Diabetic DiMo: November 2011

I woke up Sunday night after being asleep for about 30 minutes. I didn't feel right, so I checked my BG. As I expected, it was low - 52. You might think, oh that's easy to fix, just eat some carbs and you're all good, and the general recommendation is to eat 15g of carb if you are low, then wait 15 minutes and test your BG again...

Well, it's not quite that simple, and after chatting about this on the phone with my mom, I realized that it's a good thing I'm a math major!

My Insulin: Carb ratio is about 1u:33pts right now, and my Insulin: BG ratio is between 1u:60g and 1u:80g. Thus, eating 10g of carb would raise my blood sugar about 20 points. My desired BG when I go to bed (and at most other times of the day) is 100, So if I had eaten 24g of carb, my BG would be right where it should be. Right? Not quite. I checked my pump to find out that I had .37 units of "Insulin on Board" which means that it is insulin from my last bolus that could still be used by my body. I also knew that I had some Insulin on board before I went to bed, so I set a temporary Basal rate at -90% for 1.5 hr. I checked my pump to find out that this had been active for .4 hr (note: my Basal rate is .5 unit/hr). So, sum it all up and figure out how many carbs should be eaten!

...No cheating!

Let's start with the basics - 24g of carb would work, considering nothing else. .37 units of Insulin on Board translates to about 12g of carb extra to be eaten. But, a -90% basal for .4 hr equals a .18 unit deficit of insulin (-6g carb), and 1.1 more hours at that rate equals another .495 (-16g carb) unit deficit.
So, that comes out to a grand total of 24 + 12 - 6 = 30g of carb to be eaten right at that moment, then I could have canceled the temp basal and been fine. Or, I could have eaten 30 - 16 = 14g of carb, kept the temp basal going, and it would have (hopefully) worked out eventually.

What did I do then? I thought about all this math for a couple minutes, figured the temp basal for .4hr would allow me to eat about 10g less carb than I needed to, and figured that the 1.1hr temp remaining would negate the .37u on board. So, I ate as many glucose tablets as I had near me, which happened to be 6. At 4g of carb per tablet, that comes out to a grand total of 24g of carb. Math is so much fun with a low blood sugar!

...My BG when I woke up was 160. Go Diabetes.

Wow, it's been a while since I last posted here! I'm sorry that I haven't shared anything in so long. Obviously, last hockey season has ended... and the current season has begun! So, what happened between hockey seasons, you might ask. Well, during spring break, on March 15, 2011, I started using the pump.

The Animas OneTouch Ping, in all its glory on my kitchen table

It has improved my bg control and quality of life unbelievably! First of all, I don't have to worry about using a new needle or excusing myself from the table every time I have food - just eat, program the pump to bolus, and that's it (after checking my blood sugar, of course). Possibly my favorite function of the pump is the ability to adjust the basal rate on the fly. Before the pump, I would take one shot of long acting insulin every day, and if I overestimated how much was needed, I just had to suck it up and stuff my face for pretty much the whole day (this happened a couple times after Friday night games, and I would be in real trouble during Saturday's game). This function is also useful after a night out. A low blood sugar can be caused by taking too much insulin, and a low blood sugar can be caused by drinking too much (insulin is not used to process the carbs in alcohol, so blood sugar drops when your body digests the carbs from alcohol... or something like that). So you could imagine that alcohol + normal basal insulin = low bg. When you cut out or reduce the basal insulin, the chances/severity of a low are decreased. So now I can drink to my heart's content with absolutely no worries (just kidding, Mom). Another great feature of the Ping is that it is waterproof. Over spring break, I divided my time pretty evenly between the pool and the beach, so this feature definitely came in handy. Lastly (this is not the last feature of the pump, but it is in regard to this blog post), the Ping's bg monitor doubles as a remote bolus controller. This is a great feature if I don't want to take the pump out in public or if I am driving (say, back to school from practice when my blood sugar is a little high). The downsides I have experienced with the pump are the fact that you have to carry it everywhere you go, since it's attached to you, and the infusion sites sometimes start to peel off after getting (extremely) wet or sweaty. The pros definitely outweigh the cons for me!
That is a pretty short summary of my D-life last spring, now what about summer?

This summer I had the privilege of living in San Francisco, CA for an internship with Thomson Reuters. This opportunity was afforded to me by the Lawrence Scholars in Business (LSB) program. I was lucky enough to win a scholarship which provided funding for internship/job related expenses including housing, travel costs, living expenses, etc. The LSB Program also has introduced me to many Lawrence alumni who have successful business careers, one of whom was integral in helping me acquire this internship. I worked on a face-to-face sales team in the Markets division focused on Investment Management firms. The experience was amazing! After a little road bump regarding my housing situation, I ended up living with a friend and fellow LSB scholarship winner, who also was interning at TR in SF. We lived near the intersection of Polk and Union streets, in the Russian Hill neighborhood. I had a pretty regimented schedule over the summer. I would wake up around 6:15 every morning, be into work around 7:15, and get home around 5:30, then work out, eat/watch TV or a movie or read, and go to bed. I mention my schedule because it seemed to be a blessing in disguise for diabetes control, which I'll get to later. The internship was a great opportunity to meet and work with extremely talented people, see how capital markets work, research investment management firms, discover what financial services they need in order to make a profit, and learn about high performance sales strategy.
About mid-way through the summer, I realized that the internship was not just about working. It was also about getting a better perception of the world, experiencing a new area of the country, and enjoying the unique opportunities that San Francisco has to offer.

A view of the Golden Gate Bridge my first day in the city, taken from a rooftop on Union Street (see more photos from San Francisco below)

While living in the shadow of the Golden Gate Bridge (or was that shadow actually just the fog?), I:

Played in a charity soccer tournament for disadvantaged youth... then joined the league that sponsored the tournament
Met distant relatives, one of whom is a winemaker... then went on a private tour of his new state-of-the-art winery in Napa Valley
Planned to go to Big Sur for a day trip... then at the last minute decided to go to Yosemite.
Flew to Los Angeles on a "business" trip... then surfed in Huntington Beach.
Attended multiple street festivals... one of them on my first day in the city.
Met new friends from the East Bay... then spent at least one day of almost every weekend outside the city from then on.
Saw a Giants game... then sold ice cream at AT&T Park the following week.
Met some LU hockey alumni... then played pick-up hockey with them at 7am on Sunday mornings.
Saw a live concert in a park... for free.
Made many friends at Thomson Reuters and outside TR... and made even more memories.

The summer was a blast, and I can't believe it came to an end so quickly. I'm very thankful for the opportunity to live in San Francisco, work at Thomson Reuters, and make the friendships I made.

After returning home to Galveston for a week, I came back to Appleton to begin Senior year. The fall has been a blur so far. Classes, job applications, and hockey have pretty much dominated my life. We have been officially practicing as a team for 2.5 weeks, and I don't think that I could be any happier! Our first game is in 3 days... I can't wait

I guess the summer summary is short on D details, so I'll give you this one - my A1C during the first week of September was 5.7, which is almost what a normal (non-diabetic) person's would be. I was ecstatic when I found out! Unfortunately, I had way too many lows this summer. I have been trying to keep my bg a bit higher this fall since I am playing more hockey, so the next A1C won't be nearly this low.

By the way, today is the one year anniversary of diagnosis for me. One year off the zero-carb diet. One year full of needles, finger pricks, glucose tablets, skin adhesive, counting carbs, bent canulas, bg mood swings, eating in the middle of the night, keeping on weight, not waking up to pee, not drinking water 24/7... one year happier and healthier