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?

To reschecule or not to reschedule....

....that is the question.

I had to cancel my endoc appt. 2 wks ago due to a stomach bug, and have yet to reschedule it. I guess there are two components to my reluctance. First, I have the feeling my A1C will not be stellar. I'm always thinking that though, and am usually pleasantly surprised with the results. So the bigger factor is that I still feel like I don't get much help from my endoc other than ensuring a signature on those prescriptions.

When I mentioned to a friend at church who is a nurse that I had to cancel my endoc appt and mammogram last week, she got this worried look on her face and said something like "Oh, wow, that's not good, will you be OK until you can get in to see your endoc?". A nice well-meaning question, but pretty far off target. I replied, "I've been at this a long time, and really the endoc doesn't tell me much I don't already know." Probably sounded arrogant, but it's true.

Last time, I asked him for help in avoiding lows while running. He said I could fax him some numbers and handed me a worksheet with blanks for only before and after meals, no space for a pump basal rate, etc. I asked if I could send him a spreadsheet instead that included room for more testing, carb intake, etc. surrounding exercise, and he said they preferred all patients to use their (totally inadequate) form. This really should not upset me that much since I have a history of not doing a very good job of logging anyway. But it was just a sign of being alone in managing my diabetes, and has rattled around in my brain since then. Were it not for this wonderful online community, I would feel very alone with it indeed.

On the plus side, he did suggest I look into CGM's, and would likely be willing to help me get one. He was also very helpful when I had a pump malfunction that required me going back to shots for a little while. I'm probably looking for too much in a doctor, and this one isn't bad. So I guess I just need to book that appointment. Maybe I'll call...tomorrow.

I'm also curious...how many of you feel that you genuinely get help with your specific issues from your endoc/diabetes team? Am I expecting too much?

Am I Borg?

Had a weird dream last night. I was on an elevator with a bunch of strangers when I realized that my infusion set was in my cheek. No, not THAT cheek, the one on my face! It was the same feeling as the "realizing you are naked at school" dream. So what does this mean? Do I secretly want to be a member of the borg collective? Or could it be that I still feel self conscious about my pump? Or is it that I think it might be better if others had to truly come face to face with at least one reality of diabetes? It really is a hidden disease in so many ways, even for those of us who are pretty open about having it. How about you? What weird D related dreams have you had?