On The Pump

New Tech Device

Originally uploaded by cogdogblog.

After 35+ year of traditiional insulin via syringes, I am moving into the age of an insulin pump. This little pager size device (Medtronic Paradigm 722) is a powerful litle computer, and comes with a thick ownsers manual.

All of the changes are a bit overwhelming. Okay, I am giving up one thing (in jecting long term insulin, so no more Lantus), but now I have revervoirs, infusion sets, carb counting, and all kinds of micro-managing.

Until now I have been extremely sloppy on my diet and tracking, which will all need to change as my insulin “bolus”- the amount extra taken at meals, needs to be correlated closely with how much I eat.

For the first two days, i wore it filled with saline, taking my normal injections, to get used to having it attached and pretending to do my doses. It seems like a lot, but I am confident it will become second nature.

In the long run, this should help a lot, as the little incrementing flow of small doses of insulin will better mimic what my body is supposed to do.

Pump Plans

After seeing and talking to some of the other diabetic runners on Team-D, and am now more than ever ready to consider getting an insulin pump. I have an appointment for beginning of February to consult with my endocrinologist and diabetes educator, and I might be a “pumper” soon.

It should give me much better control over blood sugars and impove activities like running. I just need to get over ther phobia of having a “thing” always attached to my body, but I know I have some pre-conceived notions to destroy.

If any readers have some good pump advice, please send ’em my way!

Bad Prediction, Dr. Silver

I’ve written before how the key factor in my management of diabetes was attending summer diabetic camp in Maryland called, Camp Glyndon.

The camp was founded by Dr. Abraham Silver, who was pretty ancient back then. Even with web searching could barely find any information on him, a nostalgic photo of him in 1958 published in a University of Maryland publication. Wow, he looked kind of old 12 years before I even met him in 1970.

But I know he had an infinite amount of care and concern for children with diabetes, and was vigilent about kids learning to be able to manage their own care, to do their own insulin shots. He had a kind of gruff exterior, and I recall one time, when I was more of a loud mouth teen-ager, when he tried to scare me by saying. “If you don’t straighten up your act, you’ll be blind by the time you are 25, and dead by 30”.

Happily, Dr, Silver was wrong on that one.

Not that his statement had any impact; I did the minimal amount of care uuntil ym late 20s, eating what I liked, and pretty mush just taking my daily insulin shot. I am lucky, as modern studies show every bit of good control extends your diabetic life.

It is disappointing I cannot even find any historical information on Camp Glyndon, it is not even in its original location, northwest of Baltimore, I think it is moved to Charles County at Camp Merrick.

In fact, at a high school reunionm one classmate told me he lives in a suburb that was built on the camp land.

I more or less grew up there going every summer from age 7 to 15, then being a counselor from 16-19, and had a lot of “firsts” there. That photo of me is maybe my first year there, getting my stuff dropped off. Check out those cool striped 1970s jeans I am sporting. Stylish, indeed.

There was so much fun activity then, sports, arts and crafts, swimming, campfires in the woods on “Mount Smokey”, Green and White Day, Sadie Hawkins Day, mail call… all that plus learning about living with diabetes,

I did find a photo on a site about the history of diabetes with the caption

Testing urine for sugar is a serious business for the young campers at Camp Glyndon, Maryland. WHO photo by J. Gordon, (Baltimore City Health Dep).

I don’t remember the kids in that photo, but I recognize the old shower/bathroom building we used to test our urine 4 times a day, each with our own labeled test kit and pee cup on the shelves. It was the old 10 and 2 method in a test-tube and a drop of Clinitest tablet, and hoping we got a blue color. It seems almost stone age.

2Am Low

It’s 2:00 AM and I am wide awake.

It’s not insomnia that makes me wide awake, its the adrenline rush that is a fortunate by product of a low blood sugar incident.

Anytime I wakeup before my alarm clock, its because of “going low.” While I am fortunate it happens that my body jolts me awake (as I’d be in big trouble if it did not), the stepped up regime of this training is making it happen much more frequently… being active or very regimented in diet has this tendancy for diabetics to ride that fine line between good control and where we are frequently having to disrupt activities to quietly munch those nasty tasting glucose tablets.

I can still remember being a kid at summer diabetes camp in Maryland, and if you told a nurse you were “low”, they’d give you the appropriate half cup of orange juice and have you wait to see if it brought you around. For those who are not diabetic, its hard to describe what the internal feeling is like- – it is similar to “bonking” from intense exercise, but more intense, and its easily 10 times the biggest hunger you’ve ever felt. Your body is screaming for food, FEEEEEEED MEEEEE NOWWWWWWW and you certainly feel capable of snorting a Costco sized bag of M&Ms. My high school friends still recall me practicaly inhaling whole rolls of Life Savers.

And I tell you, a few brushes in incidents where you are low and don’t have that sugar handy are even scarier than the midnight, confused wakeups. I’ve made it thorugh times when what saved me was soggy bags of candy during a raft trip or once long distance biking from the kindness of a stranger outside the closed Reata Pass Steakhouse who gave me a tall glass of regular Coke.

So as my sugars begin more frequent lows, I am subject to what I call a Yo-Yo effect. You dip low, and to counteract it, you end up eating a bit too much sweet stuff, and your sugars swing high. So at a mealtime blood sugar test, shocked at scoring a number in the 300s, you overcompensate by taking a bigger dose of short acting insulin. Then, before you know it you might swing low again…

It’s why I’ve always struggled to lose weight once I get into a rigrous exercise routine– the more my body is active, the more food I seem to need just to keep the lows at bay and the hungrier I seem to fell all the time. Then there is the guessing game before exercise of trying to figure out how much to eat to keep you from bouncing low.

It’s also something that rubs me a bit roughly in reading the “advice/sugestion” from professionals in places like the ADA’s Diabetes Forecast who don’t live with this. Of course rationally I can see how it makes sense to only take that halp cup of OJ to treat a low, and not to over-react to a high readig with too much insulin, but in reality, your body gives strong messages, and we hate having these life interruptions to attend to them. It’s another thing listening to that monster who wakes up up at 2:00 AM, or when it does, you treat appropriately, and he’s knocking again at 2:35, 2:47, 3:15….

I think the health professionals do not give due attention to the challenges of trying to ride that fine line of “good” versus “low” blood sugar levels, just as much as your co-workers giving you the funny looks (the “I Thought You Were Diabetic And Cannot Eat Candy” look) if you are munching the lunch room chocolate like a mad man.

It’s 2:40 AM, and I am wide awake….

My Eye Wake Up Call

For my first 20 some years as a diabetic, I was fortunately free of complications, fairly active, and had a simple, maybe not optimal regimine of care, not really on a diet. I was on one shot a day, and honestly hardly ever tested my sugar levels. Still, I made it through my undergraduate years of college, moved to Arizona in 1987 for graduate school, spent a lot of time hiking/camping (several backpacks in and out of the Grand Canyon, the Superstition Wilderness area, and into the Utah canyonlands), and did 7 or 8 of the Multiple Sclerosis 160 mike bike-a-thons (a 2 day November event).

It was 1993 when I got my wake up call.

I had been maybe a year into my first “real” job at the Maricopa Communtiy Colleges, and still amazed at the things a medical benefit plan provided. On a routine eye check up (I thought I may need new glasses), the optometrist noticed some spots in my eye that were of concern. He referred me to a retinal specialist, where I learned I was in the early stages of diabetic retinopathy, the condition where higher than normal bloos sugars cause tiny blood vessels in the retina to burst and cause spots in vision, and worse, can lead to signicant or total loss of vision.

Over the next 2-3 years, I went through several rounds of laser trreatment to the eye, where the laser is used to scar of the blood vessels to keep them from bleeding. My left eye responded well to the treatment, but the right eye took several more rounds of the laser, “as much as could be done”. It was a bit odd when the first doctor who did the treatment suddenly retired (well the next time I came back, Dr. M was gone), but have seen his replacement for the last 12 years.

A treatment started with a local injected just under the eye (big needle, big dullness), and sitting in one of those contraption chairs while the laser is aimed in the eye. It doe snot hurt during, but is pretty achy as the local wears off. The side effects were some loss of night vision and periphial vision.

The thing it realy did to me was to wake me up and tel me I needed to be doing more care of my diabetes, so I began finally regular blood testing, and moving to a regime of multiple injections per day. Its one thing to get the scare talk about circulation or your kidneys, but when the prospect is losing your vision, it is a cold bucket of water in your face,

I am fortunate that it is now 12 years after starting the laser treatment, and every year I go for a checkup, and there has been no worsening or change for the last 8 years.

I certainly can do better still on ym control, diet is still my weakness, and someday I may be considering an insulin pump. I hopew that regular physical activity (ahem…. running) will go a long way to keep me going.

Watch Those Bloody Assumptions

Sometines we create our own truths, whether they are or not.

The other night, the phone rang. It was United Blood Services trying to schedule an appointment with my wife, a regular donor. She was not home, and when I told the person that, he asked, “Well what about you? Do you want to donate?”

“I’d like to,” I said, rolling out my assumption. “But I’m diabetic, so my blood’s no good.”

“That’s not true! If you are on insulin and your control is good, you can donate.”

See all my years I have told myself I could not donate, but apparently the rules recently changed, so tonight I gave my first two pints of blood ever. I hope it helps someone who needs it.

Always question your assumptions; no more is it “diabetics cannot donate blood.”

My Diabetes Story

Since this running and training are related to and hopefully good medicine for my diabetes, I’ll write a bit here and there of my experiences dealing with the big “D”.

This Halloween will actually quiety mark a milestone of my 35th year since being diagnosed. The story goes back to a day in 1970, when for some reason I decided I wanted a day off from school. So I told my Mom I was not feeling well.

I did not know it, but for some time she had been noting some behaviors and symptoms- the thirst, stomach aches, irregular eating patterns, mood swings (though I always that that was normal at age 7), some bedwetting. So she rather surprised me, and ruined my plan, when she told me she was taking me to the doctor.

So off we went– I forget exactly what Dr Kramer did during his examination, but I ended up out on the hall, while he talked to Mom behind a closed door.

Then he called me in and started explaing that I had a serious condition and needed to spend some time in the hospital and… I did not even hear it, I busted out crying, confessing I had lied to get out of school, and I really was okay… They were not even caring, and seemed intent on this hospital thing.

So off I went, spenidng 10 days at Sinai Hospital in Baltimore. The memories are blurred, there was a frug nurse shoving the IC in my arm, ordering food from a menu (ordering was fun, but the portions small), watching TV, getting get well cards from my second grade school mates. The hard part was missing Halloween, and then finding out I had this thing that meant I should not each much candy ever again! I think there was some sort of Halloween party for the sick kids. Then there were some visits from nurses, and having me practice give injections to an orange.

Upon my release, my parents and I went to a few weeks of out-patietent education to learn how to take care of my new condition. There were the daily insulin injections that my Dad did, and having to test the sugar in my urine with a test kit (10 drops of water + 2 drops of urine + a “Clnitest” tablet and hope you get blue, not orange).

The thing that really changed it all for me was attending Camp Glyndon that summer– it was its first year as a summer camp just for diabetic kids. What a great thing it was not to be the only kid with this condition, but surrounded by 100 others! They stressed tremendously that even us little kids could learn to manage our diets, testing, and injections…. I think there was a tradition that they wouldnot raise the green and while camp flag until every kid in camp did their own shots.

From then on, my camp experience enabled me to handle all the diabetic care myself. There was a lot fo power in that.