Attempts at Perfection & It’s Failures

“Have no fear of perfection – you will never achieve it.” – Salvador Dali

I can’t get my head around it.  Does anyone with diabetes who is motivated in their management think they can’t achieve perfection?  Yes I said CAN’T.

As a Person With Diabetes I think that not only can I achieve challenging feats beyond my day to day life, such as ascending the Peruvian Tundra to over 15,000 ft BUT I can also achieve perfection with my diabetes.

As a PWD I know that this mindset is superfluous.  BUT, I still want to pursue it, just in case I can achieve it.  You never know, right??  Isn’t that a great goal to set and pursue. Almost like a cure, really.

BUT….yes, I said BUT…I am reminded of how the attempts of trying to be all that to my endocrine system and diabetes management isn’t that simple. Even after coming into 40 years of living with diabetes and being a Mom of a PWD for 14 years.

I am reminded on our flight to Peru, no matter how hard I attempt to make my diabetes perfect, I cannot.

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Upon take off I am aware of the potential impact the air pressure can have on my insulin pump delivery.  The rule of thumb despite there is not total clinical evidence with regards to this is to disconnect on ascension and descending. Why?  The talk of the town is that upon take off the pressure can change the delivery of insulin to cause a low blood sugar. During the flight the pressure change can create air bubbles resulting in missed insulin after landing.

I have experienced this throughout the past 14 years of travel on an insulin pump but was not aware of the ‘talk’ that circulated about this until the past few years.

So, whether clinically relevant or not, I decide to take heed to try and avoid this.

We are prepared for take off at Pearson.  Status quo.  Prior to boarding I check my Continuous Glucose Sensor.  All is good in my diabetes world.

As the plane positions itself for take off on the runway I disconnect from my site with the intention of reconnecting within a few minutes after the rapid ascension is complete.

I am excited.  I am thinking about our trip, the flight which is 21 hours with stop overs.  In my mind I am running through what we packed versus the list I print and check off.  I am nervous.  I am landing in a city that has an elevation of over 8,000 feet.  I am worried after the stories I am told of elevation sickness.

The airline steward serves our snacks.  I give it to Steve.  Packed full of gluten. I don’t need a snack anyway.  I’m not hungry.  I look at some magazines.  I do a Word Search.

Several hours pass by.  I start to feel like the Sahara desert lives in my mouth. My stomach feels like a brick made a home in it.  My chest feels heavy.

I question these feelings.  Why?  It feels like I am high.  How come?  I don’t clue in to check my sugar though.  I attribute it to the elevation, the dry air, the excitement.

The steward comes around again.  Offers snacks.  I pass mine onto Steve’s again.  Maybe if I eat and drink a ton of water I’ll feel better.  I take one of my gluten free bars out of my bag.  I bolus, I eat. I feel like crap.

Is it the flight?  The cabin pressure?  I just can’t make sense of it.  Obviously my brain cells are not firing on all cylinders.  Doesn’t being on guard all the time with managing diabetes do that to a person?

Then…I get an itch at my site.  And so I scratch. It is so itchy I must lift my shirt enough to place my hand under so I can make skin to skin contact to find satisfaction. While scratching I realize my tubing at my site is flopping back and forth….I am NOT attached to my site.

I forgot to re-connect after take off.  That was 3 hours ago.

In my effort to achieve diabetes management perfection, I fail.

Now, forgiveness is mine. I am so insulin sensitive that I only end up with a BG of 11 mmol/L.  I check for ketones as well.  They measure at only 0.3.  So…I correct for the gluten free bar and basal rates missed as well as a small amount for the trace amount of ketones.  It takes several hours to come down and even though my sugar is only 11, I feel like I’m on the edge of DKA.  I  know what it’s like, I’ve been there.

We land in Peru and I am almost in target.

After that incident I make a promise with myself.  Disconnecting on a flight to achieve perfect blood sugars is not a goal I wish to achieve.  For what I wish to achieve I fail.  I avoid a potential low but instead end up high and feeling terrible.

What’s the lesser of two evils.  I can’t answer that but I will tell you I will no longer disconnect my site.

I’m OKAY!! Really!?

Wedding Cruise5With the exception of the time we dated in high school, my husband Steve is diagnosed with Type 1 spousal diabetes for just under four years.

It may seem silly but I assumed in all this time he knew diabetes like I did.  I can’t even tell you why I thought he would learn 39 years of living with Type 1 diabetes as I have experienced by observing signs, symptoms and random sharing of how I feel in certain situations.  He has never had formal education in the less than 4 years we have been together.

The moment I understood I need to share my life with diabetes more?

We arrived in Lima, Peru.

After settling on the last leg of our journey we decide to head out in search of a few markets and sites for some art pieces.

On the way back, my pump alarms that my sensor is telling me my blood sugars is 4 mmol/L.  My sugar is going down.  Stupidly, I have no sugar on me…Steve is so good he usually does have lifesavers in his pocket…but he has none.

I feel it is lower than 4 mmol/L.  But I am stubborn.  Steve asks if I want him to go into a store and get sugar.  I say it’s OK .

First, when my sugar trends towards low but I feel like I am not in danger, I don’t treat with rapid acting sugar, I set a temporary basal rate.  I think it’s a control thing.  I want to change the stupid system that really works…just to see if I can make it better.  I am so anti-sugar….I really want to take it…mental block.

So…I say to Steve, it’s okay, I’ll set a temp rate.

And we keep walking.

And several minutes later I become dull.  And quiet.  I lack my bubbly, sunshine Type A personality.

Steve knows but doesn’t know.  He hasn’t experienced such an extreme moment like this.

I personify strength.  Knowledge.  Power.  Ability.  I am never the victim.  He trusts that. Even thought his gut tells him different.

DBB Hypo Peru

So he trusts me and my choice.

Until I mumble I want ice cream.  And he asks further questions.  And I am indecisive and vague.

We end up in a grocery store a few blocks away from our hotel.  He asks me several times what I want to get….I don’t know.  In my mind I want to ask him to help me.  Save me from this terrible prison in my mind of wanting to be in control.  Not to ask for help.  I will take care of myself.  I won’t confess I have failed.  I won’t ask.  I refuse.  I won’t.  I have done this since I was a little girl.  My (mis)behaviour trumps my voice.

I am no good to anyone.  I know it.  I am too far gone to say that.

Steve finally suggests and I agree.

We pay out at the cash and I inhale.

Many minutes later Tracy returns.

Later that night we debrief.  He tells me…”I knew, but I didn’t because you know!”, but I did.  And I failed to tell him.  Thankfully he saw it today. Exactly what I just described.

He tells me “…from now when when you say “It’s okay, I’ll set a temporary basal rate.”  I am going to pop into a store and buy some candies.”

And he will tell me.  “You need this candies”.  And I now I will take them.  Regardless of how bad I want to be in control.  Because, we have this consensual contract.

It’s good to share my diabetes.  A liberation.  Enlightening.  It is a relief to give a very small piece of it to someone else.  Even though it is only a very small piece of what my mind thinks of 24-7-365, if feels good. Despite how much control I want.  And how hard it is to let go.

Travelling with My Pharmacy

DBB Huchay Cusco Blog

There will a few posts/Blogs about my travels to and within Peru.

BUT..

I feel this post in particular is a huge one and is pressing upon me to prioritize even though it’s not in order.

We spent Christmas Eve in Agues Calientes. We planned to climb Machu Picchu Christmas Day.

I became very ill with a very high fever and ultimately sinus congestion, sore throat, fatigue among other things.

I am proud of the way the situation turned out as I recovered very quickly compared to most times I experience this. My husband questioned if I should take part in the venture to Machu Picchu but I insisted despite feeling down and out I would not miss such an amazing opportunity. This is a chance in a lifetime!!! And so we did.

With that being said, after we returned to Cusco a few days later we made plans to take part in a two day trek up the Andes mountains, through the Peruvian Tundra. We would then be hosted by a family overnight before descending back down the next day to another town a few hours away from our starting point.

We reach an elevation of 15,100 feet. Understanding that breathing would be a challenge at the best of times, I am overly concerned that with my congestion and swollen throat it would present greater issues.

On our way to the drop off point 1 1/2 hours away by jeep, I ask our guide to stop at a pharmacy to buy cold medication to help keep the symptoms from being too overwhelming throughout the climb.

As I walk into the pharmacy I take note this is the very first lesson I learn.  Never assume I can go away for 2 weeks and be healthy the whole time. I usually pack cold medications, gravol etc for those ‘just in case’ moments.

This is the first time I didn’t take my personal pharmacy with me. Sigh.

Our guide Henry takes me into the pharmacy in Cusco. I tell Henry in English that I need an anti-histamine/anti-inflammatory. I expect something along the lines of Advil Sinus & Cold or Buckley’s.

After the Pharmacist asks Henry a few more questions in Spanish….”Is it altitude sickness?”…”No, I had a very high fever, sore throat and sinus congestion.”…He recommends a product.

I take a ticket to the cash booth/dispensary at the front of the store. She gives me the box of medication. I am so relieved I will have the meds to help with the congestion, I don’t consider that I didn’t tell the pharmacist I have T1 diabetes OR that I took time to read the ingredients.   At this point I don’t make the connection that Dexametasona (in English “Dexamethasone”) is a steroid!!! I mean, come on, I am a Nurse. I should know the 5 R’s!!

AND I can’t buy a steroid over the counter in Canada! For good reason!

I am told to take one pill now (it is 7:30am) and again at supper. I can take it twice a day for a few days.

Within an hour I can feel the relief. I am overjoyed….until…

Fast forward to that evening and into the overnight…AND the next day…my blood sugars begin to climb…and climb…and climb.

I take insulin corrections like drinking water with no change. Not even a flicker in my Continuous Glucose monitor display. My finger pokes confirm all is not right within my diabetes world.

I reflect back on when we arrived in Cusco. Within a day I was setting temporary basal rates on my insulin pump for low blood sugars and now??? I am insulin resistant in the Andes Mountains??

I play scenarios in my mind. Is it the altitude? Is it dehydration? Is it the anaerobic feedback from the intense activity which leads us to experiencing burning leg muscles, shortness of breathe so bad our lungs are burning?

When I work out at the gym and do intense heavy weights my sugars spike. When I do hill training when I run I get the same effect. Is this the same?

At this point I haven’t made the connection yet that the cold meds contain steroids.

I do think that in part, the intensity of the climb did cause an adrenalin surge that did cause my need for more insulin….pair it with an exogenous steroid in my cold meds and here is a recipe for blood sugar disaster.

My key take away?

Bring my own cold meds and pharmacy.

If ever in an emergency that I require medications while in another country, make sure to tell them I have diabetes.

If and when I decide to ascend to 15,100 feet (or higher), take note and act that if it feels anaerobic, increase my insulin rates to accommodate to it.

No doubt it is a tough balance to achieve but I wouldn’t want to throw my hands in the air and not keep playing the game. Next time I want to improve on this experience. I accept my sugars will never be perfect in these situations especially, but, I will do my best.DBB Dexalor

Gaining Perspective

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Gaining Perspective

This is me at age 8. It was 3 years after being diagnosed with Type 1 diabetes. I am standing at the entrance of Camp Huronda, a summer camp sponsored by the Canadian Diabetes Association for Type 1 children & teens. It was the first time away from home longer than a day since I was diagnosed with diabetes & hospitalized for 10 days in 1975. I learned to inject myself with insulin within a few days of being at Camp Huronda. From that day forward I didn’t want anyone else injecting me. I liked that I could control how my injections felt & when the needle was going in.

Fast forward to 1987. At the age of 16, one morning my Mom finds me in bed, unresponsive, laying in my vomit. After calls to my Paediatrician & attempts to give me fast acting sugar with no success, my parents rush me to the hospital. The things I remember of that morning are Dad standing me in the snow in my bare feet to get me into the car as I refused to, seeing my church as they drove by it & watching my Mom cry at the foot of my bed in Emerg. A few days later as I lay in my hospital bed I noticed that the nurses caring for me didn’t know a lot about diabetes. I mentioned this to my Mom. To this day it seems almost unbelievable to think my Mom prophesied my future career without knowing how big of an impact I would make in the world of diabetes. When I told her my thoughts, she said to me, “You can change that. You can educate them so they know.” She encouraged me to go into Nursing.

If you go back to several of my Blogs you can read about the many experiences I have had living with diabetes & being a parent of a child, teen & now young adult living with diabetes.

Fast forward to 1999. After working in a Licensed Daycare as the School Nurse & caring for 2 children with Special Needs for 2 1/2 years, I decided to start a Home Daycare so I could be home with Cayla & Kurtis. Within 6 months I had a ‘full house’. It was a very busy time but I loved that I could be home for my children & create a home atmosphere for the little ones who couldn’t be home with their parents. Once Kurtis started Grade 1 I felt it was time to gain some hospital experience. While running the home daycare I completed my Critical Care Certificate. Working at the daycare & running the home daycare taught me so many things; time management, communication, creativity, nutrition, working with Special Needs, how to be calm when chaos is all around.

I still remember my first interview at the hospital. The 2 managers interviewing me mentioned I didn’t have any experience. I asked them how was I going to get experience if they didn’t hire me? I surprised myself that I asked them that question. I wasn’t one to challenge anybody. They were surprised too. That got me in.

After several years of working in several areas at the hospital & particularly the Intensive Care Unit, which I loved, I didn’t like the fact I was caring for people with complications, mostly from Type 2. There was one patient who died from complications of Type 1. It devastated me. She wasn’t much older then me. My colleagues would ask me certain questions about diabetes. I liked that. It didn’t take long for me to realize I was at the wrong end of the diving board. My time in ICU was invaluable. I learned time management, critical thinking, stamina, diplomacy, focus, patience, perseverance, when it was the right time to cry when I lost a patient & when I needed to hold back my tears,. I also learned that there are times that the truth needs to be told no matter how hard it is to hear. Working in ICU made it very challenging for me to keep my sugars in check. A critical situation would drive them sky high & a missed break could bring me low.

In 2002 I attended the JDRF Walk For the Cure. To this day, I don’t know what possessed me to do what I did. Kurtis & I used a Lifescan glucose testing meter. I heard there was a new one on the market & I wanted one for each of us. I walked over to the Lifescan booth & began talking to the rep. He gave me 2 new meters. After a few minutes of conversation, my mouth opened & without plan or thought I asked him if his company was hiring. Huh? What did I just do? It just so happened that he was being promoted & his position was opening. WHAT?!? Timing is everything they say. So it was with this as well. The interview process went smoothly, the offer was ready to be presented when an internal applicant surfaced. As with most companies, he was given the position. How did I feel? I was okay with it. I didn’t think it was the right time. The kids were still young & I had a great job-share position that was flexible with shift work. It worked for our family at the time. The Rep I met from Lifescan told me he would keep me connected & that he did. My foot was in a door I didn’t even know existed.

In 2004 I ended up with one of the best jobs I could ever imagine having. I became a Diabetes Consultant for Novo Nordisk. It was one of the hardest but most rewarding jobs. I learned Type 1 & Type 2 diabetes inside out & backwards. The company kept me current in Clinical Studies & relevant literature. What I liked most about it was meeting Family Physicians for the first time & them telling me they don’t ‘do insulin’. Several years later I had these same GP’s thanking me for teaching them & how much easier it was then they thought. Through out my years at Novo Nordisk my Mom’s words echoed in my mind several times. I educated Nurses, Dieticians, Doctors, Pharmacists and Nurse Practitioner’s. I did business on all levels of health care including hospital contracts & nursing homes. Working at Novo Nordisk helped me learn time management, business planning, triaging, focus, drive, passion, knowledge about every insulin available on the market, knowledge about every oral anti-hyperglycemic agent on the market, every insulin pen, syringe & pen tip available & it’s implications on therapy.

One of the most difficult decisions I ever made in my careers was leaving Novo Nordisk to work for Medtronic. It provided me an opportunity to expand my career, work experience and meet more Health Care Providers working in the field of diabetes. It was a short tenure as Medtronic decided to restructure the Corporation both in the U.S. & Canada. I was one of ~ 100 in Canada who lost their jobs as a result. Being a Territory Manager at Medtronic taught me many skills I needed to become better at or hadn’t experienced. It was a valuable experience despite the outcome. I learned about all of the insulin pumps provided by the medical device companies. I got to know Pumps & Continuous Glucose Monitoring really, really well. Little did I know how much of an advantage that would be. I worked within a team of 3 & communication was essential to follow up & close each sale. I learned how to work directly with the consumer & their needs. Though out the years I learned how to read body language & verbal tone very well. It took a long time but I learned to listen to my gut. For the most part it was right.

After I lost my job at Medtronic, I decided I wanted to leave the world of diabetes. I didn’t know where I wanted to be. I was certain I didn’t want to be an educator. I couldn’t see myself sitting at a desk staring at someones blood sugars, listening to their excuses. Why did I have this perception? I have thought about that a lot. How could I think like that given I live with diabetes? I think that in my mind a diabetes clinic consists of Type 1 & Type 2 together, intertwined…somehow connected but shouldn’t be. I didn’t want to educate like that. They are 2 different animals & so they should be treated as such. It wasn’t the patients fault I felt like that, it is how clinics are structured that frustrates me. So…I went out on my own as an educator & consultant through my company “Diabetes Beyond Borders” to change that. As a result Diabetes Beyond Borders has over 6,700 ‘likes’ on Facebook. I became a Certified Pump Trainer for Medtronic & Accu-Chek. I had a contract with a large on- line pharmacy in which I created marketing materials, provided education on insulin pump infusion sites & cartridges.

I have applied & been through several interviews for diabetes sales jobs. I would’ve taken them if they were offered but I just didn’t feel it anymore. What was I meant to do? Where was my passion?

A few months ago I was invited to a conference. It is called Type 1 Think Tank. It’s mandate is to more or less “think out side the box” to provide better care & outcomes for people living with Type 1 diabetes. I didn’t realize I was that important! I didn’t realize my experiences were so valued. At the conference I met a long time friend & colleague. She is the founder of the Charles H Best Diabetes Centre. I called on her clinic as a Diabetes Consultant & Territory Manager from 2004-2009. My son Kurtis went there briefly after his diagnosis in 2000 before a Paediatric clinic opened closer to home. The founder, Marlene, approached me and asked if I would be interested in a position as a Diabetes Nurse Educator. I never turn down opportunity but I was pensive given it was a 2 hour/day commute & I would be ‘stuck’ inside 4 walls 8 hours/day.

As soon as I sat down to the interview I understood why I had experienced so much throughout the years. This is exactly where I needed to be, where I want to be. I just didn’t know it. I have travelled down a road of learning & ultimately making an impact though all levels of diabetes. It was time to share those experiences with the people that really, really mattered. It was time to share my experiences with the children, teens, young adults, adults & their families living with Type 1 diabetes.

The Stealth Fighter of Diabetes

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The Stealth Fighter of Diabetes

I liken a Stealth Fighter to an undetected low blood sugar. Until I started back on my Continuous Glucose Meter a few weeks ago I thought I was overwhelming tired at times because there was too much going on.

Until I experienced a few incidents…one thankfully I detected & treated by finger poke thanks to the prompting of my fiancé & subsequently, the next detected by CGM.

The first happened shortly after I woke up. Our routine involves enjoying coffee & tea while catching up on local & international events & updates. I became extremely tired soon after reading updates on my computer. By the time I was in the kitchen making eggs, my heart was beating fast & I began to have a hard time breathing…not symptoms I usually have with a low blood sugar. In my mind I reviewed the things that may be overwhelming me. I am forever making a list in my head of the days & weeks ahead. I thought maybe I was getting ahead of myself too much, putting myself in a bit of a frenzy. I realized it wasn’t that, BUT I just couldn’t put a finger on the pulse. As we sat down to breakfast & I began to eat the poached eggs the racing heart & difficulty breathing continued. As I ate my poached eggs, I realized I was having a hard time eating. I felt nauseated…almost like a brick was in my stomach. I began to tap my foot in an attempt to focus on what the issue was. Within a few seconds of tapping my foot my fiancé Steve asked me what was wrong. By this time I had tears in my eyes & a lump in my throat. In my mind I was thinking “What the heck is wrong with me!!”. I said to him, “I don’t know.” He summated what could be causing it. Then he asked if I had checked my sugar. I agreed that was a good idea. I was 3.2 mmol/L!! It didn’t feel like a low I would usually have! Once treated, these crazy, weird symptoms disappeared.

Shorty after, I decided it was in my best interest to start wearing a Continuous Glucose Sensor again. I have to be honest, when I have a sensor in I love it. It truly is the ultimate advancement in technology that I never thought could exist given what I have experienced in 38 years living with Type 1 BUT I have a huge block with taking the time to prepare, insert and calibrate. It’s not that much more work than I do with wearing a pump, but I guess it’s just that one more step or three that I just don’t want to do. The motivation to take those extra steps becomes exponential when experiencing a stealth fighting low like described above.

The second undetected one I had was shortly after I had the first sensor in. It was shortly after breakfast (do you see the morning BG’s as being my source of trouble!). Again, I became tired. Not the same tired I get with other lows…I didn’t think so. I went upstairs to have a shower. I checked the CGM graph to see what my BG was at. It was 5.4 mmol/L. Good! I have my cell in the bathroom for those ‘just in case’ moments. I never stop being a Mom even though the kids are in their 20’s. Although none of them were from my kids I hear my phone ring, text tone and email going off. I border on irritation as I promise myself that for the few minutes I’m in the shower the world & my kids will survive without me having access to my cell, thus me having a peaceful moment in the shower. Still feeling not quite right & overtly irritated given how good natured I usually am, I am not able to put a finger on it. My pump begins to go off. It is alarming like crazy. By this point, I realize I’m quite low. I finish as quickly as I can & get to my pump. As seen in the pic above I am 2.4 mmol/L & still going down!! I put in a temp basal of 0%, put some clothes on & head downstairs to get some fast acting sugar. It took an hour to have the residual symptoms subside. Boy was I ever tired!! It scared me.

It occurred to me that I had been having these incidences many times a week for quite sometime. The reason why I didn’t pick up on the lows by finger poke? Each time I tested when I felt tired except for that day at breakfast, the lowest I tested on my meter was 4.1 mmol/L. Even that morning after my shower my meter only tested to 4.0 mmol/L. Which do I trust? Based on how I felt & the technology I decided that these lows were truly stealth-like. Based on the fact that glucose meters can ‘ideally’ have a variability of 20% in tests, I decided it was time to take action.

It has taken a lot of work in the past 3 weeks to nail it all down, but changes have been made & I notice a huge difference. Be ware of the Stealth Fighter of Diabetes…it is alive, well & undetectable.

 

To Pump or Not To Pump

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To Pump or Not To Pump

I have some great questions about Insulin Pumps today.

At this point, I will now take a moment and apologize because I have pumped for 12 years & have the benefits of being covered for insulin pump therapy throughout this time, I assume everyone knows what I know about them. I also assume, if they have the ability to, they would automatically want to be on one. That is very ignorant of me and I’m sorry. I started Diabetes Beyond Borders for this very reason, to educate and give as much information to empower you. Unfortunately I missed the mark on this one.

One more small disclaimer. I worked as a Territory Manager for Medtronic Inc. selling Paradigm Insulin Pumps. This Blog will not sell one pump over another. At this point I am now doing Insulin Pump starts & follow-up for Medtronic and Accu-Chek. As a Health Care Professional, peep living with Type 1 & Mom of a Type 1, my aim now is to give you an unbiased summary about Insulin Pump Therapy so that you can research more to see if pumping is right for you & which one best suits your lifestyle & needs if you decide to.

So…here we go….

SIZE: In general, all pumps are bigger then a pager but smaller than a cell phone. Many people have mistaken mine for a pager or cell. In the picture in my hand is one of the smaller ones. I don’t need a lot of insulin, so I use a smaller pump.

COLOURS: You want colour it, you got it. There is charcoal, clear (like mine), pink, green, purple… You can buy covers & skins to decorate it anyway you see fit. I like the clear one because I wear mine in my bra a lot…I don’t want it to be seen through my shirt. A lot of guys like charcoal because it looks more like a pager.

PARTS OF THE PUMP 101:

1. BUTTONS: Used to navigate the pump.  About 5 buttons on the face/front of it, some pumps have ~1 or 2 on the side as well.

2. REMOTE:  Some pumps have remotes that work also as the glucose meter. Not all have this.

3. CARTRIDGE: Fits in the pump which has Rapid Acting insulin such as NovoRapid, NovoLog, Humalog, Apidra (when on a pump you no longer take Long Acting insulin such as NPH, Levemir or Lantus). The cartridge is plastic.

4. TUBING:  It is attached to the cartridge of insulin which comes in various lengths, as short as 18″ to as long as 43″ & a few lengths in between. The tubing is flexible & durable. There is a new ‘patch’ pump on the market that does not have tubing.

5. INFUSION SET: This is the teflon tube or needle that sits under your skin to deliver the Rapid Acting insulin. The tubing connects to the infusion set. It can be connected & disconnected as needed for showering, activity,or intimate moments. There are a variety of infusion sets to choose so that you have the right one for your lifestyle.

BASIC FUNCTIONS OF THE PUMP:

1. BASAL RATE: I call this the ‘base’ or ‘fasting’ delivery of insulin that your pancreas would be doing for you if you didn’t have diabetes. The Long Acting insulin you are taking tries to do this through 1 or 2 injections per day. On the pump, you can customize your basal rate to meet the different needs your body has throughout the day. You can make these changes on an hourly basis if needed. Most people only need 3 − 5 different basal rates during a 24 hour period. They do not change often after they have been established. BUT, the beauty is, you can change them and the time of day you need to. Basal rates are delivered in very small increments throughout the day, each pump delivers the rate based on its own calculation in which that company feels is best for their product but at the end of the day, the delivery is balanced & tiny enough it provides better balance when you are not eating. It is easier to skip a meal or get off schedule without suffering the consequences of a low blood sugar because of the features of a basal rate.

2. BOLUS: Essentially it is the Rapid Acting insulin you inject with. The beauty? The tube is already under your skin so you don’t have to inject. The other benefit is the pump does all the work to calculate your insulin dose. The increments that can be delivered on a pump can be as small as 0.025 units and as big as 35 units. I imagine now your routine on injections involves adding up your carbs, trying to decide how much extra to adjust for a high or low BG, taking a calculator or phone & crunching the numbers to find how much you will inject with your pen or syringe, which usually has to be rounded up or down to the nearest half or full unit of insulin. The built-in bolus calculator allows you to input your BG (usually remotely through the glucose meter), input your carbohydrates. The pump then shows you the breakdown of why it has decided you need a certain amount of insulin. It considers a correction for your sugar to bring it to target, whether that means adding extra to treat a high or subtracting some off to avoid a low. It also shows the carbs you chose & how much insulin you will get based on that. It also takes into consideration how much insulin you still have in your body. Having bad lows from unaccounted insulin still floating around in your body will be no more. The pump remembers.

3. BG READINGS: The pump stores your readings if you enter them into it, whether manually or through your remote meter.

4. CARBS: The pump keeps a history of the carbs you have eaten, when & how much insulin.

5. INCREMENTS: The increments on the basal rate & bolus can be as small or as large as needed. Some pumps vary, so make sure the one you choose fits your needs. Type 1 & Type 2 peeps do very well on pumps for this reason.

6. DELIVERY: The rate a pump delivers insulin varies from pump to pump. Be aware how comfortable you are with the rate it infuses into you.

7. SENSOR: There are only 2 companies that I am aware that offer Continuous Glucose Sensor technology; Medtronic & DexCom. I will post another Blog about this technology. It is far too complex to include it in this one. Suffice to say, having used the technology personally, I see the impact it has on diabetes management & glycemic control.

RESPONSIBILITIES AS A PUMPER:

1. BG TESTING: At least 4 times per day and more often as necessary.

2. INFUSION SET/CARTRIDGE CHANGE: Infusion sets need to be changed every 2 − 3 days, depending on the set you choose. Some companies are saying to change the cartridge & tubing every 3 days, others support 6 is the way to go.

3. DIABETES KETO-ACIDOSIS PROTOCOL: With only having Rapid Acting insulin in your body, it is only in a matter of hours that you will ‘run out’ of insulin in your body if something doesn’t work with your pump. It is easy to trouble shoot & correction can be quick. The trick is to be acutely aware when you test high & adhere strictly to protocol to treat the high sugar. It is rare it can happen but when it does it is SO important to follow the few simple steps it takes to correct it.

WHERE TO WEAR THE PUMP

There is an assortment of clips, pouches & belts that are available from pump companies & online stores. This allows you to decide whether you want it under your pants on your calf, under your skirt around your thigh, clipped on your belt or around your waist, in your bra, around your arm. Creativity, convenience & comfort are key. I know many with  careers from police officers, construction workers, nurses, teachers etc that find living with their insulin pump provides better quality of life for them. It is trial and error of where to place it at first, but once you get your groove, it’s a no-brainer. You’ll forget it’s there.

PROS OF A PUMP:

1. Less low sugars
2. Less variability
3. More flexibility with lifestyle & scheduling
4. Less needles
5. Ability to pro actively prevent low & high sugars with activities, exercise, work etc.
6. Less calculating

CONS OF A PUMP:

1. Have something attached to you 24-7
2. Remembering to change the infusion site, tubing & cartridge on time. (I developed a system to help me remember, some pumps have a reminder in it)

WHAT TO CONSIDER WHEN BUYING A PUMP

1. Ease of Use
2. Technology available that suits your needs
3. Software available to download the results to manage your diabetes
4. Cartridge size (they come in 1.8 mL, 3.0 mL, 3.15 mL)
5. Insurance Coverage
6. Long term costs
7. Pump Company Customer Support
8. Ease of ordering supplies
9. Features within the pump that meet your needs
10. Basal & Bolus delivery increments that meet your insulin needs
11. Infusion set choice (one pump company’s sets are proprietary so you will need to order their supplies only, make sure they have what you want)
12. Some companies require you replace your battery cap & cartridge cap every 3 months. It will be at a cost to you. Make sure to ask about this.
13. Some pumps are waterproof & some are water tight. I have always put it this way…I wouldn’t swim with my cell so why would I swim with my $7,000 pump. Especially in a lake…if it goes to the bottom of the lake there is no getting it back.

I liken deciding to pump & choosing one to buying a car. It’s a long-term, expensive decision you will live with for 4 − 5 years. Shop wisely & make sure to ask a lot of questions. If you have the option to trial one using saline in the cartridge before buying, I urge you to do it.

Always keep in mind:

1. All companies give a 4 year warranty.
2. You have 90 days after you order your pump to return it. If you decide it’s not the right one & you want a different one OR if pumping just isn’t for you. There is no cost to you to return it.
3. Please, please make sure to add your pump to your house insurance policy. If your pump is stolen (which I know people it has happened to!), you want the reassurance you can get it replaced.

You can email me at tracy@diabetesbeyondborders.com with any questions. I am here for you.

Why?!?

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Why?!?

Did you ever go to bed with a normal or near normal sugar but wake up the next morning high? You increase your insulin or talk to the doctor about it & he raises your oral diabetes medication & it continues to go high. Why?!? What is going on? Among the many frustrations to experience, what appears a simple fix becomes a complex mystery.

Kurtis is in Grade 7. It is about late September. During that time, as most kids are, he is very active, back to school & still not ready to harness the energy he had from summer holidays. He plays football with his friends at every recess. He plays hockey in his local league. At that time he is in power skating to ante up his hockey skills for the upcoming season, with the primary reason to keep him active. When he isn’t at hockey after school he is outside jumping on the trampoline or catching frogs. Aside from sitting in a classroom his days are full of activity.

During that time Kurtis is on insulin pump therapy. It is very easy to manage him on this. Predicting trends in blood sugars is easier than injections. Between decreasing basal rates & temporary basal rates, I feel I am in control of his active lifestyle.

Within that time, there is a period of weeks where Kurtis is going to bed within the safe target for his age but waking up high. I automatically assume he is growing & needs more insulin. What does any parent do? Increase the overnight dose.

With Kurtis being on an insulin pump, I don’t feel the need to set my alarm every night to check him. If there are days where he is having multiple lows, I set my alarm to make sure he doesn’t have more through the night. Otherwise, I feel confident sending him to bed at a target blood sugar, he will wake up within a reasonable target in the morning.

One morning this is not the case.

At that time I worked for Novo Nordisk. I put in an average of 50-60 hours a week. I did a lot of driving. Working as a full-time Mom in a sales career, living & managing my own Type 1 diabetes & raising a son with Type 1 diabetes & keeping a balance for my daughter was very challenging.

This particular morning my alarm goes off. I am exhausted. As I hit the alarm, I say to myself, the kids need to do a few things before I get up with them anyway, it’ll be okay. The alarm goes off one last time. My feet hit the floor. As I stumble out of my bedroom into the Great Room where Cayla sits at the Breakfast Bar eating her breakfast.  I hear Kurtis’ alarm going off. I ask Cayla if Kurtis is up. I think to myself, “I don’t hear the shower?”. She responds, “It’s been going off for a while now, he won’t shut it off, he won’t get up.”

My heart starts to pound. My concern is overwhelming. At this point, Kurtis is not at the stage to sleep deep enough through an alarm.

Kurtis’ bedroom is at the end of the hall. His bunk bed is against the wall directly in front me. As I rush in the room, I see his back facing me. The alarm is still going off. I know something is not right.

I go over to him. He is a funny colour. My heart is pounding. I shake him gently & say “Buddy” (his nickname). His arm flops over & I see his face. His eyes are rolled back in his head & there is a lot of saliva coming from his mouth. There is not a moan or a groan. He is lifeless. There is a pool of vomit in his bed. My body floods with a warm rush, a pulse so strong I want to scream. I think my baby is dead. It seems so cold, but I check his pulse. It is barely palpable & fast. He is cold. I scream. I scream so loud. I yell at Cayla to get her father. I don’t have to explain. She can tell by my voice & what she is witnessing. I keep him on his side. His father rushes in and picks him up. He holds him on his lap while I run to grab the Glucagon. My hands are shaking so bad I can barely get the needle into the vial to inject the saline. What seems like forever, I pull the syringe out of the vial & plunge it into Kurtis’ leg. He’s not moving, he’s not talking, his eyes aren’t open. I pray, please God, please, I can’t lose my baby. I am trying to keep up my composure for Cayla. She is apologizing to me. She feels bad she didn’t check on him. I say “It’s okay honey, it’s okay.” as I try not to cry. Who do I call first…Kurtis’ Diabetes Educator’s home, not 911, but her home. Why? I don’t know to this day. At that point I have lost all sense. When she answers I cry to her “Shay, he won’t wake up, how long does it take?” My hands are shaking so bad I can barely keep the phone by my ear to talk or listen. She asks me, “Have you called 911?”. I feel so stupid. Me, a nurse, who has worked in critical care. I hang up & call 911. We live in the country. It takes 30 minutes for them to arrive. About this time, Kurtis is beginning to make sounds. He is trying to get on his feet but doesn’t have the strength. The lights are on but nobody’s home. Shortly after, Kurtis is hospitalized. It takes almost a day before he becomes aware of his surroundings & his Mom. I knew my Kurtis was back when he opened his eyes after who knows how many times confused & unaware & says “I’m hungry”. I knew by baby was OK!

There is not a day that goes by that I don’t thank God that He left him here with me. Days, weeks, months & years later, I tell Kurtis that God kept him here for a reason. He has a purpose. As we all do living with diabetes (& those who don’t!). Weeks & months after I would be driving to a city in my territory to call on customers & I would visualize Kurtis lying in his bed, looking dead. I burst into sobs.

My discovery with what happened to Kurtis is that he wasn’t high all night. He was experiencing the Somogyi Effect. He was going low in the night due to all of his activity but his liver was overcompensating giving him such a surge of sugar to compensate he woke up high in the morning. That day, his liver had no more sugar stores left to save him from what happened.

I share this very emotional story with you for a few reasons.

1. Don’t assume. Nothing, not even an insulin pump is predictable with diabetes. When I worked in the Intensive Care Unit, I was taught to look at the patient not the the machine. (Although, don’t override the pump all the time that is telling you changes on the pump need to be made)

2. Set your alarm for 3 am & test your child/teens sugars for 3 nights.  It’s like fishing…you’re trying to ‘catch’ a low.

3.   If the sugar is high in the morning don’t assume it’s because he/she is high all night. If your child is on injections or a pump that does not give the technology to offer Continuous Glucose Monitoring to decide what’s happening, there is technology available that allows your child to go live with their sugars for 6 days that your diabetes clinic may offer which will help you & your diabetes team to find out what’s going on over night 24 hours a day for 6 days.

4. When kids are as active as I described with Kurtis, compensate for that. Whether your diabetes team has advised extra carbs & protein at bed or decreasing overnight insulin.

5. Journals rock!! As busy parents working long hours & being all that for our kids, we lose track. But, we don’t realize it. We think we are status quo, but eventually something has to give. A journal will tell you what’s really going on. It’s the story you think you know but  because I’ve been there, you really don’t.

I share my experiences because I learn from them & they are in the past. I write these blogs because if I can save one child & one parent from going through what I did, I have done what I have set out to do.