Monday, July 30, 2007

I'm a REAL pumper now

I have been pumping with Jeeves for almost three months now and am starting to get used to it. I am still tweaking things, but I may actually be getting to a point where I don't have to test at three a.m. every night which is, of course, lovely.

Before I started pumping I did a lot of research. I poured over the literature for the different pumps, I read Pumping Insulin from cover to cover, and I spent months reading blogs to get an feel for the personal side of wearing a pump. One event I have been looking forward to with apprehension is the first time I get the tubing caught on something and yank the infusion set out. It was bound to happen sometime; I was always getting caught on things without a pump, so that tubing was bound to get me in trouble. I tend to slide into chairs and am always getting my shirt caught up as a result. I manage to catch the drawer pulls in the kitchen with my pants pockets as I go past. In summary, I am not an entirely graceful sort of girl, so I have been surprised at my luck so far. Not that I haven't had plenty of near misses. Twice I have even had the pump swinging a foot from the ground by the tubing, with nothing holding it up but the tape on the infusion set. Impressive.

Last night it happened. Yesterday we had our annual family reunion/picnic and as the 20 something girl somehow became my job to entertain all the small children. After three hours straight of running from monsters of every description, which included a robotic baby and a dragon with a stick body and gorrilla arms (?), I finally got to go home and collapse. Face down on the couch I reached back to massage my lower back and managed to flip off my infusion set. I have to explain that the tape had managed to fold itself over on one side, and had been too lazy (and cheap) to redo it, seeing as it was absorbing fine. It didn't hurt a bit, although have my back was suddenly coated with blood. I know there wasn't that much, so how does it get everywhere?

So that's my story. Pitiful, but somehow it's more official now that I have had my first gusher.

Thursday, June 14, 2007

Dare I Believe?

Since I last posted the saga of the morning blood sugar numbers has continued. My CDE/pump trainer and I continue to tweak all aspects of my pump routine, but those post-prandial bg’s remain Public Enemy #1. I tried going off the Symlin for awhile and doing straight boluses. I still went high. I am not saying that perhaps I might not have been able to work it out. I didn’t change my insulin dose, for instance, and I assume that would need some more insulin without the Symlin. I might have continued to work things out, except for two problems: 1) I am pretty sure that I needed to wait 20 minutes after bolusing to eat to avoid peaking, but that doesn’t work with my autopilot routine and the bathroom usage schedule we have going on at my place and 2) I was hungry all the time. Not just, hmm, I am a little hungry I think I’ll have a snack. I mean, my stomach actually growling by 10 am. Was I really that hungry all the time before the Symlin?

So I went back on, but at 2.5 u, thinking that it would help me avoid those lows at 7:30. It did, but I still had bounded up to 200-250 by 8:30. Thinking it was an issue now of needing more insulin, we made the change from a 1:15 carb ratio in the morning to a 1:10. Surely that should make an impact? Ennngh. My numbers didn’t change one bit. That was almost the last straw: I increased my insulin by 50% in the morning and my numbers didn’t move? Here are the numbers from Tuesday to see what I am dealing with:

6:15 -> 137. Take 6 units in a 40/60 combo bolus, plus 0.75 u for a correction, plus the 2.5 Symlin. Eat my bowl of Kashi with skim milk and a banana.
7:20 -> 112 Check to make sure that I haven’t gone low before I hit the road.
8:30 -> 227 Crap.

As I said, these patterns were beginning to depress me. Yesterday I woke up the same as always, with little hope that this day would be any better bg wise.

6:15 -> 140, take the 0.7 u my pump suggests as a correction. Then take my Symlin and eat my Kashi and banana breakfast. After I have thrown the dishes in the sink I then bolus, maybe 15 minutes after I would normally do so.
7:15 -> 173. A little higher than I want. I am expecting this to rise still further by 8:30, but at this point, I am resigned.
8:30 - duh, duh, duh 114! 114? It couldn’t possibly. I whip out the old Fastake that lives in my desk at work as an emergency backup and test again: 127. Hungh? The number is real, so what happened? Nothing was different except for the timing. I shrug and go about the rest of my days with surprisingly good numbers given I didn’t have to recover from that morning high.

This morning I cautiously tried the same routine of bolusing after I ate. The result at 2 hrs post-prandial? 135! Have I accidentally hit on something that will work? I am too skeptical at this point to believe in complete success until I get some more data under my belt, but this is very, very encouraging. While I am restraining myself from doing so outright, there is a little happy dance going on inside me.

Thursday, May 17, 2007

Morning blood sugar blues

Guttentag. I finally made it onto the O.C. list, thank you Allison!

So my CDE who is overseeing my pump start is on vacation this week, and I can’t get a hold of her substitute. I also need more insulin, seeing as I never got a new prescription for Novolog when I started my pump, and my 1-a-month prescription that I filled two weeks ago is almost gone. I am calling as soon as I finish this post.

The patterns I mentioned yesterday are still haunting me. See, these are my morning numbers for the week so far (thanks to Kevin for the spreadsheet). Current procedure I am trying for a couple of days 40% up front, with the rest over 1.5hrs. I am flat or am dropping between the time I eat breakfast and when I hop out of the shower an hour later, so that is good (as long as I don’t drop too far), but I don’t like how much I have spiked by the time I get to work. It is starting to look like I need another bolus at 7:30ish. I think I might try calculating and taking the extended bolus and basal I missed during that 15 minute disconnect (~0.6 units) when I reconnect at the end of a shower. Probably won’t be enough, but baby steps, baby steps. Although I am faithful in my own abilities to make wise and careful decisions about my doses, its easier to explain to my doctors when I actually get in touch with them again.

I whine, but at least it is better than last week, when I was taking the whole bolus over two hours to start then moved to a 25% up front/ balance over two hour deal. Yikes! If nothing else, at least they are patterns, and I am not getting a bunch of inexplicably random numbers. Patterns I can deal with.

Wednesday, May 16, 2007

Day 9 (It's time for visual aids, ooooh)

So I am on, what, day nine now? Things are going well, although there are a few frustrations.

Post breakfast numbers. Oh me oh my. I have never had luck with this time of day. I am on Symlin, which was supposed to help those post meal spikes, but it is a hard balance between going too low within the first hour and going too high at 2-3 hours. When I was on MDI, first I tried reducing my Novolog like the package insert suggests, then I actually switched back to Regular for meals, then I went down from the recommended 10 units to 5 units when I was still having crazy lows all the time. (See my handy graph below)
Fig 1: An approximation of how Symlin affects my blood sugar. By approximation I mean I didn't use any realy numbers and I did it in Word as a drawing.
I was able to get some improvement, but it didn’t work all the time and it remains the most frustrating time of day. The first few days on the pump I passed the 300 mark with a 2 hr extended bolus. We have been experimenting with combo boluses and shortening the extended bolus, and have gotten it so now I only go to 200, but this is still not perfect. I am always back in range by lunch time, so I am pretty sure that it is the timing of the insulin, rather than the amount that needs fixin’.

4 p.m. Lunch numbers: fine. 2 p.m.: fine. 4 p.m.: 200+. Hnnnngh? Did I eat a cookie while I wasn’t looking? Did I accidentally refill my Nalgene with hummingbird food? I don’t think so- it is just the diabetes fairy and her sick, sick tricks again. At least I have a pattern developing. Can anyone say basal rate change?

3 a.m. Now, Monday through Wednesday last week were fine overnight. Steady. No more than 30 mg/dL up or down. I was thinking, this is good; I won’t have to keep doing these night time tests. Starting Saturday night I started noticing it climb towards morning. Grargh. Why can’t I just sleep through the night like a normal person?

My other problem is the alarm. I sleep through them, no matter if it on beep or vibrate. I do wake up and test, usually after they have been going off for ½ an hour or so. The night before last I woke up at 2:58 a.m. Good, time to test. Only it was my 12 a.m. alarm that had been going off for three hours that woke me. As soon as I tested, Jeeves started beeping again for the 3 a.m. test. I know you don’t like to do it, but a little shouting is in order, my good man. I have the sneaking suspicion that I am half asleep while the alarms are going off, as I keep having dreams in which beeping or buzzing noises figure largely.

So, in summary up to this point: Bitch, bitch, bitch, whine, whine, whine. But really, I am ok. I think the Insulin on Board function has already saved my derriere from bottoming out on a number of occasions.

Me: I am high, I wanna shoot up.
Jeeves: Pardon me, madam, but I think you will find that you have sufficient insulin in coursing through your veins already. Additionally, I think you will find that the correct terms are “hyperglycemic” and “bolus”. Uninformed persons might get the impression that you are a drug addict.
Me: Well hang the lot of them. And I tested a half an hour ago and I was “hyperglycemic” then as well.
Jeeves: I believe a bit of patience is advisable, madam.
*time lapse to an hour and a half later*
Me: Hey look, I am 107!
Jeeves: Miracles do occur, madam.

With regards to the other problems, I probably will never achieve perfection, but I do have more sophisticated tools at my disposal now. The average BG on the meter is coming down, as well as the standard deviation. So if I seem cranky, it's just due to the loss of sleep.

Wednesday, May 9, 2007

First Site Change

**Another previously written post that I had yet to put on the web. Someday I will be caught up, and then I might even play with my layout.**

I did my first site change on Saturday, May 5. It took me forever, as I was so nervous. I am not afraid of the needle, or the pain, per se. I have taken over 20,000 shots at this point, and more finger sticks, so that wasn’t bothering me. It was just something new, and it seemed like there were so many little steps. I have done a few now, and they are already getting better. I love the Cleo infusion sets for ease of insertion. I just have to push that big purple button and, badoing!, it’s in. That said, it probably took me 20 minutes to completely change out the cartridge and infusion set, so I am glad I was on saline. I seem to be getting little rings of adhesive from when I take the old sets off. Other than that, the old site looks good, just a tiny little red spot in the center where the cannula went in.

The cartridge was still mostly full though, at least 200 of the 300 units were still in there. Of course, I changed after two days instead of three, so I could get the practice in, and you want to leave some extra in there, but that is excessive. Do people normally change their cartridge every time they change their insertion site, or do you leave it until it gets lower? Can you fill up the cartridge part way? Of course the manuals and the books tell you to do them at the same time, but that doesn’t mean it is what people actually do.

Saline Start

**I actually wrote this post last Friday, but it was stuck as a word doc at work and I am only now getting around to posting it. I should get my arse in gear and post about how the insulin start has been going, but this one was already written so up it goes!**

May 4, 2007

My pump came last Wednesday just as promised (my UPS guy swung around again in the evening to make sure I got it that day and was able to sign for it). I think I am going to develop a repetitive stress injury in my thumb from all the button mashing that has been going on. My little black Cozmo is now named Jeeves. I have been going through a Jeeves and Wooster phase lately, and while the name Bertie sounded very cute, I thought it unwise to name my pump after a cheerful, but mentally negligible character in case the name turned out to be a self-fulfilling prophecy. (The pump would routinely alert me of gross mechanical failures with showtunes from the 20’s.)

Yesterday Jeeves and I went to the diabetes center to get hooked up together. I met with Rhonda (my CDE) and the pump trainer to get me up to speed and hooked up. The appointment was scheduled for 9-12 but we were done by 10:30. Everything went smoothly, even the insertion of my very first infusion set. I specifically chose the Cleo because I wanted the built in insertion device, at least for while I am new to this. It was really comparable to an insulin injection, and I am barely noticing the infusion set now that it is in me. After using the CGMS system gold last year, wearing the pump seems easy by comparison.

That was, until I went pants shopping in the afternoon. I was already out of the office, and in the big city, so why not take the whole day off? I had to buy a present for my father anyway (with some urgency, I might add; today is his birthday and I hadn’t yet gotten him anything!) My belt broke during a lunch bathroom break, so it was off to the mall for me. Changing in and out of clothes was a little tricky, but I figured out just to clip pump to my bra while I changed. No problem. It seemed all the pants that suited me lacked both pockets and belt loops. Clipping onto the waistband left a funny lump under the tailored shirts I like to wear, and dug into my flesh. I am not sufficiently endowed to make the bra option feasible in public. (Can you say three boobs?) Only pants with pockets and belt loops for me from now on I guess. Today I forwent the clip and stuck it in my pocket, which conceals the whole deal more effectively. I am used to having lumpy pockets anyways since I am a walking packrat.

I see the wisdom of doing a saline start. I am getting used to the controls and simply wearing the thing without messing up my insulin doses. On the other hand, bolusing and shooting up for every meal is kind of confusing. *Bolus*, great I have my insulin – wait no,*shoots up*. This will be shorter lived than I previously thought, however, as Rhonda just called to switch my insulin start from Wednesday to Monday because she had double booked and forgotten she had set aside time for pump starts on Monday.

*Realization Dawns* I am starting insulin on Monday. That is three days away. Eep!

Wednesday, April 25, 2007

The waiting

We got a call from the UPS people saying that my pump will be here today. Last night I got my hopes up when a box came, but in only contained IV dressing and prep wipes. (and a very scary catalogue containing any incontinence, ostomy, or urology products that anyone could ever need, ew.) Unfortunately, the UPS people were silly enough to give me the tracking number, so I will be watching it like a hawk today. Or maybe not. It has already gone out on the truck, so there won't be much to watch until it gets delivered. Since we have an in with our UPS man, it won't be delivered until this evening when I will actually be home to sign for it.

My CDE called to remind me that I should definitely take the pump out of the box and play around with it before the saline start on May 3rd. Who does she think I am?