Tag: BG

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. ↩

Week 3 with an insulin pump

Tomorrow will mark my third week with an insulin pump. I had originally meant to blog my daily or weekly experience with the Accu-Chek Combo but I just did not have the time. I had too many work and home life activities.

My first week was the best. Even though I had a lot of hypo episodes I felt more free. My first weekend with the pump I was able to eat pizza; something I have not done in a while. Eating pizza was like giving my blood glucose a ride at Great Adventure1. With the mutli-wave bolus feature of the Combo I could eat pizza and not worry too much.

My second week was hell. At least that's how I would characterize it. As I worked with my certified diabetes educator (CDE) to adjust my basal rates, I experienced multiple daily hypoglycemic episodes. Some occurred during the day and some at night. Thank goodness for the Dexcom G4! We adjusted my basal rates and bolus ratios so many times that I have no idea what my insulin/carb ration is. It was just all too overwhelming.

This week I am taking it a bit more in stride, although I did start off the week in a bit of a huff. I wanted to get some useful data for the CDE so I decided that on Monday I would eat the same thing for all my meals that day. I had Trader Joe's Steel Cut Oatmeal for breakfast, lunch and dinner.

My BG pattern for the day resembled the ride pattern for Kingda Ka. It went straight up and almost straight down. I was hypoglycemic -- in the 60s -- most of the day. I refused to treat the hypo. I wanted the CDE to see the pattern and sucking down glucose would have meant throwing out the results. The CDE yelled at me when I should her my data later that night but she admitted that the data was useful. My basal rate was too high. We made some adjustments.

Yesterday I went back to eating my normal breakfast, lunch and dinner but my numbers were not much better. I still got a post-prandial hypo after breakfast and lunch but dinner held steady. I went to bed with a BG near my target of 100 and woke up this morning with a BG near target.

This morning I adjusted my breakfast regimen. I took my bolus and waited 20 minutes before eating. My BG did not rise as quickly and dropped into the 80s before lunch.

I don't know how to interpret all this data. I'm hoping the CDE does. Trying to find patterns and trends with so many variables is a daunting task. Unfortunately, I'm a Mac and most diabetes medical devices are Windows. I have no way to download and chart my data. That's a real issue for me. I think if I could look at the data from my CGMS combined with my meal and insulin delivery data, I could find some patterns to inform my diabetes management.

Next Saturday I am scheduled for an early morning fasting blood glucose test. I will use that opportunity to fast until noon. Hopefully we can get an idea of what my BG does in the morning. I don't want to do this more than once. The CDE wants me to do another one for lunch but that will have to wait for another weekend. Fasting during a busy work day would leave me miserable and exhausted.

One thing I am still trying to figure out is where to place my pump. My biggest challenge is going to the bathroom. Placing the pump on my belt loop works only so long as my pants don't drop around my ankles. I've had a some situations where the pump tubing was very taught.

I've received several suggestions via the forums on tudiabetes.org and elsewhere. None of them seem practical for me. One suggestion is to strap the pump to my lower leg or my waist or chest neatly hidden under my clothing. I think this would be uncomfortable and the strap would become and irritant. One of my client's offices has security scanners. At least one a week I am at that site, placing my computer bag on a conveyor belt for scanning, removing metal objects from my pockets, and of course setting of the scanner alarm with my insulin pump. It's a lot easier to deal with when the pump is visible. I also don't see how strapping my pump around my chest and under my clothes does not leave a visible bump under business clothing. I'm usually wearing an undershirt, a long sleeve dress shirt, wool pants and if it's Winter, a sweater. I dress like this guy, except I'm not as handsome and don't wear a tie.

Screenshot 2014 03 22 15 25 50

I'm looking forward to Week 4. According to some of the people on the forums on TuDiabetes.org it can take up to 6 weeks to fine tune my insulin pump. As long as I see progress, I won't be as frustrated.

  1. Great Adventure is officially Six Flags Great Adventure ↩