Keeping on tops of the news

I know I haven't kept on top of my posts. Its because I recently started the Christine Mirzayan Science and Technology Policy Fellowship in Washington DC and I have been incredibly busy learning how the National Academies work. For those of you that aren't familiar... well... its complicated.

Maybe that's not a fair statement. I don't actually feel that the National Academies is very complicated in the big picture, but climbing into the beast and working with the nuts and bolts was a bit daunting the first couple weeks. The big picture (in my own words) is that the National Academies is a for-hire organization of truth-seekers. You call the National Academies when you want a non-partisan, scientifically-based study and you want recommendations for solutions to a question or a problem.

Here's an example - 

Let us say the US Dept of Energy wants to start using more Nuclear Power. Great. More people, more power, no problem. Let's start building... WRONG!

Define Normal

Italian book of monsters from 1618.

I can’t say how other people felt when they were diagnosed with Type I Diabetes, but for a long time I felt like I would never be normal again. All of a sudden, I needed to check my blood for sugar and I needed to take shots and carry an emergency kit around if I happened to crash really bad. The school nurse had to send notes to all my teachers and coaches warning them that I wasn't like the other kids. It wasn't as bad as the guy in the picture above, but I certainly wasn't normal anymore.

I remember one time early on in my disease, a doctor tried to scare me into monitoring my sugars more closely. He told me point blank, “Everything is different now. You have diabetes and you need to accept it for what it is. Stop thinking you're normal”...

Rising Sickness

Being sick stinks. Slowly feeling sick is especially stinky. But the stinkiest of stinks for me is dealing with diabetes while I'm sick.

The problem for diabetics is that being sick makes their blood sugar rise higher than normal. In fact, diabetics can tend to have higher blood sugar when their bodies are stressed from many things, not just the common cold. Simply put, all kinds of stress can cause blood sugar to rise. Such a short statement carries so many implications for the health of millions of people.


The complexity of stress is buried in the its definition.

Diabetic Dining in Korea

My wife and in-laws are Korean and that means we eat a lot of Korean food at home. I love when our home is filled with the smells of hot soups, spicy meats, and steaming dumplings.

We try to visit Korea every other year. When we travel, food is always a major part of our trip and it’s even more important when we travel to Korea. Of course we have a lot of the same food and ingredients at home, but the flavor, quality, and variety in Korea is incomparable. This year, our trip landed right in the middle of the rainy season (June until the end of July). And so I’ve been looking forward to a lot of hot soups and noodles.

As a diabetic, I may seem like a killjoy when it comes to eating out. I’m mentally measuring and questioning each dish, trying to find the integral for the area under the curve of my pasta. In the states, I’ve become pretty adept in figuring out my food when we’re away from home, but cuisine in Korea is particularly challenging. I wanted to share a couple major challenges and offer a few solutions so that people can understand the thoughts of a diabetic eating out in Korea.

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.

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.