Sick and Tired

I've been feeling worn down and sick for a little over a week. Moreover, I've been staying up late and having trouble staying asleep. I feel like when I'm sick and/or tired, I get unusually high BG readings. I don't think this is "in my mind" as a couple doctors have told me. And, in fact, being sick does make your BG rise. Being under stress can do the same and in some people, taking antibiotics also can make you go high (see comments http://www.tudiabetes.org/forum/topics/being-sick-high-blood-sugar)

Truth is, there's more things that can raise your BG than can lower it. The fact that a major treatment of illness (antibiotics) adds to the problem by raising your BG is really irritating to me. But sometimes its necessary and the only answer is MORE FREQUENT CHECKING. Plain and simple. MORE CHECKING followed by MORE CORRECTING.

I try to avoid making changes in my basal and correction and bolus ratios until I am feeling well again and not taking antibiotics because it can cause problems later. The better solution for myself is to correct for the highs and just check more often. The problem is that I've been slacking these past few days and my BG is going high without correction, which adds to my sick feeling and sleepless nights.

Throughout most of the winter I have this on and off again sick feeling which really messes with my health for several months. I don't know that warmer climates would help me throughout the year, but staying inside for 3-4 days in a row because of massive Balitmore blizzards has certainly kept me feeling awful.

Changing my set changes the effect

This happens every so often. I change my infusion set and my BG readings go high for no apparent reason. Sometimes for up to 1 day. What I do is to check more frequently and correct as needed. I used to change my basal, bolus, or correction depending on when I saw it and how I came to notice high BG, but by the time I changed it, the problem had already resolved and I ended up causing low BG crashes.

SOooo... what is it? Well, I've told my doctor this before and he believes my basal needed adjusting. See previous posts for the list of reasons why he is wrong. The nurse practitioner, however, listens and agrees that changing sites can cause this problem. Check out these other blogs
http://www.insulin-pumpers.org.uk/badsite/
http://www.diabetes-insulin-pump-therapy.com/high-blood-sugar.html

I really like the first one. So much useful info that I can't seem to find anywhere except from people's personal experience. Why would you get high BG from changing your site? LOTS of reasons...

• The site is close to muscle or the infusion set slope is angled to steep and is close to muscle causing higher BG (absorption is hindered).
• The site becomes swollen or irritated or at worst, infected, which causes inflammation and hinders your insulin activity and absorption.
• The site has hardened fat tissue, which hinders absorption.
• Site isn't taken very well and your body reacts to it negatively for a number of immune response reasons, which leads to inflammation...

This problem doesn't happen all the time. Maybe 2-3 times per month at the most. Usually if I give myself the infusion set and it really sings for a few minutes afterward, I know its going to act goofy for a day. Another case would be if its sensitive in that area when I press on the infusion set. I told you how I deal with it... I basically check more often and wait it out. If you call the pump company or your doctor, I already know what they'll do/say.

First, they go down a checklist of performing a Pump Self-test; make sure your tubing isn't tangled or leaking; make sure you have correct basal and bolus levels, and describe the condition of your infusion site. Is it red? swollen? do you see blood in your infusion set line? did you prime it correctly or do you see air bubbles? These are important questions, but if the final answer is that the site hurts, its hard, its red, or isn't responding to correction... CHANGE THE SITE!!! I can't emphasize that enough. If its a continuing problem, you should change the site. For myself, its not hardened, it is irritated, but it goes away after a day. I pay a lot for supplies and throwing out 3ml of insulin, an infusion set and reservoir (I don't mess around with reusing reservoir because of sterility concerns). I know that most all times my BG will go back to normal within a day (sometimes less).

Last night my site hurt when I set it up. This morning my BG was high. It wasn't a surprise, just an average bad start to a good day. If you have questions, I actually found the MiniMed site helpful.
http://www.minimed.com/help/sitemanagement/index.html#a6

And there are also the National Institutes of Health and Center for Disease Control with useful sites too.
http://www.cdc.gov/diabetes/ndep/index.htm
http://www.ndep.nih.gov/partners-community-organization/index.aspx

And I really like this book called "Insulin Pumping"... here's the website founded by the authors.
http://www.diabetesnet.com/pibook.php

Everything is going well now.

Mid-Day Downer

So I haven't been posting daily because... well.... that takes a bunch of time and putting all my numbers up hasn't been 'helping' a lot. But reviewing trends and giving tips to myself has.

For the past 3 days, I've been eating a sandwich, chips (weighed on a scale) and an apple for lunch. Each day I'm somewhere between 100-150mg/dL before eating. I keep dropping to a point where I almost crash and the nagging feeling of low BG is very distracting to my work. SO I'm trying the square bolus option, which seems to help out quite a bit. I've been doing 30min release.

Now today specifically, it dropped to 50mg/dL 1hr after eating/taking insulin. This concerns me because its a pretty accurate carb amount and I did a square bolus and started at 96mg/dL. Thank goodness there was 4-day old Birthday cake (which seems to never spoil... that can't be a healthy sign). I wonder if the increased sunlight/full-spectrum light bulbs at home (a new purchase) have actually had a positive effect already.

I'll keep monitoring and see.

Please go down

This is gonna be a long day...
10am 181
12pm 222
6pm 332
10pm 172
12am 119
So my numbers today would give my doctor a reason to say my basal is wrong (I'm not defending his suggestion I'm just explaining his initial reaction). I woke up high. I corrected and at lunch, I was STILL HIGH. I decided that I should take 2U extra to account for the 60mg/dL that I have been over. So what do you think happens? I crash real bad and fairly all of a sudden.

How does it feel when you crash? How do you know you're crashing?
Well, for me, crashing and 1-2hr after I eat feel very similar. A little anxious, fidgety and a little kind of tingle at my joints and stomach... kinda like I'm getting ready to run a race. But it goes away eventually. When I crash, it only gets worse. So I'm doing my work in the culture room and I start some really intense stuff when I feel 'normal'. Then I get involved in my work to a point where if I stop, a week's worth of material and time is trashed. I feel like I may crash, but can't really stop and then it hits hard. I barely finish before I really really start sweating and shaking.

And so I overkill and drink too much soda. I eat a couple granola bars to settle my stomach. And by 5pm I'm high as a kite on a windy day. Any doctor that says "Are you sure you were crashing that bad?" or "You shouldn't over do it" is a big fat A-hole. I'm at work. I'm trying to live. My actions before were rationale and the result was not expected. And obviously they don't know what it feels like. Seriously now... how many Type I diabetics out there have a Type I diabetic doctor? Huh? Anyone? How many doctors have woken up my sleep pouring with sweat and staggered to the fridge with blurred vision only to find the only sugar is your expired OJ? How many doctors know how the taste of Coca cola shanges when your BG is low and that sugary foods taste strange when your crashing, but you have to drink it anyway? How many of your doctors know what explosive diarrhea feels like an hour after a bad BG crash?

Truth is it scares the shit out of me and this time the crash was full-on before I treated it. I felt like crap for most of the day and it only got worse. Some freaking sympathy would go a long way. I corrected for the high BG and much later at home (we went to do taxes and grocery shopping) it was still a bit high. I ate, corrected and happily went to bed at 119mg/dL. So now we can see that clearly raising the basal is a very very dangerous idea for myself. Out of the past 5 days, count the number of reading that were near 120mg/dL. All of those times I would have been crashing. Simply put, I have a large day-to-day variation in my bolus needs and doctors have a hard time admitting that to my face. But I'm confident it my self-diagnosis.

I hope I stay lower these next days. I'm tired of feeling like crap.

Bipbimbap overload

Trying to stay down today... not very successful.
11am 146

5pm 207
8pm 213
11:30pm 274
I woke up fine and we had Tom yum soup for lunch which my wife made rice noodles for. There's something about high carb noodles when we cook them... They release a lot of gluten and carbs in the water during the boil so sometimes the count isn't completely accurate. I really only have this problem with Asian noodles and not American packaged noodles. I crashed a bit and ate chocolate and an apple and tried to patiently wait it out. I snacked on nuts while I waited to feel better.

By the late afternoon at the coffee shop, the BG only got up to ~200, which I was happy with (I felt like it was much higher). But it kept going up. I had corrected and still 3hrs later it was basically the same. Then we ate Bipbimbap and bean soup and it skyrocketed again.

I don't know what's going on, but sometimes this happens to me on a day to day basis. Like today was terrible and kinda unexpected. I feel a bit bloated, and my lips and tongue really feel like I have very very high BG (like I feel at 500mg/dL). I'm also feeling really tired. But tomorrow I could be fine and even go a bit on the low side. This is the kind of variation where sometimes I just don't even bother to try and figure it out. I'm hoping this bog will help to get at this kind of problem.

Saturday Morning Sleep in

11am 111

6p 286

1am 129

On weekends, I sleep late and don't check as often. Today we were supposed to go check out the dealership, but if snowed something awful so we went to Donna's for lunch instead. I had a Roast Beef sandwich, which was AWESOME!!! Then we went to the Walter's Art Museum. I didn't check between lunch and dinner because we were in the museum for obvious reasons. At home I expected a high reading. Why?

Fresh deli lunch meats can have preservatives such as spices and sugar and I can never gauge that correctly, especially when I eat a large Italian sub... Mmmmm mmmmm mmmm.

End of the day, I'm doing great.

Dealing with Happy Hour

So let me just list my BG for the day first.

9am 129

1pm 198

4pm 158

9pm 428

1am 131

So here's how my day went. Great start, proof that I'm obviously not having a basal problem. I started Amoxicillin for a nagging cold, which may have been the whole root of my out of control problem. Lunch was soup and some rice and a banana, very calculated.

SO I'm seeing that I really do get a small rise in BG. I don't know if its because I'm not eating breakfast (I'm very doubtful when it comes to dietitian's hand waving), but it does rise in the morning by ~40-60mg/dL.

When dealing with an event that I KNOW I will get high BG at, I always check immediately before and if its a long event, I'll check in the middle. I SHOULD have checked before 9pm, but mom called and I talked her through her first insulin shot as a type 2 diabetic. I know that's pretty ironic. BTW her doctor is way worse than any doctor I've ever seen... seriously.

SO it was the Stout beers (4-5) and chips that sent me soaring, but you can seen that by the time I went ot bed it was doing really well.