Monthly Archives: July 2013

Clinical Trial Snapshot.

July 9, 2013 – 9:31 am

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The photo you see above is indicative of something I do every day.

As part of the clinical trial I’m participating in, I have to log onto a website every day (or every other day) and enter information related to my diabetes. I also have to upload Dexcom data for each day.

What you see in the photo is from two different days. One of those was a day with a sensor change, and a comedown from a high caused by insulin that went bad overnight (both on the second day). I use some shorthand for what I need to enter. Putting this down on paper ahead of time makes it easier once I log in to do the entry. Let me break it down for you:

On the left side, you can see the times that I’m doing finger sticks each day. Next to that is the blood glucose reading (in milligrams per deciliter, or mg/dL). Since almost all of the readings are from times when I’m eating something (three meals plus a snack at night on these two days), you’ll see the insulin bolus I’m administering next to the BG number (it’s the 4.0, 3.1, etc. on the photo). The difference was on the second day, when I did the fingersticks for calibration of the new Dexcom sensor at 8:58 and 9:18. The 9:18 fingerstick was followed up by a small 1.5 unit correction bolus. Finally, there’s the code I’m using to note what kind of meal or snack I’m having. The meals are noted as small, medium, or large, and either high carb (HC), high fat (HF), high carb and high fat (HCF), and neither high carb nor high fat (N/A).

This isn’t all of the data that gets entered. I’m also entering information about exercise and how I’m feeling that day, plus a couple of other things. All of the daily data that is entered is used by the site to help guide me toward making good choices to help manage my diabetes better. Every so often, we’re prompted to learn various things about our diabetes through core studies created by the study’s team.

I’ve started keeping all of these little sheets of paper with my daily data on it. Right now, looking at this information in its simplest form really makes me cringe about how I’m going through my day. I mean, those aren’t great numbers there. My A1c is good, but I’m anything but proud of what this shows me. These are a couple of not-so-great days, for various reasons. I’ve had much better ones, but I still don’t have any great excuses. Maybe keeping everything and looking back on it will make me consider what to do to be better in the future. At the very least it will keep me from ignoring it.

The requirement is for me to enter daily data at least five out of every seven days to continue my participation in the study. We originally started the study in April. Then we took a break, and started again in late May. Getting everything down in simple form in one place has made doing this every day for five weeks a little easier.

Now I’m starting to really think about what all of these numbers really mean, and what to do about them.
 
 
 

By StephenS | Posted in Clinical Trials | Tagged , , | Comments (2)

Stay cool, my friends.

July 5, 2013 – 9:51 am

Okay, so obviously, I need to post this. If only to remind myself that insulin becomes useless once it reaches a certain temperature.

About a week and a half back, I had to toss out my reservoir with something like 65 units of insulin left. My site was working well for a few days; then allofasudden, my glucose kept climbing up. Over the 300 mg/dL mark. In the middle of the day, which is very odd for me. When I got home from work, I changed out my set, and wouldn’t you know it, before long, my BG came down into the upper 90s – low 100s.

This sequence of events didn’t surprise me too much: It is summer in Baltimore, and baby, does it ever get hot and humid here. Add to that the fact that our air conditioning unit finally gave out about a week earlier, and it’s no wonder I couldn’t keep the insulin in my reservoir cold.

Fast forward to this week. Again, I have a site that’s working very well, for about 5 days (yes, I often go longer than 3 days… so sue me). And we had a new A/C unit installed about a week ago. I go to bed overnight sitting at a pretty good 96, and I had a granola bar for a snack right before turning in, so I wasn’t worried about going low. I got up for a minute about two hours later, and a quick check of the Dexcom unit showed 124. About what I expected.

Then, about 3 a.m., the Dexcom starts beeping. That loud, “you’re high, you’re high” beep. Now it says 224 mg/dL. Great.

By morning, I was at 266 mg/dL. I took the reservoir out of the pump, and it certainly felt warm to me. I must have been sleeping right on it all night. Those reservoirs aren’t always the easiest things to look through, but what was inside didn’t look like normal insulin to me anymore. So I decided to throw out 70-plus units of insulin this time and change everything over. Today was a sensor change day too, so it was a double blessing while I was trying to get out the door to work.

Novolog, the insulin I’m using right now, has a tolerance up to 86 degrees farenheit (according to their website). By the way, Glucagon is only good up to 77 degrees farenheit. Above those temperatures, bacteria living in our insulin start to break down the protein inside our vials, insulin pens, and yes, pump reservoirs. Also, according to a Mayo Clinic blog post, “Heat can make proteins like insulin harden, which increases the potential for infusion set occlusions”. They also recommend tucking in the tubing instead of leaving it out and exposed to the heat (which is what I’ve been doing).

Man, I used to love summer. Now the hot weather gives me one more thing to consider. I know I will be much more careful through the next few months.
 
 
 

By StephenS | Posted in Pumps | Tagged , , | Comments (1)

A Silent Disease? Not Exactly.

July 2, 2013 – 8:45 pm

Over the past couple of decades, I’ve heard people refer to Diabetes as a “silent disease”, or some such nonsense. I’ve also heard the same phrase attributed to high blood pressure, but this is a diabetes blog, so that’s what I’m talking about here.

It’s strange how our minds get warped by numbers, and then by what those numbers mean, real or imagined. Our lives are consumed by it because our lives depend on it.

Our minds are constantly filled with numbers: Blood glucose, insulin on board, grams of carbohydrates, insulin to carb ratios, hemoglobin A1c, and oh yeah, our weight.

We calculate and pre-bolus and super bolus and correct and exercise and try to eat healthy to keep our numbers in a good range. To be “compliant” (don’t get me started). Heck, just to feel good.

When those numbers aren’t so great, we feel that too. We feel sluggish, thirsty, ready to run off to the loo at a moment’s notice. We also feel concern, worry that we’ll develop complications because we had a bad diabetes day today, and a bad day a couple of days ago, and another one last week. Still, we have to ignore it. Close the box. Turn off the noise. Forget about it. Because another day is here to be lived, and if we want to live it well, we have to concentrate on the here and now and try our damndest to avoid the issues that tripped us up yesterday.

If we do that, and we put a few good days together, maybe a week, what do we have? A week’s worth of good numbers. And absolutely no guarantee that last week’s efforts will help us this week. Still, the numbers and what they represent pound inside our heads, invading the silence. Always with us.

Some PWDs have doctors who look at all of the data and pontificate, prescribe, and prognosticate. They want us to maintain tight glycemic control for 90 days, then explain in 15 seconds or less why we were unable to do so since the last appointment. Even if there’s no explanation. Or a really good one that proves that sudden spike last week wasn’t our fault. More to listen to.

There are good numbers sometimes, to be sure, but the feeling I get from a well-earned 98 mg/dL is always counterbalanced by the knowledge that my endocrine system will require at least the same amount of effort to keep that number in the same place tomorrow. There is no Bank of Blood Glucose to draw from when the same efforts fall short and result in an undeserved 198. We don’t have diabetes batteries to charge up so we can use them to power us when we’re diagnosed with complications.

I’ll admit that because I write and post here, I think more than I should about what it looks like if everything isn’t great with my BG or my A1c or my weight. On the surface, that may sound crazy– why worry about what someone else thinks about something so personal to me? But, in a way, I like holding myself accountable to my readers (both of you). If I can’t always be successful, I want to be sure that at least you know I’m trying hard and not making excuses. More to think about. More noise.

In the final analysis, I try to live the best I can with diabetes every day, on a day by day basis. Regardless of how things are today… when tomorrow comes, I do what I can to forget about the past. Yesterday is only a reference point. I will do everything I can today to live well, by whatever definition that is on that day. By doing so, I enjoy what I have without worrying too much about things I can’t change anymore.

And it’s the only way I can drown out the diabetes noise.
 
 
 

By StephenS | Posted in Diabetes | Tagged , | Comments (9)

Recipe! Grilled Veg.

July 1, 2013 – 10:49 am

Seems simple… And it is.

This is the new summer favorite for The Great Spousal Unit. Go to a farm stand, find the best summer squash, onion, and pepper that we can find. The recipe is simple as can be.

Don’t blink or you’ll miss this.

First wash, then slice your vegetables in big enough widths to be skewered and stay on when everything on the grill gets hot. After that, you have your choice of waiting to skewer them so you can marinade them in your dressing, or just skewer them from the start and brush the dressing on later. As you’ll see in the photo, we did the latter.

The dressing begins with a simple vinaigrette:

3 Tablespoons red wine vinegar

¼ Cup extra virgin olive oil

Whisk the two together to emulsify. Once that’s complete, add salt and pepper to taste.

But wait… we’re not done yet! At this point, you also have the opportunity to get creative and add anything else you think might go well with this dish. We added lots of old bay seasoning. If you wanted to add some carbs, you could take some croutons or a couple of slices of bread and throw them into a food processor for about 15 seconds. Then you could sprinkle it into your mix as desired. If you wanted to brighten up things a bit, you could add the juice of a lemon or lime to add a citrus flavor. Your choice. But the vinaigrette gives you a nice base to start from.

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Then comes the fun part… the grilling. Get your grill super hot and toss on your skewers. Cook them 2 to 3 minutes on each side, and you’re done. The finished product looks like this:

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Estimated carb count per kabob: Are you kidding? Unless you’re adding the crouton or bread crumbs to this, this is a delicious, no carb dish. Hope you like it.
 
 
Do you do anything like this at your place during the summer?
 
 
 

By StephenS | Posted in Recipes! | Tagged , | Comments (4)