Diabetes Wise

The One Thing I'd Change

I'm deliberately not going to mention the the Pump Company's name here, although it is clearly visible in the photographs. I'm not going to mention it because I don't want search strings for problems associated with this pump to lead here. I don't want anyone to actually get the impression that I think my particular pump is anything less than great.

Let me spell it out: I wouldn't swap it.

Right now I wouldn't even change my pump for one with integrated sensor technology - I'd be quite happy to wear a separate device. And in the future, I can't ever see myself wanting to change for something that takes any of the decision making out of my hands, if such a device should come along. I like using my brain to decide what I'm going to do. I just wish sometimes that my current pump didn't require me to use my brain at precisely the time my brain is functioning least well. When I'm already low. So this is the one thing that I would change.

Here's the scenario:

I'm about to eat and my blood sugar is 3.5 (63) So I want to knock a little off the dose that I'm about to give to put myself back up in range:

The pump responds with:

Obviously this is a safety feature and it requires confirmation to get out of. It tends to make me respond with "D'uh, yeah... I know!". It makes what comes next seem even more daft:

In case you can't read it very well, it is suggesting that I need 1.85 units, based on the carb value I'd already entered prior to the first picture. It then tell me I need 0.37 units less than that, because I'm below my target. So far so good.

Look at the next line. It tells me I already have 1.22 units active insulin on board from an earlier bolus.
1.22 units that has the potential to push my blood sugar down around another 5mmol/l (90 mg/dL).
1.22 units that would cover 18 grams of carbs.

But the pump goes ahead and ignores that value. It tells me to take the 1.5 (1.85 - 0.37) units, which would put a total of 2.7 units on board - greatly exceeding what I needed for the carbs I was eating right then, never mind the fact that my blood glucose was already below target.

In short, the pump is quite happy to suggest that I overdose.

Every time this scenario or one like it arises, I have to remember to mentally subtract that IOB value from the suggested dose. (In this case the dose would have been 0.25 units, although I actually took nothing.)

At first I thought this was some kind of glitch or bug. I thought my IOB feature wasn't working right, but apparently that is just the way it is. IOB on this pump model is only subtracted from a correction dose, never from a carb dose. So:

Perfect. The suggested correction is less than the IOB, so a small amount is added on.

This time, no correction is suggested as the blood glucose value is right on target, so the IOB is ignored. The 3.0 units would cover the carbs, while the 0.41 on board would be excess to requirements and I'd surely end up low.

And even in this situation: a correction is suggested, but it is less than the the IOB, so it gets ignored, again leaving me with excess insulin.

In simple terms, I guess you need to require a correction dose exceeding the current IOB value before the pump will do it for you. Otherwise you have to do it yourself! Which is weird, because one of the main benefits of IOB is to avoid hypoglycaemia through overdosing. Again, don't get me wrong, it works well when you are running two ordinary correction boluses together telling you whether the second one is required or if it needs reducing. But add carbs in to the mix and it seems to flake out. It can't cope with the concept that excess IOB can be used to cover the carbs, you don't need more insulin!

I guess it just proves that next to the pancreas itself, you can't beat the old brain for thinking like one!

 

(Btw - I hope you like the new look, tell me what you think!)

Twenty Three Things

This comes from Kassie  whom I must thank, as it has provided me with an opportunity to lift the mood a little from some of my recent posts where diabetes, and everything else for that matter, has clearly been getting on top of me. Time to be more positive: Twenty three pretty cool things I've done since I was diagnosed with diabetes. 

1. Went away from home alone at the tender age of eight - to diabetes camp, of course!

2. Set two county athletics records

3. Got straight A/A*'s in my GCSEs

4. Passed four A-Levels , winning a science prize along the way

5. Was accepted in to Dental School

6. Moved to London and lived it up as a Fresher, burning the candle at both ends and managing not to let diabetes get in the way

7. Worked at diabetes camp

8. Survived meningitis, and the subsequent diagnosis of epilepsy

9. Survived encephalitis

10. Obtained my first degree - a BSc(Hons) in Pharmacology with Biomaterials Science

11. Fought prejudice to continue with my dental training

12. Started pumping, and really took control of my diabetes

13. Organised a National Conference for over 200 dental students, raising over £15000 in the process

14. Started living alone

15. Fell in love (cool) and had my heart well and truly broken (not so cool.) Later on I took my own turn at doing the breaking (not cool either)

16. Was elected as President of a National Student Organisation, and travelled all over the UK.

17. Travelled to many places in Europe and North America, sometimes alone and sometimes with great friends, making fantastic memories.

18. Graduated from Dental School and registered as a Dentist with the General Dental Council

19. Attended an ADA Day Camp in Houston, Texas where all the kids thought my accent was "Cool" (That's a cool thing, huh?!)

20. Moved to Plymouth in Devon for a year, despite not knowing a soul in that part of the country, and successfully completed a dental training year there, despite spending much of the time with my leg in plaster

21. Achieved my lowest ever A1c of 5.2

22. Established a career in dental politics, alongside clinical practice

23. Started this blog - is that "cool"? You tell me...

If you want to play along, the rules are simple. Number of cool things = number of years with diabetes.

Dispatches From the Home Front: Failure, or Success?

I had an experience at home a few days ago that contrasted somewhat sharply against my hospital experience last week. I traded blood sugars that wouldn't come down for those that wouldn't come up. This is by no means a new experience, and I've written about it before, but this time it just seemed more intense and had an outcome I can never recall reaching before.

I've looked back on it searching for the reasons, the triggers. Trying, I guess, to find fault. To find an explanation. I'd had a deeply stressful day and spent much of it running low. I'd been exhausted and in pain from my foot, so I didn't eat much dinner. Didn't eat many carbs, beyond pure glucose, all day in fact.

Until 11pm, when a quick pre-bed check revealed a symptomless 2.7 (47) In the next hour I consumed:

A whole bottle of Lucozade
Two tubes of Glucogel
At least six Choc Chip Cookies

And in all that time my blood sugars stayed between 1.6 (29) and 2.8 (50). For a whole hour, while I was pouring carbs into myself, my blood sugar stayed that low. I sat in the dark, waiting for the light at the end of the tunnel. It finally came with a reading of 5.8 (105) Only the little light didn't get any brighter. In fact, within moments it seemed the light was already fading and that control of the situation was slipping back out of my hands. Just a few minutes later I'd dropped down to 1.3 (23)

I was at home alone, with my leg in plaster. And so came my unusual outcome. I self administered a Glucagon Kit. One of the kits that usually sits in my fridge until I realise it has expired. One of the kits I had only previously had given to me as a child, or during a seizure.

I can't remember ever having received Glucagon whilst conscious before.

But I guess with just about the last strain of lucidity that I had, I figured it would be better to get it in to myself before I lost consciousness, since I was going to have to be the one to give it.

Around half an hour later, when my blood sugar had risen to 9.5 (171) several thoughts were busy running around my head:

I wondered was there any point in eating the carbs you are supposed to eat following a glucagon injection - in order to replenish glycogen stores and ensure a later dose of glucagon would work - given that I had just used my only kit and given that I knew I'd probably be seeing anything I ate again, later that night. (Sorry, gross)

I wondered what on earth had happened to the more than one hundred grams of carbs I had fuelled my body with in the preceding ninety minutes.

But most of all I wondered whether getting into the situation where I needed to use a Glucagon  Kit represented a failure, or whether having used it, and so avoided a potentially bigger problem, actually heralded the evening a success.

I'm definitely leaning towards the latter. And trying really hard to eradicate this 'failure' word from my vocabulary where diabetes is concerned, because deep down inside I know it doesn't belong there.

Daft. But Fun.

My new cast, applied today.

Only because of the World Cup, I hasten to add.

It was all the plaster technician's idea... She originally tried to use a roll of red cast tape to make the George cross, but unfortunately it delaminated (i.e. came unstuck). We had to put another clear roll over the top but then the red didn't show so well, clear not being totally translucent. My work colleagues took up the challenge, adding the word England and helping me colour it up!

Very daft, but as the plaster technician said - it is good to have a sense of humour about these things.

And I guess it is kind of funky.

Dispatches From the Hospital Frontline: Failure

Ok, not quite true. Not literally from the hospital.

Fortunately I'm at home right now despite the planned 24 hour stay in hospital for the surgery on my ankle turning instead to five days. (Plenty of stories for another time)

Then, Friday night saw me in the Accident and Emergency Department of St. Thomas' Hospital. (Before anyone gets picky about my punctuation, that is how they spell it.)

I was feeling generally lousy, with throbbing pain in one of my six inch incisions, (I'm going to look good in sandals!) a feeling like a red hot poker was being shoved under my plaster cast, and with blood sugars that stubbornly refused to stay down despite three times my usual amounts of insulin and all the usual pump problems excluded. The logical step was to get the cast off and check for wound infection.

So I spent a couple of hours in the stuffy waiting room with an assorted variety of drunks and fight victims for company and the Poland vs Ecuador World Cup match on a giant screen: a reflection of living in a football obsessed society!

The good news: no wound infection.

The bad news: I was heading for DKA.

Ten seconds after uttering the words "I feel like I've got an amazingly high blood sugar" the reply came "You're not wrong"

22.2 (400)

And I was spilling ketones.

The doctor was lovely. Efficient, but with enough time to listen and be compassionate and empathetic. She was also very insistent: I'd be better off on an intravenous sliding scale. That is when the tears started falling.

"I don't want you to do this" I insisted.

"Why not? It's the best thing for you right now."

"Because you putting me on a sliding scale is like telling me I'm a failure. Diabetes is my job. It's what I do. It's my job to manage it, keep it under control. If you take over, I've failed."

"But Caroline, everyone needs help sometimes. Getting help isn't failing. You're not a failure"

But sitting in that curtained cubicle, listening to the drunks arguing loudly with staff outside, hearing bleeps of machines somewhere in the department and the distant ringing of a telephone, I felt totally overwhelmed. Totally out of control of my diabetes. Out of control of what was happening to me.

It was a horrible feeling.

I hated myself for feeling it, but I still felt that I'd lost the battle that night and diabetes had won.