I moved up my OmniPod training to tomorrow (October 1st). I will be trained by a nurse educator from the Insulet Corporation. I am going to meet with her in a conference room at my regular nurse educator’s office.
Mama and papa are coming down this evening and staying over so that they can meet me at the appointment tomorrow. I figure it will be easier for them to come and see how everything works than for me to have to explain it all to them. I’m sure I’ll still have to explain things, but they’ll have fun coming down with Pippa for a little overnight. Plus, we’ll probably go to Thai food tomorrow night. And they’ll pay. Can’t beat that!
I have always had to estimate how many carbs are in my favorite Thai dish: Pad Thai Curry. It’s a traditional Pad Thai recipe with red curry added. It’s phenomenal, and I’d eat it every three days if my checkbook allowed it. I will take the time now, in celebration of the pump, to look up how many carbs are in a serving of rice noodles. And then I will have to multiply it by 192310. Because that is how many servings are in a typical restaurant plate. It looks like there is 42g in 1 cup. They definitely give you about three cups. So 42 x 3 = 126. After I have the pump… that’s all the math I have to do! But, since I don’t have it quite yet, let’s continue with how much math I usually have to do when I eat.
I’ll probably have dinner at about 7pm tomorrow night. This means that my ratio will be 1 unit of insulin to every 5 grams of carbohydrate. So we take 126/5. This equals 25.2. I round down to the nearest unit because insulin pens can’t do partial units, and because I wouldn’t want to end up passing out two hours later. I’d dose 25 units…IF my blood sugar at the time of eating was perfect (between 80-120). If not, then I add my correction dose. Let’s say I’m at 200. My correction dose would be 2 units. 25 + 2 = 27 units total. Theoretically, two hours later when I test, I should be pretty close to 120.
I explained this process rather explicitly because I have a quite a few readers who are friends and family, and who despite very honest efforts to understand the inner workings of diabetes, have no idea how much goes into figuring out how much insulin to give myself. I also explain it to illustrate how human error can effect a dose. If I figure a dose using the wrong time frame (my ratio is different for different times of the day), then I end up with a bad blood sugar. If I don’t calculate the right number of carbs in what I eat, I end up with a bad blood sugar. If I don’t correct accurately, I end up with a bad blood sugar. If I’m stressed or worried and my body produces cortisol, I end up with a bad blood sugar no matter how accurately I dose. And I have generalized anxiety disorder.
In sum, it hasn’t been a very fun last five years. When I was first diagnosed, my endocrinologist wasn’t very understanding of the anxiety piece. He seemed incredulous that I could be at a perfect 100 before an anxiety attack, and 350 afterwards. It happened. It still happens sometimes after a tough call with a parent of one of my students, after a challenging therapy session, and when I think about how much I have to pay in student loans. I’m kidding about the last one (sort of).
Dr. H Was also not very understanding of the learning curve for understanding dosing. He gave me a lot of information in piecemeal bits, expecting that I’d inherently know the intricacies of the disease simply because I have it. For instance, a big rule is not to “stack insulin.” This means, if you’ve given yourself a correction dose in the last 3-4 hours, that you don’t correct again within that timeframe. This is because the insulin is still working for that many hours. If you give yourself any more insulin, you’re going to end up with a really low blood sugar. He didn’t tell me that until I’d been seeing him for 6 months. He also never really explained the relationship between exercise and dosing, which is not linear.
Now I’ve got Dr. K on my team, and things are going a lot better. I had my final insulin pen a1c test done on Friday afternoon. A good a1c for a diabetic person is less than 7.0. In the last year I have gone from 9.4 to 7.9 to 7.5. I’m hoping that it’s about 7.2 this time, but I’d be happy with another 7.5. I’ll keep you updated, because I know you all care as much as I do. 🙂