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!).

Saturday, December 31, 2005

Hurricane Hypo

I knew the hypo was coming. I took a bed time finger stick. My BG was 103 with more than 2.2 units of insulin “on board,” with a tail stretching out over more than two hours. That didn’t look too good for the home team. I checked with the Guardian, clicking backwards in time in five minute intervals: 129, 136, 146, 152, 158....

Hmmmm.....we got us a trend here. One of the things that drives me bonkers is the lack of a real-time visual interface. I’m not too good with lists of numbers. Takes too much brain power. Give me a chart, map, blue print, or graph and I’ve go it down in seconds. I’m getting better at scrolling through the five minute records, but I’m still not super good at it. I can see this is a downward trend and moving at a pretty good clip. But I’m not number savvy enough to look at them and say gosh, that’s a 29 point drop over 25 minutes that’s about one and a quarter mg/dl per minute; I’d better pay attention.

I could see that we had some action going on, but it didn’t seem too fast. I’d also had a high fat dinner, so I was anticipating a kick in the BG down the road. It might go hypo, it might level out, or it could even drift up. I reported the findings to my wife (as per our New Compact) but told her I thought I was still too high for cherry slices. What are you going to do? she asked. I’m going to go to bed, I’m tired. The girl will wake me up if I go much lower. I’ve got the alert threshold set all the way up to 85.

That wasn’t good enough for Debbie. She set an alarm clock for an hour and a half down stream. She’d check on me then and make sure I was still with the living.

So with both my girls watching over me I slid my tired body into bed. Clean sheets, such a luxurious feel against the skin. Smooth, cool, crisp. Oh yeah. I close my eyes, but sleep eludes me. I check the Guardian. Still coming down.

I roll over and try to press all thoughts from my mind and let the fatigue wash over me and take me away. But deep down, I know the hypo is coming. About every ten minutes I sneak a peak at the monitor. At least I’m not wasting test strips. An hour after I went to bed she reads 86. At the next check she’ll alarm. OK, I sit up, swing my feet to the floor and turn on the red flash light. I open the case and caress the key board. Getting my fingers into position.

I don’t have long to wait.

The monitor shakes in my hands, fireworks scream, cork-screwing down out of the sky. I silence the flying saucer noises. Time for a finger stick. I know it will be lower than the Guardian reading, but of course I can’t feel a thing. I’ve got a higher alert setting, and its a fairly slow moving hypo so my money is on the low 70’s or high 60’s.

What a crappy gambler I’d be. The Cozmo clocks me in at 55.

As per our new compact, hammered out after the fast moving hypo last week, I wake the wife FIRST. Then take sugar. Just for in case, as her family likes to say.

This hypo may be slow, but it is a powerful storm. It takes three sugar hits fifteen minutes apart to stop the decent. I can watch the numbers slow on the Guardian. Still artificially high, but a great direction indicator. If she’s clocking lower each time she reports I know I’m not winning the fight yet.

Usually I just knock the hypo out, get back above 90 and call it a night. I’ve never followed up the sugar with a light meal like the ADA and others suggest. Tonight, given the length of the fight, I decide to eat half a flour tortilla with some peanut butter on it chased down by a half glass of cold 2% milk. My stomach is topsy turvery. Maybe a little food will settle it down. I don’t know if the stomach trouble is from the hypo or the lack of sleep.

After my snack I collapse in bed until a hyper alert wakes me up at 6:30 a.m. I guess the P&T was not such a great idea after all. Later I’ll study the trace on my computer. It is truly weird. It looks like a sign wave. A graceful sweeping downwards curve mirrored almost exactly by an opposite upward sweep. Too low too long then too high too long. It takes repeated poundings of insulin correction boluses followed by a long walk with visiting niece and nephew (and Rio, of course!) to get back to sane BG levels. I’ve never seen such a stubborn high. Must of been all the sugar needed to kick back the stubborn low. It was so high for so long that I was on the very cusp of yanking the infusion set and replacing it. But the girl stopped me. I did a quick review of data and saw the curve starting to drop. I decided to give it a little more time and finally the BG’s began a nice graceful sink to normal levels.

I’m super happy with the girl today, for several reasons. Although it was the finger stick that first told me about the impending hypo, the girl could have easily done the same if I’d looked at her first. But she let me study it, watch it approach like watching the gathering clouds of an approaching storm. Had I fallen asleep she would have woken me.

Plus I was able to use her to gauge my efforts and plan my sugar. I still did the finger sticks, but I liked having the real time feedback during the 15 minute intervals between sticks.
She also saved me from wasting an infusion set today too. Bonus points for the girl!

Friday, December 30, 2005

Of mice and men

Well, you know what they say about the best laid plans, right? It was the night of many false alarms...opps...errrrr...I met to say the night of many pre-mature alerts. Oh, F that. It was a night of false alarms. I got low BG alerts at 52 minutes past midnight, and again at 2:32 a.m., and again at 3:12 a.m., and again at 4:52 a.m.. All in the mid 80's of course, as my low alert is set at 85. Problem being the BG was cruising at about 100 all night long. Of course I could have changed the re-alarm period to two hours instead of 45 minutes but that's too long for my sense of security. What if there were a real hypo in there somewhere? I could have moved the threshold down to 75 for this one night. But that would have required opening my eyes more than 15%, which would have woken me fully up, which would have been the end of any chance for a good night's sleep (not that I got one anyway).

Instead, each and every time, I opened my eyes 14%, took a finger stick, entered it as a calibration--hoping to drag the sensor up just a few points so she'd stop alerting me. Alas, no such luck. On the bright side, my sugar was rock stable all night long.

Then at 8:17 a.m., after I'd been up and around about 45 minutes. Air Raid!!!

What? A high threshold alert? 193? No frickin way. My wake up BG was 127 and I haven't put a bight in my mouth yet today. Finger stick confirms the Guardian is out of her mind. Now how did that happen? I've got beaucoup calibration points in stable water all night long. The system uses the last four, weighted more heavily for the most recent. So how on earth do you run low all night and then out of the blue spike that high?

I'm guessing some sort of freak power spike. But to calibrate or not? If the sensor's out put stays high I'll wish I had. If it settles down I'll be biasing it high. It is a no win. I take the calibration.

Two hours post breakfast the children are neck-in-neck, so I guess I made the right call. Sensors often run on the low side on their first day. Medtronic admits that, and other users have told me that too. I've seen it some, but not as much as other folks. This sensor is the Hissy-fit replacement sensor, so it started its stint of duty in the early evening instead of the early morning. I'm hoping that, back on schedule, this won't be my average evening. I'll keep you posted.

Thursday, December 29, 2005


Maybe it was all the sugar over Christmas. Maybe it was the lack of sleep from a night that required six correction boluses. Yeah, that’s right. Six. One every two hours for almost 12 hours. All night long and well into the morning. Maybe it was the fact that I’m on vacation and I don’t really deal very well with time off. But I had a full blown hissy-fit the other day.

Hmmmmm.....where to start the twisting, turning tale of confusion, stress, woe, and immature impulsiveness?

I guess I’ll start at the middle. Just kidding. I’ll start at the beginning. In the back of my mind I was still pissed off about the discrepancy between the BG meter and the Guardian on Christmas eve and Christmas day that we’ve already covered in an earlier post.

By the way, I’ve since looked over the “trace” I downloaded from the monitor and compared it with the pump download and my food log. Looks like, once again, I had mislead myself and every one else too. Yes, it is true that on Christmas eve the girl had me at 97 (still above my new low threshold alert) while I was really at 66. But looking at the trace she was getting there real quick!). I’m still pissed off about the 31 point spread, but nothing was really working wrong. Besides, I was able to watch the trend. We knew it was dropping.

On Christmas day when the girl went the other way and had me at 120 when the BG meter had me at 171 the complete picture is also not as it appears. Turns out an hour later I was at 74. I don’t know why I didn’t remember that when I was writing the post. This time the girl was just ahead of the game. I’m finding that the numbers that piss you off are the ones that stay in your head.

Medtronic soooooooo needs to have a little screen on the monitor that shows the trace over the last eight hours. It would make it so much easier to internalize all the data coming out of the system in real time. It would make it easier to make judgments “in the field.” It would also greatly reduce the over-reactions of hot-heads like me to a reading or two that are out of whack. When you can see the whole picture, a funky reading doesn’t freak you out as much. Nothing beats a picture. When you are looking at nothing but numbers the only ones you remember are the ones that are “bad.” When you look at a picture, you get just that: the whole picture. Failing a screen on the monitor, maybe some sort of interface with a PDA. That would be great (hint, hint).

For what it is worth, one of the problems with the whole down-load system is that the dinosaur of a dock uses a nine-pin mini serial port. Who on earth has those anymore? My house computer is a lap top. Nothing but USB ports. I shelled out 45 bucks to Circuit City (or was it Comp USA? Well, same difference) for a serial-to-USB adaptor but it didn’t work. That has me downloading at the shop and I don’t do it every day. If I can get set up to download at home I might get better about investigating strangeness right away. It would be great if the next gen dock was USB so that you could plug it into any computer on the planet.

So, as I was saying, I was still irritated and overly sensitive to the holiday performance of the system when the Macaroni & Cheese Incident happened.

Ahhhhhhh.....Mac & Cheese. My all time favorite comfort food. Always a BG disaster. Since Dx, I can rarely convince my wife to make it for me. We use a modified recipe from the Fanny Farmer cook book. White sauce with a small splat of brown mustard. Long horn colby cheese. Baked in the oven until crispy on the top. Mmmmmmm.....

Jane at the Endo's office suggested that with pasta, and the heavy fat load of the cheese, a combo bolus might be in order. I convinced Debbie that with the combo bolus, and the girl to watch over me, it would be a slam dunk.

That was the start of the trouble. After eating I kept a careful eye on the BG, using the Guardian as a trend indicator.

Where am I at? Click. Good, everything looking OK. Where am I at? Click. Good, everything looking OK. Where am I at? Click. Good, everything looking OK.

At each check I'm between 140 and 170. This is looking really good. I'm riding 3 hours with 60% on top. I've carefully measured the capacity of the mac and cheese pan, totaled the carb load of the entire recipe, and then reverse engineered the count for each serving by dividing the total recipe by the volume of the container and multiplying the unit volume by the serving size.

Bottom line: two cup serving equals 70 carbs.

At two hours post meal the pump vibrates softly: check your BG, please. Quick glance at the Girl. She clocks me in at 117. We have this so under control! Well, that might be a bit low, but the numbers have been moving pretty slow. Time for a finger stick.


What? What?! 243! That's 126 points off! That is sooooo far beyond a tolerable margin of error that I just want to scream. Or break something. Or scream and break something. Or maybe break something first and then scream. (This isn’t the hissy-fit, that happens in the morning.)

The combo bolus is still playing out, so I can't take a correction. An hour and fifteen minutes later I check both again. The finger stick shows the BG has drifted up to 263 and the girl is now 190. A few minutes later and she gives me above range alert. A day late and a dollar short.

She's closing the gap, but that is still a hell of a long way from where she ought to be, and a hell of a lot later. I’ve got my above range alert set at the very, very conservative (read low) BG of 190. The idea of a 190 setting is so that you can’t get anywhere even near to 263 without a heads-up from the system. Clearly, it could be working one hell of a lot better.

To add insult to injury I had no idea how long I'd been up there. I had no clue or indication from the Guardian that I was running high until nearly four and a half hours after I ate. The finger stick knew two hours after, but that was a pretty high reading. I'm guessing that I must have actually crossed over the 200 threshold within an hour of eating. Guardian was three and a half hours late to the party. I went to bed pissed off and muttering about checking ketones.

So much for technology, I thought. Then came The Night of the Correction Boluses (good title for a low budget diabetic horror flick, don’t you think?). That's the six corrections I lead off with. You've probably forgotten about those because you've spent the last three hours reading my long winded post.

Fast forward to the next morning.....

Picture me lying in bed. Frazzled and exhausted. This was the day I was going to finish all those little projects that needed finishing. The plan was to jump out of bed at dawn and get after them. It is 10 am and I can barley open my eyes. I am frustrated... no.... worse. I'm just plain mad. I’m mad at everyone. I’m mad at myself for buying new technology before it has been proven. I’m mad at Medtronic for making me pay through the nose for a system that is more a beta test than a clinical product. I’m mad at Debbie for making a huge batch of fudge that everyone agrees is the best they've ever tasted. And I’m mad at God for giving me the fucking diabetes in the first place.

I sit on the edge of the bed, fuming for about three minutes. I’m at the end of my rope, and then the rope snaps. I pick up the Guardian monitor, heft it in my hand for a moment, and then I turn off the power button. Confirm? she asks. I press ACT. With a soft beep her screen goes blank. I wonder if I’ll ever turn her on again.

At the time I didn't know. I was throwing in the towel. Freeing myself of the stress. Better to have no warning system at all than one that sometimes works, I thought through my pathetic and fogged brain.

Then I pulled off the many tapes, the transmitter, and a $40 sensor that had only begun it's three day run, and threw it into the trash. (This is the hissy-fit).

Next I emailed Medtronic and gave one of the nicest, most helpful people I know an earful he didn’t deserve.

And then the emails from my readers started to arrive. More than I’ve even received for one post. The “Light Bulb Moment” post had hit a cord. The out pouring of enthusiasm for the system and my new sense of how to use it was overwhelming. Here I was throwing in the towel just as the rest of the world was rejoicing. Doubt came creeping in. Was I doing the right thing?

I started to study the data on the computer. It really didn’t look as bad as my mind was making it out to be. Had I over-reacted?

Then Rio wanted to go for a walk in the front yard. He had not asked me in months. Now it is worth mentioning that the front yard is 20 acres in size. Don’t get too excited, out here 20 acres isn’t that much. One of my neighbors has something like 40,000 acres. When I bought our place back in ‘88 or ‘89 I was able to get the entire chunk of land for ten grand.

Twenty acres in a Kansas wheat field isn’t much to look at, but we have wonderful micro-topography. You could walk this land everyday of your life and see something new every day. There are hills, cliffs, dry river beds. Meadows, groves of Juniper and Pinion. Big rocks, red earth, and more types of cacti than you can count on both hands. Petrified wood and fossils. I love it. And so out we went, hand in hand. Rio and I went down the road, then along the arroyo, and onto the back meadow behind the butte.

That’s where it occurred to me: what would happen if I had a fast-moving hypo from the exercise and passed out? It was just me and Rio. He’s three. Would he be able to find his way back home again? Or would he wander off in the wrong direction and get lost in the maze of canyons that lead up to Apache Mesa and mountain lion country? If he did retrace his steps back home, would he be able to lead Deb back to where I was? Or would he just sit next to me and cry, pulling on my sleeve and begging me to wake up like he did when I went hypo when he was two years old?

Suddenly, I felt very small, very stupid, very irresponsible, and very naked without my Guardian. Here is a piece of technology that in at least once instance had intercepted a hypo that I was in no position to even suspect; and I took her off because I....well why did I take her off? Because I got pissed off over three bad readings over three different days? And it takes, what? 288 per day?

When the little one and I were back home safe and sound both my wife and my mother (at different times and 350 miles apart) had fits when they learned what I had done. Their take: who cares if it works perfectly all the time so long as it does it’s job most of the time.

Later in the day a friend called innocently enough and made the mistake of asking, “So what’s up?” After 20 minutes of my babbling she said, “well wouldn’t it still be worth it even if it only worked half the time?” I dunno. I guess so.

But the money....“This is your life we are talking about, it is worth more than money,” echoed my wife’s words in my ears.

We have to be realistic. We are placing incredibly high tech mechanical devices into the most complex, hostile, and unpredictable environment in the universe: the human body. And I expect perfection?

I sheepishly snuck into the bathroom and quietly hooked back up again.

Wednesday, December 28, 2005

A small change for the better

Quick administrative note. I've created a new category of links here at the LifeAfterDx to feature blogs written by other diabetics who are using some sort of continuous BG monitoring equipment. I've kicked it off with Val, who writes Dr. Jekyll and Mrs. Low. She's part of a clinical trail, so she can only tease us with a few bread crumbs. Maybe she'll throw us a few more soon without getting herself into trouble. Anyone else out there? Pipe up please!

Being a good sport

We interrupt our regularly scheduled program because my dear friend Kerri of SixUntilMe just tagged me. OK, I’ll be a good sport and play the blog game. She has tagged me to post five random facts about myself. OK, here we go:

Random Fact One: I’m a high school drop out. I was once asked by a civic leader to talk to local high school kids about the importance of staying in school. Ummmmm....maybe I’m not the right guy for the job.....I quit school in my senior year, took my GED about a month later and never looked back. I never regretted it, and it never slowed me down or proved a disadvantage in any way. But I’m probably not your typical high school drop out either.

Random Fact Two: I have two college degrees. Yes, despite of being a HS drop out, I did later go to college. My first degree is an Associate of Applied Science in Aviation Technology. I have a commercial pilot’s license to go with that. Of course big D took that away, but it was not too great a loss. Flying is too expensive for a hobby, and I wasn’t doing it for a living. Once my BG settles down, if I want to go through 2,000 pounds of paper work I’m told that I can get my Private Pilot privileges back. Maybe Medtronic can sponsor me flying around the country with my Guardian. Wouldn’t that be a hoot? My second degree is a combined Bachelor of Science in Criminal Justice and Criminology with a minor in Criminalistics. I graduated Summa Cum Laude after doing the entire major and minor in three semesters. Not too bad for a high school drop out.

Random Fact Three: I’ve been married three times. Twice to the same woman. My first wife was whats-her-name. We were both young flight students. It was a crash and burn situation from the start and didn’t last long. My second and third wives are Debbie who I’m crazy about enough to marry again. The first time we were married, as they say here, “by the law.” A number of years later (we can’t remember how many, her mother is the expert on this date) we were married by the Church.

Random Fact Four: I have four tattoos. This always surprises people, as I am told I look so respectable. I guess respectable people aren’t supposed to have tattoos? I suppose not. The oldest, well they are all old, is on my left upper arm. Red and black. Biker kinda thing. You know, a winged skull. There are two on my left forearm that make up a single design. They are both black, well greenish now as they are so old. The bottom one is a badge. The top one is a Native American type motif to turn the badge into a work of art. Oddly the top tattoo was done by a woman in California who took one look at the original and recognized the handiwork of the Colorado artist who had made it. The fourth one is on my chest and is a mystical design. It drives my niece crazy ’cause she’s never seen it and I won’t tell her what it is. My tattoo advice to my son: get what ever you want, but have a skilled artist do it and make sure it can’t be seen if you are wearing a suit. You never know when you might need to get a bank loan.

Random Fact Five: I own five computers. I have a lap top at the house. I use it for evening surfing and it goes with me to doctor’s appointments. I keep all my pump downloads and the like on it. At the shop I have four more. One is our administrative computer, one is for digital imaging, one runs our film scanner, and the last one runs the digital enlarger. Weird having more computers than staff, but I guess that’s the way of the world.

Now who do I tag? I’m thinking that Scott and Melissa need to get off their duffs and start posting again: Tag you guys, you’re “it.”

Scott‘s Diabetes Journal
Melissa‘s How‘s the DB?

Tomorrow, back to Guardian Stuff.

Tuesday, December 27, 2005

The light bulb moment

I think this will be my most important post yet. It is long and deep, so if you only ever read and think about one of my posts in your life, this this is the one.

To set the stage you need to know that I'm on vacation. Most Pro-labs in the US close between Christmas and New Year. There are several reasons for this. First is there is not a lot of work to do during this time period. Second, it is the end of the year for bookkeeping, inventory and all those paperwork hassles. It gives us time to rest, look where the year went and plan for the next year. It gives us time to work on our machines, which are too key to our turn-around time to get the attention they deserve during the year. It is a time to rest, recharge, and get ready to go back into the fray.

It also has given me time to think. And I realized between breakfast and lunch today that I've been using the Guardian wrong. Totally wrong. It was truly one of those light-bulb moments. One second you are in the fog and then poooooof, the next second everything thing is crystal clear, like a frosty sub-zero winter morning. I was chatting with a friend of mine on the phone while reviewing Guardian data for the last few weeks when it hit. I guess the subconscious and the conscious linked up in a quick moment of clarity, inspiration, and mental nirvana. All of the sudden I internalized how the Guardian works, or how she can and ought to work. In short: I got it.

I've been using tomorrow's technology with today's mindset. That's worse than wearing blinders, it is like trying to put a DVD into a ViewMaster. The paradigm has shifted. This technology is so far advanced we can't use it like we use our old tools. We need to get smart and change the way we think. We need to adapt to the new tools at our disposal. No more knee jerk reaction to problems that come up: we have been given the crystal ball. We can prevent problems before they happen.

The Guardian is not merely better finger sticks. It is to finger sticks what a 747 is to the Wright Flyer. Yeah, they both fly, but the similarities pretty much end there. The Guardian is not super finger sticks, it is a whole new way of looking at Glucose data and responding to it.

When I first started using the Guardian I thought to myself: well this is great! It will let me know when I get out of control. Now I realize that is myopic. Why wait? The Guardian can be so much more. So very much more. It has the capacity to give me an advanced warning that things are going to get out of control before they are anywhere near that point.

This concept is different from how we deal with our diabestes now, or it can be. Now we can be alerted that we are leaving our normal range. Think about it for a moment. Instead responding when things have already gone to hell, we can think, plan, and respond as appropriate before they go to hell. We can be highly pro-active. I don't think I've been using the Guardian to her fullest potential.

Why did it take me so long to get it? It is partly the fault of the old ways of thinking and partly it is the fault of language. So part habit and part linguistics, lexicons? At any rate, the way we use words and the words we choose to use. Words are power. The words we choose force our minds to follow certain paths....and not always the best ones. I've been thinking a lot about words lately, and the power of words. Words often carry such baggage that they pre-bias our thinking. Words can lead to wars.

As we head quickly into a new year it occurs to me that we diabetics are headed not only into a new year, but a new era. Continuous glucose monitoring is going to change everything from the way we think about our condition, to how we treat it, to how we talk bout it. As one of the pioneers on this frontier I've decided to propose the first few new words of the language of the future. My chance to shape the conversations that will come.

First I want to talk about a BG reading that is not what we expected. Specifically a Guardian alarm that is not verified by a subsequent BG reading. Currently we all call these FALSE ALARMS. I've been thinking a great deal about this, and I think that is not entirely fair, accurate, or appropriate. I propose we hence forth call them what they are: pre-mature alerts.

If the sugar is trending downwards and the Guardian sets off an alarm before the BG actually reaches that level, is it really a false alarm? Or is it an advanced heads up? Even the word "alarm" is probably inappropriate. “Alert” is probably a more accurate word. An alarm suggests a situation that requires a response. An alert is a word that suggests you need to pay attention.

And that is the bottom line promise of continuous glucose monitoring. It is a way for us to pay attention. The idea is to provide us with a sense of heightened alertness when the tide starts going out or coming in too quickly.

Instead of using her to alarm when the shit has hit the fan I can use her to alert me before the shit hits the fan. This is where the power of language both benefits and burdens us. If we think in terms of alarms we are think about taking care of trouble that has already happened.

Example: you set off the fire alarm when the building is burning. A burglar alarm goes off once the burglar has set foot into your businesses. The Wal-mart inventory control alarms go off as the teenagers slip out the door. The car alarms fads off into the distance as the thief drives away with your car. Alarms not only require immediate action, they happen after what we are trying to prevent has already occurred.

However, look at alerts and warnings by contrast. A tornado warning tells you to get your ass into the basement. A severe weather alert tells you to get inside. The air force spent untold millions to install early warning radar across the frozen north to alert them to Soviet bombers or missiles. Alerts are proactive. Alarms are reactive.

Think about alerts. You don't have to respond to an alert. An alert merely tells you that you might be headed in a wrong direction. It is the yellow light. With conservative alert thresholds you don't even need to confirm with a finger stick in many cases. But you can be aware. Aware that maybe things are changing. You can check the trend. It is like the tickle on the back of your neck that warns you strangers are following you down the street. Hostile intent? Maybe. Maybe not. But you are alert, aware, and ready for action should it become necessary.

I had set my low "alarm" at 75 and my high "alarm" at 250. I've changed those. Now my below range alert (a BRA?) is set at 85 and my above range alert (ARA?) is set at 190. These aren't alarms. I don't need to DO anything when they go off. Their purpose is to alert me I've left my normal operating range. My blood sugar is beginning to change from it’s normal safe environment. What I do then depends on the computer in my head. That’s my brain, folks, not some new toy I ran out and bought.

If I get a below range alert half hour before dinner I don't really need to worry about it, do I? On the other hand, a below range alert a hour and a half after a meal is cause for great concern.

I've also re-set the alert repeat feature for lows from 20 minutes to 45. (If I've had a real low the pump will remind me to recheck in 15 minutes). On the high side I've left it at 2 hours.
When I get an alert I can scroll back 5...10...15...20...25 minutes. I can look at the trend and see how fast it is moving. I can think, plan, and react in a timely and safe manner.

It is a whole new world for me and the girl. Funny how guys always underestimate the fairer sex, isn’t it?

So my pre-New Year’s resolution is to try to stop using the words “Low Alarm” and “High Alarm” here at LifeAfterDx, and call them what they really are: alerts that my BG is leaving the range that my health team and I like to keep it in. I count on you to slap my hand if I slip up.

Monday, December 26, 2005

Blue Christmas

Chapter 1: Carb City. New discovery: diabetes sucks worse at Christmas than it does the rest of the year.

The rest of you probably already know this and are wondering why I'm late to the party. Well I'll tell you why. Last year was my first diabetic Christmas. I was so frail, week, and sick from all the medical adventures and miss-adventures that surrounded my Dx, subsequent re-Dx, and my final Dx that I spent the entire holiday at home in a heap on the couch. And sometimes in bed. Or on the floor mid-way between the couch and the bed. Deb and Rio made the rounds of the various parties and extended my regrets.

Both sides of the family and various friends showered me in sugar-free sweets and I rode the season out in style.

Now most of the time I'd don't find diabetes to be all that big of a pain in the ass. I give in to temptation now and again in a controlled fashion and otherwise avoid putting myself into situations I know will be bad for my BG.

But this year I'm back to OK health and I'm out and about. And no one had any mercy on me. At the first stop, at which I arrived starving, there was not one diabetic friendly thing on the over-flowing table.

Carb chips and salsa. Biscochitos, the state cookie, literally covered in sugar. Fudge. Zucchini bread with raisins. Banana bread with chocolate chips. Fresh breads and jams. It was a fucking disaster. At least there was one diet soda in the cooler. Of course it had caffeine, which generally makes me sick to my stomach.

I had expected trouble, but... I’m standing at the table with concerned family members looking on, "Aren't you hungry?" asks my hostess earnestly. Well, shit.

So I SWAG Bloused (scientific wild assed guess--really nothing scientific about it at all). I am holding a plate of food. Full of unknown and imponderable carbs. 50? 100? Who the hell knows? So I just stacked up the insulin. Each time I put something in my mouth I chased it down with a slug of insulin. Doing my best to guess what the plates might hold.

I’ve got an unstable cocktail of insulin, fast acting carbs, and slow acting carbs coursing through my body.

Now this is where the Guardian came in real handy. I changed the alarm thresholds for the weekend, making them much more conservative to head off trouble at the pass at the risk of more false alarms. But it was really nice, that every 20 minutes or so I could discretely open the cover, Click, and check my BG. No finger sticks, no "oh my God, do you feel OK," from family members.

I was also able to use the monitor to keep my mate in the loop. A high tech form of non-verbal communication. I hold the monitor up for Deb to see. 147.

She frowns. "How much insulin on board?" she asks me.

10.5 units.

A flash of anger in those beautiful dark brown eyes, "You're going to crash!"

Very likely. But we’ll see it coming. No point in rushing the sugar infusion. I keep my eye on the trend. Every ten minutes I check. I can flip back in time with a few button clicks. It is a hypo-speed drop. 182. 167. 130. 115. 103.

And I thought all was OK, and that I was in control of the situation, but I was mistaken. When we were ready to leave, with Rio’s presents loaded into “Momma’s truck” (our old Honda CRV), and Rio safely belted in and me in the driver’s seat we decide a finger stick is in order. Guardian shows me dropping but still at 97. The Cozmo clocks me in at 66. Damn. We look at each other and each get out. A quick Chinese fire drill and we change drivers. I find my self sulking in the passenger seat eating cherry slices.

Later in the night the slow acting carbs kick in and I find my self taking correction boluses of insulin every two hours all night long and spending the better part of the time north of 200 BG.

Chapter 2: Joy and Guilt. So Anita had English Trifle, a three layer Chocolate Mousse Cake with a candy crust bottom (think Nestlé Crunch Bar on bottom, a moist rich layer of chocolate cake in the middle, and dreamy fly-away mouse on the top, all dusted with coco powder), and sugar-free Pumpkin Pie. All served with champagne cocktails and de-calf coffee. After sampling all three and having a second helping of the mouse cake I said to Anita, who was abstaining but enjoying all the feedback of contented groans and orgasmic moans, "boy, I sure admire your will power." To which she replies, "it has nothing to do with will power. I want to keep both my feet and my eyes."

Wow. Well that's perspective, isn't it? What a bummer. The 100 carbs of sweets in my stomach turns to lead.

In her youth she and her husband ran an photo lab in the Virgin Islands; and in her retirement she worked for me. But in between she was an RN for years, and years, and years. She saw all the wreckage left after years of uncontrolled diabetes time and time again.

Again, the Girl shows a steady and sharp drop. It looks like Anita’s guilty pleasures had less sugar than I guessed. I’m on the ball tonight. I’m expecting the BG to be ahead of the Guardian. I watch warily. By the time we are getting ready to load up and head home she shows me in the 120s. I’m thinking we are probably closing in on the intervention threshold. I take a finger stick to get the real story.


I cannot get a break this weekend.

We load up Rio and his new constant companion: Mr. Potato Head, and make the 20 minute drive across the dark emptiness to home. The Red and White Christmas-light star that was my Dad’s pride and joy for my entire lifetime greets us home and lights the way up the porch steps to the front door. Once in and unpacked I check sugar and Guardian.

The Girl has me at 94 and the Cozmo at 74. They’ve flip-flopped again. I guess the girl had the trend right, but the numbers came down strange. First she was ahead, now she’s behind. Lucky for me Anita’s daughter (a super custom printer and very good friend who also worked at the lab in the old days) has sent us with a box of Rugula. Well if you gotta take on sugar, it might as well be something fun. It is delicious, but I’m sugared out. I’m sick to death of sweets.

I need something salty. I rummage in the pantry and come up with big bag of peppered beef jerky, my Christmas present from my mother-in-law. I’m sure glad it was Christmas, but I’m sure glad it is over. At least for this year.....Will I be more courageous next year and just say “no,” or will I indulge like a modern day Roman sugar-alcoholic and be satisfied with ending the week with not being in a coma?

Sunday, December 25, 2005

King of the bolusing holidays

Merry Chriskwanukkah and happy secular holidays.

50% through and no coma!

Saturday, December 24, 2005

New sensor and a realistic Holliday goal

Four IV3000s. Check.
Sen-serter. Check.
Hole punch. Check.
Alcohol pad. Check.
Aveeno. Check.
Sensor out of the fridge. Check.

What am I missing.....Hmmmmmm....the pile on the kitchen table doesn't look big enough. Something's missing....Ah, yes! The transmitter pads. You'd think by now I'd have this down.
Getting ready for sensor site change; and not a moment too soon 'cause this puppy is itching, itching, itching, ITCHING!!!! Aaaaaaaaaaaaaaaa!

OK, I don't know how to describe the feeling. Did you ever break your leg? Yeah. Remember what it was like when you got that itch deep, deep, way down inside the cast? The itch you can't reach no matter what? Yeah that's the one. Buried under all the IV3000s, centered under the transmitter is that same itch. The itch that can't be reached.

I've tried pushing the transmitter deeper into my leg. I've tried agitating it back and forth, but that just moves the skin over the muscle. The itch is at the top layer of skin.

Unlike the poor sap in a cast, I could, of course, take the whole array off and scratch like a grizzly bear in the woods. But I'm too cheap to bring myself to do that. I'll ride it out. Tough uppper lip and all of that.

Now, of course, today is Christmas Eve. We've got party at Rio's Great Aunt Connie's house tonight. Mid-day family meal here at the house tomorrow, and desert at Anita's house on Christmas night. Anita is actually Jewish, so I'm not sure exactly how that fits in Hanukkah wise, I’m a little fuzzy on that, but I just know to be there on Sunday at 8pm Indian Time (the New Mexico version of 8pm sharp. It means plus or minus 20 minutes--usually minus--we run on a different sesnse of time out here). Not an invitation I'd miss for the world.

Back in the early 2000s Anita worked for me as a mini lab operator. At the time she was in her early 70's. Anita is also a diabetic. One morning, pulling into the parking lot for work she had some sort of mini-hypo incident, hit the accelerator instead of the brake and drove in to the lab. Note I said in to not into.

But I digress. Anita is the single most brilliant desert cook, no.... chef, that you will ever meet. Her creations are so far out of this world that I have not words to describe them. She occasionally makes diabetic friendly stuff, but generally not. What is most amazing, is that she never tastes what she makes. Like deaf Beethoven conducting his Fifth.

I'm not sure which amazes me most, her culinary skill or her will power. I have neither, but will benefit from both.

So here is the plan to survive this string of culinary ambushes that have been laid out for me: Avoid going into a coma. That's it. That's the hole plan. Just survive the next two days with out going into a coma. High. Low. Up and down. What ever. Just keep the baby blues open except when sleeping (so Santa will come) and I'll consider it a success!

Merry bolusing to all, and to all a good night....

#$%&@&% test strips!!!

My pump alarm just went off, vibrating insistently on my hip. Two hours post meal. I slip the vial of test strips and the lancer out of their case, pull out one test strip and slip it into the meter slot on the back of the pump. Double check the code number, cold blue glowing on the screen. Lucky13 for this batch. Cock the lancer, choose and finger and SNAP. Give a little squeeze for the blood, touch the edge of the test strip to the blood dot...ZIPPPPP... it sucks it in. A few seconds later I have the reading: 250. Son of a bitch!

And today was going so well. Must 'a been the damn potato chips. Potatoes always give me trouble, but at the butcher shop yesterday they had Poor Brother's chips. I couldn't resist. My folks use to have a place in Arizona, the chips are a local product we use to eat at the Desert Museum out on the west side of Tucson. Extra-crispy-crunchy. I haven't seen them for years. Like I said, I couldn't resist. Then to make things worse, I had a tortilla burger for dinner.

Should 'a had either the chips or had the burger patty without the tortilla. I'll never learn. Looks like a correction bolus is in order. But first let's see what the girl says.

Click: 170.

Damn! That's more than a little bit off. I expect the Guardian to lag a little on the up swing, but 32%?? Grrrrrrrrr.....Well, better double check that BG before taking insulin. It is ten o'clock at night. We don't want too much. Nice to know the low alarm works, but let's not push the envelope.

Vial out. Strip into meter. Code 13. Rub finger on jeans for luck and good capillary blood flow. SNAP. Squeeze. ZIPPPPP. It reads: 203. Wha?? OK, best two of three.

Vial. Strip. Code. SNAP. ZIPPPP. BG: 180. Oh for God's sake!

I give up. If the test strips can’t agree, why not go with the Guardian’s reading? 170 is only modestly high for post two hour. I’ve still got insulin on board. I’m going to bed!

Thursday, December 22, 2005

Solstice So 'mores and an anniversary

Looking at my calendar, I realized that it was the Solstice. Seemed like we should do something absolutely Pagan to celebrate. What we came up with may be more Girl Scout than Druid, but ya gotta go with your gut on these things....

We built a fire in a circle of stones. I taught Rio how to set it up so it would burn hot and true. Wadded up newspaper on the bottom. A teepee of small sticks. Then cholla skeleton. Then larger sticks, and finally small juniper logs with their fine hair like bark. The challenge in my family has always been to light camp fires with one match. I forgot to bring the striker out, so I went to use a lighter to start the match. This isn’t cheating if you still use only the match to get the fire going.

A million years ago, when I was a smoker, lighters were better designed. You flicked them and they lit. Now they have these damn child-proof thingy-ma-bobs.

After breaking off the child safety device with a rock, I was finally able to get the damn lighter to work...

I lit the match and then touched it to the paper on three sides. The flames licked up the pile of twigs like race horses out of the starting gate. In no time we had a cheerful blaze to beat back the stretching shadows and creeping cold of the dying day. Rio delighted in throwing more small sticks into the flames to feed the fire.

Then Rio and I danced around the fire like our Celtic forbearers. Well, actually, he chased me around the fire five times trying to get the bag of marshmallows from me. Yes, while our ancestors went the human sacrifice route, we choose to make So ‘mores.

For you city folks who were never boy scouts or girl scouts here is the recipe:
One half a Graham cracker on the bottom of the sandwich.
One half a Hershey bar.
Two marshmallows, toasted golden brown over the coals of a dying fire.
The other half of the Graham cracker.

35 carbs. Gooey, messy, and oh my God good. If only the Druids had known, history would have been different.

And what does any of that have to do with the Guardian? Well not much. Just a normal Dad out having normal fun with his kid. With no BG checks, no worries about lows, and no emergency sugar. (Don’t freak out, we had a box of Hershey bars and a sack of marshmallows for God’s sake.)

That was yesterday. Today is my anniversary. Yes, the Girl and I have been together a Month. It has been quite a wild ride this first month. Joy and anguish. Stress and peace. Expectations exceeded, dashed, and exceeded once again. Doubt, name it, I've felt it.

Looking back over the month, is there any kind of summary? How do I feel about it, you ask? Has it been worth it? There were times I thought my life was finally going to be simple. There was a time when I damn near put the girl back in her box and sent her back to Medtronic.

I started obsessively tracking data. Comparing finger sticks to the Guardian readings. How accurate is she? I was determined to work out just how well this system works. And then the unthinkable happened.

The girl saved my life.

Well that pretty much sewed it all up and made the decision crystal clear. The Guardian is now a permanent member of our family. Don’t get me wrong, I’m still studding data to know learn where she is strong and where she is week; but the whole “is she worth the cost” question has evaporated.

This is also the one-month anniversary of the blog. Yeah, I know the dates go back a little further on the posts but I rigged it to make the timeline work out and make sense. I started out writing this over on Gina’s Talkfest, but she evicted me on the 21st of November (that’s OK, Gina, I still love you). And we set up shop over here at LifeAfterDx the next day--the very same day the Guardian arrived and I hooked up for the first time. Wow, what a ride that has been too. I didn’t even know if anyone would come and read at all. I didn’t know if anyone could stand to read as much as I write. But today, one month later I see I’ve had 3,301 visitors as of the time of this posting.

The feedback from the readers has been wonderful. Wow what an adventure. And then you folks nominated me for three awards. Mind blowing. Wonderful, but mind blowing.

And, what’s my blood sugar, you ask? Well, I don’t know...let me check...Click...122.

Damn, that’s fun. I never get sick of doing that!

Wednesday, December 21, 2005

A leg up

I'm really enjoying wearing the sensor and transmitter on my leg. Today kicks off sensor number 11, and I installed it over on the left leg. I've got the sensor about a third of the way down my thigh, right in the center line. The transmitter is off the side, towards the inside of my leg. I'm liking this a lot more than having the entire array on my stomach. I'm not sure why, but it seems a lot less bothersome.

It is not without it's own unique set of problems, of course. The first leg-set on the right lost it’s top IV3000 about half way through the run. Rolled up like a venetian blind. Once those puppies get covered in blue jean lint, they are just no damn good. I slapped another one on and we had no trouble.

You do have to be careful taking your pants off, so you don’t get hung up on the transmitter and there is always the risk of catching your underwear on the cable when getting ready to hop in the shower....

This time around I’ve got the cable facing down, towards the knee, rather than up. I also used a fourth IV3000 to keep the cable flush to the skin. Did I remember to advise everyone to buy Smith & Nephew stock? I’m thinking I’m going to be personally responsible for a spike in IV3000 dressing sales. I’m told they come in larger sizes, but I’ve got two boxes of them (looong story) so I haven’t looked into it yet.

Now when I was wearing it on my stomach, it really didn't bother me that much when it was in place. What was beginning to drive me crazy was trying to figure out how to re-position everything at sensor change. It is a lot of gear with the sensor, transmitter and--in my case--the three IV3000 dressings.

But once I moved the whole lot to my leg, I began to realize that it bothered me less down there. Out of site out of mind? I'm not sure why...I just am happier with it there. Like I said, it never really bothered me on my stomach until it wasn’t there anymore. Does that make any sense?

Now the big decision will come in three more days, come sensor change day. Will I go back to my stomach, which is still recovering for it's reaction to the tape, or do I switch back to the right leg and just go back and forth between the two legs? I had originally planned to alternate between two stomach sites and the two legs. Now I’m not sure.....

Well, two more days to decide.

Tuesday, December 20, 2005

Thanks everyone!

Yippee! Today we just went over the 3,000 visitor threshold!

Enemy in the dark

This is the “trace” of an actual hypo. The shadow of a silent killer on the wall. The signature of the devil himself.

While I slept soundly the attack was launched. The blood sugar drops, drops, drops, drops and had the Guardian not raised the alarm: Arise! Awake! Enemy at the gates! Who knows how much further it would have dropped, or if I would still be with us to write this post.

We’ll never know of course. But at 52 mg/dl with over an full unit of insulin in play in a body hyper-sensitive to insulin.....well to paraphrase my good friend Six / Kerri: it would have been an officially scary situation. Without the alarm would my life would have been at risk? Did the Sugar Reaper come knocking last night?

With these thoughts rattling around in my head I did some web surfing this morning as the film processors came up to temperature. Found some scary stuff online. According to “Evaluation of Death from Hypoglycemia” from the Department of Pathology at USC Medical Center: “...glucose of 40 mg/dl or less may lead to death from hypoglycemic coma.”

I have been lower than 40 in my life, but not for long. Striking like a thief in the night, if I had slipped into a coma it would have been at least seven hours before any one was up and about and in a mood to rouse me. According to an article on hypo by Ben Eastman at the Diabetes Health Magazine web site (by the way, if you don’t subscribe to this journal go now to their site and get a free copy): “Some research estimates that between four and 13 percent of the deaths of people with Type I diabetes are the result of hypoglycemic events.” Why the big range in the estimates? Apparently your blood sugar can continue to change for some time after you’ve kicked the bucket, making it hard to definitively label it as a cause of death. Night-time hypo deaths even have the quaint title of “Dead in Bed Syndrome,” so called because victims are found dead the next morning with no sign of distress the previous night.

We all know that the results of the DCCT found that intensive insulin treatment substantially reduces the risk and number of long term complications. But, quoting Eastman now, “What is less commonly known is that the same tight BG control that reduces the risk of complications has a darker side. The intensive insulin therapy described by the DCCT presents a three fold risk of severe hypoglycemia--sometimes with dire consequences.”

Wow. You can read the complete article at Dibetes Health. It’s really good.

Back to the mug shot of the enemy, my sharp eyed readers will notice I left a mouse pointer on the screen shot. Nope, not being careless and last night’s adventure did not eat half my brain cells. The tip of the point marks where my BG meter clocked me at that point in time. I also forgot to enter the first sugar dose. There should be another little triangle to the left of the one that shows on the screen shot. You’ll notice that the hypo’s drop is nearly a perfect straight line, and then there is a tiny little jerk to the right and then a gentle tapering out of the rate of decent. That was the first sugar dose kicking in. My take? Looking at that line plunge downward so aggressively with no sign of let up....I think without the Guardian’s alarm it would have been officially bad news for Wil.

I’m sure some of you are wondering why I’m not furious that I hit mid-fifties before the girl raised the alarm. Well, as far as I’m concerned the system worked. She woke me up in time to confirm the situation and take action. What more could I want?

I’m happy. Happy it worked. Happy to be here. Happy this hypo didn’t occur on 11-21-05 or earlier.

Looking at the plummeting trace it’s pretty clear to me it is on its way down to meet the arrow. Looks to me like the BG is dropping at about 1.25 mg/dl per minute. There is an inherent five minute lag in the sensor readings. So by the time I take the BG reading the Guardian most likely sees me at 67; still about 20% high. Why? Who knows? Who cares?

Well, that’s two lies. I do care, and I do know...sort of. Here’s my analogy. There two groups of tourists getting into a pair of elevators at the top of the Empire State Building--a group of Germans and a group from Japan. I’ve actually never been to the Empire State Building, so I don’t know if it has two elevators; I would imagine it has many more. I digress again...

The two groups start filing in to their elevators at the same time. The door on the German’s elevator closes a second earlier, and one of the German tourists promptly presses the button for the first floor. In the elevator full of Japanese, the tourist closest to the button is just a tab slower in pressing the down button.

And then the two elevators are on their way. Same make and model, same number of passengers. Both elevators are going the same distance. Both are going about the same speed, or maybe not.

Maybe the elevator with the German tourists has a newer motor and moves a fraction faster. Maybe the Germans as a group weight more than the Japanese, pulling the elevator down to earth just a few fractions of a second faster.

All these tiny factors add up. A door closes earlier. A button is pressed faster. A more efficient motor. More weight on board. By the time the Germans reach the first floor they are a full minute ahead of the Japanese.

Blood and interstitial fluid are on the same journey from the top of the building to the bottom; but they are not in the same elevator. Remember that the Guardian system doesn’t really measure blood glucose. It measures glucose in interstitial fluid. The two glucose values are closely correlated, but they are not the same. They travel the same journey, but not always exactly at the same time.

I could, and may, increase my alarm threshold to 80, or even 85 at night. That would allow me to intercept lows earlier. I haven’t decided yet.

But like the searchlights on the walls of a fortress, my Guardian angel spotted, revealed, and exposed the raiders lurking beyond the walls. She raised the alarm. She did her duty by me, and tonight I’ll sleep better knowing she’s on the lookout for the enemy in the dark.

Monday, December 19, 2005

Guardian and cherry slices to the rescue

The low alarm. I'm never sure I'm describing the sound right. I call it flying saucers landing. Debbie says to her it sounds more like fireworks corkscrewing down out of the night sky on the Fourth of July. One afternoon when I had a low alarm at the lab, Molly stuck her nose into my office, "are you playing video games?" But whatever you call it, Martins, fireworks, games; it is a unique sound. One that wakes me up in a flash.

I love that sound.

It is 2:24 am. The girl wakes me up: low alarm. My eyes flash open. I snatch her off the night stand, flip the case open with one hand and quickly silence her. My fingers have learned to find her buttons as surely as they know the keys of my laptop.

Her call: 74.

Time to double check. Is this the real deal or a false alarm? I fumble for the little red flashlight. On. Now I'm the U-boat commander in the conning tower, bathed in red-light, searching out my prey. Ah, there is the vial of test strips. I untangle the pump from the oversized T-shirt I sleep in. It is a XXL. The scary thing is that it used to fit. I now wear a medium.

Test strip into the port. Code number 13. Finger stick. Nada. Try another finger. No luck. Well....third time is the charm. The dot of blood looks black in the red light. I touch the edge of the strip to the dot. Ziiiiip! The strip sucks in the blood and the pump quivers in my hand at once. Wow. That was fast. This is no false alarm.


Ok. We'd better double check that number. Test strip into port. Code number 13. Finger stick. Got blood. Ziiiiip! The pump vibrates almost the second the blood is gone.

52. No sweats. No shaking hands. No falling elevator. I feel fine.

Cherry slice.

Just before midnight I took a three unit correction for high BG, a souvenir of dinner in town with my mother, who’s visiting for a few days. I tried something new on the menu. Didn’t work out so well: for either the taste buds or the blood sugar. Now at 2:26 am there is still over one unit of insulin in play with a tail that will stretch out for another hour and a half. So much for the night time correction ratio.

One slice may not be enough. I get up to write this post, and to wait for the inevitable second alarm. In twenty minutes the girl goes off again. She’s now at 70. Still trending down. I check BG again with the Cozmo. It clocks me in at 66. Well that’s moving up, but pretty slow with a lot of insulin on board. I can probably ride it out and be OK, but I eat another cherry slice to be on the safe side.

It is now 3:09 am. The girl shows me at 88. The Cozmo at 121. We are in the clear. BG is shooting up. It may go a bit too high, but I think the insulin still left will eat it up. Maybe a half slice the second time would have been OK, but when you’re in the 50’s in the middle of the night it is better safe than sorry. Besides, they are rather tasty...

You know what? I’ve bitched, growled, complained, and nit-picked about the Guardian. And I will probably continue to do so. But tonight she earned her keep. Literally and figuratively.

This girl is here to stay.

Sunday, December 18, 2005

Music, dance, and data

We are at Popejoy Hall on the Campus of the University of New Mexico in Albuquerque; about two hours south of our headquarters. Debbie and I are fourth row back, on the left isle. The perfect place to be. The way Popejoy is built you don't want to be in the front row. It is too close to the stage and the stage is too high. You end up with a sore neck and you can't see half the action anyway.

We are here for the Mariachi Christmas. Debbie loves Mariachi music. I love Debbie. Nuff said about why I'm here.

But tonight I get a treat. The dozen plus member Mariachi Nuevo Chapultepec is only half the show. They are doubling up with Ballet Folkorico Paso del Norte--an award winning dance troupe and a state treasure which is celebrating it's 25th anniversary this year. It is a dazzling riot of sound, color, and action. The dancers traditional skirts whirl and spin flashing every color of the rainbow, and occasionally (of course) the dancers legs. The air is full of sounds, the violins, the trumpets, the guitar and the guitarron. The clacking of the dancer's heals, the pounding of their partner's boots. The crowd cheers, claps, whistles and howls like coyotes. It is too much to take in. You don’t know where to turn next; where to rest your eye.

If you've never been to a Mariachi concert you need to understand that it is inactive in a way that would be considered rude in other venues. The crowd calls out to the performers. The musicians spill into the audience. It is rowdy, loud, and a whole lot of fun.

Before coming we went to Mario's on San Padero over on the Northeast side. They call themselves "traditional Italian." They kid themselves. But it is very good American-Italian food.
Tonight I get a huge plate of spaghetti (the only size they serve) with tomato-alfredo sauce. Never heard of it? Me neither. It doesn't even sound good, but oh my God is it ever. I first had it about six months ago, by stealing a taste from my more adventurous mate's plate. And then another taste. And then another. And another. Until my hand was threatened with great bodily harm by a fork.

Now I get my own plate.

Three cups of spaghetti. According to my PDA data base: 120 carbs.
Four ounces of garlic bread: 64 carbs.
Salad: five carbs.
Sauce....your guess is as good as mine. Some spaghetti sauces have lots of sugar, some have very little. What the hell, 15 carbs.

That's 204 carbs. Sounds too scary so I round down to 200. I need 13.5 units of insulin to cover it. Yikes! That sounds like a lot. Most of my meals are covered by less than two units. Well, no point in having all this info if we don't use it. I press deliver....

Several days later...

I'm sitting at my computer with three windows open. I've got CoZmanager, FreeStyle CoPilot, and Guardian Solutions all running simultaneously. I've also got my PDA and my food log on the desk. I'm looking at the effects of the combo bolus I took at Mario's and I have entirely too much information at my disposal.

Years ago, I remember reading that combat pilots flying into Vietnam would start shutting off various systems in their planes as they approached the target. They were suffering "cockpit overload." They had too much information at their disposal. They were getting districted from the main mission; which was flying it to hostile territory, dropping their bombs and getting the hell out with out getting shot down.

I think I just got shot down. I'm overloaded and paralyzed by the shear amount of information at my finger tips. I should 'a turned something off as I entered hostile territory. Instead of delving into the details I sit in a heap. To depressed and overwhelmed to go on. I close the lap top's lid. This can wait for another day....

I sit for a moment, defeated. No, damn it. I’m not going to go down in flames. I open the lap top again. First I close CozManager. No need to have it running once it beams its data to CoPilot. CozManager is fabulous software for programming the pumps, but it is lousy for data analysis. All you can get is a conventional log book. CoPilot will import data from Coz and it is truly some of the best diabetes software made.

The daily combo view is like a well designed aircraft instrument panel. One glace and you can see everything that is going on. The instrument panel shows you how high you are, if you are upside down, right side up, or somewhere in between. It shows you the direction you are going and how fast. Pretty cool. The Daily Combo in CoPilot does the same thing for your food, BG, and insulin. Laid over the back of the screen is a pale green pyramid that represents your basal pattern. On top, laid out over time are the BG sticks connected by orderly (but misleading) straight lines. Below is the carb intake, circles of various sizes to represent how large the carb load is. The Spaghetti dinner at 200 carbs looks like a nuclear explosion compared to my 20 carb breakfast. Rising above the carb explosions are tall bar-graph extensions showing insulin. Dark green for bolus and red for corrections. It is a fabulous graphical interface. It gives you all the data you could ever want in one place. Or it did, anyway, before I got the Guardian. Now she gives me a better and more accurate picture of what the BG is doing throughout the day. But of course that information can’t be imported into CoPilot, nor can Solutions import all the rest of the data from CoPilot. You gotta work with both, but today I’m concentrating more on the graphs in Solutions.

I’m looking at the night of the spaghetti. At the time I took the insulin I was around....well, it is kinda hard to tell looking at the Solutions software. A hundred points of BG takes up about an inch on the vertical scale. They really need to add some thin gray lines at the 27, 50, and 75 points to make it easier to read. Or better still, the day graphs need the feature their modal day has: you can hover the mouse over the trace and it will give you the real number. I’m thinking its looking like 120...maybe lower? I switch back to CoPilot. 111.

Ok, so we start at 111 and it sweeps up to 232 over the next three hours. Nice slope, not too fast. But that is really too high. The insulin is pumping as a combo bolus, 60% on top the rest coming in over the next four hours. After another hour it drops down to 180 and stays there, stubbornly, for hours. In fact it stays just short of 200 until 1am when I take a correction bolus. By the way, flipping back and forth between two days is a cinch with the Medtronic software.
A hour and a half after the correction I’m just above a BG of 100 where it stays until morning. Well, my early AM correction ratio sure looks great, but the spaghetti bolus needs work. I make some notes in my carb diary. Next time we’ll try 250 carbs, as scary as that sounds.

I usually look over my BG and my food log every two weeks or so, searching for over all trends, analyzing BG disasters (most self inflicted), and developing new “recipes.” If I find something I like at a restaurant it usually takes two or three tries for me to work out the real carbs. But then I’ve got them for any time I go back. The Guardian has given me a new way to look at recipes. Before I had gauged success by looking primarily at the two-hour post meal finger stick. Now I can see how a meal has effected the BG waaaaay down stream of the meal.

Very cool, but all this work and thinking about food has made me hungry...I think I’ll fly out to the kitchen and raid the refrigerator.


I've gotten a bit better at using the screen shot program. The images of the software in the post "Mother nature" are now much better. I also took pity on everyone and left them in color. Scroll down and check it out!

Finger stick city

I wince. I put my finger on the trigger, and then I chicken out. I move the Sen-serter over a little. Put my finger on the trigger, take a deep breath, wince, and chicken out again. I finally get over it on the third try. Shunnnnnk! The sensor slides into my leg without the least bit of pain.

Lot's of room here. I was able to lie two IV3000s down, side by side. Sensor on one, transmitter next to it. Nice thing about the upper thigh is that the skin doesn't bend, morph, and move around as much as it does on your stomach. Everything is lying nice and flat. This may be pretty cool.

Of course, I can't wear my skin-tight red leather disco pants anymore. Oh, wait a minute...I've never owned skin-tight red leather disco pants, so no loss there. I clip the Guardian to my right side today, over the leg the sensor is on. We don't want any transmission problems.

It has been a delight to have my stomach free of all but an infusion set today. I also want to mention that I’ve actually enjoyed splitting up the two site changes. I thought I’d rather do it all every three days, instead doing diabetes “stuff” two mornings out of three. But with the two site changes now split up, because sensor number seven coming out ahead of schedule, I’m finding that a either a traditional site change or a sensor change by itself is quick and easy.

So this is sensor number ten. I’ve reached the $400 maintenance mark. Don’t you think I should get a T-shirt or something? Tonight Deb and Rio are in town with Nana and Big Grandma--so called not because of her size, but rather her rank. She’s Rio’s great-grandmother. For a couple of generations in my wife’s family the great-grandmothers have had the title of “Big Grandma.”

Once again, I wander off track. I’m here by myself tonight so I decided it would be a good time to look at the numbers. In the life of sensor number nine there were 31 finger sticks. Most of these don’t show in the Guardian software, as only calibration sticks show up and we all know by now that we only want nice clean, calm water sticks in the machine. I’d love to see the next generation of this thing have a way to enter a non-calibration stick, just so it would be in the software and show up on the graphs. But for now I need to do it by hand.

So here’s how I wasted an hour. I scrolled through the BG history on the pump and wrote down every reading for the better part of four days. Then I opened the Guardian Solutions software, called up the latest download and went to log book. I then looked for the sensor value closest in time to the ones recorded by the pump and wrote that down next to the pump reading. In the end I had a long, long, long list of both BG checks and Guardian readings from the same approximant time. I guess it would have saved a lot of time if I had put them into my PDA or something...Any way, on to the results of my extensive third grade analysis of the data!

Out of the 31 finger sticks only six were NOT neck-in-neck. Of the 25 sticks that were close most “errored” on the low side. I have that in quotes, ‘cause if the BG meter says 101 and the girl says 99 you can’t really call it an error, can you? But you get my drift.

Of the six that were further off from each other than I would have liked, four showed readings lower than the finger sticks. These were not huge differences, just quite a bit wider gaps than the rest. For instance, with the worst of the lot the BG meter showed 204 and the girl showed 151. That’s something around 26% off, more than one would expect. But an hour and a half before they were dead on and they were very close a couple of hours later, so who knows what was going on there. Could even be one of those dreaded “bad” test strips. Or, God forbid, user error.

The other two did bug me though. One morning at a quarter after eight, as doing my pre-breakfast stick, the BG meter clocks me in at 72. I immediately re-test. Re-test shows 86; but the girl has me sitting at 100. Growl. Although, now that I study the “trace” it is slowly curving downwards. Still, a bit more of a gap than I like, and in a direction I don’t care for. Memo to the girl: in the future please error to the low side. Thank you.

The last one was sort of the same, but much milder. BG meter at 86 and the girl at 105. One hour later they are within one point of each other. I’ve really got no complaints about this sensor. It seems to have preformed as well as 1-6. Which would be to say up there in the clouds with angels and harps and stuff.

For what it is worth, I had no low alarms at all the entire three days.

By the way, number 10 has been in not quite 12 hours and she’s doing a wonderful job! Only four finger sticks, but check this out:

Coz: 143 / Girl: 135
Coz: 179 / Girl: 173
Coz: 152 / Girl: 163
Coz: 143 / Girl: 142

Those are pretty damn fine numbers in my book. Three out of four she’s on the low side in theory, but these numbers are a statistical dead heat anyway. This is the kind of performance I love to see! (And for anyone who’s upset she was high once, bear in mind there is only a 6% difference between those two numbers.)

I’m thinking it will be a good night’s sleep for me tonight! Hmmmm....maybe a cup of instant decaf with heavy cream first. Oh yeah, that sounds like a plan.

Saturday, December 17, 2005


It is 5 am. I am drifting in the netherworld between sleep and awake, trying to get back to the former. I roll over, stretch and....LEG CRAMP!!!!

Oh! Oh! Ouch! Ouch! Ouch!

I wrestle with the tangle of sheets and blankets, try to get out of bed and get weight on the leg before it totally locks up in a charley horse. This time, I'm victorious. Whew. Disaster averted. I hobble to the door, on my way to the bathroom to find a calcium pill. Whoops! Forgot the girl. I hobble back to the night stand.

I clip the guardian to my underwear band and make my way, bleary eyed, navigating by various night lights to the bathroom. Not enough light to find the calcium pills. Squinting to avoid blindness I flip on the overhead. I keep my eyes nearly shut, trying to keep my night vision. Ah hah. There you are. I turn out the lights and promptly drop the pill on the floor. Crap. Oh well, at least it didn't fall in the toilet. I lost a Synthroid that way last week. Dropped it on the counter top, bounced right off into the bowl. I probably couldn't have done that if I tried.

Back in bed I try to fall asleep, but angry dollar signs are surrounding me, nipping at me like a pack of hungry velociraptors. I'm worried about money.

When you are sick and scared, it is easy to say: health comes first. We'll find a way. It's only another $400 per month...

But in the trenches, that is easier said than done. Time are changing. It is 1910, the T-Fords are being bought as fast as they can roll off of the assembly line and I'm the owner of a buggy whip factory. Digital is killing the lab industry. Most of my colleagues are now out of business. In the year 2000 I had nine employees and over 3,000 customers spread over all 50 states, with at least one on every continent on the globe. That included our guy in Antarctica. We were busy. The lab was hopping day and night. I worked 80 hour weeks. We were a wash in cash, if not profits.

But now with digital, most professional photographers don’t use labs anymore.

Now it's just me and Molly, my half-day two-day per week angel who keeps the paperwork end of the lab in check. I do all the tech work. Some days I'm busy, some days I'm surfing the web waiting for the phone to ring.

The lab is sometimes too quiet. Too empty. I’ve got a ton of moth-balled equipment that I couldn’t sell on Ebay for two cents on the dollar. The world changed. Almost overnight. Nowadays in an entire month I process less film than we would have done in a single day four years ago.

Some months I’m functionally bankrupt. OK, I paid the phone bill late last month, so I gotta pay it on time this I’ll pay the electric bill late this time.... In fact, we had a slower than anticipated Christmas season. My health insurance bill is three weeks late.

But every time I’m about the throw in the towel, some big order comes in and saves the day. We’ll have a little flurry of business. Things will get better. I get caught up on my bills. I start to breath easier....then things slow down and I’m surfing the internet waiting for the phone to ring and trying to remember if it was the phone or light bill I paid late last time....

So into this delicate balance I throw a huge new monthly bill. I had expected the money stress to be balanced by the lack of health stress. That hasn’t exactly been the case yet. For two weeks I was in heaven. Then we had a little taste of hell. Now...I guess this must be Purgatory.

Some times when I do a BG she’s right on the ball. Sometimes a little off. Now and again, a lot off. Now I’m hyper-sensitive to it. Yesterday, in a mall, my wife asked me, “What’s your

“Depends who you ask,” I replied dourly.

No Lemons at Lemonade Life

Everyone needs to take a quick break from my blog and go visit Allison over at Lemonade Life. She has a great article on the Guardian and an interview with one of Medtronic's folks. I even learned a few new things, like the sensor reads every ten seconds and sends an average to the monitor every five minutes. I knew I got a data packet every five minutes, but I did not know it was an average reading. See how many cool things keep slipping out from under the carpet? Thanks Allison, great piece!

Post is dated 12-16. I tell you this ‘cause I’m too blog-ignorant to figure out how to link to that specific post....

I've never done this before....

I’m shaving my leg. Yes you heard me right. Or maybe you didn’t. I’m not shaving my legs. Just one leg. Actually, only part of one leg. The reason is that I’m running out of stomach. Let me elaborate....

The sensor, transmitter, and the three IV3000 bandages take up a lot of landscape. My stomach isn’t that big (I’m not bragging, that’s just the way it is). If I get too far to the right it is uncomfortable sleeping, and if I get to far left I’m closing in on the belly button. Too far down the belt line gets in the way, too far up it is uncomfortable on the rib cage when I sit down. To top that all off, I’m trying to give my skin a break between hosting stints.

So fellow Guardian user, and LifeAfterDx reader, Meg inspired me to try placing a set on my upper thigh. She reports this works well for her. If it also works well for me then I can alternate the two sides of my stomach (note: the sensor insertion site is never in the same spot, but there are only so many places to tape down that transmitter) with my right and left legs. That gives me four locations and a good week’s rest for the skin between usages.

I’ve been pinching my self tonight, trying to reassure myself that there is some fat left on my leg. Well, it’s either a half inch of flabby muscle or fat. We’ll see how it goes in the morning. That will be sensor number 10.

Attention all Guardian RT users!

I want to hear from you. I think a users group is in order. If you are on the Guardian or are about to get on one, or if you were on one and threw in the towel--I want to hear from you. My email is on my profile. Please contact me! We have lots to share and learn from each other!

Lessons learned and sunny skies ahead?

Well, any day that you don't learn something new, you should have stayed in bed. For me, today was a day well worth getting up for. I spent a great deal of time on the phone with the Medtronic folks....and now I understand a lot more about the near mystical inter-workings of Guardian technology.

I also need to introduce you to our new friend SG. SG is Sensor Glucose and is a close cousin of our best friend BG, or Blood Glucose. SG is what the Guardian reads, basically sugar in the interstial fluid. The movements of the two values are closely related, but not exactly the same. Blood supplies sugar to the fluid which in turn feeds the cells. It is apparently possible for BG to be going up and SG to be going down or visa-versa at the same time. Don't panic. It is all part of the same system. It is like measuring water temperature. Do you stick the thermometer into the stream below the faucet or at the drain? We are used to thinking about measuring from the faucet. In the future I'm convinced that all diabetes control will be interstitially based. For the sake of our mental sanity, however, the Guardian monitor feeds us data translated into BG numbers.

The troubles with Sensor number 7 were, I'm tickled to report, my own damn fault. My words, not theirs. They are waaaaay to polite for that kind of language. Actually, by the time they called I was beginning to suspect the truth from my own study of the data, but it was nice to have it confirmed by people who know what they are doing.

Before I tell you how stupid I was I want to tell you what I found out about bad sensors. A bad sensor can happen. There are basically two types of failures. In the first there is a physical problem with the sensor, and this kind will be quickly detected by the system. The transmitter passes a current though the sensor to check on it. This testing happens throughout the sensor’s
life. If there is an electrical problem with the senor, the Guardian will let you know and tell you to replace it. The other type is a sensor that has not been put into the body correctly. This leads to an erratic "tracing." Your SG track would be a dotted line, not nice and solid. By the way, they loved my traces. All were good and solid, and the accuracy was top notch up until number seven. They weren't surprised that I got shook up, given how the first six looked. They asked how it had been since. (We've had number eight come and go and I'm now on number nine. Deb and I sat down last night and studied the charts carefully and decided that eight started off a bit rocky but settled in and a that for the rest of its stint of duty it compared well to the fist six. Also, number nine is tracing well and with the same flow as the finger sticks.)

In a nut shell the problems had to do with calibration. When it comes to entering finger sticks into the Guardian more IS better, BUT only when things are relatively stable.

By the way, the official line now is: 5 or 6 calibration sticks on the first day of a sensor, and four sticks each on the second and third days. But, but, but! Never ever, ever, ever when BG is shooting up or down. The recipe is about 15 minutes before meals (unless you haven't eaten for 12 hours and your BG is falling like a bungee jumper).

Sensor number seven was ultimately the victim of Panicky Diabetic Syndrome. I got so freaked out with it's performance that I fed it a boat-load of finger sticks. This was on a bad BG day with my sugars rocketing upwards and downwards. I was feeding it data on a slippery slope. The sugar is this. No, the sugar is that. No, wait, the sugar is the third thing. The poor little thing tried to keep up, but...

Basically I gave it a nervous breakdown.

So when you get a guardian alarm it is important to take a finger stick to confirm what is going on, but don't ever enter the damn thing in as a calibration point. That is what I’ve been doing wrong. I entered EVERY finger stick I took into the unit. I thought I was supposed to. I thought that made it more accurate. Well, yes and no. If you feed it a boat load of calibrations in calm waters, then yes, it can help. But on the wild open sea in a typhoon of blood sugar, that is another story all together.

In my defense, the manual is a little sketchy on this point and I gently suggested to the folks at Medtronic that a longer discussion of it would be in order with the next generation....

From the manual: “A fingerstick glucose reading should be entered every 6 hours, however, a minimum of one meter reading must be entered every 12 hours. More frequent daily readings will optimize the accuracy of the sensor glucose readings.” That’s about all that was ever said. The manual needs work. They should really hire me to re-write it. Wow. I just had a scary mental image of myself dressed in rags on a street corner holding a sign: Will write for sensors.

I anyway, so I had thought that the more the merrier. I told all of you the more the merrier. But that is not the case. The new PLAN:

For the second and third days I’m thinking something along the line of:

Calibrate as soon as I open my eyes in the AM.

Calibrate 15 minutes before lunch.

Calibrate late afternoon. Maybe 5:30ish. We eat dinner anytime between 6 and 8pm. I don’t want to wait too close to dinner because often I’m droppppppppppping!

Calibrate at bed time.

That gives me my four sticks at my most stable times. By the way, I asked if they thought forearm tests would be better for calibration as they are less prone to show quick shifts, but no one knew if that was a good idea or not. Guess I’ll stick with the finger tips for now.

Of course, I’ll still do my post meal sticks, but I won’t enter them into the girl.

I’m still kicking around how to handle the new sensor. Skip break fast on insertion day and eat a brunch instead after the new sensor is calibrated? How on earth to fit six in on such a day? Maybe four hours after lunch, then late afternoon. I’m up to three and it is dinner time.

Hmmmm.... seems a little hopeless, but I’ll come up with something.

So, in the end, after our first fight the girl and I have made up; and are once again (for now at least) the best of friends.

Friday, December 16, 2005

Mother nature

I am used to looking at BG graphs from meter software. Clean, straight, orderly lines that connect the dots. Somewhere, deep down, we all know this is not how it really is. Nature is messy.

So I've been staring at the elegant, twisting, morphing, snake that is the plot of my blood sugar. It is so damn....un-linear. It is elemental. Raw. Wild. Biological. It is chaos, full of bizarre peaks and valleys. An alien landscape, sometimes like a river viewed from space, sometimes the jagged mountains of the moon themselves.

Why does it drift up and down throughout the night like a Chinese kite on a light summer breeze? Why over here does it look like the plot of an earth quake? I knew this would happen, but I'm having a hard time wrapping my overly technical brain around it.

Then, on the same graph, I'm staring at the little blue stars that show finger sticks. On the graph things don't look as bad as they have sometimes felt in my heart. True, the dots don't always fall on the line, but they do tend to follow the flow as it snakes it's way through the day. When the line goes up, the finger sticks are in the area. Sometimes higher, sometimes lower. When the line goes down the finger stick dots chase it. Some times in the lead, sometimes following. So bottom line: how well is this thing working for me? I'm so confused I do the only thing I can think to do.

"Babe, would you look at these charts with me?" It's good to have a wife. We cuddle up in front of the lap top. The "wall paper" is a picture of Rio and I taken on top of the butte in our front yard. The little boy and the fat man. How much has changed in a year. I've lost 60 pounds and he's gained most of it.

We call up the Solutions software. We look at the Sensor Details section. 21 mini-charts displayed seven per page. Each shows the snaking river of BG data, up and down, over 24 hours. We can click on each one to make it larger, to look and see where the blue stars lay. Some times north of the river, sometimes south. Some times dead in the center. There are several absolutely perfect days. But as we look through them I see that even with the first six sensors there were times the finger sticks were a little higher and times when they were a little lower.

Somehow, I'd gotten it in my head that the first sensors ALWAYS eared low when they were off. Not true. They were always very good, but some were on the high side throughout the day, and some were on the low side throughout the day. After number 7 crapped out I got it in my head that number 8 was always running high. Again, not true. In fact, the performance was very comparable to the first six. I had just become hyper-sensitive to it's performance because of the bad experience.

I take a look at the graph of the morning that prompted my angry call to Medtronic when Cozmo showed 65 and the girl was lollygagging around at 90. That slice of time was accurate, but not the whole story. The sugar was in free-fall, the snake was chasing the star down, down, down. Had I not woken up to test I'm betting the girl would have alarmed on her next check. Even when we look back at the "bad sensor," it is not as bad as we thought it was at the time. Oh, yeah, it IS bad, don't get me wrong, but it was trying. The blue stars are debris tossed upon an angry sea. Far off of where they should have been, but you can see the system was trying to link up, to create a unity.

Tonight: the call from Medtronic.

Thursday, December 15, 2005

An award-winning Blog?

I got a nice surprise tonight, I got an email from Allison Blass over at the OC. Rather than paraphrase I’ll just cut and paste:

Dear Wil,
Congratulations! You have been nominated for 3 Diabetes OC Blog Choice Awards in the following categories:

- Best Blog
- Best Male Blogger
- Best New Blog

There will be a special Talkfest chat on Wednesday, Jan. 4 at 6pm PST/9pm EST where we will announce the winners. You do not have to be present to win. No purchase necessary.

A list of the nominees and the voting poll will be posted at the Diabetes OC Blog Choice Awards website tomorrow, Dec. 16. Please encourage your readers to vote.

Thank you and again, congratulations!

Allison BlassDiabetes
OC Blog Choice Awards Coordinator

Wow! What can I say, I didn't really see that one coming. Oh, wait a minute, I do know that to say. Thank you. Thank you to all of you who nominated me. Muchas Gracias.

My father and the numbers

I wish my father was still alive. For many reasons, of course. But tonight I wish I could take advantage of his extensive knowledge of a subject that I am grappling with. A subject he taught at some of the nations finest colleges and universities: statistics.

I've been trying to understand things beyond my normal experience. Beyond my education. And, perhaps beyond my intelligence.

Sensor number eight has been acting up. Running high. Too high. I’m back to being THE NEVROUS DIABETIC.

My first two weeks were wonderful. Like a fairy tale. But with the 7th sensor crapping out and number 8 not acting like the first six, I find myself becoming paranoid. I don’t trust the girl as much as I used to....and she’s a lot of work and money. If I can’t trust her, what’s the point?

Medtronic has provided me with 16 pages of clinical study data in the back of the manual. I'm looking through all of this to try to answer one question: were my first two weeks typical performance and the recent trouble an anomaly, or the other way around? I'm struggling to understand what the information is saying. I wish I could call my father and have him explain it to me.

Although I remember once, when I was in college, I called and asked him a stat question. A deep sigh in the phone. A pause, and then, finally..."Well, you do have a copy of my book, don't you?" Yes, Dad. "Well I cover this quite toughly in chapter two." I was told to read chapter 2 and THEN call back if I still didn't get it.

I've looked though both of the books my father wrote tonight, but his voice isn't speaking to me through them. I'm on my own with no one to call if I don't get it.

Here is what I think the data tells us. I may not have "gotten it." So don't treat this like it is carved in stone.

The help line’s official number is that the Guardian readings are plus or minus 13.8% of a finger stick, but looking over the clinical studies it is not that simple. The results are non-linear. That means that in some ranges it is better than the 13.8 and in other ranges worse.

Medtronic have compiled various data into an analysis to show how readings could effect real world situations. Overall, about 62 percent of readings can be considered "clinically accurate." Around another 35 percent of readings would lead to "benign" decisions. In other words, yeah, off a little, but you wouldn't hurt your self. So the machine is considered golden about 97% of the time. That's damn good. But what about the other 3%? Well yes, this is the zone where you can kill yourself.

Part of that number includes lows that are not detected. The system is not perfect. Is it still worth it? My feeling is the money is well spent catching 97% of my trouble. Besides, this is not the only game in town. I'm still using my BG meter and my brain. Even though I can't feel lows I can recognize when my behavior has put me into a situation where they are more likely and I can exercise more vigilance. Might it miss a hypo? Sure, could happen. Might I miss one on my test strips? Yes, and once pre-Guardian I had a real close call. Might the Guardian catch something I would otherwise miss. Yes, 97% of the time.

Might I have a "perfect storm" with me out to lunch and the Guardian in 3% town? Could happen. And what would happen then? Well, hopefully my wife would remember how to use the Glucagon kit. (My pharmacist had a good friend who died of hypo. His frantic mother injected the saline with out first pushing it into the vial and then drawing it back it. These ain't Epi-pens. My advice: have your loved once "practice" with expired kits before you toss them every six months.)

There is a ton of data. Tables. Charts. Columns of figures. It is late at night. My mind is muddled and I am depressed by all that has transpired. But I’m feeling encouraged. Tomorrow I’ll sleep in. Then I’ll get up and look at the data again and make sure I’ve got it right. After that I’ll look over the download of my data again carefully and try to figure out what’s going on.

SIX HOURS LATER...........

This morning I was planning to sleep in. I was up late last night studying the clinical studies data in the back of the Guardian manual, trying to divine how well it is supposed to work. But I woke up at 8. Laid there trying to get back to sleep with no luck. May as well check the BG. Cozmo has me at 65. Kinda low. I take the Girl off of the nightstand and flip open the case. Click. 90.

$#%&^*@ #%#%&% $^*&%##!!!!!!

Or words to that effect. I retest with Cozmo. Now 64. I take a half a cherry slice and roll over and try to get back to sleep. No luck. I’m too pissed off.

I get up. It is site change day for the pump, but not until tomorrow for the Guardian. The sensor that died threw us off the system. A normal site changes seems so simple. So little to do.

I gather up my notes and call Medtronic. The poor guy at the 24 hour help line really gets an ear full. Among other things I dump on him I tell him this is too damn expensive not to work right and what are my return privileges if I want to throw in the towel?

He is exceeding polite to me, even though I’m probably near the edge of being nasty myself. These Medtronic folks are professional. He doesn’t know why I'm so far off, and he doesn't know about the return policy on the Guardian, but he’ll find out.

As promised, he calls back within the hour with THE PLAN. First off, the Guardian has a 30-day return. As we are closing in on 30 days they want me to know they are going to extend that for me. They want the machine to work for me and we are going to work together to try and make that happen. However, failing that, they’ll take her back and refund my money. Cool. I’d much rather spend the rest of my life like I’ve lived the first two weeks, but if that was just beginners luck then I’d rather have the money back in my checking account.

They ask me to email all data from hook up until today. They’ll analyze it and with in 24 hours they’ll call back. We’ll conference call with tech, help line, and me. We’ll all be looking at the same data on our computer screens and try to figure out what’s going on.

Tomorrow: Good News for Wil and the girl