Wednesday, September 24, 2014

Please Let Bluetooth Happen!

One of the less serious but more annoying frustrations I deal with as a Type 1 is the amount of crap I need to carry in my pockets.  Thankfully K likes her bags so I can unload my cache of diabetic paraphernalia to her from time to time but that leads to some serious angst when I have to test or if I forgot to take my testing supplies out of her bag when we return home from dinner.  So I've been incredibly excited by both Dexcom's patent filing and Medtronic's announcement at Health 2.0.

I love my Dexcom, although I somewhat agree that a CGM is a luxury device, it gives me the confidence I need to get through the day.  Seeing my glucose trends in real-time lets me make smarter decisions; like knowing if I need to exit a meeting to treat a low or run out of a movie to grab a coke. However, having to carry my cell phone, finger pricking stuff and CGM makes me sometimes feel like I need an extra large suitcase on wheels to bring everything around with me.

Having my CGM (or insulin pump controls for that matter) connect directly to my cell phone simply makes sense.  Phones have become the control center for everything we do electronically.  We can communicate with friends, book reservations, find a taxi or get directions all from our pockets.  Yet I can't look at a number that is already communicated to a separate hand held device?  Bluetooth is a pretty accurate technology and does not greatly impair battery life.  Plus I've never blindly trusted my CGM so I do not buy the worry that bluetooth may be less accurate than the current radio technology the sensor and transmitter uses.  The bluetooth direction will reduce one huge frustration I have in managing my disease and think it could open the door for some big improvements in managing the lifestyle side of Type 1.

Monday, September 8, 2014

Challenges Will Always Happen

Friday night I headed home after a long week at work excited to have my first weekend home in over 7 weeks.  K and I had a whirlwind of a summer with family obligations, vacation, sports travel and a bunch of other stuff.  This past weekend we were psyched to enjoy NYC and get in a bunch of couch time.  Friday night was relaxing as planned but the sh*t show of health issues began ominously on Saturday morning.

Since this was our first weekend home in quite some time I thought it would be great to cook K breakfast in bed on Saturday.  My awesome idea started by dropping 2 eggs directly onto the oven as I tried to flip another off our skillet and our coffee machine deciding it was a better idea to spray all over the counter than get into the carafe.  This was followed by yours truly essentially knocking himself out by banging my head on the bottom of a cupboard as I bent over to pick up a dropped water bottle.  All in a tough start to a Saturday!

Following my 1.5 hour trainer ride my blood sugar was a pesky 195; high for the amount of food I had taken in but figured my body was still just tired.  I had a kind of light lunch and was surprised my blood sugar had climbed to 285 after a mile walk.  This is when the real fun started.

Saturday evening K and I were scheduled to attend an event for Marjorie's Fund, a non-profit lead by my endo, Dr. B, that focuses on helping the under privileged and developing countries get the medical supplies they need to manage type 1.  Both Dr. B and Lauren, my sports nutritionist, were on the agenda to speak so I was actually looking forward to attending.  An hour into the event my blood sugar was still at 305 (the third straight hour of being in the 300s), so I found Dr. B and let him know I wouldn't be able to stay for the talking portion of the evening; this also meant I had to cancel K and my dinner reservations.

Once home I changed to a new vial of humalog, got a new insertion set and commenced the blood sugar management games.  My rage bolus of 4 units of humalog added to the five units I already had in made for a super interesting 7 hours.  For dinner I had an english muffin with peanut butter and an hour later my blood sugar had already dropped 175 points.  I added a clif mojo bar to my stomach and had hoped my bs would stabalize around 120.  I was woken 3 times that night with blood sugars in the 40s - 50s and woke up Sunday with a bs of 58.  It seemed the highs were over so I was excited for a Sunday of exercise and football.

Excitedly, K and I headed up to Central Park for a run mid-morning Sunday.  Most of my exercise over the past year has been focused solely on cycling.  I've run in a pinch or when my legs needed a break but 7 - 8 miles is about the longest run I've had in the past year.  Sunday I decided to get after it with a full loop of CP plus the carriage loop (another 2 miles) so 8.5 miles in total on rolling hills.  I completed the run at close to an 8 minute pace (somehow) with an amazingly stable blood sugar.  An hour later the fun began.

My blood sugar stayed close to 200 after my run (weird for me) and then my stomach was put into a vice grip.  For the next 6 hours I was laid up on our living room couch in the fetal position trying to keep my eyes open and my butt out of the bathroom.  The combination of the highs the night before and my sweat from the run must have had me totally dehydrated.  That led to some major major stomach cramps and a bad case of the runners trots.

Moral of the story, each day brings a new challenge and sometimes you just gotta roll with the best laid plans.  Plus, I owe my wife one heck of a night out with all she put up with this weekend as a type 3.

Thursday, September 4, 2014

Biking to work in NYC - $@#!!!!

During my MBA summer internship 5 years ago I got into the habit of biking into work.  I find getting to work with my legs as the engine liberating and relaxing.  Plus starting the day with a 3 - 5 mile easy bike ride tends to stabilize my blood sugars.  That habit continued through my time in San Francisco and for the past 2.5 years in NY.  To this day I find riding a folding bike in NYC the single best form of transportation this city has to offer (my Cervelo is saved for real riding).

But the liberating feeling I have found through biking into work is starting to get replaced by rage.  There have been several news articles over the past few months discussing the hypocrisy of driver v cyclist laws, including this excellent piece from the NY Times.  However, I still find riding down the middle of 5th avenue during rush hour traffic "safer" than riding in NYC bike lanes.

Both our former Mayor Bloomberg and current Mayor DeBlasso have made instituting bike lanes across the city a big priority and they deserve huge kudos for that.  Lacking, however, is the basic education of pedestrians that bike lanes are not an extension of the sidewalk and demand the same respect as the regular part of the road.

Today I hit my boiling point.  For three consecutive streets I had to tell 3 people to get out of the middle of the bike lane.  The first two were mid 20s women, texting on their cell phones, head down, walking and stopping directly in the middle of the bike lane while the "don't walk" symbol was in the cross walk.  The third was a middle aged d*ck who starred at me as he lit his cigarette in the middle of the bike lane smack in the center between 9th and 8th street who had the audacity to tell me to "shut up," when I said, "dude a little heads up here."  A little over a month ago I was also t-boned by a 10 or 11 year old girl who decided it was a good idea to sprint from between cars directly into my front wheel, I told the Mother she was lucky I wasn't a car.

NYers consider themselves the smartest people on the planet, I should know I'm one of them.  So I find it impossible to believe that NYers fail to comprehend that this huge neon green painted lane on the street is not, in fact, an extension of the sidewalk.  Biking to work shouldn't be like navigating a Bosnian land mine field, it should be a great experience that has the same protection and rights as driving to work.  Alot needs to be done to educate pedestrians otherwise there is going to be a civil war in the bike lanes of NY with a whole bunch of charging rhinos hitting into people on cell phones.

Monday, August 25, 2014

Infusion Set Woes

Bruising, blood squirts, scar tissue and funky looking sites are some of the things a diabetic has to look forward to when pumping.  Those fun events combined with the Animas infusion sets not working for me had me switch to shots for about a year.  I loved having a break from my "tail" but at the end of the day I have tighter control with a pump and a pump gives me much more flexibility for working out.

However, since going back on a pump about 6 months ago I've been dealing with a seriously viscous infusion set monster.  Once again I am a happy Minimed pumper using the silhouette infusion set.  This time around 1 in 4 infusion sets are attacking my rear end.

Not sure what I'm doing wrong this time but I've ripped infusion sets out after inserting them (ouch), have had some serious bruising, and on more than one occasion have had my wife chasing me around the apartment with a towel as I didn't realize blood was "gushing" down my leg.  She is starting to realize having white sheets with a type 1 hubby may not be the best idea in the world. 

I know I have buns of steel but it's time my caboose and the infusion sets start getting along...

Friday, August 15, 2014

It Takes 2

Well it's been a while that's for sure!  Since the last time I blogged I've gotten married, been promoted a few times, became a two-time Uncle and have had more diabetic lessons than I can remember.  I stepped away from blogging for a while so I could focus on handling my disease while my life was totally changing.

I learned that diabetes is a heck of alot easier to manage when you make 100% of the decisions for yourself. But when a person starts thinking as two and the other's happiness is even more important than your own blood sugar management becomes harder. K has always understood what I struggle with but she had to get up the same learning curve we all did when first diagnosed: what foods affect my blood sugars when, how to make time for cooking each meal, how to avoid unprocessed foods and how to help me make smart choices at each meal.  As we struggled up the learning curve my A1c and weight bounced around, my highest A1c was 7.2 (which had alot to do with the Animas infusion sets not working for me) and my weight at times crested 200 lbs.  But now she is a fully certified type 3 and understands how each piece of food will impact my blood sugar and fully supports why I'm obsessed with getting in hours of exercise.

With K's help my A1c was a shockingly low 6!  And my weight is now back under 190.  In her own subtle way she has taken over the grocery shopping, gotten me to refocus my diet and is making sure we eat out a ton less.  She lets me bring my bike on vacation and does whatever she can to help me fit in a long bike ride or run if there's going to be a feast that night.

Without her support there is no way I could have reached the lowest A1c I've had since I was still producing some insulin.  I once thought that I could fight this disease head on, that each day was about staring my blood sugar down and out working the problem.  It's way more of a dance than that; I can't do an Ironman everyday and I can't live my life on an organic farm.  It took a few years but K has taught me how to achieve amazing results while being less intense on how to get there.  No way could I have gotten to an A1c of 6 without her love and support.

Friday, September 7, 2012

Race Report: Chicago Triathlon; Ouch!

I was excited to head to Chicago for the race; neither Katie nor I had ever spent time in Chicago and I was competing having raised more than $1,000 for Insulindependence adding some special flare to the event.  Heading into the race I had felt in pretty decent shape, my training was a bit off in the weeks heading into the race as we had switched apartments and work became absolutely crazy but I was feeling good nonetheless.  Ironically, however, in the race I had raised money to support a non-profit that promotes active lifestyles for people with juvenile diabetes I was deeply affected by high blood sugars for the first time on a race day.

We left for Chicago Saturday morning and my blood sugar was a happy and stable 110.  Once in Chicago we walked to the Hilton to pick up my bike from Tri Bike Transport and on the way home my blood sugar dropped down to the 40s, the only period my blood sugar would be below 250 for the next 14 hours.

Once I finally got my blood sugar to rebound it continued to climb no matter how much insulin I took in.  From 3pm until I went to bed at about 11pm my blood sugar stayed above 300; I took in about 10 units of insulin with little or no impact.  The high blood sugars were making me feel sick, very sick.

I woke the next day at 5am to a blood sugar of 275, decided to change my infusion set and headed off to transition to rack my bike.  After riding to transition (about 3/4 a mile away) and walking back my blood sugar dipped to 230 but would then start to rise again post my breakfast of an extremely low glycemic cereal.

Once at the race site for my 8:30 am start time my blood sugar was still above 200 but started to trend just slightly downward.  The declining trend had me really worried about going low during the race so I took in a gel, got to the swim start and was off.  About a 1/4 of the way through the swim I started to feel pretty nauseous but got through it in 35 minutes (sans wet suit) and then was off for the 1/4 mile jog back to transition.

In transition I tested and had a blood sugar of 185; the downward trend was continuing so I took in another gel and headed off on the bike.  Once on the bike I knew I didn't have the pop in my legs I normally do as my mouth was getting more watery by the pedal stroke.  I finished the 25ish mile course in an hour and 10 minutes, a bit slow compared to where my cycling is and I just didn't feel right.  On the second half of the bike I was going in and out of focus; my vision was blury from time to time and I felt like I was holding back vomit as the miles ticked by.

Back in transition I tested again and had a blood sugar of 105; uhoh still trending down and time for a run.  I took in another gel and 2 minutes 30 seconds into the run I was spent.  I could barely focus, my stomach felt like it was in a vise and all I wanted to do was sleep.  I started to walk less than a 1/2 mile into the run and had to refrain myself from punching someone who shouted words of encouragement "that's it just keep going at your pace."  I thought, "dude I'm about to throw up everywhere all my pace is doing is keeping me from projectile vomiting on your face."  Realizing that I was in no condition to keep moving I found a grove of trees to "hide in." 

I sat for about 10 minutes trying to get the energy to run again.  Once I felt like my legs were coming back and that my blood sugar was rebounding I got back to my feet and started to jog again.  About another half mile in my stomach started to kill me and I started throwing up a little bit at a time.  I then began walking for the next 2 miles.  The first 2.8 miles of the run took me 45 minutes; just under the time it should have taken me to finish the entire run.

At mile 3 I was able to start jogging again fighting off stomach cramps and overall just feeling incredibly crappy.  Once down the finisher shoot I could barely focus, was starring at my shoes and just wanted to cross the finish line to throw up again.  I crossed the line, found a spot on the railing and waited for Katie to meet me with my Uncle and cousin (they live in Chicago and were awesome to come out to support me).  Once Katie met me at the railing I handed her my stuff and said "sorry I'll be back I need to go throw up."

I found a private spot and began to yak (note to self warm clif shots coming back up are disgusting).  After emptying my stomach my cramps started to go away and I began to take in a ton of fluids.  Finally back at transition I tested again and had a blood sugar of 150.  It seemed that whatever was going on my blood sugar was finally getting back to normal.

But, I finished; when I set out on this journey my goal was to prove that a chronic illness does not have to prevent what someone can accomplish and to inspire children with type 1 to chase their dreams.  The Chicago triathlon was by far the worse race I have had, the stomach cramps, weird blood sugar and just overall sickness I felt made this race emotionally and mentally more challenging than any Ironman I had done.  While laying in the trees I thought to myself, "I'm sick of this disease, I'm tired of fighting, I'm tired of being affected by a condition which is invisible to so many."  But by the time my mental focus was coming back I felt a renewed desire to fight this disease.

Managing type 1 diabetes isn't easy and sometimes I lose sight of that.  I've accomplished so much in my 5 - 6 years with this disease that I forget it is a constant, daily struggle to live as healthy as I can.  Each day a diabetic faces a new challenge; each day a new lesson is learned.  At the Chicago tri the money I raised for IN reminded me of that.  I was reminded that yet again diabetes cannot define who I am, but it does in part make me who I am.

Monday, August 6, 2012

The Kinks

I've been making great progress getting my blood sugars back under solid management.  Since my A1c wake up call I've gotten myself back to having blood sugars consistently in the 90 - 140 range and can totally feel the difference.  The constant headaches, stomach cramps and other issues related to bouncing blood sugars have left.  I'm able to focus more consistently, enjoy all my workouts and eat like myself again.  All this has left me feeling great and hopefully made me a lot more pleasant to be around.

But... from time to time I'm still getting some really annoying/ weird blood sugar situations.  I'm not sure if the infusion sets that Animas uses are less sturdy than the sets Medtronic uses but I have vastly more issues now than I did with OPP.  I've noticed a few things with the Animas infusion sets:
  • Kinks at the end of the animas set are alot more likely
  • The cannula has a much greater tendency to dislodge itself
  • Leaving the infusion set in for more than 3 days leads to a bit of a calcium/ scar tissue build up
I felt like the Medtronic sets were alot more consistent and that if I had solid skin contact on initial insertion I could be confident the cannula would be in there when my reservoir ran out.  With the Animas sets that simply isn't the case.  I'm running into case after case of the kinks; where the end of the cannula gets pinched or crimped leading to improper insulin flow.

For the past few weeks the only times I've gone above 225 have been from a case of the kinks.  I have no real desire to ever get off an insulin pump but at least with shots you know the insulin was delivered.  With a pump getting a case of the kinks is just something you have to deal with; but with tighter regulation I can be pretty sure that if my blood sugar is above 250 something is going on.