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By shannon, March 11, 2010 11:15 am

As you all know, I decided to try Symlin again.  While its primary purpose is to help reduce those pesky blood sugar spikes I get after meals, the secondary (and perhaps *my* primary) purpose is to help with weight loss.  The unfortunate side effect is nausea. 

Symlin works by replacing the natural Amylin that, in non-Type 1 diabetics, is secreted by the beta cells of the pancreas.  It works by delaying stomach emptying, which helps you digest slower.  It’s also that little voice in your head that tells you when you’re full.  Since I am beta cell challenged, my body doesn’t make Amylin, which is why I often feel hungry even after a satisfying meal (= weight gain).  It’s also why my BG can easily spike to 300+ after I eat, which = more insulin, which = weight gain, which = insulin resistance, which = weight gain, which = well . . . you get the point. 

As it happened, George (a.k.a. Ninjabetic) also decided to start Symlin again.  He and I had very similar beginnings with Symlin, and we were both reluctant to try it again.  So, it’s really nice to be doing this with someone else who knows what it’s like. 

As you know, I started on Tuesday night at just 15mcg (the absolute minimum for a Type 1).  Yesterday morning, I skipped breakfast, so no Symlin.  Truthfully, I was feeling a little nauseated, and I wasn’t sure if it was from the Symlin or just general morning crappiness.  I was super-busy at work, which meant that lunch was upon me pretty quickly.  Knowing that I had a meeting at 1pm, and feeling the desperate need to get a home pregnancy test because my period is still MIA, I quickly ran to the drugstore for the test and Chick-fil-A for a salad. 

Back at the office, I peed on the stick.  Negative, which was no big surprise, considering . . .  Even still, I was disappointed and relieved at the same time.  After all, I’m taking meds that are not pregnancy safe (Lisinopril and now Symlin).  Still, it sucks to see that one lonely line on a pregnancy test time after time. 

Anyway, back at my desk, I dialed up 15mcg of Symlin and ate my lunch.  I programmed a 60-minute square wave bolus on the pod and watched Dex like a hawk.  Sadly, my BG began to spike within 30 minutes, and it went high (like mid-200s high).  Then the nausea hit.  I felt like complete shit.  It was weird because it was more severe than the night before.  As George, Scott, and I were discussing last night on Twitter, it feels like you’ve got food stuck at the very bottom of your throat.  I don’t know how else to explain it.  Whatever.  I wasn’t going to let this nausea screw with the potential benefits of using Symlin.

So, last night before dinner, I decided to up the ante.  I dialed up 30mcg on the pen and bravely took the shot (it stung, too!).  I ate my dinner (about ½ of my typical portion size) and waited for the nausea.

It didn’t come.  As soon as I finished eating, I got up and started cleaning.  Keeping busy really seemed to help.  My BG remained steady and under 150 mg/dl before dropping slightly.  I tested before going to bed and was 145 mg/dl.  Hearing Dr. S.’s voice in my head (he wants me under 100 mg/dl in the morning), I did a small correction bolus and went to sleep.

Sometime around 11pm, I heard a low BG alarm.  I grabbed Dex from my nightstand and saw that I had dipped just below 70 mg/dl.  However, a finger stick showed me at 75 mg/dl, so I didn’t treat and went back to sleep.

At 1:30am, Brian’s stupid on-call phone for work rang.  I woke up instantly.  A quick peek at Dex showed me still hovering in the low 60s.  A finger stick confirmed, so I decided to drink a very small glass of milk.  This was definitely the right thing to do.  I woke up this morning at 99 mg/dl (hey, it’s under 100, right?), and Dex showed a nice flat line all night.  I felt pretty good, although tired because of the phone call. 

I got to work, dialed a 30mcg dose of Symlin for my modest breakfast (45g of carbs).  I programmed a 30-minute square wave bolus this time to prevent any spikes. 

That was an hour and a half ago.  My current BG is 157 mg/dl, but it looks like I’m rising fast.  I’m going to keep trying different ways to get the most out of Symlin.  I am anxious to get up to the 60mcg dose, which has more weight-loss benefits.  But, as it is, I’m eating much less than I was, so that’s good.  I’ve read that some Type 1s are able to tolerate the 120mcg dose, which offers the highest weight loss benefits.  I’m going to shoot for that, but I’m prepared to stick with 60mcg if necessary.

Overall, this experience with Symlin has been significantly more positive than my last attempt.  It’s something I’m determined to stick with, so I’m not going to let a little nausea derail me.  I’m committed to losing this weight, dammit!

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By shannon, March 10, 2010 9:41 am

As I expected, my A1c went up.  I just didn’t expect it to go up *that* much.  For almost two years, my A1c has been below 7%.  It’s a lot of work, but totally worth it.

I admit that I rebelled a bit.  I also got lazy.  I was just so tired of the tight control and limitations.  I went a little nuts.  I have the weight gain and lousy A1c to show for it. 

All other tests were good.  BP was “excellent” according to Dr. S.  He also said that I’d *lost* two pounds since my last appointment.  This just doesn’t seem right, but I wasn’t about to argue.  He gave me a list of group meetings and events (read: support groups) for Type 1s and encourage me to attend.  I don’t know if I will – I admit that it would be nice to meet some other Type 1s in person, though. 

As I mentioned yesterday, I wanted to talk to Dr. S. about Symlin.  After looking at my A1c, Dex graphs, and logbook, his initial feeling was to further increase my basals.  Since I had decided that I was not going to let that happen, I needed to find an alternative.  See, *I* think my basals are too high as it is.  The highs I’m experiencing aren’t the result of too-low basal settings; it’s because I’ve been eating like shit for months and, more often than not, SWAG bolusing.  So, I’m high because I didn’t count carbs correctly.  Sure, I correct, but once I’m high, it’s so hard to get back down. 

Which, once again, led me to the Symlin talk.  I’d tried it once before and gave up after a few days.  I was told that it is not indicated for pregnant women, and since we were actively trying at that point (and blissfully unaware of our fertility issues), I decided that it was best to stop.  To be honest, I was not heartbroken to lose the awful nausea that accompanied it.  But, the thing is, I never really gave it a chance. 

In preparation for my appointment, I did a bunch of research.  I learned that the nausea goes away pretty quickly and that the key is to stick with it.  I learned that some people have lost huge amounts of weight thanks to it.  I learned that most decrease their boluses by at least half.  All of these facts solidified my resolve to give it another shot.

So, just before dinner last night, I dialed up the minimum 15mcg and gave myself the shot.  I ate my meal slowly (I did notice that I got fuller faster) and waited.  I carefully calculated the carbs in what I ate (49 grams total), and programmed a 60-minute extended bolus.  And I waited. 

Sure, I felt a little nauseated, but nothing too extreme (I definitely didn’t feel like I was going to puke or anything).  I wasn’t hungry either, which was nice.  I often feel hungry even after eating a decent meal.  Dex showed almost no movement in my BG for over an hour.  Since I was super exhausted yesterday, I went to bed early. 

At 11:53pm, Dex beeped.  The dreaded low alarm.  I looked at the screen: 68 mg/dl.  Not too bad, but I did a finger stick to confirm:  66 mg/dl.  Since Dex indicated a downward trend, I decided to drink a juice box.  Then, I did something really stupid.  I programmed a temp basal of 50%.  I was spooked; I admit it.  I didn’t want to have a horrible low that would be difficult to treat because of the Symlin (I’d read that this happens).  I wanted to play it safe. 

Just as any sane person would expect, a few hours later, my BG started to climb.  Nothing drastic – I was sitting at 150ish.  Then my usual Dawn Phenomenon kicked in (I have a basal rate that is more than two times greater during the hours of 5am-8am).  A temp basal of 50% was not going to make a dent in that train wreck.  After my shower, I was sitting at 180 mg/dl and climbing. 

Since the pod was due for a change, I swapped it out and canceled that stupid temp basal.  Now, as I write this at 9:16am, I am at 189 mg/dl.  This is despite two decent correction boluses.  I know the crash is coming, and I’m ready for it.  I’m just pissed off at myself for giving in to the fear.  It’s the fear of lows that gives me a 7.5% A1c.  It’s unacceptable.

Ugh, diabetes, I hate you.

**UPDATE**

As I wrote this post, I got a call from the fertility doc’s office.  They wanted to tell me that they’d received a copy of my A1c (which the nurse described as “elevated”), and that for conception, they want it to be under 6%.  As if I didn’t already feel shitty enough.

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By shannon, March 6, 2010 9:00 am

Two nights ago, I had a horrible low.  It wasn’t that my BG was all that far south (only 47 mg/dl – I’ve been much lower), it was that once it hit me, it hit me like a giant bus.

I was shaky, dizzy, sweating, starving, and exhausted.  I still don’t know which of these was the prevailing symptom at first, but I know what quickly took over:  STARVING. 

I did my usual juice box thing (I ALWAYS correct lows with a single juice box), but then I lost control.  In the span of five minutes, I consumed:

1. The aforementioned juice box
2. 2 granola bar packages (with two in each package!)
3. A handful of Sun Chips
4. 1 glass of milk

By the time I was finished, I was so exhausted that I could barely keep my eyes open.  Brian came home from work to find me on the bed surrounded by the carnage of my eating binge.  If I hadn’t felt so shitty, it would have been really funny.

Actually, looking back, it’s pretty damn funny!

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By shannon, December 24, 2009 8:46 am

I had no idea that when I wrote that first poem,

That you’d kick and scream and disrupt my whole home.

If I’d known I’d have taken greater care,

To ensure that your response wasn’t too much to bear.

But, I didn’t expect your reaction to it all,

Keeping me up for two nights with your HIGH alarm call.

Yes, I know that deep down, I deserve all the blame,

But I’ll continue to throw it on you just the same.

I know it’s not fair and it’s definitely not right,

But never before had you put up such a fight.

Since we met, you’ve been there through thick and through thin,

You’ve saved my life and brought peace from within.

I know I had to bump you from your spot on my arm,

For the Pod because there, he can do me no harm.

Besides, you stick so well in your new home on my butt,

Where you’re safe from the edges and doors that slam shut.

So, this rhyme’s for you, Dex, you don’t have to cry,

Now shut the fuck up!  Kthanksbye.

Comments (6)

By shannon, December 7, 2009 9:06 am

As you guys know, I’ve decided to change insulin pumps next year.  I’m still trying to decide which one – I received a demo OmniPod last week, but I was too sick to care.  

But, I was recently asked why I wanted to jump ship from Medtronic.  I responded with a laundry list of features and benefits of the other guys, but what it really boils down to is trust.  I’m just not as comfortable with Minimed as I once was.  There are two big reasons why:

The Recall. 

One day last July, I found a UPS package outside when I got home.  Since I LOVE presents, I got excited.  But, when I tore into the box, all I found was a box of infusion sets and a letter telling me to discontinue all infusion sets from “Lot 8.” 

As a diabetic, I receive recall notices all the time.  Sometimes it’s for test strips, sometimes it’s for meters.  Never before had I actually had in my possession one of the recalled lot numbers.  Not once.  So, I meandered on over (I was feeling swanky) to my stash of D supplies.  Sure enough, all of my infusion sets were the dreaded Lot 8.  I couldn’t believe it.  I’d spent years stockpiling (more on that another time) these infusion sets, only to have to send them back to Medtronic!

Like a good little customer, I boxed them all up and sent them back.  They promised they’d send a replacement box for each one I sent back, so I felt a little better.  For a while.

Then, I started thinking about my crazy BG numbers over the past few months.  I know, I know, you’re going to say, “Shannon, your numbers are always crazy!”  But, this was different – it was CRAZY crazy.  Like, I need to change by basals kind of crazy.  It was so frustrating because I couldn’t explain why my numbers were so unpredictable.  But, I assumed it was my fault (don’t we always).  Lo and behold, it was Minimed’s fault.  (Note, since using the new infusion sets, I’ve had better stability – well, at least “normal” crazy.)  I stumbled across a discussion on Tu Diabetes about The Recall, and I was happy to read that I wasn’t alone.  

The fact that Medtronic issued a recall isn’t what killed my trust.  It was how they did it.  I knew nothing about the problematic infusion sets until I received a brand new box to replace the defective ones.  Where was my “heads-up” that there could be a problem?  How long did it take from their discovery of the issue, to the release of replacement infusion sets?  Days?  Weeks?  Months?  Seriously.  Why didn’t they send a notice saying, “hey, we know that there’s a problem, so you might want to switch to MDIs until we figure it out.”  Something, anything would have been better than silence.

My second reason is a little less directly-relevant to me, but it bothers me none-the-less.

The Death.

I recently learned of the death of Steven Krueger, although he passed away over three years ago.  At first, I didn’t believe what I read regarding his death.  It seemed impossible.  However, further discussion at Tu Diabetes (yes, I spend a lot of time there and you should, too!) revealed that many others experienced the same problem that caused Steven’s untimely (and preventable) death.

In a nutshell, while he slept, Steven’s pump went into Prime mode.  His model pump (MMT-511) emptied the ENTIRE RESERVIOR of insulin into his body.  Steven never woke up.

While the situation is tragic, and I place the blame completely at Medtronic’s door, I also don’t like the fact that there’s been a cover-up.  Yep, according to the lovely Anna, “The pump left the coroners office in B.C., Canada – intact (pictures were taken prior to being sent off) – but a week later – Medtronic sent back the pump stating that the case was cracked – therefore they could not perform any tests!”

WTF, Medtronic?  I don’t like that kind of sneaky crap.  It makes me feel dirty and in need of a shower.

So, those are my reasons.  If I could, I’d dump Minimed today.

Comments (4)

By shannon, November 23, 2009 10:45 am

As I roll forward into my third week of Weight Watchers, I thought I’d take a few minutes to tell you all about my progress.  So far, I’ve lost six pounds.  In two weeks! 

I’ll be honest, I didn’t have high expectations for this when I started.  I wanted to like the idea, but I’m just not a “healthy” eater.  However, I’ve learned a few things since that first day:

1. I’m hungry a lot, but I can live with that. 
2. 96% lean ground beef makes a very tasty burger, especially with a lightly toasted whole wheat bun.
3. Weight Watchers (Smart Ones) has some super yummy dessert choices.
4. My insulin sensitivity increases with each lost pound – basal changes coming again soon.
5. I feel better.
6. It’s a completely livable system.  I haven’t cheated once, but I also haven’t felt the need to.  If I know I’m going to be eating badly or a lot of food, I just save up the points.

Overall, this system has opened my eyes to how much food I used to be eating.  I love that I can still eat anything; it’s the moderation factor that I just didn’t grasp before.  After eating, I almost never feel full, but I always feel satisfied.  By BG control has been so much better, too.  Although I’ve been battling some pretty serious and annoying lows, lowering my A1c even further in preparation for pregnancy is totally worth it.  With tighter control, lows are inevitable (are you listening, Mom?).  It’s just part of being a type 1.

So, I’m going to continue on WW journey until I’ve achieved what I view to be a healthy weight for me.  I’ll never be a skinny girl; I’ve got hips and boobs and they’re not going anywhere.  But, I can and will get to a place where I feel best.  Then, (hopefully), I’ll get pregnant and fat and happy!

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By shannon, November 15, 2009 11:29 am

My 24-hour DexCom graph.

It’s been a rough few days.  On Friday, when I was running high for most of the day, I started wondering WTF is going on with my diabetes.  I can’t blame it on SWAG bolusing because I’ve been really good about measuring my food.  The only explanation is stress.  I’ve been pretty stressed lately with lots of family issues.

At dinner on Friday night, I carefully calculated my carbs and dialed up a bolus.  DexCom showed me spiking slightly after we got home, but nothing alarming.  By bed time, I was at 97 mg/dl and steady.

That was the last time I felt normal.  Around 12:30 am, I woke up.  I knew something wasn’t right, but I didn’t move.  I just laid there for I don’t know how long.  Then, the three wailing beeps of the DexCom permeated the haze.  I was low.  I knew I had to get up and test, but I just didn’t want to.  Brian didn’t wake up, and since I couldn’t talk, I couldn’t wake him up.

Somehow, I managed to reach over to the mini-fridge on my nightstand and grab a juice box.  I struggled with getting the straw out of the plastic and into the little hole, but eventually, I managed to drink the entire box.  That’s when I noticed the sweat.  I hate sweating; it’s the main reason I loathe exercising. The amount of sweat pouring off my body was equivalent to what I’d expect during a hard, long workout.   My brain knew that I had to test, but my body was not listening.  I glanced at the DexCom and saw a 41 mg/dl.  Hands shaking, I fumbled with my meter, wasted at least two test strips, and pricked every finger on my left hand.  Finally, I got a reading:  37 mg/dl.

That didn’t make sense to me – I felt a lot worse than 37!  What was happening?

As the sweating continued and the shaking increased, I took another look at the DexCom.  It simply read:  LOW.  The little graph was at the very bottom line.  I waited for 10 more minutes before testing again.  The result:  LOW.  No number, just LOW.  I think this was actually a good thing because it managed to “wake me up.”  I grabbed another juice box and sucked it down (the next time someone teases me for keeping a mini-fridge next to my bed, I’m going to pull out this blog post).

After another 10 minutes, I started feeling a little more steady.  Not great, but I could think a little more clearly.  That’s when I noticed the hunger.  I was hungrier than I’d ever been.  I stumbled into the kitchen, grabbed the bag of Sun Chips, plopped (there is no better word for what I did) down on the couch, and I ate.  I devoured the contents of that bag.  Nothing has ever tasted as good as those Sun Chips.  I didn’t care about the carbs; I didn’t care about Weight Watchers; I didn’t care about crumbs.  If someone had tried to take them away, I probably would have growled.  Seriously, it was animalistic.  I didn’t care.

I then went to work on my little Weight Watchers mini cakes.  I ate two of those, followed by a large milk chaser.  It was awesome.  Feeling much better (no more sweating or shaking), I crawled back into bed and crashed.

Two hours later, I was awakened by the two wailing beeps of the DexCom.  And so began the next high-to-low-to-high cycle.

Last night, as Brian and I were falling asleep, he says, “Oh, so it’s two beeps for high and three for low, right?”  Welcome to the roller-coaster, babe.

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By shannon, November 3, 2009 9:33 am

Recently, there was a discussion on tudiabetes.com about driving while diabetic.  Evidently, some countries restrict diabetic drivers, especially those who use insulin.  While the title of the thread was a bit controversial, the spirit of the article was one that promoted personal responsibility.  

Some people use their diabetes as an “excuse” for a crash or other traffic offense.  This, frankly, pisses me off.  It’s this kind of irresponsibility that promotes the many misconceptions about diabetes.  It is casual comments like these that cause lawmakers to think that they must “protect” other drivers from the dangerous diabetics.  This is what leads to driving restrictions being imposed on diabetics.  It shouldn’t happen.

However, I have to wonder how many diabetics really take all necessary precautions before getting behind the wheel. Driving is something that I take very seriously for two reasons:

1. I’m married to a racecar driver.
2. I was involved in a pretty serious car accident almost two years ago.

My husband is an amazing driver.  Sometimes, it’s like he knows what his car is thinking.  He’s taught me (and many others) more about performance driving than I ever thought existed.  He’s helping me overcome my fears (from the aforementioned crash), and I’m so proud of all that he’s accomplished.

The crash I was involved in was, without a doubt, the worst thing that has ever happened to me.  But, the first thought I had after coming out of the post-crash daze was “where is my blood sugar – am I low?”  I wasn’t, but that’s only because I’m very proactive when it comes to driving and diabetes.

Before I start my car, I have a little mental checklist that I follow:  I take the juicebox out of my purse, check the DexCom, and, if I’m not confident of its accuracy, I test.  If I’m low (or dropping quickly), I drink the juicebox.  I never drive if I don’t have fast-acting glucose on hand.  EVER.  I’ve gone low when driving, and let me tell you, it’s a scary thing.  I’ve had to pull over on a busy interstate and chug juice (or eat glucose tabs) just to keep from passing out.  It sucks and I hate it.  But, it would suck a lot more if I wasn’t so prepared.   

It’s part of being a diabetic.  It’s my responsibility and I take it very seriously.

Comments (3)

By shannon, October 23, 2009 10:16 am

CGM Wars: Get Ready to Rumble.

For over a year, I used Minimed’s Continuous Glucose Monitoring System.  It was a logical choice since half of its technology was already built into my pump.  For over a year, I dealt with highs and lows much better than I’d ever done before.  My A1c dropped to 6.8 – the lowest it had ever been.  I didn’t go low as often, and when I did, I knew it was coming.  Sometimes.  See, I thought the wide variations between the CGM and my meter were normal.  I knew it wasn’t 100% accurate, so I accepted the false highs and, far more often, false lows as part of CGM life.  I dealt with the painful, bloody insertions as “a small price to pay” for better overall health.  But, as time went on, I began to trust it less and less.  It was just wrong a lot.  The constant calibration errors and “Meter BG Now” demands were seriously cramping my style.  

All that changed a little over a month ago when I switched to the DexCom CGM.  Right away, I was impressed.  Not only did this company fight for me to get insurance coverage, they rectified a rocky beginning by going far above and beyone.  These folks know customer service.

When I received the box, I tore into it like it was Christmas morning.  I impatiently waited for the receiver to charge, inserted my first sensor (totally painless and NO blood), and I was off.  This thing lasts for (at least) seven days, and the readings are consistently accurate.  My current sensor has been chugging away for 12 days (restarting a sensor after the initial seven days is super easy), and until I start getting funky readings, I’m sticking with it.  (Note:  DexCom does not condone this behavior.  They say to wear the sensors for seven days.  PERIOD.  What they don’t know won’t hurt ‘em.)  

Unlike the Minimed sensors, I don’t have to use any kind of surgical tape to keep my DexCom sensors stuck.  Their adhesive is very similar to what is used for my pump’s infusion sets, which is (thankfully) non-irritative to my sensitive skin.  I used a little Skin Tac to help it stick better, and I’m good for the entire seven days.  For wearing the sensor longer than seven days, I will use some waterproof bandage tape, but that’s it.  You don’t have to cover the entire sensor with tape so that it stays down.  

So, there it is.  My independent assessment of the Minimed vs. DexCom CGM.  For a year, I believed that all CGMs were the same, with the same pros and cons.  They’re just not.  I’m glad I took a chance and found the one that works best for me.

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By shannon, April 24, 2009 7:33 am

*Originally posted on 5/8/08*