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!!!!

Gastric Sleeve Surgery and Blood Sugars

I’ve had a handful of surgeries in the past 20 years since being diagnosed with Type 1 diabetes, and there are a few tips and tricks I’ve learned that have helped immensely:

  1. I want to be the FIRST surgery of the morning. Since you’re supposed to stop eating/drinking anything at midnight the night before, it’s much easier to manage blood sugars for a short amount of time in the morning before a surgery rather than attempt to manage sugars all day on an empty stomach, risk potential lows you might have to treat with food/drink, thus negating the whole not-eating-after-midnight thing.
  2. Better to risk running high than running low. The night before surgery, I usually cut back my basal rate to about half of what it normally is. I don’t do any corrections for high blood sugar unless it starts running over 200. Then, I very conservatively correct – again, give myself about half of what I normally would to correct it.
  3. FILL OUT PAPERWORK ahead of time that says YOU take responsibility as soon as possible after surgery for your own diabetes/insulin/blood sugar management. No nurse or doctor knows how to work my insulin pump and CGM better than I do, and I had no desire to go back to getting injections at the whim and on the time-frame of nurses who don’t understand MY diabetes.
  4. Take at least 1 brightly colored piece of paper with you that states you are type 1 and notes your management regimen. For example, mine said, “TYPE 1 DIABETIC, on Insulin Pump and Continuous Glucose Monitor (CGM.) Please NO acetaminophen – it disrupts my CGM.”  This worked very well for me during this stay – had several nurses comment that it was very helpful for them to see that in my chart and know it immediately when they were treating me. (It also led to several educational moments where nurses had never seen a CGM before, so of course, I showed them and explained the whole she-bang.)
  5. Ask if it’s OK for that surgery to keep on your insulin pump port-site, and/or your CGM sensor. For my c-section, my OB preferred I didn’t have anything foreign on my skin or body, but for this surgery (since it was obviously way higher up on my torso), every nurse, doctor, and anesthesiologist I talked to said I could keep them on.

Now, onto gastric sleeve surgery …..that morning of surgery, I kept my pump hooked up  – running on 1/2 my usual basal rate – and also kept my CGM sensor on and the receiver with me until the very last minute when they were going to wheel me back to the operating room. Then, I relinquished my pump and CGM receiver to my husband for safe-keeping.

IV, Pump, and CGM, oh my!

I was running in the 180s right before surgery, which was perfectly fine with everyone involved.
Immediately post-surgery in recovery, I have no idea what my blood sugars were there – I was just trying to get reoriented and awake from anesthesia, and make sure they gave me some more pain meds. Thankfully, they got enough pain meds into me fast enough so I wasn’t very uncomfortable for long. Waking up from a surgery – always surreal for me.

Once I was in my own room and my husband gave me back my CGM and pump, I fingerstick tested (just to calibrate the CGM for good measure), and I was somewhere around 270. I knew I wouldn’t be eating or drinking anything for the rest of the day, so I wanted to be very careful about correction bolusing. I gave myself about 1/2 of what I thought I needed to bring it down to 150. Waited a couple hours. I had a decently steady downward-heading arrow on the Dexcom, so I just kept doing little correction boluses until I got down to 150, then I stopped.

Amazingly, for the next 24 hours, I had steady and decent blood sugars. Of course, I consumed literally NOTHING on the day of surgery – not even a sip of water (thank goodness I was on IV fluids, but my mouth felt like a desert.) And the following day, I could start on clear liquids, but that meant broth, water, sugar-free lemonade, and the like that had zero carbs and minimal calories. You can see my Dexcom graphs below, but it doesn’t show what I was doing with my insulin and boluses. Short answer = I kept my basal rate at close to 1/2 of what it used to be (for me, that is 1 unit per hour), and made only teeny tiny correction boluses here and there (of like, 0.5 unit)  if my sugar started sneaking upwards.

Day of surgery graph

Day of surgery blood glucose graph, from 12 midnight to 12 midnight. NO food or drink.

Day after surgery graph

Day after surgery blood glucose graph – on clear liquids only.

Now, the 3rd day after surgery, I was allowed to start on “full” liquids again, which meant the nasty protein shakes, 1% milk, sugar-free Jello, chicken broth, sugar-free Popsicles, and all that sort of stuff.
That is when blood sugar management got….interesting. The second I had a protein shake that morning with milk in it, my blood sugar RACED up to the  mid-200s. Seriously, it was like dawn phenomenon, the breakfast spike, and who knows what else all came into play at once.  You know how many carbs were in that shake? Like, a measly 13g. And the spike happened after I’d taken only maybe 2 or 3 sips, so I’d be surprised if I had consumed 1g of carbs at that point.

Spikey spikey

On full liquids, “breakfast” spike and subsequent calm-down over the course of each day. My graphs looked like this for several days, until I let the Metformin kick in again AND started bolusing at least a little something well-before I started sipping on my breakfast.

  • Note: I had not returned to taking my Metformin, but decided to start back after a couple of days of these spikes. Realization? My insulin-resistance wouldn’t just suddenly disappear after surgery, it would take time to lose some weight and hopefully get it down that way.
  • Another note: On all liquids, whatever I intake now hits my system *almost immediately*, and I had gotten into the habit of bolusing right when I eat, using dual-wave boluses, etc. Nope, NOW I need to bolus well *ahead* of eating/drinking, so that the insulin has some time to get into my system before I consume something that takes zero time to digest.
  • Crap, one more note: I waited a couple days post-surgery before I reset my basals back to the rates they were before surgery. With the weird spikey spikey happening, I guessed (correctly) that I needed a higher basal rate back again, regardless.

I hope this is all making some sort of sense. Today, I’ve actually had a pretty decent blood sugar day, and my spike this morning was not nearly as bad! I am hoping I’ve turned a corner in understanding how fast my stomach is digesting things now, and can take insulin accordingly/ahead of time to help stave off that spike. BUT, I know things will be changing in the weeks to come as I introduce “regular” food back into my diet. For reference, here is the upcoming schedule of how I am working up to eating regular food again while my stomach heals from surgery:

Bariatric diet stages post-surgery

It’s going to be a wild ride on the roller coaster of blood sugars, I’m sure! 🙂

Even more notes: I am NOT a doctor or medical professional of any kind, and am just sharing my personal experience. Individual bodies are different, and just because this is how MY body is working as a Type 1 post-surgery for gastric sleeve, it doesn’t mean that everyone else’s will work this exact same way! Your Diabetes May Vary. 

 

Bubbly High Sugars…the REAL Culprit??

A few days ago, I was waxing poetic about how I had these really odd overnight highs that seemed to be for no good reason. I sort of (but not really) thought they could be connected to bubbles in my insulin pump cartridge reservoir. Or they could have been because of any number of extraneous causes. With blood sugars and diabetes, just when you think you’ve figured something out, something else comes out of left field and wrecks your theory.

Well, now I have a NEW theory….a couple of months ago (around the time the night-time highs started), I decided to give my hips and upper butt pump site areas a break, and went back to using my stomach. I really hadn’t used my stomach for infusion set sites much since I was pregnant – the past 3 years have FLOWN by! – but it always worked fine before, so I didn’t even think twice about it.

Now, remember: the crazy unexplained highs I was getting were mainly while I slept. I sleep *on my stomach.* After I wrote that post the other day, I did a site change-out and moved back to using ye olde trusty hip zone. Voila!! My first night in a long time where I had no crazy high readings. The next night, the same. And the next. Seriously folks, we are on a roll now!

So…..could that be it? Could the weight I put on an infusion site overnight (because I sleep on it on my stomach)  have caused all those high sugars? Or maybe, uptake of the insulin was somehow lessened because I was sleeping on my stomach, right on top of the infusion set site? How many licks does it take to get to the Tootsie Roll center of a Tootsie Pop? For all of these questions, and more,  the world may never know….

I wish EVERY overnight and morning looked like this!

Since I moved my infusion set back to my hip, here’s what my overnights and mornings have looked like, for the most part.
I WILL TAKE IT, HAPPILY, regardless of what the reason may be!!

 

 

Diabetes Art Day Failure (Sort Of)

I had such grandiose plans of what I was going to do for Diabetes Art Day yesterday. I love art, I love creating, and I love getting together with my group of D-girls on a regular basis to hang out, chat about our lives, discuss the latest in diabetes technology, or commiserate on whatever random topic comes up. (Like poop – for some reason, poop came up in a lot of our conversations last night?? Poop is funny! And only some of it was related to our kids. But I digress.)

It was only fitting that we should have our girl’s night on the same day as Diabetes Art Day so we could all create something together (like we did last fall.) I had all the supplies set out and ready:

Ready to create...something?

But you know what? We never got around to making anything.
We thoroughly enjoyed our meal together….a hodge podge of appetizers, snacks, and a couple of yummy desserts that everyone had a hand in bringing or baking. There was wine (of course! This is MY house we’re talking about) and general, “hey, how are things going?” talked about around the table. We laughed, we nodded in agreement, we shook our heads in disgust, we heard beepings of CGMs going off, we noted blood sugars from fingerstick meters, we pumped up the insulin to cover all the delicious carbs we were consuming, and we just had a good time.

The “gift of gab” is not a present to be taken lightly. To be able to interact and share and love and accept others regardless of different beliefs or opinions is so very worth it, especially when you all have a common bond that brought you together. For us last night, that bond is diabetes, and the amazing art of it all is our ability to fellowship with one another. Love you D-girls!!!

Love you D-girls!

Diabetes Awareness Month Photo-a-Day 12, 13 – Work and Awareness

Appropriately, I had a work “meet & greet” event last night that occurred over dinnertime. Random “finger foods” and appetizers were served like egg rolls, pot-stickers, chicken fingers, cheese, crackers, fruit, cookies, brownies, jalapeno poppers, etc. Pretty much a smörgåsbord of “guess how many carbs are in THIS??” nightmare. Luckily, there was also wine on hand, and my sugars stayed amazingly level, even amidst the stress of meeting executives that could someday decide my employment fate.

Yummy and questionable all at the same time
As for “awareness” for today….taking some more liberties here with this prompt. It made me think of the awareness that my husband has of my diabetes…or the lack thereof in some areas of my diabetes care.

Now, my husband knows what a low looks/sounds like. The only time I’ve EVER had someone call 911 for me was when he and I were first dating, we were out on a walk after dinner (it was in the BCGM days – before continuous glucose meter), and I crashed and passed out on a stranger’s lawn. He was a trooper through that….and continued to date and eventually marry me – such a keeper.

But as far as all my testing, pump site change-out, CGM sensor supplies, what I use to do what, etc….he’s never been much involved with that. I mean, why should he? I’m the one in charge day-to-day of poking, prodding, and inserting medical devices into my body, and I tend to do a lot of site changes and CGM sensor change-outs when he’s not even around, so he really doesn’t see it much.

Last night, we were upstairs watching How I Met Your Mother (catching up at last on season 8 so we can get to season 9 and finally find out who the heck she is), and we had about 30 minutes before bedtime. My pump was vibrating it’s  “Low Reservoir” alarm – 10 units wouldn’t get me through my basal rate overnight. I would need to change out my set before bedtime, but I was too lazy to go downstairs and get my supplies, and I’d be half asleep once we finished TV. He offered to go get the “stuff” for me, so I gave him the vague directive of, “Under my sink, in the plastic drawer, I need an infusion set and insulin cartridge, and the black bag on top of the drawers.” Here was what he saw:
Stuff, stuff, stuffHe brought me the black zipper case/bag that contains my open insulin, set holder, and various pump accoutrements = score 1 point! He brought me an infusion set = score 2 points! And brought me a sensor set for my Dexcom CGM, saying as he handed it to me, “This isn’t the right one, is it?” To his credit, I only had a couple of reservoirs left, and they were obviously hiding in this messy drawer that is pretty much as unorganized as I get. He re-confirmed with me that it would be a “cylinder-looking thing” and then successfully found it and brought it up to me. I love my husband. And lots of times, he’s more aware than I give him credit for.

Artificial Pancreas? Not.

Artificial is defined as:
1. a. Made by humans; produced rather than natural.
b. Brought about or caused by sociopolitical or other human-generated forces or influences: set up artificial barriers against women and minorities; an artificial economic boom.
2. Made in imitation of something natural; simulated: artificial teeth.
3. Not genuine or natural: an artificial smile.

Pancreas is defined as:
A long, irregularly shaped gland in vertebrates, lying behind the stomach, that secretes pancreatic juice into the duodenum and insulin, glucagon, and somatostatin into the bloodstream.

By smooshing (clearly, a scientific term) those 2 words together, somehow mainstream media thinks that because the FDA approved something with ONE FREAKING NEW FEATURE ON AN INSULIN PUMP, suddenly we all will soon have fake pancreas machines that will “fix” our diabetes.

Scott Hanselman wrote a post about this that describes (better than I can) exactly how I’m sure a LOT of us feel: http://www.hanselman.com/blog/ItsWAYTooEarlyToCallThisInsulinPumpAnArtificialPancreas.aspx

Am I excited about new pump technology? Yes. Would I love to have an artificial pancreas so I didn’t have to think about managing my diabetes 24/7? Of course. But please – until it really does everything-my-broken-pancreas-should-do, or very close to it – don’t call it an artificial pancreas.
English: Diagram shows insulin release from th...

English: Diagram shows insulin release from the Pancreas and how this lowers blood sugar leves. (Photo credit: Wikipedia)

Test, Bolus, Eat, Repeat

A public service announcement for Type 1 diabetics from my daughter:

When I first got this t-shirt, she saw all the symbols on it, and asked me what they were, so of course, I told her and explained them, in the best way I could for a 2 year old to comprehend. Now, it’s just a game for her to say the words, but one day…she’ll really get what it means to me, and I hope she’ll realize the weight of those words on my daily life.

One of many awesome T-shirts from: http://type1diabetesmemes.spreadshirt.com/

One of many awesome T-shirts from: http://type1diabetesmemes.spreadshirt.com/ (photo credit for this goes to them as well)

For many years post-diagnosis, I never wanted the general populace to “know” I was different, and I hid all my diabetic accoutrements when I was out in public….when I was on MDIs and was eating at a restaurant, I would excuse myself from the table and discreetly go to the bathroom to take a shot or check my blood sugar. Once on the pump, I used to do the same thing (because it was housed in my bra, and digging around in your shirt at the dinner table is usually frowned-upon.)

But now? I’m wide open. I will whip out my pump or test my sugar anytime and anywhere. I don’t care. I’m like the honey badger in that respect.

I frequently wear t-shirts with obvious diabetes-related content in the hopes that someone will see me, realize I’m one of their peeps, and we’ll have a “diabetes in the wild” adventure. And every day, until there’s a cure, just like the t-shirt shows: I test, bolus, eat, repeat.