LifeAfterDx--Diabetes Uncensored

A internet journal from one of the first T1 Diabetics to use continuous glucose monitoring. Copyright 2005, 2006, 2007, 2008, 2009, 2010, 2011, 2012, 2013, 2014, 2015, 2016

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Location: New Mexico, United States

Hi! I’m William “Lee” Dubois (called either Wil or Lee, depending what part of the internet you’re on). I’m a diabetes columnist and the author of four books about diabetes that have collectively won 16 national and international book awards. (Hey, if you can’t brag about yourself on your own blog, where can you??) I have the great good fortune to pen the edgy Dear Abby-style advice column every Saturday at Diabetes Mine; write the Diabetes Simplified column for dLife; and am one of the ShareCare diabetes experts. My work also appears in Diabetic Living and Diabetes Self-Management magazines. In addition to writing, I’ve spent the last half-dozen years running the diabetes education program for a rural non-profit clinic in the mountains of New Mexico. Don’t worry, I’ll get some rest after the cure. LifeAfterDx is my personal home base, where I get to say what and how I feel about diabetes and… you know… life, free from the red pens of editors (all of whom I adore, of course!).

Sunday, December 11, 2005

Trouble in Paradise--Chapter 1

I had some of my the first "real" trouble with the Guardian yesterday. It was site change day. Hook up seemed to go well. Afterwards I had my usual 20 carb breakfast and took insulin adjusted for a finger stick BG. Then I was bustling around picking up the clutter caused by our painting project. A little over two hours later the girl piped up and asked for a finger stick to calibrate.

I whip out the Cozmo and go through the routine. 70. Yikes! I've been ambushed! The Guardian wasn't on duty yet and I'm dropping. Must be all the exercise. Now what?

The reason I asked is this other wise foolish question is this: The sensor is now initialized and is waiting calibration. I enter the 70 into the Guardian, but if I reach for the candy, that is going to put my sugar on the elevator while the sensor is trying to get its feet under it. Hmmmm....Ten minutes. It's just me and the little one...Deb is in town helping her grandmother get ready for dialysis.

I decide to let the sensor calibrate. I put a sack of cherry slices in my back pocket and Rio and I go out to cut the bottom off of the Christmas tree so it will wick up water to keep fresh and so that it will stand up straight in the stand. I worry a little that I'll pass out in my tracks if I'm dropping quickly. The first saw doesn't work so we take the 100 yard walk down to the shop for a better one. Once there the Guardian comes to life and the Martians land. The expected low alarm. Also right around 70. Cherry candy to the rescue. Back to the tree...

Later in the day, while catching up on some film processing I get another low alarm. Huh. That's weird. It's been like five hours since brunch, it is late afternoon so my basal is set low, low, low. Where on earth is the insulin coming from to create a low? Oh well, mine is not to reason why; mine is to eat sugar or die.

Twenty minutes later, still low, she alarms again. The level is still showing around 70, so I silence the alarm and skip on the sugar. I'm assuming the interstitial fluid hasn't caught up with the rapidly rising blood sugar yet. Another 20 minutes and another alarm. This time I take sugar. At this point I'm realizing that I've had an awful lot of sugar today. (In fact, when I check the log at the end of the day I've had a total of six low alarms.) I can't even remember for sure how many, or how many mind is a bit of a muddle. But the facts aren't quite adding up. I take a finger stick. Guardian:70. Cozmo: 210. Whoa! Something is fubar here.

Now I wish I had taken a few more finger sticks earlier, cause I don't really know when the trouble started. I have a stick at about 1pm showing the BG meter 120ish while Guardian in high 80s. This was post-low with a sugar intervention. The sugar is shooting upwards so the "lag" is about what I've come to expect. The next check is about 4:30 pm with this HUGE difference. This is also post multiple alarm with several hits of sugar. But I think the gap is too great. Something is not RIGHT.

For what it is worth, within another hour the two machines are back in sync.
So what happened? Well, I won't really know until I'm dead and get to ask God all the questions I want answers to. Who really shot JFK? Is there a Loch Ness Monster? What caused the Hindenburg to explode? What happened to the twin princes? What the Sam heck happened to my Guardian on the 10th of December, 2005?

So until then (hopefully after my boy is raised and off on his own); all I can do is guess. And here is my operating theory. I think the whole thing was caused by a bad test strip. Now I know we all hate to admit that there are bad test strips; but there are. A bad high reading once caused me to correction bolus myself nearly into insulin shock and left Deb so jittery that she stayed up all night long and poking me every fifteen minutes; "you still alive?"

If you want to scare the hell out of yourself just get one really big blood drop on your finger and test two strips in a row on the same sample. It won't be pretty. That's way I'm surprised how close the Guardian and Cozmo usually are.

But once again, I've wondered off track. Here is my theory. The calibration BG finger stick was bad. I think I might have been lowish, but not that low. The finger stick gave me 70, which surprised me. But rather than question it I just entered it. Now let us assume for the sake of argument that my sugar had actually been 90. Guardian reads it, and I tell her you are looking at 70. Guardian, says "Ok, if you say so." Now the rest of the day she's biased low. It is not until things are getting funky and I'm entering more finger sticks that she's able to correct.

Now adding fuel to this fire is the fact I skipped lunch today. Normally on a new sensor I would have had the calibration stick and an hour or two later the lunch stick. But today she ran a lot of the day on just the calibration stick.

I don't know if any of this is true. Just a theory of my own to try to explain a strange day. I've haven't called the wizards at Medtronic to ask them (and I probably won't--they'll just give me the lecture bout how you are supposed to take a finger stick before making a therapy adjustment).

The lesson, however, is that on a new sensor a few more finger sticks and/or suspicion about alarms right out of the gate is in order. Live and learn. Sharing knowledge is what this bog is all about, after all.

End result in my book: I’d rather have her error on the side of caution on the low side. As I can’t feel getting low I’d much rather my Guardian Angel gave me an alarm when I didn’t need one than have her not give me one when I’m really crashing. In the end, small trouble in big paradise.

Tomorrow: just when you thought it was safe to go back into the water....da-dum da-dum da-dum da-dum (Jaws music): more trouble; this time more serious.


Blogger Scott K. Johnson said...

I bet you're right! If you look at how small errors when the numbers are low (say 70 vs. 90) make a BIG difference (low vs. Ok), whereas numbers in the high range that small difference doesn't mean much (220 vs. 240).

So that small difference on the low end probably skews the guardian quite a bit.

It sounds like the more finger stick readings you feed it, the more accurate it is (it adjusts itself)? And it would make sense that it would want your BG's to be "stable" (yeah right) as it's trying to calibrate after a new insert.

Very interesting. I can't say enough how much I'm enjoying these great real life insights into wearing the Guardian. Thanks!

9:22 AM  
Blogger Sandra Miller said...

Wil, your theory on what happened makes a lot of sense. Still kind of scary, though.

I must admit, your line about your next post has me sitting on the edge of my seat, as we are still seriously considering this for our son... I'll be checking in tomorrow.

1:46 PM  
Blogger Wil said...

Scott--True, the more you feed it the more accurate it is. More on that in a day or two, stay tuned.

Sandra--prepare to be on the edge of your seat for a few more days...

4:13 PM  
Blogger Ellen said...

"...they'll just give me the lecture bout how you are supposed to take a finger stick before making a therapy adjustment)." I guess we're learning why that is! Besides the fact that it's not FDA approved for insulin dosing based on the reading of the Guardian.

I'm waiting until it is approved for therapy adjustment before encouraging my son to go through all of the frustration of wearing it.

The Glucowatch was similarly not approved for immediate insulin dose adjustments, and IMHO for many other reasons never should have been released to market.

Wil, you're a diligent adult making wise decisions with the Guardian. Parents who are considering this need to be acutely aware that kids/teens and many other adults will NOT take the time to analyze what's going on with the Guardian, and will come to rely on the output, rather than do extra fingersticks.

5:03 AM  
Blogger Keith said...

Wil, I'd love to hear about your 20 gram breakfast. I've found the best way for me to limit both highs and lows is just not eat many carbs, that way I don't get the yo-yo swinging. I do a 30g-breakfast, 30g-lunch and 60g-supper routine which works pretty well most of the time. The other advantage of this is it keeps me from gaining weight and developing that middle age belly that alot of guys get--while my weight is remaining constant, I'm going to lose the belly battle if I don't get into the gym soon!

8:03 AM  
Blogger Wil said...

E--I quickly want to point out that I've never taken insulin based on Guardain data. However, I have taken on sugar based on Guardain low alarms without taking a confirming finger stick. That was not so smart, as it turns out...that said I never sent my self super high having done that. (but maybe I just got lucky). I'm going into this more in today's post (Trouble in Paradise Chapter 3, which I'll post shortly).

The Glucowatch was a travesty. Is the Guardian the answer to our prayers or another Glucowatch? I have had both thoughts over the last few days...

One of the greatest risks of the Guardian is that it CAN make us lazy, or at least less dilligent. This holds great risk, and I'm going to talk about that in much more detail over the next few days.

Keith--my 20 carb breakfast is as follows:

1 cup Kashi 7 Whole Grain cereal
1/2 cup 2% milk
2 little packets of Splenda
1 slice Sargento Pepper Jack cheese.


11:12 AM  

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