Not a Flat Line

This week I had my annual eye exam with the retina specialist. I thankfully don't need a retina specialist at this point, but figured it would be good to get to know a good one before I do. And it fulfills my annual oath as a person with diabetes to have the all important dilated eye exam. OK, so there is no oath, and I apparently turned it into a biennial kind of thing since they don't send out reminder cards and neither did my brain. But I digress....

The real reason for this post is the conundrum posed by the ineveitable questions posed by most health professionals to those of us who are pancreatically challenged. The first of those is "so, what do your blood sugars usually run?". This time I dodged that bullet by giving them my A1C of 6.5, which drew a "not too bad" response (is that like a 7 from the russian judge?). Then, the tech or assistant or whatever her title moved in for the kill..."so, are they pretty steady?", she queried. At this point, I couldn't help it, and just laughed. After I got that out of my system, I told her that "Type 1 diabetes simply isn't like that. Different days bring different challenges, and blood glucose is not always a flat line, so that is a very difficult question to answer. Today happens to be a good one, but a couple of days before that...not so much." Then a really good and unexpected thing happened, and she told me she has a friend with type 1 who says the same thing. Well, yippee, at least we are singing the same song.

Anyway, I'm not sure why those questions are so annoying to me, but they are. The tech was very nice, and our exchange was amicable, but I always feel icky after answering, like I'm taking a test with no correct answer. Basically, anyone who asks me things like that, other than my endoc or another person living with T1, just draws an automatic assumption on my part that they won't possibly understand a real answer. I have this desire to whip out a few weeks worth of CGM data and ask them to tell me "Can you define steady? Is this steady enough?". Maybe I'll do that next time :). Life is not a flat line, and neither is my CGM graph.

First Triathlon

Monster Triathlon Race Report (300 meter swim, 12 mile bike, 3.1 mile run)

A good friend and I finished our first triathlon this morning, and had a great time doing it. I still don't know our time, but I'm sure it wasn't particularly fast. Had lots of time to get nervous before the swim, with 750 of us lining up (sort of). Nice big pool with 50 meter X 8 foot lanes, and after waiting about 45 minutes for our turn, my friend and I were able to start one right after the other. We actually passed a few people! Considering that both of us were freaked out about just putting our faces in the water only a few months ago, we did pretty well. We did get held up behind a couple that missed the memo about staying right unless you are passing. They insisted on staying side by side, taking up the whole lane. While she attempted to breast stroke and side stroke, he swam along shouting encouragement whilst not letting anyone pass. Tried the left, no good, tried the middle, and they closed ranks, but finally got by! Other than that, our swimming fears have been laid to rest, and the swim was my favorite part of the whole thing, even though it was the part I dreaded. Go figure!

T1 was fine, and thanks to the volunteers, I didn't miss the timing mat on the way in like I tried to. I didn't test, and my CGM had not "found iteslf" by the time I started. The bike leg was good, but pretty hilly and quite windy today, so a bit tougher than we anticipated. Two loops, so we knew what we were in for the 2nd time around. We were both riding our mountain bikes, but managed to actually pass a few folks on spiffier bikes. Heard a high blood sugar alert from from my continuous monitor early in the bike ride, so knew I didn't need any carbs.

Before the swim, my BG was 181 and supposedly dropping. But by the time T2 came, it was at 340. Adrenaline + going anaerobic on the hills + being disconnceted from my insulin pump waiting to swim + plus the beginning of a cold = not a good combo for that. So I need a new plan for next time to at least replace the basal insulin I missed during the swim line up and swim.

Between that and the harder bike ride, the run pretty much sucked for me. Back tightened up like never before, and I had to stop to stretch it and walk a fair amount. My friend stuck with me, but I kind of wish she had gone on so I wouldn't feel bad for sucking AND holding her back. I think it was something like 34 minutes for the run/walk we wound up doing. It was her turn to come in ahead (long story), so I encouraged her to go ahead for the last 1/10th. I managed to run in the last 1/2 mile or so looking reasonably strong, and raised my arms in victory crossing the finish line.

Cool finishers medal, and nice long sleeve orange and black tech shirt to complete the halloween theme. Awesome support from our husbands, who carted our extra "stuff" around, took pictures, and put up with our pre-race nerves. My mom even came to cheer us on . Would I do it again?....yep....but not right now!

The Hay is in the Barn

This Sunday I'll be attempting my first triathlon. It's a relatively short one, with a 300 meter swim, a 12 mile bike ride, and a 3.1 mile run. This will be a fairly light workout week leading up to it, since the training I have already done is what matters physically. It's been a bumpy ride during the 12 week training program, with a 2 week cold/flu thing in weeks 4 and 5, being a few lbs heavier than I'd like to be, and now a tear in my right arch. As of today, I think I'm reasonably ready to complete it, though perhaps not as well as I would have hoped initially.

The training has consisted mainly of doing either a swim, bike, or run 5 or 6 days a week. On some days, I've put together biking and swimming, and on a few others, biking and running. But Sunday will be my first time putting all 3 together. Although that's fairly normal in preparing for a first triathlon, it leaves me with some lingering questions as far as BG management. I'm hoping my CGM will be in synch come Sunday so I don't have to test in the middle of the bike ride, but it may come down to that. I've had a couple of episodes lately where the CGM trend totally misled me. The swim is so short that testing after that in T1 won't do much good, and after the bike ride in T2 will be too late for any carbs I take in to do much good. I'll just have to play the CGM game by ear and hope for the best.

So I'm reminding myself this week that: "Many are the plans in a man's heart, but it is the Lord's purpose that prevails." (Prov 19:21). I've trained with a good friend who will be racing that day too, and our friendship is stronger and deeper as a result. My awesome husband will be getting up a 0-dark-thirty with me so he can support me and hand my pump back to me after the swim. God willing, all will go the way I would like it to, but if not, it will still be alright, and there is purpose in that too.

CGM Jury Still Out

Thanks so much for the comments on my last post. In spite of a power outage that caused some bad hair this morning, I went to my Endoc appt today. I received the results of my first A1C after starting on a CGM two months ago. He does the quickie in office A1C test, and has even moved the machine that hums and whirs to produce that magic number into the exam room, which leaves me with sort of a Magic 8 ball type of feeling about the whole thing.

A1C six mos ago was 6.5, and today it was 6.6. I've bounced between 6.3 and 6.7 for the last few years. So is the CGM helping? I think the jury is still out. I know I like being able to see what's going on, and that I'm less hesitant to make changes, but I think a little less talk and a little more action (thanks Elvis) are in order. Got a couple of suggestions from my endoc that will hopefully help get my overnight #'s in better shape, and he offered to help me troubleshoot between appts if not.

I also have to realize that over time, my body changes, and sometimes just staying the same is a victory. I'm in my 40's, have put on a few unwanted pounds in the last few months, and have seen, but not wanted to acknowledge, that I'm not quite as insulin sensitive as a result. Denial is a many splendored thing. So I'm crankin' up the juice a little more and we'll see what happens.

The A1C after the CGM

Tomorrow is my first post CGMing appointment with my endoc. I almost cancelled it, but somehow managed to "select 1 to confirm the appointment" when I got the reminder call yesterday.

So what's the problem?? I'm afraid I haven't done the CGM justice by reducing my A1C.

I have made some positive changes that may actually lower it, like increasing overnight basals, not purposely running so high prior to exercise, bolusing more aggressively when appropriate, and correcting more often. It's also been less than 2 months that I've been hooked up and seeing those nice graphs, so why can't I cut myself a little "learning curve" slack?

But I have this feeling in the pit of my stomach like if the A1C is not better, I might have to give my CGM back. Ridiculous thought (I mean...who would I give it back to?), and intellectually I know it's not true, but it is how it FEELS. But I'm going tomorrow, though I may look odd clutching my CGM site and hissing at anyone who approaches me.

Breaking the Rules

Disclaimer: I'm not a medical professional, just another diabetic, so don't take what I do as correct...it's just what I do.

We had a series of thunderstorms this week, and my 90 year old father-in-law lost his power. So he came to spend the night with us. We got up early the next morning, and he was stressed out about getting home...insisting he needed to take one of his medications right at 6:45 am. We took him home right away. This may have been right for that medication, and perhaps a few minutes on either side would really matter.

Since then I've been feeling resentment about the many "rules" that I was told early on applied to my diabetes care. I know the folks who taught me these rules were erring on the side of caution, and telling me what they were legally bound to say. But diabetes puts enough demands on life that I don't need any "extra" ones. Early in my diagnosis, I didn't know how to sort out what was really critical, so tried to follow everything to the letter. Here are the ones I can think of that I have kicked to the curb over the years:

1. Change your lancet after every use -- umm once in a blue moon
2. Swab your finger with alcohol before you do a finger stick -- never
3. Swab your injection site, pump site, CGM site with alcohol prior to injecting (or inserting) -- never, just make sure area is clean
4. Always refrigerate your insulin -- I used to stress over whether there would be a fridge at hotels, now current bottle stays at room temp and additional supply is in fridge at home
5. Change your pump site every 2 days -- umm 4 or 5 days usually
6. Change your CGM site every 3 days -- I lie to my pump -- telling it I have a new sensor when I really don't -- so I can use for each sensor for 6 days. The poor thing has yet to wise up!
7. Take Lantus at same time every day -- early on I was dogmatic about this, but soon found out that for me the darned stuff didn't last 24 hours anyway
8. Swab top of insulin bottle with alcohol -- never

How about you? Are you a diabetes renegade?

CGM Truth or Dare??

Last week the curtains were pulled back to reveal a 24X7 movie of my BG control. There was no red carpet rollout for the premier, but it was a big event for me nonetheless. I started on a new Minimed pump and CGM last Thursday.

First, I was giddy with being able to see so much more about what is happening, and just kept looking at the trends in a distant sort of way, as if they were not really connected to me. This week, reality is starting to sink in, and I'm faced with some things that I need to change if I want to improve my control. Like cutting out the late night snacking, and upping my basal rate after I workout. Both of those things are scary to me in their own ways. Even though I may have suspected them before, now the data is smacking me in the face and hard to ignore. No more namby pamby..."I'm not really sure what's happening so I'll just keep doing what I want to." I know this is a good thing, but as with facing any challenge, there is emotion and resistance to overcome.

So I guess it's really more of a game of truth AND dare now, isn't it?