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!).

Monday, January 16, 2006

By the numbers

Let’s re-visit the subject of the number of calibration sticks. We haven’t talked about this for a while now. My current thinking is three on most days. The system requires two, twelve hours apart. But think about it. If I do 7am, then I need to do 7pm. Not good. In the morning it is calm water, but in the evening it would be right after dinner. What I’ve been doing is either three or four per day.

I always do a wake up stick. By the way, this is a new stick for me. I use to just wait an hour and hit it at breakfast. But this is a good time to give the girl her first cal stick. Sometimes I do a noonish stick, but usually I wait until late afternoon, and then again at bed time.

I had been toying with the idea of dropping the pre-breakfast stick and just using the wake up stick as I’m usually eating breakfast within 45 minutes of getting up. However, I’ve noticed that there is often quite a lot of changes going on in that first 45, so I’m still doing pre-breakfast. I don’t enter any of my pre-meal sticks on two theories: one, I’m about to pump insulin and two: I’m about to dump sugar into the system. I figure either one could start things moving pretty quickly and that could throw off the calibration process. Of course there are other finger sticks during the day that don’t go into the machine as well, like responding to an alert, but overall my test strip usage is way down.

Another number: I’m trying two IV 3000s under my transmitter. I’m still getting some localized rash on my skin from the transmitter adhesive. I guess it’s working its way through the IV 3000. That now means I use five each time I change a sensor. What was that sound? Oh...just the sound of Smith & Nephew sock going up 5 points. Lucky for me that with these modern windows computers my readers can go buy stock without having to close me down!

The best new number yet: fewer hypos. I've noticed looking over my data that not only do I have fewer hypos, I'm spending less time "in the basement." I've also clocked less high time too. My sugars have settled down considerably. I’ve had very few alerts the last several weeks, and almost no real hypos. I credit the Guardian for this. I think now that I've "mastered" the work flow of using the system to keep tabs on where I am, my control has improved. I'm heading trouble off at the pass. I'm preventing trouble. I’m being ProActive Man! (Readers Vote: what color of cape should ProActive Man have?)

But most important : I feel safe again.

I'm boss now, well me and the girl. So it is sort of like a marriage that way, I think I’m the boss, but we all know who’s really in charge....

But not the specter of hypo, that’s for damn sure. During the day I'm on top of things. As bed time rolls around I don't have to resort to taking a finger stick, looking at my IOB (if any) and winging it, like I did in the old days. (New view of the morbid child’s prayer: Now I lay me down to sleep and if I die before I wake...I sear I will never teach that prayer to Rio!).

Now at bed time I can see the rate, speed, and direction of change before hitting the hay. I'm in control. In the pilot's seat. But it is good to know that I have a co-pilot, just in case. If something unexpected happens during the night, the girl is on the job and will wake me up.

For what it is worth, I had expected many "false alarms" when I cranked up my alert thresholds, but that has not turned out to be the case. The last few weeks I've only had a fraction of the alarms that I had in the beginning. Again, I think this goes back to good control, and the opportunities for good control that constant feedback bring.

This leads me into one last point that I haven't spent enough time on. The name of the system is Guardian RT. The RT stands for real time. Of course we know it isn't, but it is close enough. Even though the data is delayed by as much as five minutes, it lets you take action in real time. Think about that. No, really think about it. Is a test strip real time? No, it is slice in real time. That's not the same. I've come to appreciate that the most powerful element of the entire system is the recent history that can be accessed by checking your now, then scrolling backwards a few clicks.

Tonight, two hours post sugar-free Klondike Bar: 104 now and going back wards: 104, 104, 105, 106, 108. Dropping, but slowly. According to the pump the IOB is 0.4 units. Looks like we are cleared for landing! (In bed that is).


Blogger Scott K. Johnson said...

Hey Wil!

I too do a wake up test and usually a breakfast test too. I too see a lot of change in that first piece of the morning.

I'm not a morning person, and if left to my own decisions I would sleep in every day until 10am at least.

I believe that my body is dumping out all kinds of "get up and get moving" hormones after that damn alarm goes off and I start moving around.

If I skip breakfast it really makes things weird. Seems like I need that first meal and insulin dose to get me off on the right foot.

So, to make a long comment a little longer, I do a wake up poke and a pre-breakfast poke too.

I'm curious as to what the CGMS system shows once you wake up? Do you notice a spike in BG values?

That's really great to hear about things moving in the right direction. I think you are treating your diabetes in a much different fashion - proactive rather than reactive - which will make a HUGE difference in your overall therapy.

I'm excited to see this stuff mature, and I'm soo tempted to go rob a bank or something so I can join the club. Again, your blog, and your willingness to share your everyday life with this is so valuable - thank you!

10:05 AM  
Blogger George said...

First off I wanted to tell you how much i enjoy reading your Blog each day. I look forward to when the West Coast has a place to pick up a "girl" like yours.
Second, we taught our kids, "Guide me through the Stary Night and wake me with the sunshine bright." a much better ending to that prayer. It always freaked me out as a kid!
Anyhow, Thanks so much for the Blog, it is always interesting, well written, and very entertaining.

2:23 PM  

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