Insulin

Replicating the Good Days

2 Comments

At the moment, I’m trying to replicate days like these.

Rather than these.

I have whole weeks where my carb counting is spot on, insulin just ‘works’ and blood sugars are simply effortless to manage. There are less highs, and less lows. The stream of good blood sugars seem to have somewhat of a flow on effect, so long as I can keep the train on course.

Then there are the weeks where blood sugars simply do not want to co-operate with the maths. Blood sugars feel like a lot of effort to manage, because naturally the insulin doesn’t work as well when levels are out of range. The urge to rage bolus is real, ultimately leading to more lows, and more rebound highs. It feels much more difficult to get the train back onto the course, rather than simply keeping it on the course.

In the midst of trying to pinpoint things, this was yesterday’s discovery.

11.1 was the greeting that I received from my FreeStyle Libre sensor after breakfast yesterday. It’s not what I was expecting, given that I had woken up to a blood sugar of 6.2 and carb counted my eggs on toast and milky coffee.

I gave an additional unit of insulin, and decided against reducing my basal rate for a day on my feet at work until that stubborn high started to come down.

Normally, a one unit correction while ripping open pallets of bulky furniture would send me plummeting. Yesterday, I was lucky to nudge the top edge of my target range.

As I recalled the day prior, my blood sugar had also remained stubbornly in the 8s despite repeated corrections. After increasing my basal rate in the evening and avoiding every urge in my body to rage bolus, I slowly but surely landed back into range by bedtime. Only to find that the ascent had begun once again when I checked at 1am.

By this point, I knew what had happened. In fact, I was feeling like an idiot that I had not picked up on this sooner.

Perhaps not as terrible as the banana bread highs that spoiled insulin had given me last time, but spoiled enough to make my blood sugars noticeably more stubborn to manage than usual.

Tools and technologies are only as smart as the people using them.

By sharing some more bits of the daily grind here, I’m hoping to make myself a bit more accountable to replicate more of those good days.

One Messy Night.

1 Comment

I was ready to go to bed.

As I watched my blood sugar slowly climb into the 10s, I gave a unit of insulin to correct. Thinking about the after effects of stacking my dinnertime insulin on top of a late afternoon coffee and one of Nonna’s biscotti, I set a temporary basal rate of 150% for 2 hours to help that insulin better do its job.

I set the alarm on my iPhone for 1am and switched off the lamp on my bedside. With a nagging feeling of doubt as I turned on my side, I fumbled for my pump in the dark and gave another unit.

DURN! DURN! DURN! DURN! 

I hastily fumbled for my phone to silence the shrieking alarm, before switching on my bedside lamp again. As I swiped my Libre reader, I was half expecting see blood sugars heading into low territory.

Instead, I was actually a pleasant 13.8.

I was in disbelief. However, I thought it could be plausible after having pasta for dinner. I reached for my insulin pump, and gave a rage bolus of 3 units.

ZZZZ! ZZZZ! ZZZZ! ZZZZ!

My rage clearly wasn’t enough to fuel the delivery of this bolus, which was stopped in its tracks by a very irritating occlusion alarm that was hissing and vibrating at me for attention.

I ripped the cap off my infusion site, which revealed a perfectly clear looking site. A poke and prod around the area showed no signs of any discomfort. I primed several units of insulin out of my pump line, watching it spill over the cannula and pool around the cap to satisfy my paranoia. I held my pump line up in the air and ran it through my fingers, watching it like a hawk for signs of air bubbles.

With my paranoia satisfied, I reattached the cap to my infusion site and delivered the remainder of the bolus that my pump had cut off. I set another temporary basal rate of 150% for the next two hours, setting my alarm for 3am.

When I stirred at 2.17am, feeling rather uncomfortable, my Libre reader revealed a reading of 17.7 and rising. I hastily grabbed my pump and went to deliver another rage bolus of 5 units.

ZZZZ! ZZZZ! ZZZZ! ZZZZ!

That hissing, vibrating occlusion alarm sounded once again, stopping my rage bolus in it’s tracks.

By this point, I was furious as I flung my bed covers away from me and was forced out of bed.

Finally, I ripped the infusion site away from my stomach. There was no kink in the cannula. There were no signs of blood, bruising or bleeding on my stomach where I’d placed the site. Everything looked fine, and I was convinced I had just wasted a perfectly good site.

After inserting a fresh infusion site, setting a temporary basal rate and delivering my third rage bolus of the night, I was finally able to close my eyes.

I wasn’t surprised to learn that I’d slept over my 6.25am alarm. I gulped down my coffee, showered, and hastily threw two pieces of frozen Pane Di Casa into my bag to toast at work.

I soldiered on, reminded of just how much responsibility rests on my shoulders every day.

YpsoPump Lanches In Australia!

9 Comments

Did you just say that we’re getting a pump?

Yes.

To keep?

Yes. If you’re going to write about it, you need to know all of the facts.

All of the other bloggers were convinced that I must have misunderstood Ypsomed Australia’s General Manager, James Mayjor. I was convinced that perhaps he was just leading me on.

I walked away with the brand new YpsoPump, that officially launched in Australia today. Consumables are listed on the NDSS, meaning that Ypsopumpers will be able to access subsidised supplies just like any other pump.

I believe that a large group of Diabetes Educators will also be coming to Sydney for pump training over the next two days, so if you are thinking of starting on the Ypsopump there’s a good chance you’ll be able to find a trained CDE near you.

So, disclosures. My Life Diabetes Care covered my travel expenses and accommodation in Sydney to attend the launch of the Ypsopump. The team from My Life Diabetes Care kindly gave us a platform for the consumer voice to be heard, as well as hearing all sorts of crazy dinner conversations last night! If that wasn’t generous enough already, I was also given a Ypsopump, some infusion sets, reservoirs, pump cases and an inserter to trial.

So before you read any further, there is a pretty big bias in place. However My Life Diabetes Care have not paid for my time or my words which are, as always, my own.

First up, hooray for new pump choices in Australia!

Secondly, I honestly cannot believe just how sleek and lightweight the Ypsopump is compared to my chunky Animas Vibe that’s looking increasingly like something from the last decade. The My Life Diabetes Care team did highlight that the Ypsopump had been designed to fill the gap in a market filled with complex, medical looking devices.

I was also most impressed to hear about the My Life Diabetes Care portfolio of products, which included things like needles, pen injectors and blood glucose monitoring for people on Multiple Daily Injections and Structured Blood Glucose Monitoring. The tech is not for everyone, and offering choice to consumers is extremely important.

The pump is touch screen, although not a full colour pump. The biggest difference to my late Vibe is that the bolus calculator is not contained in the pump itself, but rather done in the My Life Diabetes app. So, I would calculate my bolus in the app, and then administer the recommended dose using the pump. The pump then connects all of my insulin dosing data to the app via a Bluetooth connection.

Infusion sets come in either steel or teflon, are available in a variety of lengths, and also have the option of manual insertion. Another noticeable difference for me compared to the Animas was the lack of a 45 degree angled cannula.

If you hadn’t noticed my enthusiasm already, I obviously hooked up straight away. It’s still very early to draw any more conclusions, but I will have more to share in the coming weeks. For the time being, I’m more than happy to stow my late Animas Vibe away in my pencil case.

P.S. A photo where I’m actually smiling!

P.P.S. Could we have thought of a better product placement? From left to right: Ashley (@hangrypancreas), Melinda (@melindaseedt1d), Renza (@RenzaS), Rachel (@yoga4diabetes), Me (@FrankSita) and CDE Blogger Extraordinaire Jayne (@JayneEdHealth).

Dear Pancreas

5 Comments

Dear Pancreas,

Congratulations. You’ve officially been in retirement for eight years today. I hope you’ve enjoyed the seemingly endless stretch of long sleep ins and lazy, effortless days.

If there’s one organ in the human body that I’ve truly come to appreciate since you clocked off for the last time eight years ago, it would have to be you.

You were able to produce just the right amount of insulin for the carbohydrates that I sent your way, and convert those carbs into energy for me to use through the day.

You were able to respond to all of the crazy factors that affected my blood sugars. Things like pizza nights, illness, stress, physical activity and even how well I slept last night!

You were able to produce just the right amount of insulin so that my blood sugar didn’t peak too high, but also didn’t drop dangerously low. You never had to chase the unicorns.

I honestly don’t know how you did that gig all by yourself for 17 years. You didn’t have any resources at your disposal. You didn’t have any healthcare professionals to guide you. You didn’t even have any friends to support you. Yet you never once complained.

Being a pancreas is in no way normal. There’s no one else quite like you. The nature of your job can feel rather isolating. Yet you held your head up high. You stood tall. You never once showed a single shred of emotion. You never burned out.

You’ve definitely pushed me far from my comfort zone. I’ve met new people, I’ve visited new places. Your retirement has definitely instilled a great deal more confidence in me than I’d ever once imagined.

Dare I say I’ve taken quite an interest in you. I read about you. I talk about you. I write about you, frequently. I’ve even dedicated a whole blog to your demise. Some might say I’m obsessed with you.

You’ve left me with tonnes of additional duties since you departed the office eight years ago. I’m ashamed to admit that I don’t do the job half as well as you once did. I have to do the job of a human being as well, you know. I do try my best, you know, but somehow I don’t think I’ll ever be able to fill your shoes.

So, in case you had forgotten, today also happens to be my eighth diaversary. I’m not sure if you’ve been out shopping yet, but if you wanted to get me something really nice to mark the occasion, you could simply get up off the couch and come out of retirement.

I know I can’t offer you much, but I promise to feed you, take care of you and provide a roof over your head. I’ll never for a second take your job for granted again.

So, what do you say?

With all my love,

Frank

Insulin Gone Bad.

3 Comments

I couldn’t help but notice the reading of 14.1. Is that high? My friend asked me from across the table as I was demonstrating my FreeStyle Libre.

Yeah, I obviously haven’t given enough insulin for the banana bread, I replied, pulling my pump out of my pocket and bolusing for another 30 grams of carbs ever so casually.

I had already bolused a very generous 60 grams of carbs for the slice of banana bread and iced coffee I had ordered at the local cafe, but I wasn’t overly surprised to see the upward trend arrow on my Libre.

My blood sugar was still skyrocketing by the time I arrived home an hour later, with my Libre clocking in at a lovely 17.4. I bolused for another 10g of carbs, bringing the total for my mid morning coffee catch up to an overly generous 100g of carbs. I was certain that all of this insulin was bound to kick in any minute now.

After another hour had passed and my Libre clocked in at 25, I had figured that banana bread was the devil. After a prick of the finger came in at 20.4, I ignored all insulin I had on board and gave a full 4 unit correction. I also set a temporary basal rate of 100% to help get things moving in the right direction.

After a bucketful of insulin, my blood sugars slowly but surely began moving in the right direction over the course of the afternoon.

When dinner time rolled around and I was back in range, I bolused for the 50 grams of carbs on my plate. I drank a glass of water. I stepped outside and turned the sprinklers on. I washed some strawberries that I planned on having post dinner. I drank yet another glass of water. I stepped outside again, and switched the reticulation off. After distracting myself for a good 20 minutes or so for the bolus to kick in, I finally tucked into my dinner with the hope of avoiding another blood sugar rollercoaster.

Fast forward to me in front of the television 2 hours later, and my blood sugar clocked in at 16.1 with an upward trend arrow on my Libre.

I scrolled back through my pump history, noting that my last prime was four and a half days ago. As I swapped out the infusion site, my brain began to cotton on to other moments of particularly difficult-to-manage post meal blood sugars in recent days.

The lone milky coffee that sent my blood sugar upwards of 10. The hot cross bun that I’d carefully pre bolused for, but landed me close to 20. Rising blood sugars, despite a long walk fuelled by 10g of chocolate beforehand. Even a pasta meal had been extremely difficult to manage.

As I connected all of these recent occurrences together, I eventually recalled another occurrence of skyrocketing levels when my insulin had spoiled 2 years ago.

My insulin had spoiled! There was my answer! 

So, maybe Banana bread wasn’t the devil after all.