LifeAfterDx--Diabetes Uncensored

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

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Location: New Mexico, United States

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

Sunday, August 26, 2007

Conquering the Elephants….err….Elements

Sir Edmund Hillary and Everest. Admiral Richard E. Byrd and the South Pole. Charles Lindbergh and the Atlantic. Wil and the Fudge-fudge Walnut Brownie at the Elephant Bar in Colorado Springs. Yes, these are all epic tales of man versus nature; of overcoming insurmountable odds and succeeding. Of pushing human limits to the edge of oblivion.

Ever been to an Elephant Bar? They are wonderful restaurants, but not particularly diabetes-friendly. The decor is Africa, pre-World War II. Kaki, brown, beige and black. Zebra stripes and bamboo. Funky ceiling fans and giraffe patterns. Vintage travel posters from airlines that no longer exist. Fits my deluded self-image of being a Hemingwayesque world-traveling adventure-seeking journalist. There is even a life-sized elephant head on the wall, made of plaster. I boost Rio up so he can touch the tusks.

But the name of the restaurant has nothing to do with the retro-safari décor. I really is all about the portion size.

The Fudge-fudge Walnut Brownie (hence forth the FFWB to save space) comes in a zebra-striped bowl the size of your head. There are two slabs of brownie the size of your face. Scoops of vanilla ice cream in between and everywhere else. A gallon of hot fudge sauce. Enough whipped cream to camouflage an aircraft carrier.

But this is not an indulgence; this really all about science in action. I’m selflessly doing this for you, dear readers, with no thought of myself what-so-ever. Time to really put this new Guardian through her paces. I’m too lazy the look up the pump log, but I think I programmed 150 carbs on a combo bolus over three hours with 55% on the table. It wasn’t nearly enough.

So the new girl’s screen maxes out at 350. Above that you get a solid bar at the top of the graph. You’ll still get SG numbers for a little while. Until 400. Then you only get a message that says “above 400.” Could be 401. Could be 550. Could be 800. Who knows?

In all fairness, if you’re diabetic, you really don’t belong up in these rarified numbers. In all fairness, most meters crap out at 500 too. I didn’t stay above 400 for long; but every two hours I got a high SG alarm, even though my blood sugar was dropping steadily. Both high and low alarms feature a “snooze” feature. This works just like a snooze button on an alarm clock. It lets you sleep a while even while the alarm condition continues to persist.

I’ve set my high snooze to two hours. If I’ve eaten a FFWB in the interest of science, I know I’m going to be high a while. It took about 4 correction boluses of various sizes to get me “between the lines,” back to my target BGL. You can select your snooze length. With the duration of action of NovoLog being around four hours in my body, I find the two hour to be a good choice. I don’t get “bugged” constantly, but the system checks in with me every couple of hours and reminds me to decide if more correction insulin is in order.

There is a low snooze too. That I have at 20 minutes. If I’ve had a low alarm, I sure as hell want to keep an eye on it. That said, I’m yet to see a low alarm.

No, my control hasn’t improved. No, with one exception a few months ago, I haven’t re-gained my ability to feel lows. I’m still flying blind. No, as you can see, I still eat like an idiot. I recently compared my relationship to sensible diet to being like a televangelist. I understand the word. I preach the word. I believe the word; but I’m still in the back room screwing the church secretary. I’m easily tempted by culinary delights that would leave me healthier if I could resist their charms.

Must be because I became T-1 late in life; after fully buying into the American diet. That’s my story and I’m sticking to it.

No, I’ve not seen a low alarm because the magic of predictive alarms really works. When I first read about the MedT predictive alarms I had a vision of a wrinkled gypsy crone with a brightly colored head scarf and large gold hoop earrings peering into a dusty and cracked crystal ball. (In reality I’m pretty sure that the guy who came up with this wears wire-rimmed glasses, a suit and tie, and spends waaaaaaay to much time at the office rather than out having fun.)

I was pretty skeptical that this hocus-pocus would work. I mean, I could see that in theory, in perfect world, in the laboratory, that it would work. But out with the Elephants, in the wild of America’s carb-soaked streets, in the complex bodies of T-1s….well, now that’s another story altogether.

But it really, really, really does work. No shit. Every time I get a predicted low alarm I do a fingerstick to discover that my BG is a bit lower than the Guardian thinks. No surprise given the lag between capillary glucose and interstitial fluid glucose. The alarm is looking for either an 85 at night or a 75 during the day, as those are the settings I’ve selected. It’s looking 15 minutes into the future, again, because that’s the time window I selected. In most cases when the predictive alarm goes off I’m actually already about 5 points below the low threshold. But who cares? Those number are still solidly above a hypo. I’ve had an accurate advanced warning that lets me take proactive action. A quick glance at the graph will confirm the rate and speed of the drop in progress. Hmmmm….D.I.P. Drop in progress=Dip. I like it. New word for the International Diabetes Dictionary!

Where was I? Oh yes. Now ParaPump had a graph too. But you had to (A) turn the damn thing on by pressing a couple of buttons and (B) you had to remember to look at it at all. It’s simple threshold alarms weren’t much help. By the time the alarm went off, you’re already going low. If you set your low threshold artificially high, you are plagued by false alarms.

I’m sure the design wizards at MedT think we’ve got diabetes on our brains all of the time, when in fact, we are all doing everything we can NOT to think about our diabetes. Diabetes can be all consuming, forcing out work, family, fun. I want to be healthy, but I don’t want to use all of my energy to do it.

The new Guardian is exactly what we need. It is a way for us NOT to have to think about our diabetes. It frees us because it watches out for us in the back-ground and alerts us to when we have to pay attention. Of course it still could alert us a bit more aggressively. Which brings me to my new Timex from Wal-Mart. It’s part of the Expedition series (see the Hemingwayesque self image above) and cost me less than 50 bucks. Burnished stainless steel. Kaki face. Leather band. Retro-future in an art deco kinda of way. A device out of a time when devices had both beauty and function as a requirement. It is waterproof to 50 meters and it’s alarm will wake the dead. The Guardian is only water resistant to a splash and I was recently told that’s why the alarm couldn’t be louder. Considering my new watch, I think some one is blowing smoke….

OK, enough ranting. Fact still is that I’ve had no lows or even real low alarms. I get the predicted alarm, which reminds me that I’m diabetic. I check my sugar and find it is already below 80. I look at the graph and see that sure enough, I’ve been steadily (or sometimes rapidly) dropping for some time. I open my go-bag and get out a cherry slice, eat it, and go on with whatever I was doing.

It’s never been easier to be diabetic. Even when your hunting elephants.


Anonymous Anonymous said...

Wil...what is the cherry slice you mention in the post.

1:39 PM  

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