Ninja Insulin #dblogcheck

You would think after close to 15 years on the pump I would know all the tricks of the trade, all the quirks of the pump, all of the sneakiness of insulin absorption…..but, nope.

I’ve come up with some blood sugar savers that really do work for me, though….like, when I change out an infusion set site, I used to ALWAYS have high blood sugars for hours afterwards. Thanks to a comment by Katy, I was encouraged to “ka-chunk” in a new site without removing the old one for a few hours, let it settle in & calm down, and then connect up the pump to the new site. Bells ringing, fireworks going off, and a ticker-tape parade later, I rarely have any post-site-change highs anymore, and when I do, they are due to other variables of life.

Sneaky, sneaky....

But lately, I’ve discovered a new brand of insulin….the Ninja Insulin. I swear, I take a bolus for a meal or correction, and go about my business, but my blood sugar remains slightly high. Then, I drink some water, or sometimes, even eat a couple grams of a carb, and whoa! Here comes that insulin out of nowhere, and suddenly I’m on a downward trend of blood sugar. It’s really weird. It’s like it’s been hanging out in the shadows of my bloodstream, just waiting for the right time to take effect. It’s a most puissant ninja.

Don’t forget to #dblogcheck today!!!!

Goodbye, Site Change Trauma High Blood Sugars

It’s amazing how many years it took for me to make the connection between high blood sugars for no-good-reason and changing out my insulin pump infusion set site.

I guess coming off of multiple daily injections that just, you know, had the insulin working pretty much when I expected it to, I assumed the same would be true when I would unceremoniously jam a 9mm plastic cannula into my skin using a metal needle….my body shouldn’t put up a fuss about that, should it??

But somewhere along the way, I was reading a blog or swapping comments with another member of the DOC, and a light-bulb went off. Duh! After always wondering why I would give myself tons of insulin right after a site change and NOTHING seemed to budge my blood sugars, it all made sense. The skin/cells around that site were traumatized, and not absorbing insulin yet or doing what they should. Inevitably, a few hours later, I’d come to a crashing low-blood-sugar-screech because suddenly the site had calmed down, and the cells finally absorbed the copious amounts of insulin I’d been giving myself. Argh.

So I learned to try to do site changes at least a few hours before meals (if I could do it without wasting too much insulin), and to never ever do them before breakfast because I would be even more spikey after breakfast if I did. Our girl Katy made a comment/suggestion that I have FINALLY implemented, and it is working like a charm!

My belly isn't 2 shades of pasty, just a camera lighting issue.

New site on the left side, while I still have the old site on the right. I do cover the new site while I’m waiting for it to settle in.

It’s so simple: when I notice I’m within a few hours of needing an infusion set switch out, I insert a new set somewhere else, and just leave the port there ready for whenever I run out of insulin/am ready for the switchout. Sure, it means I have 2 sites on my belly or hips at the same time for a few hours, but so what? It saves me from at least 3-4 hours of wrecky-high blood sugars and feeling like poop. I’ll take that trade-off ANY day.

Now, as we all know, Your Diabetes May Vary. In talking with my d-girls the other night, who also have various brands of pumps and insulin delivery systems, some of them experience site change trauma, and some do not. So obviously, do what works for you!!

Wordy Wednesday – Low? Low…. Low!

If I could just bottle this to use on the days I was running high, it would be worth it.This was my Dexcom G4 view for the majority of the day yesterday. It didn’t start going up until I consumed a VERY carb-filled Italian dinner last night, but even then, it spiked up, then sorted itself out pretty predictably (after a few hours.) No post-breakfast spike yesterday morning or this morning either. What am I doing different? What am I eating different? Nothing out of the ordinary, as far as I can tell. Could it be a new bottle of insulin? Could it be the new-ish infusion set site absorbs better?

This diabetes thing……always confusing. always a moving target, always a celebration around the corner for the beneficial accomplishments, or a curse on those not-so-controlled days.

Insulin 101 – did I miss that class?

I swear I know how insulin works. Really, I do! I’ve always been told that NovoLog in my pump has an active life of about 3 hours, with it’s highest time of effect being within 1-2 hours of taking it.  (Of course, I just bulled my way through the ho-hum boring patient information leaflet and it says it sticks around and is active for 3-5 hours. Learn something new every day!)

Blue skies.....reminds me of a songSo WHY then, after I did a site change before lunch, do I end up crashing and staying low all evening (after micro-bolusing for a high carb dinner even), which was like, close to 8 hours after last taking a rage-bolus of insulin?

Seriously, it drives me nuts. The hanging out in the 200s for several hours after a pump infusion set site change is bad enough. But then, add insult to injury when suddenly, all those attempts at correction boluses come avalanching (is that a word? It is now!)  into effect 8 hours later? It makes no sense!! Are the cells around the new infusion set site area just holding onto the insulin for a while until it calms down from some sort of site trauma? Do I really not understand Insulin 101 and how long it works in your body/ what it’s time-frame of effect is?

Whatever the issue with me and my insulin education, I am happy to have my Dexcom CGM clue me in when the sugars-tumbling-down begins. Guess it’s time for some more learnin’, ya’ll.

In Case of Apocalypse

Being the sci-fi and fantasy aficionado that I am, I have read numerous books and seen scores of movies and TV shows that center around some type of “end of the world as we know it” scenario.

The Stand, by Stephen King, is one of my favorite books of all-time (and the miniseries was awesome as well.) It focuses on small groups of survivors existing in a world where 99.4% of the population was killed by a weaponized version of the flu. In The Walking Dead, the world has been overrun by zombies. The book Ariel takes place when one day, all technology of any kind stops working, magical creatures appear out of nowhere, and a man and a unicorn navigate through that world trying to survive (yes, I read this book as a teenager because it had a unicorn on the cover. Love.) Then there are books like Spellsinger, Guardians of the Flame, and  The Architect of Sleep that center around the main character(s) being magically transported to some alternate reality – in The Architect of Sleep, that reality is one where raccoons became the dominant species instead of humans. (Ha! Planet of the Apes has got nothing on a freaking planet of the giant telepathic raccoons!!!)Ah, the memories

Inundated with Armageddon-like possibilities in movies, books, TV and reality shows where the contestants have to survive with limited means, my thoughts occasionally turn to….what would happen IF the world as we knew it changed for some reason, and suddenly we had to survive without power, without medical devices that require batteries….without INSULIN??!

It could regularly keep me awake at night if I let that line of thinking go too far. In my little corner of the world, the “preparation” I’ve done in case of an actual emergency is to stockpile maybe a month’s worth of insulin, syringes, test strips, batteries, pump supplies, and CGM supplies. But if the power went out f-o-r-e-v-e-r, how long would my insulin and supplies last? How would I get more? How would anyone be able to make more? If chaos and havoc reigned around the world, could I overtake the looters to raid pharmacies and get enough insulin to last me until we became a fully functioning society with regular access to medicines again? How would I physically survive without the “comforts” of modern medicine that I currently use to keep myself (relatively) healthy? I feel pretty sure things would turn quickly into “survival of the fittest” mode, and I’d unfortunately be one of the first casualties.

Most people in an end-of-the-world-as-we-know-it scenario would only require the basics to survive – food, water, and shelter. But anyone with any sort of chronic disease or condition (and it goes without saying,  the people in hospitals/care facilities, etc) would be pretty much at the mercy of the kindness and expertise of others in order to live. Thankfully, I have several friends who are super educated and have a wide variety of survival skills and knowledge, so connecting up with them would be my “go-to” plan if all heck broke loose one day.

Synthetic insulin crystals synthesized using r...

Synthetic insulin crystals synthesized using recombinant DNA (Photo credit: Wikipedia)

Last weekend, some of those friends and I were actually talking about this “what if” scenario….the group included 2 chemical engineers, an aerospace engineer, a computer programmer, and myself – the psychology major turned project manager. (I am seriously out-classed in the higher math/science department, so thank God I have such smart friends!) I was asking them things like, “would we be able to get insulin from cows and pigs like they used to do?” I am still curious as to how EXACTLY the insulin was taken from animals and purified, so if the rubber met the road in a post-apocalyptic world, I might could acquire a pet cow or pig to help me live for a while. My chemical engineering friends felt confident they could figure out how to make insulin for me, and it would be the first thing they would work on (as soon as we all had gotten to safety and avoided the zombie apocalypse or whatever had happened.) Can I just say I have amazing friends? Their willingness to take on saving my life as a top priority when the world could be ending made me feel so loved. Hypothetical situation or not, it kind of got me a little weepy.

Unless something truly earth-changing happens in our lifetime, I should never have to call in that favor from my friends. If I had any hope of the internet being available in a worst-case-scenario event, I would say all of us DOC folks could ban together and form a Diabetes Republic where we all could help each other, share supplies and knowledge, and create a safe haven for diabetics. We would learn how to make insulin, syringes and the supplies we needed to survive with whatever resources were available to us. Really, when you think about it, our whole online (and sometimes in person!) community of diabetics is already a collective group of awesome people that has found each other, shared and connected in so many beneficial ways, and made our world a better place for so many through the support and care we give each other. I think if we could all find each other in case of Apocalypse, we’d do just fine.

OK, I think I have all this “what if” stuff out of my system now, and won’t be worried about it again for a while. (But if anyone wants to start working on a secret diabetic hand-signal or bird call so we can find each other in the wild when the power goes out or the zombies start their attack, let me know…..)

Dawn Phenomenon, Site Change, and Breakfast Spike, Oh My ???

Wow, talking about a trifecta of ugliness that causes a bad blood sugar day…..this particular morning, it was a combination of:

  1. Dawn Phenomenon – no matter what the linked Wikipedia article says, I *do* have to change my insulin intake to manage the spike in sugars that happens in early morning. Over the years, my endo and I have tweaked my morning basal rates to account for it in some part.  And I *do* eat a small snack before bed that has about 10g-15g of carbs and some protein and fiber in it so that my stomach isn’t so absolutely empty by the morning that the dawn phenomenon cranks up my sugar to exponential heights. For me, if I don’t eat breakfast by around 8am, my sugar just starts climbing and climbing no matter what I’m doing or how much insulin I take. Thank you, Mr. Liver for that input of yours. Sigh. This particular morning, I was so busy doing other things, it was close to 9am before I could eat.

    An infusion set, showing the insertion needle.

    An infusion set, showing the insertion needle. (Photo credit: Wikipedia)

  2. Infusion set site change – My pump ran out of insulin at 7am, so I had to put more liquid life into my pump (in the form of Novolog) and change out the infusion set. It never fails – no matter if it’s a new or old bottle of insulin,
    no matter if I’m putting the site on my stomach, my hip, etc, it seems to take a few hours for the insulin from a new site to really start absorbing and working. I sometimes supplement with shots, but that brings on it’s own level of danger since who knows when the pump insulin will start absorbing.
  3. Post-Breakfast blood sugar spike – I have fought this battle for many years, and Metformin has helped immensely with this, but with the dawn phenomenon and infusion set change already hard at work at wrecking my sugar, it was inevitable that breakfast would send me over the edge. (I took the picture of my Dexcom at 9:17am right after breakfast, and then it got all confused at the rapid rise and gave me the ???, but trust me, it stayed up in the 200s for several hours of the morning.)

Ugh.

The good news? By lunch time, the new infusion site had settled in and started working, and my sugars only mildly tanked because I had so much insulin on board from taking a couple of shots in an attempt to avoid the 300s. The rest of the day was thankfully uneventful, sugar-wise. Note to self: in the future, try to think ahead and change out the infusion set at ANY other time than the morning. Of course, we always have the best intentions that don’t always pan out…thinking of and remembering to do every-single-thing-every-day-to-counter-bad-blood-sugars? Good luck!