Blog Entries With Tag: basal


Posted: Nov 15, 2013

I just did my first Morning basal test – ever – in all my years of MDI (multiple dosage injections) and insulin pump control for my Type 1 diabetes.  I’d only ever done an Overnight basal test when I kept on experiencing hypos (low blood sugar) readings) during my beauty sleep and waking up bright eyed and bushy tailed (NOT).  Also, as a few experts point out – when trying to get a better grip on your basal regime – it’s always best to tackle the overnight one first.  THUMP!! – gold BLUE star to my forehead!

Good Little Bee by thisonlyexistsinmind.deviantart.com

Why did I perform a Morning basal test? Well, I’ve been starting to have more frequent lows a few hours after waking up – with or without a breakfast – or doing activity (remember – I’m trying to shed some weight here for heart protection).  It’s gotten to the point the last few months that my day is RULED by how my blood sugar (BG) is doing.  Often I’ll have tested prior to going out (remember – always to test your BG before hitting the open road) – and then within a few hours – I’m dropping like a brick. I used to think it was maybe due to stress of shopping (yes – most women like shopping – I detest it immensely – though if it involves hardware / auto or other manly diversions – then bring it on – I’m in).

Yesterday, when I was out getting weekly shopping done – I had to make a bee line back home before finishing off the tasks at hand.  I find this EXTREMELY annoying – and at that point – I really REALLY hate diabetes – and how it can take over our lives.  Planning to do something – takes back seat to the blood sugar fairy – and at that point – I feel like I’m ready for a straight jacket – since I don’t like feeling out of control.

Dude driving a little red car

So, the results of my basal test this morning?  My BG’s went down 1.7 mmol/l (31 mg/dl).  Not a great drop – but still – it dropped at the same time it seems to do – even after I’ve eaten a healthy breakfast – taken the correct insulin to the carbs I’m eating (that’s another test I have never done – and want to do after all the basal testing is done).  I’m learning with age (ahhh wisdom of the Old Type 1 Fart like myself) – that you never can say you’re a pro at anything (just like I can say about sailing, and other hobbies I do – I’m constantly learning new tricks of the trade).  I now know that I’m VERY insulin sensitive as I’ve gotten older (as a teen I was using up to 100 units a day of insulin – though that was after I almost snuffed myself with being out of control for a year and ending up in DKA coma – live and learn I say – and luckily for me – I survived).

Tomorrow, as suggested by Gary Scheiner from his 2nd edition book entitled  ‘Think Like a Pancreas’ – redo the basal test the next day if possible – using the reduced basal settings .  Along with the “bible” of ‘Pumping Insulin by John Walsh and Ruth Roberts‘(now in its 5th edition) – these are my CDE’s that I’ve always used to teach me how to use my insulin over the last 10 years.  With no help from my medical team in this area – I am lucky I can wing it on my own – of course – with much appreciated feedback from the D-OC (diabetes online community).  The world becomes a smaller place with all the help that you can find from other diabetic buddies around the world!

I’ll tell you – that double espresso along with toast and lemon marmalade and some cottage cheese at 12h30 never tasted soooooo good!!  Mmm, it’s now 14h12 – I’m now craving another espresso – time to go test my BG’s ...

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Posted: Jul 18, 2013

When I first started to wear an insulin pump back in 2008, I didn’t realise that wearing one would restrict some of my clothing options.  Living in Montreal, the fashionista capital of Canada (okay – there’s Toronto – aka mini-me USA – but they just don’t have that French flair like we do ).

It was sort of nice since January, when I took a pump break, not to have to spend the extra time to pick out clothing that would not reveal a bulge of George Michael aka GM (pun intended there – remember – I grew up with Benny Hill) my insulin pump.  Now that I’ve been back on the pump for over a month now, I realise that I have to take extra time to figure out what to wear that will allow me easy access to George Michael.   Hmmm, should have I had added that time factor into my application for DTC?

I did the stint for almost a month of wearing the infusion set in my arms.  That was kind of neat – almost like I wasn’t wearing an infusion set except when I’d hit a muscle or nerve ending in my arm with the stainless steel infusion needle (found Contact Detach/Sure-T does this more than the Inset 2 sets). One thing I am going to try out if I can get some samples of shorter needle/cannula length for the infusion sets - just like I have done with the shorter 4mm pen needles I started to use back in April.  My absortion with the shorter pen needle created no change in my BG's - which I thought it would due to my not being a slim gal (as I had told the RN when she gave me some samples of the BD 4mm pen needles said skin depths for absortipon of insulin doesn't change in the human body).  Anyway, back to old GM, here  I was tucking him into a sports bra – where I couldn’t believe that despite how hot it gets inbetween the girls – the insulin would keep on performing 100%.  My fear, like other diabetics is that heat will deteriote our insulin – but after 3 days of using the same insulin in the cartridge – my blood sugars (BG) stayed stable.

Actually, stable isn’t the word I should be using here.  I’ve been experiencing hypos (low BG) more often - that almost reminded me of my days when I was MDI prior to going onto the pump (one of the reasons I went onto the pump in the first place was due to having frequent hypos.  I sort of didn't understand how to use my combinations of insulin properly pre-2008, I was trying to learn how to do the poor man's pump method - but not quite doing it correctly.  As I keep on telling pumpers who’ve never gone back to MDI since starting on the pump - being on the pump has taught me how to fine tune with ONE insulin and that with that knowledge - you can easily transferred over to using TWO insulins when doing MDI.  It really isn't that difficult - honest - you've just got to know how to use your insulin(s) - and their little quirks.

So, with the hypos I’ve been having – sometimes a few a day – the things I have planned to do – that usually involve some activity (even simple grocery shopping believe it or not) – have to be shelved.  I do NOT like to have my diabetes rule what I can or cannot do.  My poor DH has to put up with my having to tell him that I can’t do this / that – and he’s so far not really sad much – as I go “I’m so sorry, I’m so sorry” or “Get me some quick acting sugar NOW!!!”.  What a range of emotional outburst I put him through – that is so not me – that it makes me cringe if a fly is on a wall witnessing this (thank goodness they don’t have the ability to hold a video camera).

My basal rate has now been reduced by almost 20% - but I’m still needing to tweak it abit with some more basal testing since now I am going low in the afternoon (very rare for me).  If that doesn’t work and I’m still experiencing low blood sugars (hypos), then it’s looking at my carb ratio (I:C) – which I have slightly changed since I’m now understanding I’m insulin sensitive.  The other thing to look at is my Insulin Sensitivity Factor (ISF) - which to me is a trial and error type of test - since there are a few different formula's out there to deterimne what is best for "you".  

Ahh isn't diabetes control a fun puzzle or what?
 
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Posted: Jul 7, 2013
Image of high 5 cat from reallyfunnypictures.co.uk

I had attempted an overnight basal test on Friday - but that was a failure with going low (3.2/57) - but last night - with having tweaked basal rates abit was SUCCESSFUL!!  I went to bed at 6.2/112 and woke up to 5.4/97.  During the night around 5 AM I had gone to 4.2/75 - but according to Gary Scheiner's book 'Think Like a Pancreas' - he says staying within a 1.7/30 up/down range from your original starting BG (blood sugar) - I was in the good zone. 


I have to admit - I'd like to be abit higher overnight with my BG - more in the 6-7/108-126- - so will tweak basals eventually - but am so looking forward to having a solid sleep tonight - as last few nights have been very broken with getting up every hour.

I guess this would be where a Continuous Glucose Monitoring System (CGMS) would come in handy - I know of some US health centers loaning them out to patients - but when I asked my endo about whether this was possible here in Montreal - he said no.  Anyway, the good "old fashioned" way of testing with the blood meter went well.

So much more precise than the urine testing in my earlier days of diabets control as I'm sure many of you will agree on!

Curious - how often do you test your basal rates (pumper or MDI)?  I have to admit - I blog about it "how to do it" - but have never really done a full night one before until having had difficulties the past month with low BG's since starting back on the pump after my break from George Michael.

I know that due to not having a Certified Diabetic Educator (CDE) or endocrinologist (endo)  to show/tell me how to do these sort of tests - I've pretty well had to go with what I read in books that others have recommended within the DOC (diabeties online community).  I have to admit - this time I was using Gary Scheiner's book I mentioned above instead of the John Walsh book - 'Pumping Insulin'.  I actually found Gary's book abit easier to understand - he writes more from the heart with being a Type 1 diabetic (T1D) like myself - and a pumper as well.  Both books though are very good - so they have many dog earred pages!

Picture courtesy of Fiction Writers Review
                                                 Picture courtesy of Fiction Writers Review

There's a few more tests I'm going to be doing over the next few months - to get more use out of my pumps programming (e.g. I have a feeling due to my sensitivity to my insulin - that perhaps my carb ratio is set too low - there are tests in both books that talk you thru' how to perform this).  The pump as some people think doesn't mean you'll have better control of your diabetes if you DON'T use it properly.  The same applies to multiple dosage injections (MDI).  You are the brains behind these devices we use - they can only help - if you know how to use them - along with help from your health care team (provided they are up on all the latest and greatest).

I know some of you may think it's dangerous for me to be doing this on my own - but sadly - not all of us have the resources / services available to us - and this is the only route we can go.  I would LOVE to be able to have a CDE or endo that understood the fine tuning of the pump - but alas - I've not lucked in as of yet.  A few years ago my GP had referred me to an endo here in Montreal that does research in the diabetes field and works with pump patients.  Sadly, when I saw her (Dr. Natasha Garfield) - she told me that my A1C of 5.9% at the time was dangerouosly low if she was to take me on as a patient.  I had hoped due to her having a team of CDE's trained in the pump area - that I'd be able to go to them for help when I needed it.  So, I walked away with my tail inbetween my legs and carried on the way I always do.

The Cat that Walked by Himself - by Rudyard Kipling
The Cat That Walked By Himself - by Rudyard Kipling - picture courtesy of  -http://www.mainlesson.com

So, this is why I do my own thing - and again - some of you maybe in the same boat as I am.  So far though, I seem to be on the right track - despite the little roller coaster ride from time to time that we all have with this disease!
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Posted: Jun 14, 2013
Artwork from bunbunlandia on WordPress dated March 10, 2012                                   

For those of you wondering about my little SCREAM on Facebook earlier today - about removing an infusion set (Contact Detach) - from my arm - that could be a potential gusher (in my eyes I was thinking more of a geyser) according to some of my D-mates 3 days before and how I faired.  Well, here's the LONG low down (and this is aimed at some of the commentors saying that they'd never done an arm infusion site before - it can be done - even by yourself).  


The reason I had written this - was my tubing the next day after putting the infusion set in (my 2nd arm installation - yes - I'm no longer a virgin) - had a very very weak pinkish tinge to it - though I couldn't tell if it was inside (from rubbing on a red top - which I hadn't) or from a broken blood vessel when putting the set in.  The funny thing is - it was not at the infusion site where the needle was inserted - but further past where the detachment area is on the tubing (managed to luck in on finding a 31" tubing from the Comfort sets I used to use in the beginning).  The longer tubing is much better so I can also clip the pump onto my usual waistband of my pants - before that - it was impossible unless I had no long neck/torso.  Having that extra 10" really makes a difference (oh this sounds like a Long John Silver movie).  And yes, for those dudes out there - who asked the question - where does the pump go - check my previous blog.

Many comments on my post at the Facebook group page of Insulin Pumpers gave varied responses to my plea of "help"!  Due to being self taught on the insulin pump - and not having an endo or diabetes team I can go to for help - in person - I've had to be my own human guinea pig in many things I do - of course - along with the bible from John Walsh - Pumping Insulin (5th edition was released last year) and various other books I've recommended over the years here at Diabetes1.org.

Just a joke but Duck tape is VERY handy

So, here I was prepared - armed with my medical kit - pads & tape to soak up this potential pouring of blood when I remove my infusion set.  I actually thought I was having a low blood sugar at the time, except I wasn't.  I thought I should pop one of my Ativan aka "happy pills" I was given earlier in the year by my GP when I went away on my 2 week sailing holiday - but resisted the urge due to my fear  of becoming dependent on them (insulin is ENOUGH thank you very much).  My GP was a smart cookie - as she only gave me 20 - and I still have 9 left six months later.

I gently pulled out the infusion set - all set to put the padding/tape in place - prior to hitting the floor - NOTHING ... I mean .... NOTHING - all I see is a little teeny tiny hole where the infusion needle was inserted - that's it! Phew!  At that point I knew thare was higher life above us - that is looking down  - knowing that I didn't need any drama in my life (hmmm, what's this blog all about??). 

Today, for my third try at an arm infusion site - I've decided to use the mini-wanna-be Omnipod (humour me John as the wanna-be-Princess) - aka Inset II.  The tubing is turned the right way - and as usual - pump is sitting in it's normal happy place (BTW, it gets REALLY warm there).  Sadly, the tubing on the Inset II I use (I've got 2 more boxes before I can reorder longer tubing of 43") - isn't as long.  I liked having the option of wearing in either places the last 3 days.

And yes, to some of those on Facebook who asked the question about absorption of insulin being better or worse in the arm, than my usual stomach, legs, lower back sites - I'm wondering if it's better - due to never having been used for infusion sets that stay in place for 3 days.  I did find I had a few interesting low's with this past infusion set - that aren't quite explainable - except at the time I thought perhaps it was due to hitting blood vessel.  It could be due weather - since I tend to use less insulin when it's humid AND warm.  It also could be due to the fact the set was in part of my muscular part of my arm - which can cause faster absorption of insulin.   Lots of scenarios here as to "why".
Back of arm for latest infusion site
Luckily, the latest infusion set is now in the back area of my arm that you see above - in the fatty portion of my arm - not up front in the more muscular area that I had just removed.  I just know I'm sensitive to insulin (I use less insulin than a person of my weight should use according to books I've read) - so wondering if I've become more sensitive.  Questions, questions, questions.  Who knows - but in the meantime I'm back to keeping a written log during this arm infusion test and see if perhaps I have to make some changes on my programming (either basal / I:C / ISF).  One step at a time of course - starting with basal testing first if my blood sugars (BG's) continue wonky.  Otherwise, things get even more complicated with too many scenarios that can overwhelm what you are trying to accomplish.

I am a contented cat

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Posted: Jan 18, 2013

So, here’s the deal.  Because of the problems with getting any response from Animas Corporation until Jan 28th (I’ve been switched back/forth from Canada/USA/Canada since the notices came out in Dec) on my out of warranty Animas 2020 pump aka George Michael with the little “minor” glitches with his stopping delivery of insulin.  I’m still continuing to relearn MDI to be prepared.  I’ve done it before (over 40 years prior to going onto the pump actually).   I KNOW I can do it again – despite my griping – but as before –my issues with MDI – has always been my basal rates with Lantus.  I wish I could use Levemir – I could do better – but sadly – last time I tried it – I had allergic reactions to it – and it was like I was injecting water for my basal portion of my insulin coverage.

Sadly, I’ve had responses (privately or via FB groups I belong to) from many T1D’s who have been pumping on average 20+ years.  They are terrified to go back to MDI.  They wouldn’t know how to do it – and have asked me how do I know what I’m doing?  I guess in away, I’m lucky that I only starting pumping later on in life, that I “sort of” had a handle on MDI prior to the pump, and with abit of head banging, and if you’ve got a good endo or medical team behind you (sadly, I can’t say I do), then YOU CAN DO IT!  Maybe taking a break from their pump once in awhile – to get back to their roots – might be something that endos should encourage their patients to do – so incase a) they no longer have insurance coverage for a pump; or b) flung into a situation where pump cannot be used for x amount of day/weeks/months – then taking these mini pump holidays is not such a bad thing.  Yes, I know, control may not be as good in the beginning, or it may never be as good as on the pump, but at least you will get over that fear of going off the pump, and with practise, might not mind it so much.  I know I don’t  - it’s nice not to have the tubing, pump clipped on my pants (dragging the waist band down to reveal my knickers).  It’s just a change of pace for me at the moment, relearning how to do (and saving some $$$’s at the same time – since pump supplies don’t come cheap (if you don’t have insurance or co-pays are high), etc.


I’m now into Week 3 – and getting used to it (oh – wait – I have to go check my BG’s – will be back in a sec) … okay – I’m back – BG was 9.9 ml/L (178 mg/dl) – did a correction with NovoRapid (aka bolus to you pumpers out there) – and hopefully my BG eventually levels out to my happy zone of 4.5-5.5 mmol/l (81-99 mg/dl). 

Back to my rambling,  on the pump, I rarely had to do corrections like I’m doing now – since on the pump – you can change your basal rate right away – compared to the 1 – 3 shots of basal insulin that some MDI folks do.  To me that’s one of the great things about the pump – the accuracy of how much you have going into your body for your basal insulin – it can be tweaked per hour – to reflect hormone issues, exercise, etc.  With MDI, once the basal rate is given – bing, bang, boom – you are slave to the slow acting insulin for your basal coverage – that’s if it works properly (like it does for me sometimes – then other times – not so good).  I really can now live up to my Facebook page of The Roller Coaster Ride of Diabetes with what I’m doing with MDI … but … MANY  do it this way, they are fine with what I feel is like being a slave to their condition (since starting MDI – I find I am constantly thinking about my diabetes – with my pump – it wasn’t so much).

The other thing, some MDI folks just don’t give a hoot, and just do the shots without much hoopla over their happy zone range for BG’s (hey, even folks using pumps are the same).    Sadly, or maybe I shouldn’t say this, I like to be in control, I don’t want to lose my eyesight, kidney function, put a strain on my heart due to continue up and down of BG’s, lose a leg due to infection … the list goes on when you have diabetes and don’t take your health care by the horns.  Remaining as stable as possible is my goal in my diabetes control – with as little convenience for my life as possible. 

I discovered after posting on my Facebook wall with the forum post from Diabetes1.org – about having another blood meter with them when they go on holidays – many folks have not just ONE – but sometimes FOUR spare meters with them.  Either it’s due to their 3 year old T1D Johnny Be Good fingers destroying one of the meters his Mum has packed in her bag – or it’s just for sanity sake that incase their regular meter goes on a walk about – they’ve got something to fall back on.  I know for myself, I’m lost without my meter, and would be probably housebound, unable to go anywhere.  That is not me, I won’t let diabetes stop me from doing what I want to do.

I have to admit – I’ve never EVER brought a spare blood meter with me – it’s usually all the insulin paraphernalia that I bring (with the pump – 3X the supplies you would use for the period you are away, insulin and needles, extra BG strips, glucose tabs, spare pump/meter batteries ….).  So, some of their replies back really got me thinking – I should consider bringing a spare meter with me – especially since the FreeStyle Lite I use – I’ve had for over 5 years (one Mum said – “ours only last 1 – 1 ½ years).  I guess  I’ve  been lucky that I’ve never had a problem with the meter – but like the pumps – do they ever need to be recalibrated?  Hmmm.

So, luckily, with the diabetic conventions I attend a few times a year – I have one meter that I know I can get strips for in Quebec  (other meters I have surprisingly enough – when I ask my pharmacist about purchasing strips – they can’t get them for me – or their distributor can’t for one reason or another).  So, this time I will be prepared on my holidays – and maybe I’ll do like other diabetics do – carry a spare one in their bag all the time.  Again, I’m not a big bag carrying type of gal – but I’m learning that maybe I should just swallow my pride, and start lugging more stuff with me – just incase.

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