High road for me today

Its been one of those nasty, unexplainable weeks with my diabetes. My blood sugar has been difficult to manage and keep constant. I have had times where my blood sugar skyrockets overnight and then dips too low when I correct. Other times my corrections are just fine and the expected dose works well. Because of this fluctuation I can't really make changes to the three holy numbers of pumpers;
Basal rate
Bolus ratio
Correction ratio

Because SOMETIMES it works and SOMETIMES it doesn't.
Diabetes know the stress of diabetes, but it is difficult to explain to others. Diabetes is a disease with a personality and the way it affects our lives changes from day to day. Many times, there are sudden and unexplained changes in blood sugar. It could be that the seasons are changing, or there's a tickle in my throat, maybe the extra stress at work or depression, anxiety, possibly its traveling. But worst of all is when it is a combination. Its a conundrum of diabetes that becomes a discouraging factor in everyday life and I personally feel that its something medical doctors tend to quickly forget.

Last night, I was 200 before dinner... probably because I was 279 before lunch, crashed at 60 after lunch and overate before dinner. Before bed 150. Morning..... 379!!! These aren't typical numbers, but they are frustrating.

Diabetics need consistent normal blood sugar to be healthy. They need exercise and good food and plenty of sleep. Fudge up any of those factors and the wheel gets lopsided and problems start compiling. Didn't sleep well? Your BG could go high, making you sleepy and sluggish and not sleep well the next night. Not eating well? Missing meals? Then you're in the high and low game. Sick?.... the problems work off each other so the combination is exhausting.

Solutions? Check often and correct often. Do your best to get good long sleep. Avoid caffeine and try to breath deeply at work. That is all you can do. But as a diabetic, if you have the same kind of day as me, you should know I sympathize with you.

Morning Highs

For the past week, my blood sugar seems to be very irregular in the morning and is followed by strange changes later in the day. For example, I could wake up a bit on the low side (70's) and by lunch it could be close to 300mg/dL. Even today I began at 95 and now at 11:30am, its at 244mg/dL.

I haven't been able to pinpoint the cause. As of late, I have been working quite a bit and not sleeping very well so it could very well be a lack of rest and possibly an illness coming on. What I do know is that times like these are very frustrating. Ever type 1 diabetic I know has had these periods of unexplanable changes in their blood sugars and every person I have talked to has the same advice... just monitor it and ride out the problem for at least a couple days.

I know that for myself, the transition from Winter to Spring is always really tough for me. The basal rate, correction and carb ratios tend to change a little bit between summer and winter, which requires a time to completely transition. I'm hoping these highs settle down soon.  I'm keeping tight control on my diet and monitor more frequently until the problems subside.
Wish me luck!

Bloody mess

Today, I'm talking about a new issue I've encountered with my infusion set for the insulin pump. I should have learned my lesson the first time, but I repeated my mistake. I thought I would share my experience to possible help others in the future.

I use the Paradigm Insulin Pump from Medtronic and the Silhouette infusion set. A couple days ago, when I put on my new infusion set, I noticed a little blood in the catheter. No problem, I needed a morning Bolus and the blood went away instantly. However, because of a past experience, I believe I should have changed the set right away. The site began to look progressively worse over a couple days time and I took it out this morning.

I was very surprised by what happened next (warning for those that are squeamish about the description of blood). From the site, blood began coming out at a pretty good flowrate. Bright red and quickly streaming down my side. I scrambled for a napkin to sop up the mess and as quickly as I could I covered the site and applied pressure for several minutes.

This is the second time this has happened within a year's time. In very basic terms, it really freaked me out. A stream of blood coming from a puncture on your stomach would do that I guess. Now I'm left with a very sore and bruised area about 1/2 inch in diameter. I cleaned the area thoroughly and bandaged it as I would bandage any other basic wound.

Blood in the catheter should have been a strong warming that the site was not good for me. I had crazy high blood sugar readings for nearly 3 days and I was also very high this morning. Aside from using excessive amounts of insulin, the experience was frustrating and then frightening. I don't like having to change an infusion set right away because its painful and wastes supplies, but in the long run, I felt much worse when I kept it on and I wasted insulin, time, and health. It just isn't worth it to save an infusion set

Sick and Tired

I've been feeling worn down and sick for a little over a week. Moreover, I've been staying up late and having trouble staying asleep. When I'm feeling sick and/or tired, I get unexpected high blood sugar readings. Many doctors will warn diabetics that illness can lead to extra bodily stress and cause elevated blood sugar in diabetics. Being under other kinds of stress can do the same and in some people, taking antibiotics also can make you go high (see comments http://www.tudiabetes.org/forum/topics/being-sick-high-blood-sugar).

The truth is, there's many more things that can raise your blood sugar than can lower it. The advice for diabetics that are feeling under the weather or super stressed is the monitor more frequently (maybe 6-8 times a day instead of the typical 4) and to correct as frequently as needed.

Another cautionary tale is to avoid making changes to basal rates, correction and bolus ratios until you are feeling well again. I know that I have felt the pain of being sick and having high blood sugar in the past and wanted to ignore the problem and hope that the sickness passes soon. Unfortunately, ignoring the high blood sugar can compound the problems of illness and actually make recovery time much longer.

Throughout most of the winter I have this on and off again sick feeling which really messes with my health for a couple months. I don't know that warmer climates would help me throughout the year, but staying inside for 3-4 days in a row because of massive Baltimore blizzards has certainly kept me feeling awful.

Changing my set changes the effect

Every so often, I change the infusion set for my insulin pump and my blood sugar rises unexpectedly. Sometimes I see this effect for an entire day. I follow the common advice of frequent monitoring and correction as needed.

Because this happens regularly with my Silhouette infusion sets, I began to ask why it would be happening. My endocrinologist suggested my basal rate needed to be adjusted, however, when I increase my basal I tend to be too low after the first day. At my next appointment with a nurse practitioner, I heard anecdotal accounts of problems with sites immediately after changing. I also read similar stories on other blogs
http://www.insulin-pumpers.org.uk/badsite/
http://www.diabetes-insulin-pump-therapy.com/high-blood-sugar.html

I really enjoy the UK Insulin Pumpers site because there is so much useful info that I can't seem to find anywhere except from people's personal experience. But I digress. Back to my original question - Why would you get high blood sugar from changing your site? From other diabetics and physicians, I found several possible explanations.

• The site could be too close to muscle or the infusion set slope is angled to steep and is too close to muscle causing higher blood sugar because insulin absorption is hindered.
• The site becomes swollen or irritated or at worst, infected, which causes inflammation and compromises your insulin activity and/or absorption.
• The site has hardened fat tissue, which prevents absorption.
• Site isn't taken very well and your body reacts to it negatively for a number of immune response reasons, which leads to inflammation and results in the same problems as above.

This problem doesn't happen all the time. Maybe 2-3 times per month out of 10-12 at the most. Usually if I give myself the infusion set and it really sings for a few minutes afterward, I know its going to act goofy for a day. Another case would be if its sensitive in that area when I press on the infusion set. I am now considering changing the type of infusion set I use to see if there is another set that may work better.


If you do call a helpline, I can give you an example of what you might hear, but please do call and do not rely on my personal account to make judgements on your own situation.

First, the insulin pump company asked me to perform a Pump Self-test and to make sure the tubing wasn't tangled or leaking. Ensure that the basal rates and bolus ratios are correct. Make sure the site isn't painful or problematic (is it red? swollen? is there blood? was it primed correctly? were there air bubbles?). You may need to change the set.

I found this MiniMed site helpful.
http://www.minimed.com/help/sitemanagement/index.html#a6
And there are also the National Institutes of Health and Center for Disease Control with useful sites too. http://www.cdc.gov/diabetes/ndep/index.htm
http://www.ndep.nih.gov/partners-community-organization/index.aspx
And I really like this book called "Insulin Pumping"... here's the website founded by the authors.
http://www.diabetesnet.com/pibook.php

Bipbimbap overload

Some days it feels more difficult ot control my blood sugar than others. Today was an example of my diet and stress making my management difficult.

I had homemade tom yum soup with rice noodles for lunch. I particular love rice noodles in my Thai food but there's something about those high carb noodles that tends to throw my levels for a loop. They have a lot of carbs to begin with, but then if we boil and wash them too long, I tend to go low because we are washing off a lot of the starches on the outside of the noodles. If I'm eating a lot, that makes a larger difference in how much insulin I take versus how much I need.

Today, it resulted in a mild drop in my blood sugar. Its important to follow the trends because I will revisit this dish and then I'll be able to take the correct amount. It requires mindfulness of what most people consider mundane details of daily life.

Later we had bipbimbap and doen jang (two of my favorite Korean dishes)soup for dinner. These dishes I eat frequently and I can control very well. However, the first few times I wasn't very successful and my blood sugar went very high. It turned out that I wasn't accounting for the gochu jang (pepper paste) that has some carbs, as well as the carrots.

But after some trial and error, I almost never have any problems.

Finding New Spots for my Insulin Pump

I use the Paradigm pump from Medtronic with the Silhouette infusion sets. For a variety of reasons, I sometimes have red irritated spots when I change the set. I was getting tired of a dozen dots on the front of stomach and last night I tried my back on ride side just above the hip. It was a little challenging getting the inserter steady, but with a mirror, I was able to successfully place my pump.

3hr post dinner, I was very high (288) and I corrected before bed. This morning I was surprisingly still high (235). My feeling is that there is less fat on my back and adsorption is not the same. Unfortunately, I had just filled it last night, so I don't want to throw out the reservoir of insulin.

I planned to ride this one out and monitor throughout day. Perhaps, I just needed time to adjust.

By lunchtime, my blood sugar was 166. Not too bad! Later, I would be going to a JHPDA Happy Hour. The Happy Hour started around 5pm, and I tried to only drink Michalob Ultra and not eat chips (instead I ate cheese, veggies, and the toppings on the pizza). It was a very successful Happy Hour and lasted for a long while. I got home around 9pm with a blood sugar of ~200. I corrected and ate some Ramyun for dinner.

I have a feeling my site needed time to adjust. The back seems to work just as well as the stomach and I should continue looking for sites to rotate my infusion sets.