Diabetes Wise

The Accidental Overdose

Because I prefer to be discrete, I tend to leave my pump's alarm set to vibrate, and that means I'm used to random buzzing from my pocket, my waistband or wherever my pump happens to be lying beside me. High alerts, Low alerts, Cal reminders, low reservoir alerts... between the pump itself and the CGM the list is endless.

The 522 is pretty cool in that it will give you a different number of vibrations for different alerts. Three means 'take no action' and happens for stuff like temp basals. Four is something which requires prompt action - highs and lows for example. Six means 'pay attention to me now or you'll be sorry' - No delivery alarms and stuff like that.

The problem is, I often only feel one or two vibrations so I have to dig out the pump to check no matter what.

This morning, sitting on a bus overcrowded with soaking wet passengers, I felt that single vibration. I pulled off my gloves and dug through layers of coat and sweater to reach my pump in my pocket. As I glanced at it, I was sure I saw the bolus delivery screen, but a second later it was gone.

The strange thing was, there was no alert to have triggered an alarm. And the only other time the pump vibrates is when it finishes delivering a bolus. Scanning rapidly to the bolus history screen, there it was. I'd just given myself a 4.6 unit bolus.

Only, I hadn't.

Or at least I hadn't meant to. I'd eaten breakfast about 40 minutes earlier and bolused then. But that had only been 3 units via the bolus wizard. It was right there on the history, below the 4.6 unit manual bolus.

The pump had been in my pocket the whole time and easy bolus is disabled.

So what on earth happened?

The only conclusion I can come to to is that somehow, in the course of getting on the bus, I'd leaned on my pump in such a way as to press the buttons in sequence: ACT, ACT, down arrow, ACT, ACT, up arrow...for a while, ACT. But crazier yet is that with every press of the ACT button, the pump vibrates.

Still, it's either that or else I was briefly abducted by aliens. Unless anyone has any other suggestions?

Oh, and the overdose was sorted with a temp basal and a big bowl of cereal when I got to work.

Running on Empty

At 8am this morning I had a choice:

a) get up now and refill my reservoir/change my infusion set, or

b) roll over and grab five more minutes sleep.

I chose b.

(Five minutes in fact turned to over thirty and a mad panic to get ready and make it to work for 10am ensued.)

At 8am this morning I had 3.2 units remaining in my insulin pump. Not anywhere near enough to get me through the day, but I made my lazy choice based on the 10-15 'hidden' units at the end of the reservoir. Minimed pumps never show they are there, but I know they are.

And 13-18 units was plenty of insulin to last until this evening.

Or it would have been, had several of us not decided to head out after work for a Chinese meal.

Mmmm... Chinese.

Mmmm... big bolus.

Sitting in the restaurant in Greenwich I contemplated my empty reservoir and the plate of noodles and chicken that I'd just ordered.

I knew what had to be done.

I am very lucky to have work colleagues who don't bat an eyelid when I pull out insulin,  a reservoir and infusion set and proceed to change out the entire thing right there at the table, without even dropping a beat from the conversation.

I know that there are many people who would not do it that way. I know that there are many people who would actually criticise me for doing something so medical in public.

This is the way I see it: I was running on empty. If your car runs out of fuel, you fill it up. Or, a better analogy, if you get hungry, you eat to fill yourself up. To me, insulin in my pump is no different. It was a necessity right then, so that I could go on with my evening in the way that most people take for granted. None of my immediate dining companions objected, and nobody else in the restaurant had any cause to even look at what I was doing. And yes, it was clean and I had already washed my hands.

A girl's gotta do what a girl's gotta do and filling up her insulin pump and changing her infusion set is an important part of this girl's life!

Unlucky 13

I'm not a particularly superstitious person.

Actually, I'm not superstitious at all. To me, a black cat is just a black cat and magpies are just magpies. I'll happily cut my nails, and my hair, when I want and I'll walk over any number of drains in the street. I don't walk under ladders, but that is common sense, not superstition!

Thirteen?

Just a number.

Thirteenth of the month?

Just a day...

Or so I thought. But whether it was the date or something else entirely, the blood sugar monsters have been out to get me today.

It started off badly. At around a quarter to two this morning, I woke up to find my pump and I had parted company. It had made a bid for freedom out of the far side of the bed leaving its tail of tubing trailing in its wake, infusion set still attached, ripped clean from my body.

There was a very big part of me that wanted to leave it there. I wanted to stick two fingers up at it and say "You can't get one over on me. If you fancy a night sleeping on the floor, you've got it!"

The idea of rolling over and ignoring the problem entirely was given more consideration that it surely should have been.

But diabetes invades my every waking hour. I don't want it invading my sleep. I wanted to ignore it so badly.

Of course I didn't. I didn't even really pursue a mental calculation of how many hours until I would be getting up and whether I could get by on a interim shot of Humalog. Instead, I forced myself out from under my warm duvet into the cold of the bedroom to collect a new infusion set. Given that I only had around 20 units left in the reservoir, I grabbed one of those as well and proceeded to replace the entire shebang.

By late this afternoon, I was back wishing I'd left the pump where it was. The infusion set having been placed through a blur of sleep, the adhesive had caught up a little and it has irritated and scratched at my skin all day. And as for my blood sugars, they've soared and crashed from 2 to 20 and back again.

I'm frustrated.

I want to blame my pump because it is a tangible object. I love my pump, but unlike my other love, this relationship is tinged with hatred and resentment. I wish I didn't rely so totally on it. I wish I had a fully functioning body that didn't need it.

That's the bottom line. It's diabetes that I'm frustrated with. It's diabetes that I want to toss out of my bed.

But I can't.

So I'll resign myself to the fact that today was an unlucky day; Tomorrow is a new one.

Is there anywhere they don't end up?

I was cleaning out the filter in the dishwasher earlier. Along with a stray food scrap I found a used test strip and one of those plastic Quick-Set donut caps.

And rinsing the shampoo out of my hair in the shower the other morning, I glanced down to see a test strip circling the drain.

Is there anywhere this crap doesn't end up?

I can't help but wish for the day when I can ban it from my house. The day when I don't have to rely on this stuff anymore.

Updates - Exams and Pumps

1. My new pump has arrived.

Yay!

And, it arrived on time as promised. Double yay!

In fact, even Medtronic were impressed at their own efficiency. On Friday morning, when I already had the new pump attached and pumping the telephone rang.

"Hi, I'm just calling from Medtronic. I understand that you have a pump that needs replacing" came the chirpy greeting.

"Well I did. It's been replaced though, thanks" I replied.

"Oh no, the American technical assistance line isn't able to replace them direct, so it hasn't actually been replaced yet" she said, with the patient manner of someone who has had to explain this point before.

"Erm... I can assure you that it has. The new pump arrived this morning and I'm wearing it now!" I responded.

"Oh, I'm terribly sorry..."

"No problem, it was already dealt with yesterday."

"Well, that's great..." I don't think she knew what else to say, caught off guard that the job had already been done. I'd definitely rather they tried to replace it twice than not at all!

I'm also pleased to find that Medtronic no longer demand that I pay the cost of shipping and insurance to get the old pump back to them. This was an aspect of their customer service that really bugged me a few years back. I once had two pumps to ship back to them at once where the total cost would have come to around twenty pounds. In that case I dropped the pumps off at my hospital and let the rep pick them up from there, but glad I can simply send this one off at the Post Office.

2. The exam went pretty well.

Went well, insofar as there were a decent number of very straightforward questions that I definitely knew the answers to.

Went well, insofar as nobody batted an eyelid about my pump, clipped visibly on my waistband, or  my test kit laid on the desk and called in to service twice during the three hour paper. After all my panicking it turned out that I actually knew the exam coordinator from when I was an undergrad!

The exam did not go so well with regard to my actual blood sugars, which hovered between 10 and 13 (180 - 235) throughout, failing to respond to corrections.

It must have been stress, because the minute I left the exam hall, it started falling nicely.

Another Pump Bites the Dust

There is a definite theme emerging amongst diabetes bloggers in recent days. And it seems like my pump is the latest one to join the club.

Last Sunday afternoon, as I lay curled up the sofa with R and my MacBook, my pump started up an insistent pattern of 6 vibrations. Uh-Oh.

"MOTOR ERROR"

Huh? Well, I've never seen that before.

Without really thinking, I cleared the alarm and, since it was due for a change anyway, loaded a new reservoir. Problem solved.

Until yesterday evening.

"Buzz... buzz... buzz..... look at me" demanded my pump.

"MOTOR ERROR"

This time I figured I'd look it up on line.

This is what I found out:

Motor Error
Insulin delivery has stopped. This alarm occurs if your pump detects a motor error.

No shit, Sherlock!

None the wiser, but with a cruising blood sugar of 10.7 (185) I went ahead and rewound and reloaded the reservoir and plugged in a bolus. I figured I'd give Medtronic's 9am-to-5pm-weekdays-only helpline a call in the morning to check it out.

But then, around 15 minutes later and approaching the midnight hour, the pump piped up again.

"Buzz... buzz... buzzz..... look at me"

"NO DELIVERY"

Hmm. Coincidence?

Unsure, I dug out the cost-of-a-local-call-connect-you-to-Medtronic-in-California-24/7 telephone number and dialled.

I explained the problem, finishing up with "so I just wanted to check what those alarms actually mean, since I couldn't find anything in the user guide."

To be honest, I could have done with Mr Medtronic-California being a little more chipper. It was approaching midnight for me so I guess I was allowed to sound tired and jaded. But midnight for me meant 4pm in California. Being even more honest, though, I guess I knew it was coming before he said it, probably before I even picked up the phone to dial.

"For safety, we have to recommend that you discontinue using the pump and revert to the back-up plan you have in place with your medical professional."

Damn.

Mr Medtronic-California couldn't arrange a replacement directly,  but to give them credit, I did receive a call from Mrs Medtronic-UK this morning. She had all the details in front of her and was ready to arrange a replacement to be shipped to arrive tomorrow.

I admitted to her, sheepishly, that I was still using the pump in question.

"Were you not advised you to discontinue using it?" she asked, surprised.

"Yeah." I admitted. "It's just that reverting to back-up isn't as simple as it sounds."

"My blood sugars are doing great." I added, as an afterthought.

"MOTOR ERROR" responded my pump, smugly.

The number, the whole number and nothing but the number

Imagine, for a moment, an adult attempting to explain to small child, in appropriate terms, where babies come from. Or how Santa Claus makes it round the whole world in a single night. The course of the conversation will doubtless be punctuated by frequent buts, whys and hows on the part of the child. Small children have an uncanny knack of seeing straight through any confustication and sadly the skill of explaining complex things in simple terms is not widespread.

Imagine, then, trying to explain not only the concept of blood glucose values but also the information CGM and/or knowledge about past and future food and activities adds to those values, to the uninitiated. A comical situation rather like that between a father and his small son could easily ensue. In most areas of daily life, mathematicians aside for a moment, a number is just a number. If someone asks you for three pounds/dollars/groats, three is what they want. But a number in diabetes? Is a number ever just a number?

So let's start with the real basics: Under 4 is low, requiring sugar. Over 8 is high. Or sometimes over 7, or even over 12.  What's that? Why? Well it just depends. Different people have different needs and different situations require different targets. Yes, it is a bit like shooting. We're aiming for a target. Yes, that's right, it sometimes moves.

But anyway, high numbers need insulin. Got that?

OK.

Whats my number now? Well, yes, 3.9 is low and yes, normally that means sugar. But hold on, I just ate 10 minutes ago and look at this line on my CGM - it shows I'm going up. So yes it's low, but no I don't need sugar.

You want me to test your number? You're at 3.5. No, no. That doesn't need sugar either. You see, you don't actually have diabetes, so your body will take care of your numbers for you.

A little later...

See - I came up just fine. I'm 8. No 8 isn't high today. Yes, I see from the graph that it's going up, but I'm just on my way to the gym. So 8 going up very slowly is just fine today.

Later still...
What's that? You want to know what my number is now? Hold on...

Oooh... 5.5.

Yes, yes... I think you understood the basics and yes, that is a normal number. But look, my pump says I still have one whole unit of active insulin from what I gave earlier and look how far my CGM graph has dropped in the last hour. So I'm normal, but actually I need to eat.

What do you mean you think I' making it up as I go along? I'm really not. It's quite simple and logical when you look at it. We have low numbers and high numbers. But we also have normal numbers that can act like low numbers if we are falling, and normal numbers that can act like high numbers if we are rising. And a high number isn't always a high number, for example if we are about to drive a long way or do something where it is really important we don't have a low. And a falling number is...

What's that? You just want to know where babies come from? Now that's a much easier question to answer...

The Mystery of the Missing Meter

I'm currently still on vacation in San Francisco, taking advantage of the free WiFi in the air-conditioned comfort of the Metreon. It may just be the result of dragging my luggage around SF on Muni and Bart between a friend's house and my brother's office, but the Bay Area natural air-con doesn't seem to be going at full strength today! This is just one of several stories I have to share from my trip.And thanks for all the advice about Cheesecake Factory. I haven't risked a re-run yet, but there is always tonight...

Last week we had a pretty full day planned up at Fisherman's Wharf. We'd taken advantage of the San Francisco City Pass which included both a Bay Cruise with Blue and Gold Fleet and a ticket to the Aquarium of the Bay. I had booked us tickets on an evening tour to Alcatraz and also hoped to fit in some time at the awesome Musee Mechanique and a meal to showcase the madness of Bubba Gump to R. An exciting day, but the kind of tightly planned schedule that just doesn't leave room for things going wrong. Certainly doesn't benefit from the invitation of diabetes t spoil the fun.

We started out with a delicious pancake breakfast and, for me, a pretty hefty bolus to cover all that syrup:

 

Next up we took the F-Line streetcar round to Pier 39 and started out our day with the Bay Cruise, sailing right out beneath the Golden Gate Bridge and around Alcatraz Island

I could have sworn to you that at some point on that cruise I checked my blood sugar and it seemed to have come down nicely from breakfast. I'd have bet against a dunking in the freezing water of the bay that I did it.

Back on dry land, we took a look around some of the shops and other tourist tat on Pier 39 before heading into the Aquarium where we enjoyed tunnels through the tanks, starfish and jellyfish and sea anemones:

During our time in the Aquarium, I rummaged through my backpack several times, searching for tissues, my phone and money, but I thought I was careful not to let anything drop out the pen bag.

It was shortly afterward, as we were waiting for our table at Bubba Gump for a very late lunch (to fit in with a schedule of late dinner post-Alcatraz visit) that my CGM alerted me that it needed a calibration within two hours. As I checked the screen I noticed a double down arrow indicating a fast fall. No problem, we'd be eating fairly soon but I'd just do a fingerstick to check...

I looked everywhere. I emptied every pocket in my backpack, piling everything up on the bench beside me and growing ever more frantic as the search yielded no test kit.

Damn.

I needed the test kit then. I needed to check I wasn't already low. I needed to calibrate my CGM well before we would get back to the hotel. We wanted to eat, and as R pointed out, Bubba Gump's isn't the kind of food you can tackle without means to know accurately what your blood sugar is.

I wanted to wing it, rely on the CGM and keep going. We were on the wrong side of town to go back and pick up my spare kit. I didn't want to ruin the day, but deep down I knew that the day would be ruined anyway if I couldn't stop worrying what level I was at or if I purposefully tried to run high to avoid a low - I'd feel awful.

It was only then that I turned to R and started to cry.

"I just can't believe I've lost it." I said, as it hit me that this is the little Freestyle Flash that  got in pre-launch trial in the UK some three or four years ago and that I've used ever since. My blue Multiclix, a present from a friend and very much preferable to the white version sold in the UK, was in that kit. And all my data. All the numbers from the trip so far that told me how well I'd been working out the time zone change and the pancake breakfasts.

"I'm being pathetic" I sobbed, "but I was really kind of attached to that meter, and I know I tested on the boat earlier. I could have lost it anywhere." I imagined my little kit falling off the side of the boat and swimming to the bottom of the bay or being swept out into the Pacific.

"You're not being pathetic" R said , giving me hug. "I totally understand. Let's go and see if we can find it."

We went back the Aqarium, who were very helpful, even checking the restrooms that were closed for cleaning, but no sign. Next we tried Blue and Gold, who were much less helpful and as we got redirected from person to person, I gave up.

"Come on"I said. "Let's just jump in a cab. This isn't helping and I need a meter now."

A speedy cab ride later we were back at the hotel.

And there, nestling in the bottom of the small black bag I'd taken out to breakfast, was my precious kit. It seems I'd imagined testing on board the boat earlier, which perhaps proves that it is possible to take a least a little vacation from concentrating on diabetes.

And all's well that ends well.

We got back to Fisherman's Wharf, via Cable Car, too late to fit in Bubba Gump ahead of Alcatraz. But Alcatraz was awesome, and afterwards we enjoyed a sunset view from the window with our Bubba Gump Shrimp.

 

I've been keeping a much closer eye on that little black kit for the remainder of our vacation. I won't be leaving it behind again.

Getting My Groove On

I love getting stuff in the mail.

Stuff, that is, that isn't bills or junk. Cards, letters, things I've ordered or exciting, oddly shaped packages. You can't beat the feeling of peaking into the mail box on your way in from a tiring day at work to find an interesting envelope or package peeking back at you.

Like the one I found today:

It has been almost exactly a year since Kerri posted about these.

At the time Groovy Patches were only available for Quicksets, which I wasn't using and wasn't able to use right then. But I loved the idea. In fact, I thought they might even just be the solution to the ongoing problem I experience with Silhouette/Comfort infusion sets where the little cannula viewing window pulls away from the plastic hub, leaving the point of insertion completely exposed. I've tried ordinary surgical tape and pieces of IV3000 cut down to size to deal with the issue. Both of these solutions work well enough, but look so darned ugly.

I discovered a while back that Groovy Patches were now available for Silhouette/Comfort (in both short and regular cannula lengths). Last week, perhaps spurred on by my upcoming holiday or even the simple desire for some exciting mail, I finally allowed curiosity to get the better of me and I ordered some. I've got some retro patterns, flowers, underwater scenes and even jelly beans!

I can be an impatient person at times, and this was one of them. I couldn't wait to get my groove on:

The verdict so far?

I love it! It remains to be seen if the patches will solve my problem, but I just love how much fun they are. It's great to glance down at my hip and see a little starfish instead of a large white blob. All we need now are Minilink Patches!

I'm feeling groovy... how about you?

Lucky Idiot

“Come ooooon…..” I whined, zipped into my coat practically before my boy, R, was dry from the shower. “I’m reeeeeally hungry now”, pointedly putting my boots on as he tried to brush his teeth.

That should have been clue number one, the raging hunger. Fair enough it was already past one o’clock and getting late for lunch But then, we hadn’t eaten breakfast until gone eleven. This was pretty excessive hunger.

By the time we were standing, well wrapped up against the cold, at the bus stop outside my gastric juices were foaming and gurgling and my stomach was beginning to ache. As we sat on the bus the ache turned to nausea, my head beginning to throb ever so slightly.

We stepped off the first bus, waiting for our second ride into Greenwich, and I leaned against the wall to steady myself.

“I don’t feel hungry anymore” I muttered. “I just feel really ill.”

“I guess” I added, almost as an afterthought, “I’d better test my blood sugar, to make sure it isn’t that.”

I fumbled with cold hands in my bag, withdrawing the black zippered case, flipping it open, inserting a strip and applying blood. I watched the little lines dart round in a square shape on the screen of my Freestyle Mini for what felt like an interminable period - something that almost invariably pre-empts a high result.

20.1

“Shit. I’m really high.”

“How high?” R asked as I’m glancing down at the screen of my 522, first cursing it for not warning me, then cursing myself as I realised mistake number one: having earlier silenced a pump alarm without really taking in what it was telling me – that I was already high and on the way up back then.

“Pretty high.” I replied

“Yeah, how high is pretty high?” he asked, without a hint of accusation.

“Twenty. That’s why I was so hungry, and why I now feel so sick”

“What do you want to do?” he asked gently, after guiding me to a seat, buying me a bottle of water and assuring me that no, it really didn’t matter if I was sick right there on the pavement, yes he would hold my hair, and no my breath didn’t smell like pear drops. “You want me to get you home?”

I shook my head.

I made him sit there in the freezing cold, arms wrapped around me as much to keep me warm as to support me, watching buses that would take us where we wanted to be go flying past, for a full thirty minutes as we waited for the insulin to kick in, the sick feeling to go away and normality to return.

“I’m sorry” I mumbled, more than once.

“It’s ok, it’s not your fault” he assured me.

But I think it was. Earlier I’d made the elementary mistake of forgetting to reconnect my pump after disconnecting it. I’d compounded the error by not actually checking my blood sugar at that point, or attempting to bolus for missed basal. I’d well and truly wrecked any chance of getting out of the situation by failing to properly acknowledge the earlier high alert. All of which goes to show that both a pump and a continuous monitor are only as good as the person using them.

“I could have reminded you too though” was his response. “And next time I will. It can be my responsibility as much as yours.”

This crappy situation had a silver lining. As I started to feel better I smiled to myself, really happy to have found someone prepared to embrace this head on.

Sometimes, at least as far as diabetes is concerned, I'm an idiot.

But I feel like a very lucky idiot.

I Don't Do That!

I had coffee this evening with a friend from dental school who is currently working as a Senior House Officer (SHO) in Maxillofacial Surgery. I haven't seen her for a while and this was the first time she had seen me wearing the Guardian RT. Since she was interested, and already familiar with my pump and the concept of infusion sites, I showed her the sensor and transmitter.

"I'm not sure I could cope with wearing all that stuff" she said.

I guess this could almost be perceived as an equivalent to the people who exclaim "I could never inject myself!". The standard retort to such a ridiculous suggestion being "Between death or injections, which would you choose?" It's a no-brainer.

But I don't think this is the same.  After all, using an insulin pump and wearing a continuous monitor are choices that we make in a way that we can't with the idea of simply taking insulin. And many people with diabetes who are hesitant about pumping feel that way due to a fear of being attached to something twenty-four-seven. Maybe she wouldn't cope with it.

I put it to my friend though that, yes, I have two things stuck in me and carry two monitors around and, yes, the transmitter is bulky, but for my quality of life this is totally worth it. I can see how people, looking in from the outside, would think carrying around a pump, or having the Guardian sensor attached would interfere with life. Would be a hassle and an annoyance. But the good control and the peace of mind those things afford me is priceless. Far from interfering with my life, they allow me to lead my life on my terms.

She could see my point.

Time passed and we chatted about other things. Another SHO, the SHO on-call tonight, came in. While she chatted briefly with us, one of the two bleeps clipped to her waistband began going off. As she left to answer it I joked that "wearing this stuff [pump and monitor] isn't much different to wearing hospital bleeps, even down to them screaming at you at inopportune moments."

My friend replied "Yeah, but I don't wear my bleeps during sex."

I couldn't do anything but laugh, and concede that she probably doesn't wear them in her bra either!

Tuesday Top Three

1) Today, I was a prisoner in my own lounge.

Mr Gas Man was sprawled across the central hallway of my flat for two hours, replacing the burnt out immersion heater in my hot water tank. And I chose that two hour window in which to be low.

No access to the kitchen (obvious source of carbs) - that is right where he is lying.
No access to my bedroom (glucose tabs kept by the bed) - that is right where he has piled all his tools.
No access to the bathroom (glucose tabs in the cabinet) - a large tube is draining the hot water tank into the bath tub.

And all the stubborness and irrationality of a low blood glucose preventing me from just asking the guy to move for a moment.

So today's number one is most definitely the Quick Fix Keychain

Clipped to my meter case and containing 16g worth of glucose tabs. I got my carbs without having to give in and ask. A win-win situation!

2) Also today, I dropped my pump. Twice.

So today's number two has to be Tubeguard

After my bad experience with EZ-Wrap, I love this even more. Not only does it keep my long tubing tidily away from those pesky door knobs while it isn't needed, but it also takes the place of a 'safety loop'. You know, that thing they told you at your pump training about taping down a loop of the tubing so that the infusion set doesn't get pulled out if you drop your pump. That thing that kind of negates the point of quick-to-detach infusion sets. That thing that no pumper I've ever come across actually does. But with the Tubeguard firmly clipped to a pocket or waistband, that is what takes the strain if you drop your pump.

Which I do. Far too frequently.

3) Today's number three...

... is apple flavoured hypo treatments.

After years of orange and lemon or 'original' (for which read'yuck') flavoured Lucozade, they've just brought out an apple flavour, which is delicious. It also compliments the great 'Sour Apple' Dex-4 glucose tabs, brought over from the US.

They're what I use to fill up the keychain!

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!)

The Girl at the Crossing

Standing waiting to cross the road, she lifted up her shirt, looked down and peered at her infusion set. The lights changed. She put her shirt back down and carried on her way.

The girl wasn't me.

I've been overwhelmed in the last couple of weeks. Being in plaster and having to wait for surgery, knowing that it will be at least another six weeks in plaster after surgery and just wishing I could get it done sooner, to end this thing sooner.

I still have to get up and go to work. I'm self employed, so if I don't work, I don't make any money. And the bills won't pay themselves. I have to hop on and off the bus and hope the drivers don't pull away sharply before I'm safely seated.

While my friends and family are great, they can't be with me 24/7. I don't have a partner, and I live alone. (And, in fact, most of my close family have chosen this very week to be on holidays in far flung places.)

I ran out of milk today, and there was no one else to get some for me. Picture this: girl on crutches with two pints of milk swinging from  the little finger of her right hand, and a box of fabric conditioner pearls tucked under her chin. I swear the guy on the till sniggered, but no one offered to help!

There was no one to take out the rubbish today, and I didn't want it sitting in the kitchen overnight. The laundry still needed doing. The bathroon needed to be cleaned.

But seeing that girl, standing by the roadside checking out her infusion set reminded me that, at least as far as diabetes goes, dealing with the crazy effects all of this is having on my blood sugar, I'm not alone.

It is just a matter of typing the words.

My Insight on Insets

For many of you, this may well come under the 'totally uninteresting' category of blog posts: Anyone who, or whose child, doesn't pump, anyone who uses or has ever used an Inset themselves, or anyone who is perfectly happy with the infusion set they already use, thank you very much. That is probably quite a lot of you, and the rest of you will probably be struck by how much like a High School 'Compare and Contrast' science essay this is, but since at least one person (thank you Tiffany) has expressed an interest, here I go.

As I stated here, I was lucky enough to acquire some Insets on my trip to San Francisco. This is significant because Insets are not available in the UK and I am currently only able to order Comfort and Comfort Short sets without having to pay out of pocket for them. There is a part of me that really likes 90 degree sets, as I have always found they scar my skin less and stick better, especially when swimming. So when a friend offered to trade me a box of Insets (I took a box of Comforts back in return) I jumped at the chance.

The verdict?

Love 'em!

The sets stick to my skin brilliantly with no peeling after three and half days, which is how long I'd ideally like go between set changes, in order to make it a twice a week routine that is easy to stick to. I always find with the Comforts (Silhouettes/Tenders) that the little window (see picture on the right) that enables you to see the cannula starts to pull away from the rest of the infusion set after a couple of days leaving it semi-uncovered. I worry that this raises the liklihood of an infection, and also seems to cause the skin around the site to redden, which in turn leaves a mark on my skin after removal. I often end up changing these sets sooner than three days, which obviously pushes costs up.

The connector between the set and the tubing on the Inset is universal - it can be connected either way round unlike that on the Comforts, which have a 'right' and a 'wrong' way. This saves fumbling in the dark after I've disconnected for a trip to the bathroom in the middle of the night! And the different colours on the plastic of the set area nice, if totally unnecessary, touch!

One of the biggest benefits of the Inset is the built in Inserter. I've used Quick Sets in the past, but when I was out of the house I either never had the Inserter with me, or found it in the bottom of my bag (usually covered in crushed glucose tablets and biscuit crumbs!) Although these sets can be inserted by hand, Medtronic don't recommend it, and I tended to find that hand inserted ones led to more problems - kinking and crimping.

The Inserter also has the value that you can replace the lid on it after the insertion which instantly securely covers up the used insertion needle until you get somewhere to dispose of it correctly. Comforts are a nightmare in this regard. If you have to insert one whilst out and about you then have an inch and a half long needle to carry around with you without sticking it into anyone. I've often had to find creative ways of keeping them safe.

Today was a case in point. I accidentally pulled out my Inset while trying on new spectacle frames. (The spectacle frames are not related, but this proves how you can trash an infusion set in the most unlikely ways!) I was just about done with choosing, and needed a coffee, so I popped next door to Starbucks, where I proceeded to insert a new Inset, seal the inserter off and enjoy my Macchiato. I often wonder if people will look at me strangely when I insert a set in public, but when I got up to leave I spotted a man caressing and sniffing (yes, sniffing) a pair of shoes. By London standards, inserting an infusion set is not odd at all!

A Not So Nice Surprise

Where there is good, there is... not so good.

A surprise bg test result of 17.5 (315)

Ok, the result was not a total surprise, because I felt high. But being that high definitely hit me out-of-the-blue.

I had to take my pump off earlier. Right before I disconnected I was 7.9 (140). I took a correction to bring me to 5 (90) and added 0.5 units. In the end, I was disconnected for a little over an hour. I reconnected and gave myself another 0.5 unit bolus. I'll admit, I didn't test because I was in a hurry. When I tested 30 minutes later, I was at 6.8 (122) and an hour an half after that 6.4 (115)

Caro 1, Diabetes 0

Until three hours after that, when I got the 17.5 (315)

Why?

And why, diabetes, do you have to insist on kicking me in the teeth after I've won a small victory: tamed you, and kept you down as I negotiate an obstacle?

I don't like your surprises, diabetes.

I prefer nice surprises

My Favourite Colour

My favourite colour is blue.

When I was growing up I had a beautiful blue carpet on my bedroom floor. I no longer have the blue carpet, since I no longer have the same bedroom, but I do have a blue throw on my bed, with blue cushions. And blue curtains. The towels in my bathroom are all blue. You get the picture.

My first ever pump, a Minimed 507 on loan from the hospital, was blue. It was followed by a blue 508. I liked those pumps in blue. In they looked sort of funky and, after all, blue is my favourite colour.

But right now, today, I don't like this blue pump. The blue pump that is attched to me, infusing my basal and tracking my insulin on board as I type this.

The colour is an issue. Whilst I don't remember ever having trouble with my Minimed pumps clashing with my clothes, more than once in the last week I've cursed the.... the... blueness, of this pump. I have a great pair of khaki green coloured trousers, but they look simply awful next to a blue pump. 'Blue and green should never be seen'  anyone remember that one?

I don't know if it is the shade of blue that is the problem, or the way the blue looks next to the black rubber of the button strip (I don't even want to think of what a search engine might do with that sentence!)

Or maybe it isn't the colour at all. After all, blue is  still my favourite colour.

Maybe it is simply because it isn't mine. It's a loaner, replacing my own silver model that betrayed me last week by going wrong. It's got history. I know; We're not talking about a potential boyfriend here, but I'm serious. It had 'History' stored in it when it arrived. And nevermind the colour, it doesn't sound the same. The familiar smooth whirring of a bolus being delivered has been replaced by an altogether more guttural sound. A sort of Brrrrr instead of a Whhhhiiiirrrrr.

I know, I'm daft.

It is actually a very nice sparkly sort of blue, and it does exactly the same things that my previous pump did. And of course I'm glad just to have a pump, any pump, which so many people who really need/want one don't.

I suppose it may seem that I'm never happy. Back in January I complained about feeling too attached to my pumps when they had to go back. How then can I explain that this time I don't feel connected to something that I'm physically attached to? I guess I can't, but maybe someone out there will understand anyway.

Happiness is... A Pump That Works

So loaner pump number two arrived this morning.

I'll admit I set it up with a little trepidation, especially when, on trying to set the time to 54 minutes past the hour, it wouldn't scroll down from zero. But evidently that is just the way it is, because the down arrow key works just fine.

I've learnt a couple of things from this experience; That being without 'Smart' features makes pumping a whole lot more like hard work. I'm not quite sure how I ever managed with a Minimed 508, but maybe my mental arithmetic was better back then. So definitely a case of really appreciating what you have when it's gone, and remembering how lucky I am to have access to this technology at all now that it is back.

I'm no stranger to pump problems. In fact I think I may just be a little bit jinxed. By my calculations the pump I'm wearing right now is the 14th different one I've had in the last four years. Is that some kind of record? What I've learnt this weekend, though, is that it isn't that a problem has occurred that matters, it is the way that it is dealt with. Everyone has been professional and apologetic, and the replacement pumps have arrived right on time. The pump this morning arrived with a great note apologising for the problems and thanking me for, and I quote, "being so reasonable about all of this" and acknowledging that "it must have been a very stressful weekend." It is very easy to be reasonable when everyone is supportive and doing their very best. Some other pump companies, at least here in the UK, have much to learn.

Oh, and the new pump is blue.

Pump Woes

Maybe I jinxed myself when I commented here, on Sandra's blog about how my Animas IR1200 was three months old, and I was keeping my fingers crossed as I'd never had one for longer than that.

Or maybe I accidentally uncrossed my fingers.

My pump went wrong on Friday afternoon. Of all times, it would be a Friday afternoon.

Actually it hadn't been quite right for a little while. I kept missing alarms and alerts, even though I had them set to 'High' volume level. I have the pump set to beep before and after bolus delivery, just to confirm. But lately I haven't always been hearing those beeps, even when the pump is right there in my hand.

On Friday morning, I was doing some work on my laptop lying on the sofa (what can I say... I'm just a slob at heart!) The pump was right next to me, not even in my pocket, as I hadn't bothered to put it back after a bolus. I was startled to hear the ascending-and-descending-siren (aka 'Sweep alarm') plus vibrate start up. I hadn't confirmed a low cartridge alert. Looking at the alarm history, the pump had supposedly been alarming for nearly an hour.

It was right there, and I didn't hear a thing.

I'm absolutely certain that there is nothing wrong with my hearing. Certainly I don't seem to need to have the volume of my iPod as high as 90% of people on London's public transport, and often I can still hear their music through my own!

I resolved to call Advanced Therapeutics, the UK distributor for Animas, but it wasn't a high priority, at least not compared to other stuff I had to do right then. In the mean time I set most of the alarms to vibrate instead, and looking back think it was probably a little daft to rank the machine I depend on as 'low priority'!

Then, that afternoon, when I was changing the cartridge, the screen just went blank in the middle of the prime sequence. Stunned for a few moments, when I next pressed a button, the main screen, showing time, current basal etc appeared fine. Relieved, I went finish the prime, only to find that the prime menu was completely unintelligible. It seemed to have alternating dark and light stripes at varying intervals both up and down and across. Parts of the actual screen display were still sort-of visible beneath the gobble-de-gook.

What threw me is that this wasn't a straightforward screen failure. Several of the screens were still fine. For anyone familiar with the IR1200: Status 1, 3 and 6 are unreadable, but 2, 4 and 5 are normal. The entry screen for ezBG is unreadable, but if you go through to the results page, it is fine!

I managed to complete the prime cycle intuitively i.e. by remembering the usual sequence of button presses. Got myself hooked back up, and gave Advanced Therapeutics a call. As always, I got awesome service. They arranged, with some effort and several calls back, to have a new pump with me before noon on Saturday. In the meantime, I could bolus with a syringe, and the pump would continue to deliver my basals.

Ah... Basal.

It was at this point that I realised the basal review and edit screens were affected, and having made a number of basal rate changes recently, I didn't have a back up record.

The moral of this story is, of course, always have a written record of your basal rates!

Fortunately I was saved by the fact that the main screen was still working, and shows the current basal. The clock setting screen was readable enough that I was able to set the clock to different times of the day, and retrieve the basal rate from the main screen. Phew!

Saturday morning came and the new pump arrived as promised. It was black, instead of my usual silver. I'll admit that as I sat looking at the two pumps together I felt a fleeting sense of sadness that I've written about before. Nevermind, I thought, at least this one will work...

Got the battery in. Set the date. Accidentally scrolled to 19 instead of 18 for the day. Tried to go back.

Nothing. Happened.

Huh?

Left the wrong date, went into the main menu.

The down arrow key: Doesn't. Work.

Shit.

So I was left with a choice between a pump that I can't read, or one on which a major button doesn't work. No choice really, since no down key means you can't access the prime menu or set basals.

So the black IR1200 is all packaged ready to go back. And I should have another new one tomorrow morning.

Perhaps the next one will be blue...

EZ-Wrap: 1, Caro: Out For Revenge

I like long tubing.

I like the fact that with long tubing I can wear my pump in my socks (rainbow striped today) or clipped to my boots, or tucked inside a piece of Tubigrip around my calf. I like the fact that when I'm asleep, my pump can do it's own thing, far away from me. If it falls on the floor, I'm not woken by a tug on my infusion set. I can roll over at least twice and the tubing just wraps round me without me actually lying on my pump, which is, let's face it, a pretty uncomfortable way to be woken up. I like the fact that my pump, which, despite being quite happy with water, doesn't like bubbles so much, can sit on the floor next to the bath tub and I'm barely aware that I'm wearing it while I soak away the stresses of the day.

But sometimes that long tubing is just a pain.

Like when my pump is tucked into a pocket, and no matter how well I coil it up and tuck it away, it always springs out just when it sees a door handle or knob. Or when my pump is tucked discreetly beneath a sweater and it snakes its way out, hanging nonchalantly almost to my knees when I meet a new person for the first time.

This is where the ez-wrap comes in.

The ez-wrap is a piece of plastic that slots on the back of the IR1200, creating a channel between it and the pump. You then wrap the excess tubing around the ez-wrap, sitting in the channel, tuck the pump in your pocket and go. No embarrassing hanging tubes, or sudden door-knob snags.

Even before today though, there were problems with the ez-wrap. I don't like that you can't use it when the pump is in its holster. I'm not a case kinda girl. I hate trying to push buttons through the plastic window, and while I'm happy to fish the pump out of my bra, socks or tubigrip, taking it out of a case is just too much work. Trouble is that pump-in-holster-on-waistband is one of the times ez-wrap could be of most benefit. I doubt too that it will work with the long-awaited "Slim Clip" (which has been a prototype for, like, forever!)

Today was the big one though. The ez-wrap definitely got one over me.

At 4pm I felt pretty off. Blood sugar clocked at 16.4 (295) with no logical explanation. My infusion set was two and half days old and feeling a bit sore, so I changed that. I had plenty of insulin in the pump, so I just ran a prime and checked for air. Seemed good.

An hour later, feeling worse, not better, I tested at 20.4 (367) Eeek.

I unwrapped my tubing from the ez-wrap, and this time noticed that it was wet. A sniff confirmed that smell, that to anyone without diabetes you might describe as that of elastoplast, but to anyone with is just 'insulin'.

The damn ez-wrap ate my tubing! Not so e-z now, huh?

Now that my blood sugar is perfectly ok again, I'm out for revenge. My ez-wrap may find it has an untimely meeting with a hammer, because I choose a door handle snag over an unnecessary high anytime!

Nice One, Caro!

It was three hours this morning until I realised that I wasn't wearing my pump. Three hours!

Obviously this is not a good thing.

Should I have been content in the fact that if I can foget to wear my pump, I must be pretty comfortable with it, and planned to use this anecdote to reassure people who are worried about pumping, afraid that they will always notice the pump? Would that have helped in any way as I impatiently waited for my blood sugar to come back into range and to start feeling better than awful?

Sometimes I can't believe the things I do and, being honest, this isn't the first time I've forgotten.

Surely I can't be the only person to make such a stupid, fundamental mistake?

Chicken

I'm a chicken. A coward. Sometimes I'm a hypophobe with an appalling lack of judgement that leads me headfirst into unnecessary, avoidable highs. Last night was a prime example.

Last night, after a high protein, high-ish fat meal, I tested at 6.0 (108) at a little after two hours into a four hour extended bolus. Great!

But: I had a little under three units active on board, and a little under two units still to go in. So I chickened. I cancelled the remainder of the extended bolus. And I paid with a 14.5 (260) a little over two hours later.

Why do I do this to myself?

I generally do check my blood sugar at around 90 minutes after eating. This gives me enough time to work with the active insulin on board to get myself where I want to be. If I'm cruising towards being low in around another hour, I can use a temporary basal, or eat a small snack. If I look to be leaning towards finishing up high, I'll take a second bolus. (N.B This works for me, but I'm not advocating that everyone should do it.)

But I always seem to come unstuck when I use combo boluses. I seem to forget that there is a reason that I use them. That whatever it is I've eaten is going to continue pushing my blood sugar up for hours past the normal time frame.

Or more likely, I'm just a chicken. A hypophobe...

Attached

I'm guessing that the concept of attachment is a familiar one to anyone using an insulin pump. After all, this thing, small as they now are, is physically attached to a pumper almost 24 hours a day by somewhere between 20 and 45 inches of plastic tubing. Physical attachment is one of the strangest things about beginning to pump, and seems to be one of the many worries of prospective pumpers.

But it isn't the only kind of attachment.

No one ever mentioned to me the emotional attachment. No one ever warned me that the first time I had to pack a pump up and post it back to the company that I would find it difficult to do. A pump that was meant to be a loaner, but stayed with me for nearly six months, sharing everything that happened to me in that time; the highs and the lows, both in terms of blood sugars and life in general. There was nothing wrong with it when I had to send it back and the way I felt about it, you might have thought I'd actually had to cut a piece of my body off to send in.

On the other hand, no one suggested that if a pump went wrong I might feel betrayed by that, as if my very best friend had suddenly let me down. After all, it is a piece of technological equipment, and sadly they break down from time to time. But if my mobile phone, my ipod or even my computer, acts screwy or dies I may get a bit annoyed, especially if it is a less than convenient time, but then I get over it and get the problem sorted. If my pump goes wrong, it... well it sort of hurts.

Am I weird?

I don't think so. Overly sentimental definitely, and overly trusting of my pump, possibly, but surely I can't be the only person who feels this way?

What the...?

Incident Number One

Feeling a little on the low side, I grab my trusty Freestyle Mini (aka Flash) to test.

Result? 5.9 (106)

Note: I've been descending into impaired hypoglycaemia awareness for a while, and really don't trust how I feel too much right now. But I do feel odd. Let's repeat that test.

Result? 1.3 (23)

What the...?

To be honest, I'm surprised that I was still concious. This wouldn't be so mad if I hadn't done the repeat test using the same finger, without washing my hands and only 30 seconds after the first test. Otherwise I'd just have laughed that I must've had something on my hands to give a screwy reult.

I didn't hang around to do a third confirmatory test, figuring I could be dropped on the floor before I even got the result. But considering that 15g, probably more like 20g, of carbs and 15 minutes later I was still only at around 3.3 (60) on two different meters, I'm guessing that 1.3 was on the money.

I'm with Allison  on this one!

Incident Number Two

Just over two hours after dinner, I test.

Result 9.8 (176) but my pump tells me that the insulin-on-board will bring me down to a nice 5.5 (100) or thereabouts before bed.

Fast forward to bedtime, around an hour and a half later. Test again.

Result? 16.6 (298)

What the...?

Let's get this straight. This was no high fat or high protein dinner. This was straightforward food I cope with everyday. There was no stress or anything else going on. Just a perfectly normal evening. There is no air in the pump tubing, the infusion set is around a day old and has been working fine. Looks fine, feels fine. I bolus 3 units, and fall asleep.

Fast forward to 3am: I wake up with that thirst that is indescribable to anyone who doesn't have diabetes. Fumbling for the test kit beside my bed, getting the back light on so I can avoid turing on the main light, I test.

Result? 20.1 (362)

What the...?

I have to give in, put the light on, check the pump all over again. Still seems fine, even give it a good prime. Damn. Get a syringe and Humalog out of the test kit case. I am not changing the infusion set at 3am, when I'm half asleep. (Did I tell you I'm stubborn?) So I whack in eight units. My correction factor below 11mmol/l is 1:5, this should rise to around 1:2.5 at these kind of levels. This technically means my eight units is enough to knock me down to nothing.

It is the middle of the night. I'm not sensible enough to check for ketones on my trip to the bathroom. Nor am I sensible enough to set an alarm for a couple of hours time after downing two glasses of water. I go back to sleep and wake up at 7am with a desperate need to pee. But the first thing I do is test.

Result? 14 (252)

Now I'm really serious: What the fuck?

I took EIGHT units of insulin, with a SYRINGE!

How can I possibly be 14?

I finally relented, and changed that infusion set. There was nothing wrong with it when I took it out. No kinks, no blood in the cannula. So I'm currently cruising along at a basal +50% with around 8 units on board waiting for a big crash anytime soon.

I have no idea wether incident one and two are somehow related, but that was a crazy 24 hours.

Damn, I hate this thing at times.