Thursday, November 17, 2011

Pumps and Setting Basal Rates. um, yeah..

A type 1 diabetic that follows a routine of Multiple Daily Injections (MDI) needs 2 insulins: 
- A short term insulin that you take every time you eat to process the carbs from the food
- and a long term insulin to process the hormones that your liver produces which manifest as sugars in the bloodstream
Those of us that wear insulin pumps, only have 1 insulin -the short term insulin on a constant drip.  This allows quite a bit of flexibility, because this steady drip of insulin, called BASAL insulin, can be adjusted to suit the users needs

The adjusting can be tricky.
Priority one, is to equip yourself with the Insulin Pumper's Bible, called Pumping Insulin by John Walsh.  This book adresses most situations and teaches you how to set and correct rates.

Personally, I have found that some levels are easier to set than others: for instance setting a level that will deal with Dawn Phenomenon.  
Dawn Phenomenon is an increased blood sugar towards the morning.  Basically, it's your body's way of saying it's time to wake up and eat.  The way I programmed my basal insulin in my pump to deal with it, was the following:

I wake up at 6AM
My insulin has a reaction time of 3 hours
I adjusted the rate from 3Am-6Am tweaking slightly every 2 days until I was waking up within range (which for me is 4.3-6.4mmol/L)

Setting daytime basals is much trickier though.... The goal is to have steady levels that answer your body's needs without any other factors contributing -like the doses for food (bolus).  SO you have to fast, and can then start to assess about 5 hours after your last dose for food (bolus).

So you choose a portion of the day that you want to assess. This means, find a day when you can fast.  BUT!  I don't want to fast!I love my meals and snacks!!!!
That means skipping a workout at the gym, possibly for a few days! 
I don't want to miss my Zumba class!  It's a highlight of my week!

OK, that aside, it's really hard to find an 'average' day, when you are contending with 
hormones -which for most women differs from week to week
And the activity level is almost never average -what of the 3 trips to the car to load up before dropping off your child at daycare, not to mention carrying around my 30 pound child, up the stairs, down the stairs...
AND, if you get all that right and you go low, then you learned that your setting 3 hours prior may be too high.  So you fix that, and the test is now over.  You have to redo it to lock in more numbers.

TRUTH: I kinda do my own version of basal testing/adjusting. I'm not suggesting it for anyone, but I'm being honest.
I did extensive basal testing once upon a time, I have those values set.
When I want to fix an emerging pattern, I test often and I  track everything
I eat the same thing several days in a row.
I spot check any numbers that don't make sense.

I can't be the only one though, can I?

Wednesday, October 12, 2011

Loving Medtronic!

SO at long last, VACATION!!!!

We rented a condo in Fort Lauderdale by the sea. Right on the beach!  Walking distance from a Winn Dixey grocery store... and all the low fat and low carb US food offerings (yay!  Publix Key Lime frozen yogurt!!!!!)

Day 1
We arrived! It was hot!  We slathered ourselves in sun screen and walked down the beach, right by the water because the sand was HOT!  We drank ice cold glasses of Diet Sierra Mist (Love it!) under parasols.  We admired the aquariums in the lobby of our condo.  We shopped for sand toys for my son and did our first round at the grocery stores.  (Not so easy to find Quinoa, by the way)

Day 2
We woke up early.  We sunscreened and went to play in the sand: my son was very excited to scoup up buckets of water and pour them onto my sand 'birthday cakes'.  We waded into water up to our thighs.  We admired sea shells and dodged jelly fish.
At about 11AM, it started to get too hot for us .  We walked back into the wonderfully air conditionned lobby.   My son eagerly rose to his tippy toes to press the elevator call button (he gets so proud when the button lights up).  We get inside and wince at the high pitched ringing noise.
'Do you hear that too?' I asked my husband
'They must be working on something to do with the elevators' he replied

We got out at our floor.  And the high pitched ringing sound continued.
 My husband and I exchanged a look of resigned annoyance but what could we do.

We walked into our condo.  And the sound continued.
'My God!  It's in here too!' I said.
My husband walks into the kitchen, I followed behind 'here too!' he said.
'Oh no, hope it's not in the bedroom, we have to put the baby to nap!'  I hurried into the bedroom

'It's here too' I called out
'It stopped in the kitchen' my husband yelled back. 

I went to to check it out myself and my husband went to check out the bedroom

'It's back in the kitchen' I yelled
'It stopped in the bedroom' he responded.

We met in the living room,
my husband looked at me
and pointed at me
'It's you!' he said

Yes, indeed.. It was my pump.  It had died and was screaming on it's deathbed.  Just 5 years old and dead.  This was my first and only insulin pump.  This had never happened before.  A piece of the plastic at the top of the battery compartment had actually broken off.  And now my pump was finished!

I called the 1-800 customer service number for Canada/US Medtronic and learned that my warranty had actually expired 3 weeks prior.  We're talking about a $7,000 medical device here!
Now what?  I had no emergency rental pump that smarter people obtain from Medtronic ahead of time to bring with them on vacation for just this purpose.  I have never needed their help for anything actually.
I was suddenly very upset and overwhlemed.
'What do I do now?' I asked Shilpa, the Medtronic customer service rep
'Well, you go back to multiple daily injections.  Do you know how to do that?' Shilpa asked
'I guess, but I think my Lantus is expired' I answered 'But you know', I continued, ' I never once needed any replacement pumps from Medtronic'

And then, the lovely Shilpa said this:
'Well, I see you never needed a courtesy pump.  Since you are just 3 weeks past expiry, I will ask my manager if we can still send you one'
'Wow!  Thanks!' I said 'Go ask, I'll wait on the line' 

At this point, I was still hoping a new pump would magically appear and I could avoid going back to 4-7 injections per day.

'I'm sorry Tamara, but I will need to get back to you after I have spoken with my manager, it may take a day or 2'
Oh no!  A day or TWO!!!!
So I hung up, went through my diabetes supplies and my emergency diabetes supply.  The short term insulin, Novoprapid is what I used in my pump, so I had plenty of that on hand, I had planned for that!  The Lantus had expired.  You don't need Lantus when you're on a pump, the Lantus stays in your system for 24 hours, with the pump, you get a steady drip of short term insulin instead (which can be adjusted to suit your body's needs)
I set about finding the name and number for a pharmacy nearby. CVS on 34th avenue.  Good.

I called my neighborhood pharmacy.  I needed them to call in a prescription for me. 
'I'm sorry' said the curmudgeon pharmacist over the phone, 'we can't call in a prescription to a pharmacy in  foreign country'.
'But it's the United Stated!' I said, making an effort to sound likeable and friendly (I am in sales after all, no one wants to go out of their way for a shrew) 'Our friendly neighbor to the South.  And it's insulin not morphine.'
'Nope, nothing I can do, sorry' he said cheerfully and hung up
'Prick', I mumbled.
'Pwick! Pwick! Pwick!' chirped my 2 year old happily, seizing on a new word he clearly wasn't supposed to hear

Luckily I have an awesome endocrinologist at the Montreal General Hospital.  I left him an urgent message. 

Meanwhile Shilpa from Medtronic called me back.
'Good news' she said' we've approved a one time courtesy pump for you, since your warranty expired so recently.  Where should I send it?'
I did a happy dance and gave her the Florida address.  It would take 2-3 days but a pump was on its way!!!!!

My endo called 5 minutes later.  He called in a prescription for Lantus at the CVS pharmacy (good thing I had the information).  He instructed me how much to dose.  He coached me on how to transfer back to a pump.  He even gave me the settings for my hourly insulin rates and food ratios (which I had updated him with at our appointment a month earlier.

It's a funny thing to find yourself absent a medical device that you've worn 24/7 for over 5 years!  First, I took advantage of not having anything to clip to my persons and wore a fun and flirty summer dress with NO BELT!  Then, I ended up taking 3 injections within the next 3 hours: for lunch, a second helping and then a snack later.  I was used to eating and dosing with the push of a button.  Without a pump, each of these actions required injecting insulin.  And at night, every time I rolled over, I woke up panicked that my pump wasn't there...until I remembered.

The moral of the story:
1. Visit your endocrinologist with regular frequency so they have a record of your ever changing dosing needs
2. Always send your endocrinologist a Christmas card; you never know when you need them to call you long distance to help you out of a jam and call in a prescription to a foreign country
3. make sure you have up to date meds and a back up pump (lesson learned!)
4. Choose a reputable company from which to purchase expensive medical devices (yay! Medtronic!)

Lastly, Medtronic Rocks! 
and of course, love your pancreas.  You never know when it up and ditches you

PS Was super cool to meet a fellow pumper at the Winn Dixie while grocery shopping! We totally started chatting as though we were soldiers in the same war.

Monday, August 8, 2011

SO, how'd that walk go, ay?

Hello Fabulous and wonderful people,
I hope that this message finds you all in the midst of enjoying a lovely summer!

To give a little debrief…
The walk was a big success!
It wasn’t cold
It only rained AFTER the event
The JDRF Quebec region had set a goal of $370,000 but at last count we raised $420,000!
We couldn’t have done it without you!

We had a team!
Some friends and colleagues that never let me down (you know who you are!)
Some friends of mine that had never walked before (thank you!)
Some former colleagues and some friends’ relatives
All brilliant and gorgeous people!  Thank you!

And as for those that couldn’t make it but promise to attend next year, I’ll hold you to it!
It’s so nice to have an annual event that allows us all to see each other and catch up!

It’s also so nice that the president of AMG, Philip delBuey, is tall enough to help our team assess how far we are when we fall behind.
(Stop to fix a stroller or grab a snack, next thing you know you’ve been passed by 50-some people, you lost the team…but wait!  There’s Philip!  We’re OK, not too far behind)     

Yes, it was a grey day, it event drizzled a touch
And yes, the rain prevented the JDRF from putting up the big bouncy things
BUT!  We walked, we chatted, we collected bike reflector lights, we played with our free Frisbees, we tasted nutritionally boosted milkshakes, we doled out samples of Dex4 (New Tropical Fruit flavor!)
We saw ducks and peacocks, we ate sandwiches and interesting yogurt flavors, we crunched organic apples and we polished off the free frozen yogurt (LOVE TCBY!)

As for Team AMG & Friends,
We came in a little shy of our $10,000 target amount, but I will only get the add up in a few weeks (some donations are still trickling in)
All in all, a decent showing and I was proud to be your captain.
I was very touched by your support and your words of encouragement.
And yes, everything from my ‘Day in the Life’ message, is a truthful account of a day in my life!

I’ll follow up with the add up of donations as soon as I get it

Until then…..  love your pancreas!

I’ll be seeing you!
Tamara Segall

Tuesday, May 24, 2011

A Day of My Life -Starring Type 1 Diabetic Me

Hello My Friends, Colleagues, Family, and Polite Acquaintances!

This is a personal communication from me, Tamara… (so it’s a long one, juicy too)
At long last, spring is upon us.  This means we have so much to look forward to: longer days, warmer sunshine, fragrant fruits and vegetables, and the JDRF walk-a-thon also known as our annual hike and picnic event!

Every year, when I draft these messages inviting you to walk with my team and encouraging you to donate to finding a cure, I try to share with you the realities of Diabetes.  Basically, I want to help you to understand why your donations and efforts are so important to me…. and your friendly neighborhood diabetic community.

It occurred to me that you all know that I have juvenile diabetes AKA Type 1 (my pancreas does not make insulin)
                you all know (more or less) what juvenile diabetes is,
you all heard about how I was diagnosed,
This year, I thought I would share with you what it is to live with Type 1 Diabetes.  This will perhaps give you an idea what a cure for diabetes means to me.

A Day of My Life –starring Type 1 Diabetic Me

3:45 AM                I wake up from a deep sleep.  Still in bed, I check my alarm clock and realize it’s not yet morning.  I mentally quiz myself as to why I woke up
                Did I have a bad dream?  No, that’s not it (I think I dreamt I was flying, that’s awesome)
                Do I have to go to the bathroom?  No, I’m OK
                Am I low? I better check.
I swing my legs over the side of the bed to sit up.  Immediately I start to feel dizzy and weak.  I grab my glucose meter, a strip of plastic is sticking out of it (I prepared it the night before so that I wouldn’t have to fumble and get one out and try to put it into the little slot when/if I need to test in the middle of the night, like now). I prick my finger and a drop of blood beads at the puncture.  I apply it to the strip.  The machine beeps a reading of 2.4mmol/L.  This means I am having a low (because the number is under 4.0mmol/L).  I grab a tube of Dex4 tablets from my night stand (watermelon, my favorite) and shake out 3 tablets.  Crunching, I lie back down on my pillow and try to figure out if my low is due to a mistake I made. 
Did I over inject for my cookies and tea, the package said 20g of carb, I injected 2.0 units of insulin, but was there fiber?  How much fat was there, I think it was 7g of fat, not enough to affect my dosing… Do I need to adjust my basal insulin?  Am I getting too much insulin in the middle of the night?  Was it because I had a harder workout?  I fall back asleep

5:45 AM                                The baby singing through the monitor gets me up.  It’s morning.  I get out of bed and prick my finger, dab the drop of blood onto a fresh test strip to check my blood sugar.  A glorious 5.2mmol/L.  Excellent!  Over 4.0mmol/L and under 7.0mmol/L, it’s time to eat!  For breakfast, I prepare 1/3cup of Oat bran (20g of carbs) with 2/3 cup of unsweet vanilla almond milk (1g of carb) and a cup of strong black tea with 5 tsp splenda (1.5g of carb) and about 2 Tbsp of almond milk (0g carb) .  I count it as 20g of carb and inject 2.2 units of insulin as per my breakfast ratio of 1.1units for every 10g of carbs

8:00 AM                                I’m at the office booting up my computer.  I carried baby, gym bag, purse, lunch bag, and briefcase to the car (2 trips to the car half a block away and back up the stairs into my house), dropped the baby off at daycare, walked across the employee parking lot to my office then over to the kitchen in the office to get a cup of tea: 2 packets of sugar twin (0g carb) and about 2 tbsp of the lactose free 2% milk (0.5g carb), so I neglect to inject for it.  I prick my finger, dab the drop of blood onto a fresh test strip to check my blood sugar.  The machine beeps 4.8 mmol/L, very good, yay me!

10:00 AM              Snack time!  I pull out Ziploc bag with 10 baby carrots and a low fat baby bell cheese (6g of carb) so I inject 0.6 units of insulin

11:45 AM              The plan is to leave in about 20minutes to go to the gym for a lunchtime run and some light weight training.  I prick my finger, dab the drop of blood onto a fresh test strip to check my blood sugar.  The machine beeps 4.0 mmol/L.  So I pull out a protein bar (16g of carb, 4g of fat, and 15g of protein) and it’s chocolate coated, yum!  I polish it off (embarrassingly quickly, but come on!  It had chocolate on it) and drink half a bottle of water.
1:15 PM                 Back at my desk.  Fresh from my shower with my cheeks flushed red.  I prick my finger, dab the drop of blood onto a fresh test strip to check my blood sugar.  The machine beeps 5.8 mmol/L.  Yay!! Lunchtime!  I earned the right to eat this lunch! And it looks like I got almost 30 e-mails to read through.  Perfect!
For lunch I have packed my usual: 4 cups of salad (2 types of lettuce, spinach leaves, and endives), 1 small can of Clover Leaf tuna pre-seasoned sun-dried tomato and basil (2g carb and 4g of fat –the carb counts differ by brand), 4 Tbsp Kraft light Zesty Italien dressing (that’s 4g of carb and 2g of Fat) and for desert 1 ½ cup of sliced strawberries (15g carb) with 3  tbsp low fat ricotta (2g of carb) sprinkled with 2 tsp Slenda (1g of carb)and to wash it all done, a massive cup of peppermint tea with 2 packets of twin (og carb)  I add it all up to 25g of carb and inject 3.3 units of insulin as per my lunch ratio of 1.3 units of insulin for every 10g of carb. 

3:30PM                  I’m not exactly starving but am becoming very aware of the muffin I brought for a snack.  It’s a Zucchini ginger muffin, one of my favorites!  It clocks in at 15g of carb and 4g of fat.  What the hell, I could do with a nice strong cup of coffee (my colleague Cris has brewed a little extra for me to partake ...he’s a good man!)  I prick my finger, dab the drop of blood onto a fresh test strip to check my blood sugar.  The machine beeps 11.4 mmol/L.  Dammit!  But hang on, I still have some insulin in my bloodstream from lunch, so to fix this, I need to inject an extra 0.8units of insulin (and the thought process starts, was I overly generous with my portion of fruit?  Was it the dressing?  Was it an air bubble in my last injection??? Was my work out too hard?) But the thought of the muffin pushes all the other thoughts away.  I opt to inject for it anyway because Cris’ office is down a long hallway and up a flight of stairs, so maybe that’s enough to get things moving a bit.  SO I inject 1.2 units of insulin as per my afternoon ratio of 0.8 units for every 10g of carbs.

4:30PM                  Time to leave the office and go pick up the baby.  So before I drive home,  I prick my finger, dab the drop of blood onto a fresh test strip to check my blood sugar.  The machine beeps 7.2 mmol/L.  I’m good to go

6:00PM                  Dinner is served.  The baby and I go wash our hands, and I hoist him on my hip so that we can check my blood sugar.  Using one hand, I prick my finger, dab the drop of blood onto a fresh test strip to check my blood sugar.  The machine beeps 3.2 mmol/L. What?  The baby eagerly yanks the used strip out of the meter and drops it into the bright yellow ‘used medical waste’ container, I pop a Dex4 tablet into my mouth (the new tropical fruit flavor, yum!)  The baby tries to pry my mouth open to see what I have dared to eat without offering him to taste.  Dinner is steamed tilapia with my husband’s secret marinade and capers, ¾ cup Quinoa (35g of carb) and ¾ cup of steamed broccoli with sesame seeds (15g of carb) The dinner is 50g of carbs but since I’m low, I inject only once I’ve eaten, 5.5units of insulin as per my dinner ratio of 1.1 units for every 10g of carbs.  My sweet tooth start to tingle though, so I eat 2 squares of Lindt 75% Equador chocolate 6g of carbs and I inject 0.7units of insulin

9:30PM                  On the sofa watching a few episodes of Community (that Chevy Chase!) and Modern Family.  I want desert.  So I decide to check how much leeway I left myself for desert.  My guidelines are 150g of carbs, hmmm, I’ve eaten 130g of carbs, if I include the protein bar).  I prick my finger, dab the drop of blood onto a fresh test strip to check my blood sugar.  The machine beeps 6.0 mmol/L.  Yay!!! Desert! I opt for the same pack of cookies I had the day before.  20g of carbs.  I decide to inject properly for it 2.0 units of insulin (as per my late evening ratio of 1.0 units for every 10g of carbs) and make a mental note to explore  If I go low in the middle of the night again…

SO, dear readers,  I’ll have you know that this constitutes an excellent day!  Sometimes I wake up thirsty because my blood sugar is too high and I need to give an injection of insulin to fix.  Sometimes I go low in the middle of my work-out and have to stop for a bit until the Dex4 takes effect and I can continue. Sometimes high blood sugars follow me around all day, leaving me wondering if I’m fighting off a cold or infection.  Also, I am a good diabetic, because I check often.  That’s my tactic to make sure that I minimize my odds of diabetic complications years down the road (like losing my eye sight, compromised circulation in my legs and hands, strain on my kidneys…) 

Bang for your Buck
When you sponsor me for this walk-a-thon, your donation goes to the JDRF (Juvenile Diabetes Research Fund).  To give you an idea of the types of cures JDRF is presently exploring:
Developing an artificial pancreas -a device that combines continuous glucose monitors with insulin pumps, joined by a computer algorithm, to deliver insulin when needed based on glucose levels,
Various areas of research from stopping the immune response to regenerating and replacing beta cells… 

The Walk
You bring your friends and family to walk with you on a lovely Sunday morning, in a beautiful park.  You meet great people, you breath fresh air, you walk, and then they feed you!  You get a lunch bag loaded with good stuff and we all sit down and have a picnic and catch up like we haven’t since the year before.
It’s a great morning of activity for the kids, by the way; face painting, inflatable games, entertainment music, the walk( obviously),  David’s tea will be there.….  and fun  fun fun!!!!

Personally, this walk-a-thon is one of my favorite outdoor events.  I don’t even care if it rains because I’m so happy to be outside, plus I have beautiful rain boots that make puddle jumping really run….BUT IT WON’T RAIN!

The future of Diabetes Research –starring you

1.       Please sponsor me.  I am aiming to raise $10,000 this year for Team AMG and friends.

Tamara Segall
So far I raised $176 from the AMG book fair and from donations.  (thank you Marcia!!!)
Team AMG has raised $361
SO, clearly, I need your help to reach this goal.  You could also give me the funds in person as a cash or cheque.  My office is all the way at the end by the windows near Danielle and Janelle’s candy dishes. (By the way, the candy’s are on average 7g of carbs each.  I would need on average 0.7units of insulin to eat one :-)

Please join my team and come walk with us! 

So far, we are a team of 8 people.  A few awesome colleagues, some with their families (thank you Josie!), my husband (he hasn’t missed one yet), and my friend Sandy (you’re fabulous, thank you!)

The Walk : Details
Centre de la Nature parc in Laval
901 avenue du Parc
Sunday June 12th, 2011
Registration starts at 8 :30AM
The walk starts at 10:00AM

FYI: there will be a free shuttle from the Cartier Metro station every 30minutes starting at 8:00AM
I end with a final reminder to LOVE YOUR PANCREAS!  Love it good for everything it does for you that you don’t know.

And we’re off!

Thank you,

Tamara Segall