Jun 18

Carbs

By Cary diabetes, food, lifestyle 3 Comments »

Low carb? Not me. I’m a high carb intake type 1 diabetic. Breakfast is usually a bowl of cereal and milk (not a small bowl, but a bowl that is about 1.5-2 serving sizes). I eat lots of pizza. Cheese and crackers are a fantastic snack (and easy to bolus if you are counting the crackers in advance).  Some days I may eat 500 grams of carbs, other days I may eat 100 grams. It all depends upon the needs of my body that day and how hard I am working.

As long as I am not constantly consuming carbs to keep BGs within range (a BG control issue) – I am happy to consume carbs to keep my body energized.

Reading another athlete with T1:

Carbs are not my problem. I take Novolog insulin analog to replace the insulin my body isn’t producing. And as a type 1 diabetic friend once said, “I’m not on an insulin budget.”

If you are working hard and burning energy, you need carbs (sometimes a disgusting amount).  End of story.

Jun 16

Insulin Pump and Changing Sites

By Cary diabetes, lifestyle, pumping No Comments »

In my opinion, the biggest annoyance with insulin pumps is the sites and changing sites.  It is substantially better with the OmniPod for insertion.  However, the biggest problem has to do with pooling of insulin at the site.  Basically, eat a big meal, and take a large bolus.  The insulin has a tendancy to pool at the site.  And if I decide to change my infusion set/pod a short time after taking this insulin — well, most of it is going to fall out.

Even though I give myself the correct dosing, if I decide to change my site after eating, I will go high unless I administer a guesstimate of how much insulin I have lost.  A big part of the calculation has to do with how long after eating/how long after giving myself the bolus.  Almost impossible to get right.

Moral of the story: never give yourself a bolus right before you change your set.  It never works.

Jun 10

OmniPod Complaints

By Cary OmniPod, diabetes 4 Comments »

I want to preface this post with the note that I am actually really enjoying the OmniPod and is has some really wonderful functionality.  It’s about 80% there. 

My current list of complaints about the OmniPod system:

  • Does not show Insulin left in the resivor until you are under 50u.
  • Will not calculate bolus after first insertion (had to wait for my IOB to clear before it would calculate) — I must have missed a step to enter my current IOB, so it turned off the calculator as a precaution. Nice safety feature–yet annoying.
  • Cannot change basal pattern without suspending basal.
  • PDM is much too large and has a button I will never use — “?”. And it does not even work for more than half the menus.  They could actually have designed the whole button interface with just four buttons and saved a ton of space (this is just asking for a iPhone like touch screen).
  • UI is a little slow (but I would say that about all Insulin Pumps) — I like to flick through menus quickly when I know where I am going.  Forcing me to slow down is annoying (but probably a safety feature to make me read it–while I actually am multitasking and not paying attention).
  • Food library is not very helpful since it seems to be quite arbitrary AND it does not let you bolus from it — I want it removed from my home page (best part of the Cozmo, I could REMOVE crap I didn’t want to see).
  • Calculates IOB in a strange way – only takes into consideration bolus on corrections, not food.  It is easier to stack boluses without realizing it.
  • Self-destruct mode – 3.5 days and the pod basically self destructs.  I would much prefer that I could set an amount of units to remain as basal in the event of emergency.  Basically, I want 10u that I cannot ever bolus, and will just deliver as basal at the end of the Pod.  Again, this is a safety thing that I really liked in the Cozmo (always important when you could be stuck at sea/on a mountain).

Wants
Touch bolus on the pod.  It’s so obvious to me — not sure why it is not there. (Cozmo had it, it looks like the Solo system may have it too)

OmniPod likes are too easy — however, the funtions they highlight when they sell/advertise the device is completely backwards in my opinion.  It’s all about the automatic insertion. Stick it on, click go on the PDM, and it is done.

May 11

A1C

By Cary diabetes 2 Comments »

Last week I clocked a 6.3 A1C at the doctor – remarkably good for a 3 month pump vacation. I attribute most of the low A1C is an increase in exercise, a super high Lantus dose, and eating within reason. Controlling eating has become much easier as I now have a cause and effect to eat. If I eat, I must take a shot — not exactly as easy as hitting a few buttons on a pump.

The one thing with feeding the basal (taking too much Lantus), as a course of treatment — good numbers will become bad numbers automatically. What appears to be a stable BG of 90 is usually going to be heading DOWN. Not fast, but since the basal is too high, it will continue a downward slope. Eating regularly and testing frequently is a requirement to make it work.

Apr 21

Burning Carbs (I like chocolate)

By Cary diabetes No Comments »

I can almost guarantee I am the only person who stops at the newsstand to pickup a candy bar before going to the gym.

Pre-workout status: BG 150, Zero COB pre-test, Zero IOB, 45g carbs (candy bar)

My workout was a 4 mile run, 1.5 mile stair climb, 20 minutes of lifting to cool down.

For 45g of candy I would generally use 4.5u of insulin, or else my BG would rise by 270+ to 400+ within an hour.  However, considering I am using an extremely high basal rate for my current exercise regimen and metabolism my 150 BG would start coming down closer to 100 even without working out.  Therefore, I need a pretty big bump in carbs to attack this somewhat intense hour long workout.

Through this hour long workout, my body worked like it had almost 5u of insulin working on that candy bar.

If you see me in the gym walking to the locker room to change and I am eating a candy bar; believe it or not, I am not eating it because I like the taste of chocolate.

Apr 21

Feeding the Basal – A Follow Up

By Cary diabetes, exercise, lifestyle 2 Comments »

There is a downside to every huge upside — something you can prove in life, money and diabetes.  It’s called opportunity cost.  Diabetes is a math game.  A really annoying one where the rules always change.

I wrote about feeding the basal with enthusiasm.  However, I forgot to mention a very key downside that hit me recently.  Basically, I take more basal (currently Lantus) than I need to keep my BGsat 115 (my target, not my goal).  Therefore, if I do not eat, I will go low.  Not a problem with exercising (exacerbating the lower need of insulin), I eat and want to eat constantly.

Got home late last night at 8pm with a BG of 80, I proceeded to eat 90g, bolused correctly.  I continued to feel hungry, and therefore continued to eat (an unknown amount via blind eating for an hour plus).  Falling asleep with a BG under 100, I felt good.  However, bolusing for blind eating is tricky, especially so close to bed time – so I made a guess.  The guess was wrong — by a long shot.  I woke up very early and was very thirsty — the cue to know instantly I am running very high.

The worst part about being high is how difficult it can be to come down.  The usual ratios do not work. If you are 1u:60 points when you are 200-275, everything over 275 may take more insulin to bring down.  So from 275-350 you may need 1u:40 points, and anything above that may need 1u:30 points.  Basically, the higher you get, the harder it is to fall.  In my experience, I really hate to do this kind of math when realizing a high BG and just do a normal 1:60 correction.  However, in an hour I will see that I am not coming down fast enough.

Given the above situation, let’s say I was 400 and want to get down to 115.  I would need 1.6u to get me to 350 (1:30), 1.9u (1:40) to get to 275 and 2.6u (1:60) to get to 115.  For a total of about 6.1u — versus about 4.75 that I would take using my 1:60 baseline approach.  The difference?  1.35u or about 80 BG points.

Guess what happens when I used 1u:60 this morning instead of my more complicated formula?  I was 260 3.5hours after the correction.  Makes sense, since 80 points higher 3+ hours ago can easily translate into an additional 65 points over a few hours of higher BG.

Moral of the story
1. Watch what you eat before bedtime.  It can really mangle your morning.

2. Feeding your basal has the side effect of giving you lower BGs right now (as does increased metabolism from exercise) but Carbs on Board may not appear till later in your BG.  Must have enough insulin to cover.

Nb. These are my numbers — that work for me.  Your numbers will not be the same as my numbers.

Nb. Blind eating is a curse for diabetics.  It’s something I know I should never do, but I do it.  It causes havoc to my numbers, but I doubt this will be the last time I ever do it.

Apr 18

Sitting vs. Standing When Hill Climbing

By Cary diabetes No Comments »

Found this decent video by Active.com on the difference of standing versus sitting while on a hill climb. It’s done by a Tri guy on a Tri bike. However, if you ignore the aero bars, the message stays the same: keep spinning, don’t mash your pedals. But there is some really nice technique notes in the video.

Apr 04

Feeding the Basal

By Cary cycling, diabetes, exercise 4 Comments »

Yesterday I went for a little 50 mile bike ride.  However, for the past few days I have been running BGs from 60-95 or so.  When I woke up in the morning I was at 70, and after eating a small breakfast, still under 100 a few hours later.  Suiting up for my ride, my numbers continued lower to around 60 — so I started consuming: 26g via soda, 30g glass of chocolate milk, 20g candy, 40g bread and cheese.  I did not bolus for any of that food.  During a few mile warm up I remained in the 60s, so continued drinking Gatorade and downed 1 GU (20g).  So I’ve consumed well over 100g of carbs — and finally start getting my BG to 100.  And that’s where it stayed for the entire ride (where I added a bag of chips, 20g and a sandwich, 35g).  I bolused nothing, zilch from 10am till 6pm when I got home and feared having a huge amount of Carbs-on-Board (COB) and took a few units of Novolog since I was at 180.

Why did this happen and work in my favor?  I’m taking too much Lantus — and this is partly my purpose.  I am doing something known as feeding the basal.  I only slightly reduced my Lantus dose for riding, not nearly enough to require adding fast-acting insulin to the mix.

Mar 31

Exercise without the Pump (and thinking about another pump)

By Cary MDI, diabetes, exercise, lifestyle, pumping 4 Comments »

In all reality, not much has changed in preparation of exercising. COB, IOB are still the two items I am always conscious of – just how they get to me changes. While on the pump, I always disconnected before working out for 1.5 hours or less. This would tend to leave me in a basal deficit when I got out of the shower and reconnected and I would be forced to bolus immediately to both fill the cannula and get some insulin on board. However, now using Lantus, I do not have that insulin deficit when disconnecting. On the other hand, I do not start working out with a BG <180, Carbs-on-board and limited Insulin-on-board. I have purchased fun-sized candy that are 10 grams each – one or two candies are usually enough to get a BG <150 into my acceptable pre-workout range (also ensuring limited IOB). On the flip side, using the pump, I could be at any BG, and as long as I lowered my basal far enough in advance, I could raise my BG manually without additional carbs (however, I would end up going into further insulin deficit during the period of disconnect from the pump).

Not having to worry about the insulin deficit from disconnecting is a huge benefit for me during exercise – one reason why I am currently considering the OmniPod for my next pump.

As for the OmniPod in particular, I used a demo Pod for a few days over the weekend and I was somewhat impressed. Although the device is significantly large, it stays in place and has a smooth surface all around, unlike some of the MiniMed infusion sets I have used over the years. However, the inside information is calling for a 40-50% smaller Pod late 2010 or early 2011 (awaiting FDA approval). From the investor relations slides, it appears to retain its distinctive shape in a smaller package.

Mar 31

Insulin Leakage

By Cary MDI, diabetes, lifestyle No Comments »

Since I went on a pump “vacation” back in February, I have been using Lantus/Novolog with decent results. However, one of the downsides has been leakage from the injection site. This tends to happen if you pull the pen away from the skin too early (the pen is still releasing insulin for several seconds after it clicks done).

However, for some reason I feel like I am getting a little more leakage than what is normal and my precision boluses that I used on the pump are getting bumped up 10-15% to cover leakage (this is true to both my Lantus and Novolog).

Experienced leakage woes?  Just another part of living life as a diabetic and playing with the numbers.

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