Month: October 2015

Executive Disfunction

My ADHD mind is constantly spitting out information and reminders. Don’t forget to call Jack because you have to find out if the birthday party is happening. If it’s not, you should read that Oliver Sacks book you’ve been wanting to dive into and if you’re going to do that, you should get some snacks, maybe some tea, but not all carb-y because you need to work out more and. . . .

On and on my mind churns out things like that. When that happens I bust out my notebook and on a page I’ll write: Call Jack, Oliver Sacks book, workout tomorrow, get some snacks.

The ADHD voice cuts out because I no longer need a reminder. My ADHD is the kid in the backseat on a road trip: “Are we there yet?! Can we get there?! How long?!” Once I let my ADHD know that I’m not going to forget, that it’s eventually going to get done, it quiets.

Sure I could put this information in my phone, but I find that using the phone tends to bog me down and disconnect me, but I do use it for other tasks.

Ryan McRae

I think ADHD is one reason I started to forget to do things again. I stopped using my notebook and started using my iPhone and iPad more -- to create to do lists etc. I think I need to do both. But I want to start with pencil and paper. It just feels more natural to me and the author of the article is right. Once I write it down, my mind knows that I’m not going to forget, and it gets a lot less noisy up there.

The Flatliner's Club

I recently discovered the Flatliner's Club club on TuDiabetes.org. The club is described thusly:

A club to share your success and not so successful trends graphs (all graphs time wise are welcome, 1hr to 24hr) from your CGM or Glucose Meters...

I started up some conversations that at first seemed confrontational. Quite frankly, I missed the second sentence in the club's description.

"Post your trends, don't be bashful. There are not many things better in a diabetics life than discussing glucose trends (good or bad) with other diabetics. Remember, the bottom line is this group is for support, not in anyway a competition."

Not reading that second sentence got me into a few heated discussions on the forum. I felt that the expectations of what people should be willing to do to maintain normalcy in their blood sugars were too much work given that people with diabetes (PWD) also have work lives, family lives etc. that need attention.

It was only later when trying to get my blood glucose (BG) numbers under control that I realized that perhaps I had over-reacted. Perhaps I was feeling the wounds from my battle with the diabetes monster. But I did find people, like Zoe, who felt that the tone of the club could be taken the wrong way.

So I set a goal to correct the issues I was having with my A1C and weight etc. I decided to join the club. My goal is to be in target range about 80% of the time, with a BG between 70 and 140. I felt that aiming for tighter ranges would be a burden for me and increase my stress which runs counter to control BG. Some in the club aim for a very narrow BG range between 65 and 85. While I think that is achievable, the level of attention -- testing, adjusting, micro bolusing, etc. -- would soon occupy most of my waking hours and borders on obsession. I also don't think I need that sort of narrow range to get an A1C between 5.5 and 6.

I have had some success meeting those goals in the last few weeks but overall I still have a challenge in the evenings. I discovered that changing my infusion set the manufacturer recommended cycle help reduce the likelihood of severe hyperglycemia. I had developed a bad habit of leaving my infusion set in for one or two days longer than Accu-CHEK recommended. Once I started changing my infusion set on a regular schedule the incidence of severe hyperglycemia dropped.

Someone on the forums mentioned that Dexcom's Clarity app was now freely available to use but they also recommended Diasend. This two-week chart from Diasend1 shows my average daily BG ranges and I am happy with those results. Based on this trend my A1C is expected to be between 6.1 and 6.6. This is a huge improvement. Just a few weeks ago, my A1C was 7.4.

Two Week Trend based on data uploaded from Dexcom G4 to Diasend.
Two Week Trend based on data uploaded from Dexcom G4 to Diasend.

One thing that I learned from reading the posts in the forum is that while the effects can be slower, protein and fat have an impact on blood glucose. I started bolusing for protein and the fat in my meals. This isn't something I have experience doing so I have become dependent on an app called, PredictBGL. I know what my carb ration is -- 1⁄7 or 1 unit of Novolog for every 7 grams of carbohydrate -- but I don't know how much insulin I should take for the fats and protein in my meals. The PredictBGL app helps with that.

It took some time to enter my ratios and a lot of other information into the app. However, now that all the setup is complete, I simply enter my current BG, meal carbohydrate, protein, and fat values, and the app computes a suggested insulin dose. The doses are usually a few units higher my bolus advice from my Accu-chek Avica Combo meter.

30 Day Trend based on data uploaded from Dexcom G4 to Diasend.
30 Day Trend based on data uploaded from Dexcom G4 to Diasend.

This regimen seems to be working for me. I am getting the results I want. The only downside is an increase in lows -- hypoglycemia -- which I think is just par for the course, some extra time spent in data input, and ensuring that I change my infusion set regularly. Attempting this type of tight control over BG can challenging and you may not be able to get the results I did. But I think it's worth a try.

  1. I'll do a review of Diasend and PredictBGL in another blog post. There is more to PredictBGL than just bolus advice and Diasend does too much go into here. ↩

Kaneda

Naming My Things

Some people like to name their vehicles, but I like to name my electronics and vehicles. Maybe it’s because I’ve loved computers since I was a kid, or by giving them a name, I mentally take better care of the devices, I’m not sure. Sean Patterson

I used to name my things as well. I have named my cars and computers for almost two decades. In the past, I have used names from Japanese Anime and science fiction movies. My first car after graduate school was a 1994 Honda Civic EX named Tetsuo. My second car1, a 1994 Acura Integra GS-R I bought pre-owned in 1996, was named Kaneda. Both names are from the same movie, Akira, by Katsuhiro Otomo. That movie left a lasting impression on me.

1994 Acura Integra GS-R | December 1996 | Pentax P3 | SMC Pentax-A 50mm f/2 |

A colleague of mine named his servers after coffee and cars. He named his low-end servers and workstations French Press, Espresso, Cafe Au Lait, Cappuccino, etc. He named his more powerful servers after American muscle cars such as Mustang, Olds 444, Viper, etc. I started naming my computer, too. My computers were named after characters from the Matrix, such as Morpheus, Neo, Trinity, Dozer, etc. I know. Cheesy, right?

Sometimes, I reused names. The current car, the Honda Accord, is Tetsuo II.

For some reason, I have never named my Macs creatively. I have had several, but they are always just iMac or MacBook. This wasn’t a conscious decision. It's something that just happened. Maybe it’s time to start doing that again. Where shall I start?

  1. Tetsuo was destroyed in 1996 when a drunk driver ploughed into the rear while I was stopped at a traffic light. ↩