Complications - Remember them.....It's important!

It's really funny how things happen sometimes.  I have another appointment with my endocrinologist coming up in a little less than a week, and I know that I am going to get an earful at the appointment.  Despite having my insulin pump, I have not been following my own advice.  I have said before that simply having the pump is not going to control my diabetes, I have to take an active involvement in making sure it is doing a good job for me.  To make a long story short, I have not been doing a good job.  I just had my HA1C test done yesterday, and I am dreading the results.  It is as if the "world" knows this and has been trying to send me a message, in a sense.  In the past two or three weeks I have met up with two new people who, upon finding out that I am a Type 1 diabetic, have shared with me some their experiences with people close to them who have had serious complications from their ill-managed blood glucose levels.  This might be one of things I needed to knock some sense back into me!  

Many of us who have been diabetic for many years (I am "celebrating" my 21st diabetic birthday this week) need a jolt back to reality every once in a while to remember what we are facing.  Sure, there are the short term problems like dizziness, slurred speech, confusion, and irritability, but what I want to rehighlight for you are the long term complications, those that aren't so easily (if at all) fixed.

HEART (AND OTHER BLOOD VESSELS):  Chest pain, heart attack, and stroke are all major and serious  problems that can occur.  In fact, by some estimates in North America, 65% of diabetics (Type 1 and 2) are killed by some sort of heart or blood vessel disease.  In fact, as a diabetic your chances of death from heart disease and stroke are up to 4 times higher than other people in the population

EYES: Diabetic retinopathy is a damage of the blood vessels in the eyes.  Almost 30% of diabetics age 40 and over have some sort of diabetic retinopathy.  This is the leading cause of blindness in North America, for people aged 20 - 74.

KIDNEYS: Your body's filtering system can be damaged with bad BG control for an extended time.  The results of which are kidney failure or end-stage kidney disease.  Diabetics account for almost 50% of all new cases of kidney failure.  

FEET: Nerve damage to your feet or poor blood circulation can lead to a loss of feeling in your lower extremities  leaving you unable to feel when problems persist, leading to a requirement to amputate your foot.  or leg!  More than 60% of non-traumatic lower limb amputations are taken from diabetics.

TEETH: Higher blood sugars result in more sugar in your saliva and lead to gum disease and plague build-up.    Roughly a third of diabetics have severe periodontal disease resulting in loss of attachment of your teeth to your gums!   

This post isn't ALL doom & gloom, though.  There are some diabetics who are able to escape without serious complications.  Studies seem to talk about different groups and percentages, but approximately 10-15% of diabetics can get through life without any serious complications of the disease.  Is there something special that they have in their genes that help them?  Is it their diet?  Is it care they received early in their diagnosis?  Is it care they have received throughout their diabetic life?  Studies are still being done, but the one thing that is agreed to is that their HA1C tests are consistently within acceptable limits (below 7.5 for sure, and the numbers get stronger the lower that number is).  

Which statistic do you want to be a part of?

Do Not Try This At Home

So this will not be something advocated by any health care professional.  Isn't that the best way to start a health related blog piece?!  I only share this story as a conversation piece, and because I feel in control of my diabetes and my body - possibly misplaced feeling of control considering how this story goes.

The other night I was laying in bed and thought I hadn't bolused for my late snack or, as I thought about it, my late night snack.  So I lay in bed and bolused for both.  Less than fifteen minutes later I was still watching TV in bed and felt myself getting a low blood sugar.  I dutifully went downstairs and tested, and I was low (4.0), especially just before going to sleep.  I ate my 15g of quick carbs and a granola bar.  Testing 10 minutes later my blood sugar was well on it's way up, so I headed to bed again.  Thought of a problem though....I just bolused another 5.4 units of insulin, which has hardly had a good chance to run through my system, so I will be very low overnight.

At that point I remembered I had given myself a bolus at super time, so I effectively gave a large bolus for no reason.  I REALLY did not want to easy any more to absorb the mistaken bolus I had taken.  My solution was to reduce my basal insulin amount to almost 0% for the overnight hours.  The result was a perfect morning BG of 6.2.  Times like this I wish I had a CGM connected to see what my overnight readings were.

Bear in mind I DO NOT RECOMMEND THIS COURSE OF ACTION!  There are many things I did wrong, but highlight the fact I am human.  Never take your insulin regimen for granted, know what you are doing, consider all actions you have taken and will take, and most importantly don't panic.  This could have just as easily happened on a traditional syringe therapy, as well, however knowing what options the pump can afford me, I was able to come up with a creative solution.

Beeps, sounds, and alarms.....oh my!

At times your insulin pump will sound like a badly tuned musical instrument.  Your pump will come with many beeps, sounds, and alarms that are all designed to help you give attention to your pump.....you know, like you will forget it it there! 

Your alarms will generally be the same sound.  The difference will be how long the sound goes on for, and may be accompanied by a vibration.  The alarm is then posted as text on your pump that you are to read/clear.  Here is a list of various alarms you can either set your insulin pump to give you warning of certain things, or preset alarms that you cannot turn off (for safety sake):

- low battery: your insulin pump does not run on love, it runs on a battery.  While your pump will have a visual meter (just like your cell phone), you know that people do not always look at that.  Your pump will alert you to the fact that your battery will soon die.

- dead battery: unlike your cell phone, your pump will tell you that your battery can no longer function.  It holds onto just enough life to alert you every few minutes that your battery is dead (well, almost dead), until it actually dies.

- low insulin: when you are getting low on insulin in your resevoir, your pump will alert you that you will soon need to get more insulin.  You can generally program at what level you want to receive this alert.

- suspended: when you take off your pump, for things like a shower, or other activity, you can suspend your pump so it no longer pumps a basal amount of insulin.  However, it can be easy to forget to unsuspend it when you reattach it (I know it can happen, because I am often caught by this alarm).  If you get the suspended alarm while you are wearing the pump again, you hit yourself on the head and unsuspend the pump.  (The pump doesn't know it is reattached to you, but rings every so often just to say "Hi".)

- BG reminder: you can set your pump to remind you to test your blood glucose levels at a set time after doing a bolus.  Your doctor will often ask for a post-meal BG, and your pump can help you remember to do it.

- temporary basal: when you set your pump to do a temporary basal amount, as opposed to the preset basal rate, your pump will give you a quick reminder saying "remember me, I am giving you a different rate!".

- auto off: as a safety feature, you can set your pump to turn itself off automatically after a set number of hours (mine is 12 hours).  This is meant so that if you find yourself (or someone else find you) unconscious in a ditch, unable to eat, your pump is not going to continue giving you insulin bring your blood sugar lower and lower.  In my case, if I don't bolus (or tell it what my blood sugar is) for 12 hours, the pump turns off and gives an annoying alarm!

Use the wizard!

Using a wizard is really a great and easy way to help get the most out of your insulin pump.  I am not referring to the Dungeons and Dragons wizards or the one from Oz, either.  Your insulin pump will come with something called a "Bolus Wizard", or some other name that basically means a program to tell you how insulin you should be pumping.

How it works is that you will tell your wizard what your blood glucose level is, and how many carbs you are about to eat.  You then hit a couple buttons and the insulin pump will tell you to give yourself a certain volume of insulin, and it will break everything out into how much insulin is meant as a correction for high blood sugar, how much is for the food you are about to eat, and will also compensate for that fact that you may have some insulin left over in your body that is still working, if you only recently did your previous bolus (with a couple hours ago).

All of the settings that you enter into your insulin pump when you first set it up, or on-going changes based on discussions with your diabetes professional, contribute to this "magical" function that tells you within tenths of a unit of insulin how much to give yourself (note my constant use of "give yourself", because ultimately you are responsible for what is taken, but use of the wizards helps you see how much you SHOULD take, assuming no other extenuating circumstances).

This wizard will be able to take things into account, like the day of the week, time of day, and if you have set up rules for these time constraints.  What it will not know is what you cannot tell your pump, such as the exercise you are about to be doing, or if you are sick.

All pumpers should use this feature when they first start using their pump.  I would suggest that most experienced pumpers continue to use this function.  It ensures you are giving yourself a consistent bolus rate for discussions with your doctor, and it is so quick and easy.

Technology is great.....but

I love technology.  I love my smartphone.  I love my computer.  I love my tablet.  I love to bank on-line.  I love that I have an insulin pump and software available to me that will help me track my blood sugars and see trends. 

However, my smartphone cannot yet make phone calls, send texts, or access my facebook account without me doing something.  My computer can't type my blog posts for me.  My tablet can't make Skype calls for me.  My bank account still can't manage itself.  My insulin pump and associated software can't manage my diabetes for me.

Never has this been more evident to me than over the past almost month.  Today I finally did an upload of my blood sugars and basal/bolus amounts, etc.  I had to blink a couple times seeing how badly I have done with respect to control recently.  Had I done this review a couple weeks ago I would have surely seen the slippery slope I was starting to embark upon.  This has given me another jab to get things going again (I seem to need them every once in a while).  My only saving grace is that this has not been caught right before a doctor's appointment where I have to show the details of my recent control.

It is so easy with technology to assume it will do things for you, but you have to realize that while the technology in life, especially the technology designed to SAVE YOUR LIFE, makes things easier for you, you still have to be actively involved in what it does and how it helps you.  Information is only as good as what you do with it.

Exercising With Your Insulin Pump

So, as I have noted in previous posts, I am trying to lose weight, a difficult task for sure.  With an insulin pump you will get quite a few differing suggestions on how to set your insulin basal rates.  The only common thread among the different regimes is that exercising with an insulin pump is certainly easier than traditional syringe therapy, once you get the hang of it. 

The first thing to know is that you should not simply remove your insulin pump when exercising, unless you are in sports that require it (you know, like sumo wrestling or deep sea diving!).  Even when playing contact sports, like football, you can keep your pump on, provided you have taken precautions, like having your cannula inserted somewhere unlikely to get pounded, and your tubing is safely tucked away.

Obviously important is to test your blood sugar before, during, and after vigorous activity, to ensure you are not experiencing low blood sugars.  With all the various diabetes educators I have had, I have rarely had anyone tell me to watch out for lows hours after activity.  I have found that not only will my blood sugar dip during and immediately after activity, but also up to 8 or 9 later (fun when you are asleep!).

Now, you will find many suggestions as to what basal rates you should change your insulin pump to during sports or exercise.  I have tried at least three different ideas on how to make things work, none of which have worked for me. This, like everything else that deals with a person's body, is highly individualized, and you will have to experiment for yourself.  As much as I would love to say "before going out for a 20 min. jog reduce your basal rate to 25% for 2 hours, and ensure your blood sugar is at least 6.5 before starting", I can't.  That is what works for me.  What works for you may be something close, but maybe your optimal basal rate is 50% or 0%. 

What I am truly trying to communicate, is that you have to try and experiment on your own.  Start conservatively and work your way towards what is best for you.  For instance, I started at 0% basal rate for three hours.  My sugars were too high an hour (and two and three) later, so I worked towards something that was optimal for me.  Make sure you do start conservatively, though.  You don't want to mix up the feelings of adrenaline with low blood sugars.

As a famous Canadian fitness team says, "Keep fit, and have fun!".

Diabetes Blog Week - Diabetes Hero

This Diabetes Blog Week has been fun.  I hope you have had fun reading the posts, not only by me, but by everyone involved in it.  I learned a few things!

The last topic for the week is about who my Diabetes Hero is.  My hero is you, me, and millions of others around the world who contribute donations to their local diabetes related organizations.  Without the help of all of us, many advancements and discoveries would not have happened, and many of us may not even be here today.  Fundraising and donations do not only occur in November (National Diabetes Month in many countries) but throughout the year, and in different forms. 

Whether it be through donating used clothes and household goods (through the ClothesLine program in Canada), volunteering your time, fundraising with the Diabetes Walk, or donating money, you should all stand up and take a bow.  While I am sure we far from a cure, we can certainly take solace in the fact that everything we do brings us one step closer.