Diabetes Awareness Month Photo-a-Day 12, 13 – Work and Awareness

Appropriately, I had a work “meet & greet” event last night that occurred over dinnertime. Random “finger foods” and appetizers were served like egg rolls, pot-stickers, chicken fingers, cheese, crackers, fruit, cookies, brownies, jalapeno poppers, etc. Pretty much a smörgåsbord of “guess how many carbs are in THIS??” nightmare. Luckily, there was also wine on hand, and my sugars stayed amazingly level, even amidst the stress of meeting executives that could someday decide my employment fate.

Yummy and questionable all at the same time
As for “awareness” for today….taking some more liberties here with this prompt. It made me think of the awareness that my husband has of my diabetes…or the lack thereof in some areas of my diabetes care.

Now, my husband knows what a low looks/sounds like. The only time I’ve EVER had someone call 911 for me was when he and I were first dating, we were out on a walk after dinner (it was in the BCGM days – before continuous glucose meter), and I crashed and passed out on a stranger’s lawn. He was a trooper through that….and continued to date and eventually marry me – such a keeper.

But as far as all my testing, pump site change-out, CGM sensor supplies, what I use to do what, etc….he’s never been much involved with that. I mean, why should he? I’m the one in charge day-to-day of poking, prodding, and inserting medical devices into my body, and I tend to do a lot of site changes and CGM sensor change-outs when he’s not even around, so he really doesn’t see it much.

Last night, we were upstairs watching How I Met Your Mother (catching up at last on season 8 so we can get to season 9 and finally find out who the heck she is), and we had about 30 minutes before bedtime. My pump was vibrating it’s  “Low Reservoir” alarm – 10 units wouldn’t get me through my basal rate overnight. I would need to change out my set before bedtime, but I was too lazy to go downstairs and get my supplies, and I’d be half asleep once we finished TV. He offered to go get the “stuff” for me, so I gave him the vague directive of, “Under my sink, in the plastic drawer, I need an infusion set and insulin cartridge, and the black bag on top of the drawers.” Here was what he saw:
Stuff, stuff, stuffHe brought me the black zipper case/bag that contains my open insulin, set holder, and various pump accoutrements = score 1 point! He brought me an infusion set = score 2 points! And brought me a sensor set for my Dexcom CGM, saying as he handed it to me, “This isn’t the right one, is it?” To his credit, I only had a couple of reservoirs left, and they were obviously hiding in this messy drawer that is pretty much as unorganized as I get. He re-confirmed with me that it would be a “cylinder-looking thing” and then successfully found it and brought it up to me. I love my husband. And lots of times, he’s more aware than I give him credit for.

Insulin 101 – did I miss that class?

I swear I know how insulin works. Really, I do! I’ve always been told that NovoLog in my pump has an active life of about 3 hours, with it’s highest time of effect being within 1-2 hours of taking it.  (Of course, I just bulled my way through the ho-hum boring patient information leaflet and it says it sticks around and is active for 3-5 hours. Learn something new every day!)

Blue skies.....reminds me of a songSo WHY then, after I did a site change before lunch, do I end up crashing and staying low all evening (after micro-bolusing for a high carb dinner even), which was like, close to 8 hours after last taking a rage-bolus of insulin?

Seriously, it drives me nuts. The hanging out in the 200s for several hours after a pump infusion set site change is bad enough. But then, add insult to injury when suddenly, all those attempts at correction boluses come avalanching (is that a word? It is now!)  into effect 8 hours later? It makes no sense!! Are the cells around the new infusion set site area just holding onto the insulin for a while until it calms down from some sort of site trauma? Do I really not understand Insulin 101 and how long it works in your body/ what it’s time-frame of effect is?

Whatever the issue with me and my insulin education, I am happy to have my Dexcom CGM clue me in when the sugars-tumbling-down begins. Guess it’s time for some more learnin’, ya’ll.

Dawn Phenomenon, Site Change, and Breakfast Spike, Oh My ???

Wow, talking about a trifecta of ugliness that causes a bad blood sugar day…..this particular morning, it was a combination of:

  1. Dawn Phenomenon – no matter what the linked Wikipedia article says, I *do* have to change my insulin intake to manage the spike in sugars that happens in early morning. Over the years, my endo and I have tweaked my morning basal rates to account for it in some part.  And I *do* eat a small snack before bed that has about 10g-15g of carbs and some protein and fiber in it so that my stomach isn’t so absolutely empty by the morning that the dawn phenomenon cranks up my sugar to exponential heights. For me, if I don’t eat breakfast by around 8am, my sugar just starts climbing and climbing no matter what I’m doing or how much insulin I take. Thank you, Mr. Liver for that input of yours. Sigh. This particular morning, I was so busy doing other things, it was close to 9am before I could eat.

    An infusion set, showing the insertion needle.

    An infusion set, showing the insertion needle. (Photo credit: Wikipedia)

  2. Infusion set site change – My pump ran out of insulin at 7am, so I had to put more liquid life into my pump (in the form of Novolog) and change out the infusion set. It never fails – no matter if it’s a new or old bottle of insulin,
    no matter if I’m putting the site on my stomach, my hip, etc, it seems to take a few hours for the insulin from a new site to really start absorbing and working. I sometimes supplement with shots, but that brings on it’s own level of danger since who knows when the pump insulin will start absorbing.
  3. Post-Breakfast blood sugar spike – I have fought this battle for many years, and Metformin has helped immensely with this, but with the dawn phenomenon and infusion set change already hard at work at wrecking my sugar, it was inevitable that breakfast would send me over the edge. (I took the picture of my Dexcom at 9:17am right after breakfast, and then it got all confused at the rapid rise and gave me the ???, but trust me, it stayed up in the 200s for several hours of the morning.)


The good news? By lunch time, the new infusion site had settled in and started working, and my sugars only mildly tanked because I had so much insulin on board from taking a couple of shots in an attempt to avoid the 300s. The rest of the day was thankfully uneventful, sugar-wise. Note to self: in the future, try to think ahead and change out the infusion set at ANY other time than the morning. Of course, we always have the best intentions that don’t always pan out…thinking of and remembering to do every-single-thing-every-day-to-counter-bad-blood-sugars? Good luck!