given me a terrible headache that I can’t quite shake. I officially hate Apidra. However, having a carb-free dinner has allowed me to sleep an entire night without any complaints from Dex. (Although he caught a low before bedtime that I corrected with ice cream perfectly – flat at 100 all night!!)

Day 7: After talking with the nurse educator and experiencing my 8th BG over 400 in less than a week (which is a number I haven’t hit in years!), we decide that I will switch back to Humalog immediately after work today.  Good bye Apidra.  You will not be missed.

So, unless this was some sort of ill-timed, un-related BG surge (which I doubt), everything should be straightened out soon.  And I can’t wait.

However, I now have 5 bottles of Apidra that I don’t know what to do with.  does anyone know of a place to “sell” (It would be great to get some part of the $60 copay back) or donate unopened bottle of insulin?

Über Frustrating

Typical Dex graph for the week…unfortunately.

Lately I have been constantly chasing highs – it seems like insulin has completely lost its effect on me.  I’m not sure if it’s because I haven’t been taking as much of the Symlin or because I haven’t been eating particularly healthy foods, but I hate this roller coaster and I can’t seem to get off of it.

Obviously my basals need tweaking (as does my I:C ratios and insulin sensitivity factors) but I’m just not seeing any patterns andI just can’t seem to “find” the motivation or time to do the tests.  Truthfully, I’ve never tested my basal rates.  I know what you’re thinking: how have I developed my basal program, with 7 rates throughout the day, without the occasional basal test? And the answer is quite simple: It’s a SWAG basal plan, and it has worked damn well for me up until now.

When I first started on the pump, I was a teenager and I had no problem running high or low occasionally (more often high than low) so a flat basal rate was fine.  Then, as I reigned in control of my BGs, the basal rate changes came naturally.  Now, with a general lack of routine in my life, my basal needs just aren’t as obvious and my BGs are suffering because of it.

So, my goal for the next week is to formally test my basal rates.  Tonight I will do day one of the overnight test.  Wish me luck!

Pain Happens

As a diabetic, I have learned to have a fairly high tolerance for pain.  I stick needles into various limbs multiple times a day so I didn’t have much of an option but to adapt.  (I am still a wimp when it come to D-unrelated pain.  For example:   At this sketchy pet store in Allston, where too many small mammals occupy too-small cages, reptiles and amphibians live in mineral stained terrariums, and dogs, cats, and birds roam free, I was attempting to befriend a nice macaw.  He bobbed his head up and down, inched toward me, and looked me in the eye.  He climbed onto my finger with little prompting, and “tasted” me gently with his beak.  Then he suddenly became infatuated with the strap on my purse.  He began to grab at it violently with his beak and talons.  So, naturally, I decided it would be best if this bird were no longer on my person.  So I tried to move my hand away from my body and encourage him to relocate himself on the perch, but he wasn’t about to give up that easily.  Instead, the bastard bit me.  Twice.  I have photographic evidence to prove it.   It hurt.  I cried.  Pathetic. I know. There was pain involved but I think I was really more emotionally wounded than anything – I was nice to that stupid bird and he bit me.  Bastard.  But I digress.)  Mostly, I have just learned to ignore D-related pain altogether.  A little discomfort is not worth the $12 I pay for a Dex sensor, or the cost of a new infusion set.  Plus, I typically don’t feel these things at all, but occasionally I encounter a site that stings or itches incessantly,  and I usually choose to just leave it be.

However, sometimes the prudent thing to do is not to ignore the pain but to figure out why it is there.  Like the infusion set that I out in yesterday morning.  First, a little background:  most of the time, I use my abdomen for infusion sites (along with the occasional thigh or arm) and I stick Dex almost exclusively on my thigh (although it sometimes resides on the back of my arm, or, rarely, on my abdomen) alternating from left to right with each new sensor.  My last Dex sensor failed after only 8 days (beyond the FDA approval but too short for my liking), so the two week break from Dex that I like to allow each site before beginning a new one required that I move off of my thigh.  Since it’s still short sleeve season, I decided against an arm site and settled on an abdominal insertion. (Doesn’t that sound like some sort of alien abduction thing?)  So, my Dexcom is now on the left side of my abdomen, using up 50% of my infusion site real estate.  Thus, when I had to pull an old site and insert a new one, I made the decision to keep it on the right side of my body, rather than alternate left like I would normally do.  I moved it about 4 inches out from the old one – toward the side – to a location that I rarely use.  The insertion was slightly painful, but nothing too notable.

I left for work, without eating breakfast and noticed that my dawn phenomenon seemed to be in full force.  I bolused a little correction and went on with my day.  At lunch time, I was flat around 200.  High but not too high.  I took my symlin, a correction bolus and ate lunch.  An hour later I took my carb bolus and another correction because the first one seemed to have failed me.  3 hours later I assumed that I must have counted my carbs wrong and took another bolus.  All the while, there was a constant stinging at the site of my newest Ping-connection.

By the time I got home from work, I had spent the entire day with a BG>200 (more like 300).  I felt pretty nasty, scratched at the stinging site, and still chose to ignore it – it’s just a little pain.  Finally as I was about to get into the shower, I noticed that adhesive of the site was already wearing off (apparently my clothes rub at that spot quite a bit) so I finally decided that it might be worth removing.  The moment I pulled the site, a steady red geyser of blood and insulin erupted from my side.

Had I listened to my body and conceded to the pain in my side, I might have removed this sensor much earlier and saved myself from an entire day of high blood sugars.  I’m glad that I have learned to deal with a little pain every now and then but, sometimes pain is worth paying attention to.

The Interview

Since writing my thesis in December and moving here to Boston, I have been on the job market. I’ve had a few interviews here and there but all of a sudden, right as I’ve begun to get a bit desperate, I have three interviews (all good, respected companies) within a week.  The prospect of having a salary and benefits (and vacation days) is so sweet that it is effecting my BG levels.  Literally.

I was at an interview yesterday at Company X.  It’s the perfect job.  I would be doing chemistry that is similar enough to my graduate work that I wouldn’t have to spend months figuring out how to even get started but different enough to be exciting.  I would work only during normal human working hours (no more nights and weekends!!) with people who seem to be incredibly friendly and inviting, and I would have enough money to move out of this mouse-infested apartment, buy a new (to me) car, and open a 401k.  More importantly, I would have employee sponsored benefits.  So, logically, I wanted to make a good impression so that they would want to hire me.

However, I was so nervous that the insulin in my Ping was rendered completely useless.  I went into the interview (and noon and thus immediately post-lunch) with Dex showing a flat arrow at about 120.  Nonetheless, I switched my Dex upper limit to 280 (normally 160), thinking that this would be high enough that I wouldn’t possibly ever reach it and I wouldn’t have to deal with and unwelcome beeps or vibrations.

The moment I set foot in the lobby the arrow rose to the NE position (which I attributed to that lunch that I mentioned), but the number was still reasonable so I figured it would be ok.  However, over the course of the 4 hour interview, my BG continued on a steady climb upward.  I was meeting with about 8 people from the company and I had a few minutes between each meeting to check Dex without being noticed.   Each time I checked (no more than a half hour apart) my BG had rose by at least 50 mg/dL so I began to pile on the boluses.

By 2pm my BG was over 300, Dex was still pointing toward the ceiling while vibrating angrily, and I was beginning to feel pretty awful.  During one break, I checked my infusion site, but found no obvious signs that it needed changing.  At the next break, I snuck a bolus via syringe, straight through my gray interview pants.  Nothing was helping.  The people I was meeting were great which was helping to calm my nerves but the knowledge that my blood was now the consistency of pancake syrup wasn’t allowing me to completely relax.

By 4pm, the arrows had settled and I was steady at 350.  I was feeling pretty crummy about the state of my blood, but great about the state of the interview, and it was time to go.  I shook hands with the head interviewer and stepped back out into the world.

I pulled Dex out of my pocket and saw a down arrow for the first time since before lunch.  Suddenly all of the blind bolusing that I had done in the last 4 hours didn’t seem like such a good idea.  By the time I completed the 30 minutes drive home, my BG had settled down to a steady 65, a little lower than I would like but not nearly as low as I had expected based on the nervous bolusing.

It’s like my nervousness made my cells impermeable to the insulin I kept feeding it while simultaneously removing it from my blood stream so as not to cause me to crash too low afterward.

I have another 2 interviews coming up next week and now, aside from being nervous about the actual interview, I’m also nervous about the state of my bloodsugar.

I should know by next week if I’m getting an offer from Company X and I’m feeling pretty confident that it will happen.