Ages

Sticking to my new years resolution and training hard for the Earth Day Half Marathon in St. Cloud, MN. It’s not imaginary anymore. I have the pleasure of running it with my cousins Christy and Emily. Hopefully Matt joins us, too (but he never signs up for races longer than 2 weeks in advance).

I have been using the Temporary Basal option on the OmniPod during my runs. I started by decreasing my basal (background insulin) by 50% for 2 hours. I ended up low about 3 hours after each session, so I change it to 50% for 3 hours (which is the maximum time period for a temporary basal). The longer I ran, the lower I went 3 hours post workout. Through trial and error, I have my current running temp basal at a 90% (yes that’s ninety percent) decrease for 3 hours. I start it about 20 minutes before I actually start running.

I have also had to decrease my insulin across the board. The regular running has increased my sensitivity for both my insulin to carb ratio (was 1 unit to every 14 grams of carbs, now at 1 unit for every 18 grams of carbs), as well as my correction factor (was 1 unit to lower me 34 points, now is 1 unit to lower me 40 points).

Right now I’m waiting for a call from the nurse line to see if my throat culture grew a streptococcal jungle.

Too Far

A new online diabetic friend, Sophie, posted that yesterday was her one year diagnosis anniversary. It was a rough day, and it got me thinking about my upcoming appointment with PA J (Dr. K’s physician’s assistant).

I know my a1c is going to go up. Last time it was the lowest it had ever been, at 6.9. However, this was an artificially low number. Over the course of a month or so, I had been increasing my insulin rather than decreasing it. I did this through decreasing the number in my insulin to carb ratio as well as by decreasing the number in my correction factor. For some reason, my brain was thinking, “decrease number = decrease in insulin.” Well, it was a stupid mistake. Decreasing the number in either your insulin to carb to ratio or your correction factor actually increases the amount of insulin you receive.

Long story short, I was experiencing extreme lows nearly everyday. This drove down my a1c number in the long run, but wasn’t healthy or safe. I figured out my error with PA J, and I have had far fewer lows in the last three months. That means that the a1c is probably going back up. My guess is she’ll come in at about 7.3.

When I have upcoming endocrinology appointments, I get to thinking about all of my past failures and how all the chips are going to fall in the future. I should have googled what was in those brownies. And that frozen yogurt. And everything I ate that I estimated for. Will I go blind? Will I have neuropathy? Is it all my fault? Is it all under my control?

The answers are all yes and no to some degree. The only principle that remains true is that I try to manage my health the best I can on any given day. Some days are much more regimented than others, but it is not to say that the less than perfect or terrible days are terrible ever for a lack of trying.

Ketones

I hadn’t thought a lot about ketones until a week ago when they hit with a vengeance. Ketones are a yucky thing produced when blood sugars are high for a prolonged period of time. They are the bodies reaction to the high blood sugar. You can have different levels of ketones in your system, depending on how high the blood sugar has been and how your body decides to react to it. The ketone test describes the amounts as: none, trace, small, medium, and large.

Whenever my blood sugar has run high, I have simply corrected until it came down. Correction doses are doses of insulin only to bring the blood sugar down (not as a part of eating something with carbohydrates in it). In the past, my blood sugar has usually come down pretty predictably. I’ve only tested for ketones once or twice before in my 7-year tenure as type I diabetic. And those two tests were just to see what happened. Both tests came out ‘none.’

On the Sunday before Memorial day, I was running between 300-450 all day. I was at home and munching on treats all afternoon, so I assumed I wasn’t giving myself enough insulin to cover what I was eating. Each time I’d test, a high number would appear on the screen. I felt okay, so I just kept eating and correcting assuming it would eventually make it’s way back into my desired range (between 80-120).

I tested before bed that evening and it came back as 350. I corrected one last time before bed, which freaked me out a little as I was risking going low while sleeping, but I figured if I didn’t give myself a correction dose, I’d wake up with a blood sugar of 1 billion. In the middle of the night I woke up feeling like a train had hit me. I was very nauseated. I tested again at 1:00am and was at 370. The (pretty large) correction dose had done nothing. In fact, my sugar was higher than it was before the dose. I started flipping out.

I am a part of some diabetic groups on Facebook. A favorite is called I Hate Diabetes (Type 1). A rather aptly named group, most people come with questions, concerns, and to complain heavily about the disease. I’ve read various posts about people experiencing ketones and ketoacidosis. Mostly stories of them having to go for a stint in the hospital. Thus, when my blood sugars weren’t coming down, I knew I had ketones.

I tested my ketone levels and they came back as “moderate.” It was the darkest color I had ever seen on the test, and started dreading a visit to the hospital. I looked up treatment for moderate ketones. Half the websites said: GO TO THE HOSPITAL. The other half said: drink lots of water, keep giving large correction doses, and keep testing blood sugar and ketones until they both come down. Water flushes ketones out of the system. Such a simple, but powerful treatment to a yucky thing.

So I made my first post to I Hate Diabetes and described my situation. The consensus among members and fellow T1Ds was similar to my Google results: half said GO TO THE HOSPITAL. The other half said treat it yourself for a couple hours and if it’s still terrible THEN GO TO THE HOSPITAL.

Over the course of 2 hours, I drank about 7 glasses of water, tested my blood sugar 10 times, and tested for ketones 5 times. I gave myself approximately 40 units of insulin to correct the high blood sugars. That’s a TON of insulin. For a Thanksgiving meal, I have given myself 25 from a pen at most. My insulin pump won’t let me give a single dose of more than 20 (you’ve got to split it up into 2 separate doses to bypass it). Basically, it’s a ton of insulin. Even 10 units of insulin given to a non-diabetic could kill them.

I started feeling better once I was at 120 with trace ketones. At 3:30am, I flopped down in bed–exhausted from the ordeal. After only one minute, my mouth started watering and I knew I was going to throw up. I leaped out of bed and dashed to the bathroom where I had the most violent and glorious vomits of my life. They broke blood vessels all around my eyes; the ‘gin blossoms’ lasting three days. After ralphing, I finally felt just right. So I passed out a second time–making it until morning.

And then I woke up low.

Everything’s Up

I had an appointment with my interim diabetes practitioner on Friday afternoon. Dr. K is on mama-leave with her kids, so I’m seeing PA. L, who is an endocrinology physician’s assistant. I had my labs done and everything is up including the a1c. It’s now at 7.4. As much as I’d like to blame it on the Freestyle test strip recall, it’s also due to guessing on carb counts at lunch everyday and eating too many treats at work. We made small changes to my basal rates, bolus rates, and correction factor, but two mornings in a row, I’ve gone low at the all day correction factor of 22. Between 6am and 9am it should probably be closer to 25. It all feels like one big test of trial and error, but at least the snow is melting.

I also donated a pack of unused Levemir pens to the clinic, along with 100 or so used pen needles. Just kidding. They had not been used. They were sealed and all. Since I use a pump, I don’t have a need for the long acting insulin. It’s been sitting patiently in my refrigerator since two Octobers ago. The expiration date is August 2014, so I figured I should let some living being get use out of it before it goes to waste.

I contacted a twin cities dog rescue, and they told me they would be happy to take it. Dogs use the same long acting insulin as humans, albeit in smaller amounts. I noticed there was a diabetic doxie on their site named Junior Mint, and emailed them letting them know that I would be happy to donate the insulin to be used for any dog that needed it, and that if a family adopted a diabetic dog that I would be more than fine with them taking the insulin to ease the initial cost of the adoption.

After consulting my ever wise and patient sister, Beth, I decided I should offer it to the nurse educators at my endocrinology clinic for human use. They have an ’emergency supplies’ area for patients who are in between insurances, aren’t/weren’t covered for health insurance, or don’t have enough money for their prescriptions even if they were covered. The clinic happily accepted it, and I feel good today knowing that the insulin I donated will keep someone from having to urinate 46 times a day, blurred vision, headaches, and a general feeling of malaise.

All The Math

Having diabetes has been a whole lot of math. Friends sometimes ask me to explain how I figure out how much insulin to give myself at any point in time. After I show them my insulin ratio and correction scale (typed out in a chart and taped to a notecard) they stop wanting me to explain it. It wasn’t always so complicated, but no one can quite seem to figure me out.

One of the problems is the dawn effect. In the early hours of the morning, between 4am and 6am, my liver decides to make glucose. It sends it out to my body and my blood sugar goes up. I don’t regularly wake up  in the middle of the night, check my blood sugar and dose appropriately…so I end up around 250 when I wake up.

When I was diagnosed I was giving myself 10 units of Levemir (long acting insulin) in the morning and at night. I’m now at 22 units in the morning, and 26 at night. Yikes. I also started at 1 unit of Novolog (fast acting) for every 15 grams of carbohydrate. I’m now at 1:3 in the morning, 1:4 in the afternoon, 1:5 in the evening, and 1:7.5 at night. My correction scale is also not linear (out of control).

I’ve had 3-4 constant glucose monitoring tests but the hardware never worked right. Maybe it did, but my blood sugars were so messed up they couldn’t make sense of it. Who knows. I didn’t have any tests done in the ‘burgh. They weren’t very fun tests, but I’m good at tests so I’ll take as many more of them as I need to.

I’m gonna turn in my insurance enrollment information at the beginning of next week. GET THE BALL ROLLIN’!