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!

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

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…

Evolution of Insulin Delivery

In the Beginning, there was Regular and NPH delivered via disposable ultra-fine hypodermic syringes, circa1992.

Sometimes with the “help” of funny little contraptions designed to “hide” the needle, or speed up insertion.

Then came insulin pens.  At first, they were made to look like any other pen with all of the Rx info printed only on the disposable cartridge inside the pen.  I switched to these pens around 2000.

At some point, pens became entire disposable units.  Luckily, I never used these…

…because I began pumping in 2002.  I chose Animas because, at the time, they were the only waterproof pump on the market.  Despite pull from my doctors to choose MiniMed, I insisted.  My IR1000 pump was a brick, but I loved it.

I didn’t so much love the infusion site insertion.  Equipped with a 2 inch needle that needed to be inserted manually, I was still grateful to not to have to take 4+ shots per day.

Then, in 2006, Animas came out with the new IR1250 which had a built in food database for carb counting, smaller dosing incriments, and a sleek new design.  Goodbye brick, hello future!  (It also helped that the new pump came with a free iPod nano.)

The new pump also came with a new way to infuse.  Automatic insertion quickly became my new best friend.

Ping became a part of my life in 2010 (I always managed to get an entirely new pump system whenever my warranty for the old pump expired.)  With the remote in hand, Ping and I get along swimmingly to this day.

In 2011, I added Dex to my D-care team and I am now patiently awaiting the release of Dex and Ping’s child, Vibe, which will hopefully take place soon! (Ping’s warranty is up in 2014, hint, hint!)

It feel like the only thing left to wait for is a completely integrated, closed loop system,

Or maybe just a new one of these:

Isn’t he cute?

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.