As Sofia gets bigger and bigger, she is getting more and more mobile. As she attempts to pull up on unsteady household objects, or tries to put non-baby-things in her mouth, I will usually try to get her attention using my discipline voice first prior to walking over to remove her from whatever potential harm or object she shouldn't be near. Disa is very familiar with the discipline voice from her puppy days, and her occasional behavioral outbursts. This has created a unique situation in my house. As I try to sternly talk Sofia out of whatever mischievous activity she's in, Disa thinks I'm speaking to her, and will shake with anxiety while she lays on the couch next to me because she can't figure out what she has done wrong. Even when I say "Sofia, don't touch that" Disa still thinks I'm talking to her due to the tone of voice I'm using. Hence when I address Sofia I'll say "No Sofia, Good Disa!". Its very interesting. I hope the dog becomes less sensitive to this tone as Sofia becomes more and more curious. Fingers crossed. Its very tiring to address my human child and then have to praise my furry one all of the time.
So I'm still on the CGM learning curve roller coaster. I had been doing better but in the last week or so I've hit some more rocky road. I've had a few issues with my pump being clogged, which I can always assume is the problem, but I won't really know until I remove it and see if the cannula is clogged, which is a risky move because then I may be under-utilizing a perfectly good 3 day pod. It's been quite frustrating lately. I can't tell if the poorer numbers are due to exercising less ( the weather has been very rainy and I haven't been able to get out on any walks with Sofia AND basketball is over) or if I just need to create a non-period basal. It seems that my numbers are better when I am menstruating, but I'm not really sure. Sorry if this is TMI.
Anyway, I've realized that I really am going to have to become a complete lunatic with my diabetes if and when I'm able to get pregnant. I think that I've tried to avoid the reality of how meticulous I'm going to have to become, but I think I know even now, prior to any pre-pregnancy consultations, the lengths that I will need to go to in order to keep my diabetes in outrageously strict control. This will mean really scheduling my meals, making sure to do insulin way before I eat, measuring out exact food portions (I hate measuring things when it's not for a recipe), exercising on a regular and consistent basis, and God knows what else. I'm sure that when I am able to get pregnant I will be so focused and dedicated that it will all just seem like things on a to-do list, but it's very daunting at this point.
As far as pre-pregnancy consultations, I have my first one in the beginning of June. I'm kind of excited, but also kind of sad. My wife and I work opposite schedules mon-thurs, and of course my appointment is early in the day when she is teaching as they do not have any hours that would accomodate both of our schedules. And of course her co-teacher is already going to be absent that day and she will have to go in to work. So I will be walking into this sit down appointment with just my daughter, who they will probably assume I birthed, and then I'll have to explain the whole sitaution. I debated taking one of our friends who knows the baby plan (as we intend to keep the process secret from 99.5% of our family and friends as we begin trying for baby #2) but then I'd have to explain how "no, this is not my wife, my wife is working, but she is just a good friend" and I feel that situation might seem a little odd. I'll just put on my big girl mommy pants and go without any adult support. I'm sure I'll be fine.
Anyway, baby #1 is just waking up from a nap, and we'll be heading out on a laundry trip in just a few. You can not imagine how badly I wish I had a washer dryer in our apartment building. (its only a 3 fam)
More to come soon, stay tuned.
Thursday, May 19, 2011
Thursday, May 12, 2011
1 Month in with the CGM
So I'm pretty sure that I've had the CGM up and running for 4 or 5 weeks at this point. I've really done a lot of learning and a lot of tweaking to my pump settings, and for the most part I've seen some really good improvement (on some days). I still have the bad days where it seems like I'm high for no reason, but thats usually because there is an issue with my Omnipod Insulin Pump (my pod). Like yesterday for instance, I knew I had eaten a lot of carbs, but I had also done enough insulin to correct myself a couple of hours after I had eaten and I just stayed high. Even when I was at work, and had pumped myself full of insulin before I left to go to work AND corrected even more before I left to go home for dinner, I remained high once I got home, and for the rest of the night. When I went to change my pod it seemed as if there had been some kind of blockage in the cannula, but not a complete blockage, which is why my pump did not alert me of the problem. Changed the pod before bed, and woke up in significantly better range. Not where I prefer to be first thing in the morning, but below where I had been.
One thing that I have learned helps to keep me from spiking is doing my bolus a good 15-20 minutes prior to eating. Now I know that a lot of people know that already, but (a) its hard to schedule yourself like that (b) when I want to eat, I want to eat (c) if you have no idea what you're about to cook, that only takes 20 minutes to prepare, its hard to estimate how many carbs you'll be consuming. But long story short is when I make an effort to bolus prior to eating, I'm much happier with the curve my sugar goes on. It's much less severe.
The last couple of days have been pretty good (other than yesterday). I've been able to keep my numbers between the two dotted lines that is my goal range, and it was lovely to go on a brief hiatus from the beeping and buzzing my cgm does when I'm too high or too low. It also helps my mood significantly, and I find that I'm generally much happier when I see that I'm in really good control. It's a good, healthy, happy feeling. I'm really hoping that I can keep up the good work and really get my A1C down before my next endocrinologist appointment. That would be so lovely. Keep your fingers crossed for me... thanks.
One thing that I have learned helps to keep me from spiking is doing my bolus a good 15-20 minutes prior to eating. Now I know that a lot of people know that already, but (a) its hard to schedule yourself like that (b) when I want to eat, I want to eat (c) if you have no idea what you're about to cook, that only takes 20 minutes to prepare, its hard to estimate how many carbs you'll be consuming. But long story short is when I make an effort to bolus prior to eating, I'm much happier with the curve my sugar goes on. It's much less severe.
The last couple of days have been pretty good (other than yesterday). I've been able to keep my numbers between the two dotted lines that is my goal range, and it was lovely to go on a brief hiatus from the beeping and buzzing my cgm does when I'm too high or too low. It also helps my mood significantly, and I find that I'm generally much happier when I see that I'm in really good control. It's a good, healthy, happy feeling. I'm really hoping that I can keep up the good work and really get my A1C down before my next endocrinologist appointment. That would be so lovely. Keep your fingers crossed for me... thanks.
Wednesday, May 4, 2011
The Learning Curve...
First of all, I have no idea how other moms manage to write blogs on a somewhat consistent and continual basis. I barely have time to do all of my household chores everyday before I have to get ready for work in the afternoon, never mind sitting down for a few minutes to try to think clearly and write a blog.
So the learning curve. I've had the Dexcom 7 for almost 3 weeks now and it really is interesting. It is certainly a tremendous help to know where my BG is at and in what direction it's going. The one thing that I really wasn't expecting was the sensor's "margin of error". It only has to be within 20% of your actual BG to be considered accurate. So if your BG is particularly high, the "margin of error" just gets larger. I really thought that once I had the Dexcom I wouldn't be checking my sugar with fingersticks often at all, but I find myself sticking to my usual routine of checking all day, up to 10 times per day. I just don't trust the CGM to be that accurate. For me its really important to know exactly where my sugar is when I wake up, before meals, after meals, before bed, and any time I think the CGM is lying to me.
One of the most interesting things I've found with the CGM receiver is just to see the wave of my blood sugar. We all know that your blood sugar will go up and down throughout the day, but it is reallllly interesting to see it plotted out all day continuously. The smaller waves are nicer to see, and the mountains and valleys aren't that fun. I've been struggling lately to keep my blood sugar up in a good range in the evenings around bedtime, which is a big change for me. It's really a new thing for me to need a cup of juice and a bite of peanut butter to try to keep my BG in a safe range when I'm trying to fall asleep. I'm not quite sure why this is happening lately, but I'm not ready to just change my pump settings just yet. I want to see if this issue is going to level itself out or not. We'll see.
I've been changing the settings on my pump to tend to some of the daily issues I've been seeing on the CGM receiver, and one major change that I needed to make was to my overnight settings. I found that I'm spiking around 3am, which I would never have known. According to the CGM I've gone up to 250 on some nights around that time and I was really unaware of the fact that this was happening to my body. Although I think the CGM's readings might be a little exaggerated, I've been able to change my settings to the point where I am waking up slightly under 100 in the mornings. I had been having some trouble keeping my BG in that range for my morning reading and it really does help me start my day in a better mood when my BG is where it should be.
Speaking of moods, prior to being diagnosed in March of 2009, I never really knew much about diabetes and how it affects a person's personality, but I feel like I am a prime example of the possible effects. Prior to my CGM, if I tested and my BG and it was unexpectedly high, typically I was in a pretty foul mood. Angry, unpleasant, cranky, etc. I guess we could call that the effect on a person's personality. If I am low, I get very strange. My wife says that she can tell when I'm low just from the way I act. I'm not sure how she would describe it, but I think I get a little intense, irritable, and disoriented. I'm not quite sure what it's like being around an intense disoriented person, but it must be an interesting experience. I don't have any diabetic friends either, so I've never had the experience of witnessing someone else's low.
Anyway, back to the learning curve. I have found that doing a bolus 15-20 minutes prior to eating really helps to keep me from spiking too severely. I know that a lot of diabetics know this as a fact, but it is really difficult for me to put into practice and make a daily habit. So I've been making more of an effort to try to make sure that I start my bolus insulin a good amount of time before I start to eat.
I just feel like there are so many things on this CGM learning curve I've yet to master, and so many more things on my pre-pregnancy checklist that I really need to get into the habit of doing. But one step at a time I guess... yea one step at a time.
So the learning curve. I've had the Dexcom 7 for almost 3 weeks now and it really is interesting. It is certainly a tremendous help to know where my BG is at and in what direction it's going. The one thing that I really wasn't expecting was the sensor's "margin of error". It only has to be within 20% of your actual BG to be considered accurate. So if your BG is particularly high, the "margin of error" just gets larger. I really thought that once I had the Dexcom I wouldn't be checking my sugar with fingersticks often at all, but I find myself sticking to my usual routine of checking all day, up to 10 times per day. I just don't trust the CGM to be that accurate. For me its really important to know exactly where my sugar is when I wake up, before meals, after meals, before bed, and any time I think the CGM is lying to me.
One of the most interesting things I've found with the CGM receiver is just to see the wave of my blood sugar. We all know that your blood sugar will go up and down throughout the day, but it is reallllly interesting to see it plotted out all day continuously. The smaller waves are nicer to see, and the mountains and valleys aren't that fun. I've been struggling lately to keep my blood sugar up in a good range in the evenings around bedtime, which is a big change for me. It's really a new thing for me to need a cup of juice and a bite of peanut butter to try to keep my BG in a safe range when I'm trying to fall asleep. I'm not quite sure why this is happening lately, but I'm not ready to just change my pump settings just yet. I want to see if this issue is going to level itself out or not. We'll see.
I've been changing the settings on my pump to tend to some of the daily issues I've been seeing on the CGM receiver, and one major change that I needed to make was to my overnight settings. I found that I'm spiking around 3am, which I would never have known. According to the CGM I've gone up to 250 on some nights around that time and I was really unaware of the fact that this was happening to my body. Although I think the CGM's readings might be a little exaggerated, I've been able to change my settings to the point where I am waking up slightly under 100 in the mornings. I had been having some trouble keeping my BG in that range for my morning reading and it really does help me start my day in a better mood when my BG is where it should be.
Speaking of moods, prior to being diagnosed in March of 2009, I never really knew much about diabetes and how it affects a person's personality, but I feel like I am a prime example of the possible effects. Prior to my CGM, if I tested and my BG and it was unexpectedly high, typically I was in a pretty foul mood. Angry, unpleasant, cranky, etc. I guess we could call that the effect on a person's personality. If I am low, I get very strange. My wife says that she can tell when I'm low just from the way I act. I'm not sure how she would describe it, but I think I get a little intense, irritable, and disoriented. I'm not quite sure what it's like being around an intense disoriented person, but it must be an interesting experience. I don't have any diabetic friends either, so I've never had the experience of witnessing someone else's low.
Anyway, back to the learning curve. I have found that doing a bolus 15-20 minutes prior to eating really helps to keep me from spiking too severely. I know that a lot of diabetics know this as a fact, but it is really difficult for me to put into practice and make a daily habit. So I've been making more of an effort to try to make sure that I start my bolus insulin a good amount of time before I start to eat.
I just feel like there are so many things on this CGM learning curve I've yet to master, and so many more things on my pre-pregnancy checklist that I really need to get into the habit of doing. But one step at a time I guess... yea one step at a time.
Friday, April 15, 2011
Time to start something new..
So, here goes nothing. I recently found my Livejournal stuff that I wrote 6-7ish years ago when I was 20/21. Apparently I had over 200 posts! I had no idea I wrote that much about my life but I do remember feeling like it really helped me to cope with all of life's drama. I had stuff in there about my jobs, my family, my friends (and in some bad moods I made my posts private so it was like a real diary and I said kind of mean things sometimes.. but the funny part is that the 2 people I wrote about in private entries, are still my best friends... one of them is now my wife). Since that time a lot has changed/happened, and I think its time I give whats now called blogging another chance.
At this point in my life, I've pretty much achieved all of the goals I had set for myself, something I'm very proud of. I've gotten the degree I wanted, I own a dog, and I have a loving marriage with an amazing woman. Yes I said marriage. We were married in 2008 while it was legal in California. We created a baby out of a lot of love and just a tiny bit of sperm, and little Sofia is now almost 8 months old. There are still 2 more lifetime goals that I want to reach. The first is having a successful pregnancy, and birthing a healthy baby, as a diabetic mother. This one is somewhat in the near future and I kind of started on that journey last week. I'll get into the details in a second. But the other goal, is to own a home, and that my friends, is a very long way off as far as I can tell. Reason? Two words. Student loans. Uh...... yea.
But back to the pregnancy goal. After fighting my insurance company for over a year, I was finally approved for a Continuous Glucose Monitoring System (often referred to as CGM or CGMS). This is a device that will track my blood sugar every 5 minutes, show me my blood glucose reading, and also tell me in which direction my blood sugar levels are going on a little cell phone sized wireless device. Amazing right?
I started using the CGM (a Dexcom 7) last Thursday. It was really interesting because with my insulin pump, I have to do very little in terms of its attachment to my body. I currently am using the Omnipod wireless and tubeless pump, and luckily for me it has an automatic insertion method. I press a button on the Personal Diabetes Manager (PDM, kind of like the pump's remote control) and it does all of the work of inserting a small plastic tube called a cannula, under my skin to allow the pump to deliver insulin directly into my body. My biggest concern when setting up my pump is to make sure there is enough insulin in the pump to last me for 3 days, and to make sure that the adhesive bandaid type fabric that holds the pump onto my body is nice an flat and seals all the way around the pump. With the Dexcom CGM, I understood that from the moment I inserted it, I would not be given any information until the first 2 hours had elapsed. This is very different from my pump, which allows me to utilize any option I want immediately after the insertion is complete. But I think that all good things in life are worth waiting for so I've got no complaints there.
On the first full day I was extremely frustrated because I was having very high readings from the CGM, and I confirmed all of these high readings with my regular meter (integrated into the PDM) and I just could not seem to get my blood sugar levels to come down. It seemed like it didn't matter how much insulin I did, my levels just remained so high. At that point I was feeling helpless, and it seems silly to feel helpless when you have two devices attached to your body that are supposed to help you to feel in more control, but all I could do was wait for the insulin to kick in, and hope that happened fast. It took a few hours but eventually my blood sugar levels came back down. I'm still not sure if the high readings were due to stress, or by body reacting to the soreness at the CGM site (on my abdomen, the only location of the body the CGM has been approved for use) or what, but I was super frustrated.
The next day I had planned to walk to our daughter's pediatrician's office which is about 2 miles away to see how exercise would affect my blood sugar. I had a bowl of cereal which usually makes me spike pretty high and did about half of the insulin I would normally do. About 3/4 of the way to the office I was at almost 200, but my exercise managed to keep me from hitting that point. I got there, picked up the paperwork I needed, and headed across the street to the park. My numbers stayed in a slightly high range at the park, but I had prepared myself for that because I wanted to see how much the walk home would bring my numbers down. When I left the park I was at 150 and as I occasionally glanced at my receiver through out the walk, I watched my blood sugar steadily come down. When I opened my front door, I was at 104 with a straight down arrow, meaning that my blood sugar was dropping 1-2 mg/dl per minute. The arrow that I mentioned is shown on the CGMs receiver (the cell phone thing) and shows the "trend" of your blood sugar. If your blood sugar levels are staying pretty steady, then you get a sideways arrow, if they are increasing you can get an arrow pointed diagonally up, saying it's rising at a certain rate, a straight up arrow, saying it's rising kind of quickly, and a double up arrow means its rising really quickly. Same thing goes for the down arrows, diagonal, single down, double down. I wound up hitting 80, still with a down arrow, and knew I'd need some juice to keep my blood sugar from dropping too low. The juice started to kick in a few minutes later, and I wound up around 100 in just a short while. It was a really interesting experience and was the first positive one I had with the CGM. We all know that exercise is good for us, but for me to be able to actually see the exercise having such an impact on my sugar made me feel really good.
Since Friday, I've had good days and bad days. I think thusfar the hardest part for me has been when I feel like I've estimated the amount of carbohydrates I'm going to eat correctly, I do the amount of insulin I think I need, and I sit there obsessing over my receiver, watching my blood sugar levels go up. That just makes me feel like I'm a bad diabetic and that I have no idea how much insulin my body needs. But after 2 years of doing this, I've gotten pretty good at estimating (most of the time) and I think the problem is that I'm not waiting long enough to check my blood sugar levels. The body is going to have some blood sugar spikes when you eat certain things, but if I didn't have a CGM up and running on my body, I would probably not know about these spikes, and I wouldn't feel so frustrated, as when I tested 2 hours later, I'd probably be back in a healthy range. Having and utilizing a CGM could easily drive a person insane, and to avoid that outcome for myself, I'm starting to train myself to look at it less.
Yes, this is getting kind of long for an entry, but it's hard to get everything I've been dealing with for the last week out in one short burst. It's something new, and of course there is a learning curve. I just have to learn to let myself learn. How's that for a sentence? I need to give myself time to adjust to a new system, and that is something I've always struggled with. When I need to learn something new, I hate the process. I always feel like I would like to fast forward 2 months to the time where I've finally gotten the hang of whatever it is I'm learning. Then again, everything in life is a learning process.
So the CGM is my first step towards getting my body ready to attempt getting pregnant. I've started to exercise more lately even though I like to think I stay moderately active. In the winter and spring I play in an indoor basketball league, and in the summer I play softball. I really enjoy taking walks when the weather is nice, and I've been able to do some of that more recently as the winter weather is finally winding down. Notice its almost late April and I'm not counting Mother Nature's winter weather as down for the count yet? It's sad but true here in New York. The climate is definitely changing, and I don't think its a good change.
I'm hoping I can keep this updated pretty regularly. Guess we'll all just have to wait and see.....
At this point in my life, I've pretty much achieved all of the goals I had set for myself, something I'm very proud of. I've gotten the degree I wanted, I own a dog, and I have a loving marriage with an amazing woman. Yes I said marriage. We were married in 2008 while it was legal in California. We created a baby out of a lot of love and just a tiny bit of sperm, and little Sofia is now almost 8 months old. There are still 2 more lifetime goals that I want to reach. The first is having a successful pregnancy, and birthing a healthy baby, as a diabetic mother. This one is somewhat in the near future and I kind of started on that journey last week. I'll get into the details in a second. But the other goal, is to own a home, and that my friends, is a very long way off as far as I can tell. Reason? Two words. Student loans. Uh...... yea.
But back to the pregnancy goal. After fighting my insurance company for over a year, I was finally approved for a Continuous Glucose Monitoring System (often referred to as CGM or CGMS). This is a device that will track my blood sugar every 5 minutes, show me my blood glucose reading, and also tell me in which direction my blood sugar levels are going on a little cell phone sized wireless device. Amazing right?
I started using the CGM (a Dexcom 7) last Thursday. It was really interesting because with my insulin pump, I have to do very little in terms of its attachment to my body. I currently am using the Omnipod wireless and tubeless pump, and luckily for me it has an automatic insertion method. I press a button on the Personal Diabetes Manager (PDM, kind of like the pump's remote control) and it does all of the work of inserting a small plastic tube called a cannula, under my skin to allow the pump to deliver insulin directly into my body. My biggest concern when setting up my pump is to make sure there is enough insulin in the pump to last me for 3 days, and to make sure that the adhesive bandaid type fabric that holds the pump onto my body is nice an flat and seals all the way around the pump. With the Dexcom CGM, I understood that from the moment I inserted it, I would not be given any information until the first 2 hours had elapsed. This is very different from my pump, which allows me to utilize any option I want immediately after the insertion is complete. But I think that all good things in life are worth waiting for so I've got no complaints there.
On the first full day I was extremely frustrated because I was having very high readings from the CGM, and I confirmed all of these high readings with my regular meter (integrated into the PDM) and I just could not seem to get my blood sugar levels to come down. It seemed like it didn't matter how much insulin I did, my levels just remained so high. At that point I was feeling helpless, and it seems silly to feel helpless when you have two devices attached to your body that are supposed to help you to feel in more control, but all I could do was wait for the insulin to kick in, and hope that happened fast. It took a few hours but eventually my blood sugar levels came back down. I'm still not sure if the high readings were due to stress, or by body reacting to the soreness at the CGM site (on my abdomen, the only location of the body the CGM has been approved for use) or what, but I was super frustrated.
The next day I had planned to walk to our daughter's pediatrician's office which is about 2 miles away to see how exercise would affect my blood sugar. I had a bowl of cereal which usually makes me spike pretty high and did about half of the insulin I would normally do. About 3/4 of the way to the office I was at almost 200, but my exercise managed to keep me from hitting that point. I got there, picked up the paperwork I needed, and headed across the street to the park. My numbers stayed in a slightly high range at the park, but I had prepared myself for that because I wanted to see how much the walk home would bring my numbers down. When I left the park I was at 150 and as I occasionally glanced at my receiver through out the walk, I watched my blood sugar steadily come down. When I opened my front door, I was at 104 with a straight down arrow, meaning that my blood sugar was dropping 1-2 mg/dl per minute. The arrow that I mentioned is shown on the CGMs receiver (the cell phone thing) and shows the "trend" of your blood sugar. If your blood sugar levels are staying pretty steady, then you get a sideways arrow, if they are increasing you can get an arrow pointed diagonally up, saying it's rising at a certain rate, a straight up arrow, saying it's rising kind of quickly, and a double up arrow means its rising really quickly. Same thing goes for the down arrows, diagonal, single down, double down. I wound up hitting 80, still with a down arrow, and knew I'd need some juice to keep my blood sugar from dropping too low. The juice started to kick in a few minutes later, and I wound up around 100 in just a short while. It was a really interesting experience and was the first positive one I had with the CGM. We all know that exercise is good for us, but for me to be able to actually see the exercise having such an impact on my sugar made me feel really good.
Since Friday, I've had good days and bad days. I think thusfar the hardest part for me has been when I feel like I've estimated the amount of carbohydrates I'm going to eat correctly, I do the amount of insulin I think I need, and I sit there obsessing over my receiver, watching my blood sugar levels go up. That just makes me feel like I'm a bad diabetic and that I have no idea how much insulin my body needs. But after 2 years of doing this, I've gotten pretty good at estimating (most of the time) and I think the problem is that I'm not waiting long enough to check my blood sugar levels. The body is going to have some blood sugar spikes when you eat certain things, but if I didn't have a CGM up and running on my body, I would probably not know about these spikes, and I wouldn't feel so frustrated, as when I tested 2 hours later, I'd probably be back in a healthy range. Having and utilizing a CGM could easily drive a person insane, and to avoid that outcome for myself, I'm starting to train myself to look at it less.
Yes, this is getting kind of long for an entry, but it's hard to get everything I've been dealing with for the last week out in one short burst. It's something new, and of course there is a learning curve. I just have to learn to let myself learn. How's that for a sentence? I need to give myself time to adjust to a new system, and that is something I've always struggled with. When I need to learn something new, I hate the process. I always feel like I would like to fast forward 2 months to the time where I've finally gotten the hang of whatever it is I'm learning. Then again, everything in life is a learning process.
So the CGM is my first step towards getting my body ready to attempt getting pregnant. I've started to exercise more lately even though I like to think I stay moderately active. In the winter and spring I play in an indoor basketball league, and in the summer I play softball. I really enjoy taking walks when the weather is nice, and I've been able to do some of that more recently as the winter weather is finally winding down. Notice its almost late April and I'm not counting Mother Nature's winter weather as down for the count yet? It's sad but true here in New York. The climate is definitely changing, and I don't think its a good change.
I'm hoping I can keep this updated pretty regularly. Guess we'll all just have to wait and see.....
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