Keep on swimming, swimming, swimming…

Here we go again! At least I can say that my A1C is improving. Not quite where I’d hoped it would be this time, but getting there.

  • Hemoglobin A1C: 8.2% (was 8.8%) [4.8-5.6%]
  • Serum Glucose Fasting: 119 mg/dL (was 83 mg/dL) [65-99 mg/dL]
  • BUN: 14 mg/dL (was 14 mg/dL) [6-24 mg/dL]
  • Serum Creatinine: 0.79 mg/dL (was 0.66 mg/dL) [0.57-1.00 mg/dL]
  • TSH: 1.330 uIU/mL (was 1.330 uIU/mL) [0.450-4.500 uIU/mL]
  • Total Cholesterol: 226 mg/dL (was 213 mg/dL) [100-199 mg/dL]
  • Triglycerides: 129 mg/dL (was 137 mg/dL) [0-149 mg/dL]
  • LDL Cholesterol: 138 mg/dL (was 124 mg/dL) [0-99 mg/dL]

I really thought that my A1C might sneak in under 8.  I was so hoping for a number in the 7s (I knew it couldn’t possibly be less than 7, which is the ultimate goal for this T1D), but I would’ve been thrilled with a 7.9999 (smile).

[For those who may not know or have forgotten, the Hemoglobin A1C test is a diabetic’s touchstone into how they well they are managing their diabetes.  It measures glycated hemoglobin, or, simply put, your average blood glucose for the past 2 to 3 months].

So, my A1C was 8.2%, which means my average blood glucose for the last 2-3 months has been around 190. (Last go ’round, it was 8.8%, which is an average blood glucose of 200+.  And the time before that, it was 9.0%, which is an average blood glucose of 212).

Note that  a normal A1C is between 4.5 and 6. Most diabetics have a goal of <7%, which would indicate an average blood glucose of about 154.  That sounds like nirvana to me!

Anyway, my doctor and I looked at graphs of the last 3 weeks from my pump and CGM.  There were two clear trends:

  • My morning blood glucose is running too high (which means it has been running too high through the middle of the night too often) and it doesn’t seem to lower quickly enough (whether I eat or not).
  • My late afternoon blood glucose is dipping too low too often.

We made some adjustments to my basal rate and carbohydrate ratio at different points in the day. And she was happy that I am exercising more (so am I, although a bit frustrated that the scale moves down as slowly as my A1C).

I did mention that I am not sensing my lows like I used to (I’ve had several in the 40s recently where I barely knew I was low – this can be a bit scary).  She said that is a normal progression (neuropathy) for someone like me who has been diabetic for 30+ years.  We also discussed using a temporary basal when I exercise to (hopefully) prevent the lows that I seem to be having now that I am exercising more.

You might have noticed that my cholesterol inched up, even though I have been exercising more and eating better.  I realized a couple of weeks ago that I had not been taking my Crestor as regularly as I should (it is on a different refill schedule than my other meds, and I have another pill that looks very similar. Doh! So hopefully, with more rigor in taking my medication, that will improve, too).

Overall, a good appointment, and I am trying to focus on the good news. My initial reaction was to be disappointed and discouraged, but I told myself (and keep telling myself) that I am doing the right things, and it just takes time.  So I shall, like Dory, keep on swimming, swimming, swimming…and work towards that ever elusive <7% in June.

Thanks for listening!

 

WARNING: If the sight of a 54-year old belly makes you queasy, do not read this post!

You have been forewarned!

As I was looking at the paraphernalia that is regularly attached to my abdomen, I thought many of you may not know what it it’s like to use an insulin pump and/or a continuous glucose monitor (CGM).

Well, it’s not pretty, especially on a 54-year old’s belly. So, in the spirit of sharing, here’s what it looks like on me (the only PhotoShopping I did was to add the text and arrows):

InsulinPump&CGM

All wired up!

 

[Side note: Quite often, I have bruises from all the various insertions, but lucky for you, when I took this photo, my tummy was pretty clear].

Realistically, it’s not a lot of equipment – just 3 pieces:

  • The insulin pump
  • The infusion set
  • The CGM transmitter and sensor

First, let’s talk about the pump. This is truly my lifeline.  Most T1Ds inject insulin into their bodies several times a day with a syringe. I used to do that, but I have been lucky enough to wear an insulin pump for the last 10 years or so.  (As a reminder, an insulin pump is an external, battery-powered device that delivers insulin into my body at a programmed rate.  The infusion set is a reservoir and tubing, which, when connected to the pump, delivers insulin from my pump to my body).

I always have the insulin pump on and the infusion set inserted into my body.  I’ve kept it on during surgeries, I sleep with it, I keep it on when I’m flying, I wear it when I’m exercising…The only time I don’t wear it is when I am showering or swimming (and then it is only off for minutes at a time).

The pump is “programmed” for my specific needs.  (And I purposefully put that in quotes because it is not an exact science by any stretch of the imagination).  Essentially, my insulin pump works this way: I get a tiny but steady stream of insulin all the time (the basal rate) and when I eat, I give myself additional insulin (a bolus) to compensate for what I ate (so that my blood glucose doesn’t get too high). Now, I used to have to do those calculations in my head when I was giving myself shots, but the pump has a featured called the Bolus Wizard which helps me with that.

Sounds simple enough, but you also have to take into consideration things like exercise, glycemic rates, the fat content in your food, stress, whether the stars are aligned (you think I jest) and so much more. And sometimes (many times, actually), what worked yesterday doesn’t work today.  But that’s the life of a diabetic.

Theoretically, this combination of basal rate and bolusing mimics how your pancreas works (if you’re lucky enough to have a working pancreas). For people like me, this little machine and my brain are doing the work for my pancreas. Like I said earlier, it is truly the lifeline that I cling to.

I change the infusion set every 3-4 days.  I usually rotate from one side of my abdomen to the other each time I change it.  It takes me about 3-4 minutes to remove the old equipment, rewind the pump, fill the reservoir, insert the infusion set and prime the pump.  Once that is done, we’re off and running again.

Occasionally, when I remove an infusion set, I’ll have a bleed out.  Those can be quite embarrassing (I had it happen in a restaurant once), but you just handle it.

Lest you think this is a lot of trouble (and it can be), I wouldn’t go back to giving myself six shots a day for anything.

Now on to the Continuos Glucose Monitor, or CGM, which measures my glucose levels in real-time, twenty four hours a day. A tiny electrode (the glucose sensor) is inserted under my skin to measure glucose levels in tissue fluid. It is connected to a transmitter that sends the information wirelessly to my pump.  The pump can then detect and notify me if my glucose is going too low or two high (thresholds that I have set in my insulin pump).

And notify me it does! Which is a good thing, but sometimes (especially when it is going off in the middle of the night), it can be overwhelming. (Just today I was yelling at my pump because the low glucose alarm kept going off, and I was eating, and it was taking longer than I would have liked for my glucose levels to rise).  And yes, I can adjust my thresholds and other things to make those alarms occur less often (but that kind of defeats the purpose, imho).

I change my CGM every 6 days (which is the life of the sensor).  It takes me about 5 minutes to do this, mostly because it’s a little trickier than the pump and infusion set, and I haven’t been doing this as long. I still mess it up from time to time, and when I end up wasting a sensor, I just think “ka-ching, ka-ching.”

Note that I do not have to wear the CGM all the time, but I am finding it quite useful these days in helping me try to keep my blood sugars in better control.  We shall see how I am doing when I visit my endocrinologist in a couple of weeks.

So, there you have it.  There are a lot of other details and nuances about using a pump and CGM, and this was in no way meant to be scientific or comprehensive. But it thought it might give you a glimpse into what I – and so many other T1Ds – do every day of our lives.