Category: Health & Well Being

Well, damn! Just shy of three weeks after starting on Continuous Glucose Monitoring with my new insulin pump, I’ve discontinued its use and I have no idea if I’ll be able to get back on it. I’ve already described some of the problems I started out with, using CGM in a post from last week entitled Step By Step, Day By Day… but the past week has been even worse. In twenty days, I burned through a seventy-day supply of CGM sensors. How did I get here?

The first instance is described in the linked post, so I won’t get into THAT one, but even that one gets me to my second sensor on the second day, which should only have happened after seven days. Luckily, the second sensor lasted the full week. I was elated and happy, and just a little bit impressed at how the pump would instantly stop and start delivering insulin based on my blood sugar levels. It wasn’t responding quite as quickly as I would have hoped, given some of there highs and lows I had, but I guess the idea is to get levels to taper off as opposed to just suddenly dropping a high.

But anyway, the third sensor I placed barely lasted twenty-four hours. Two workouts and some hot showers later and the adhesive dried out and the sensor slipped. After about a week and a half I was already on my fourth sensor, which should have lasted me a month! No small wonder that I’ve grown frustrated and have taken a break from CGM.

It seems as though all these little problems, lack of adhesive, faulty sensors, bad sites full of scar tissue, etc… are a repeat occurrence for me. Consistent physical activity, especially long bike rides in the sunny, Saskatchewan heat, doesn’t bode well for CGM. I’ve even tried wrapping band-aids around the adhesive site in an effort to try and keep the site intact, to no avail.

The night before last was the straw that broke the camel’s back. I noticed that the adhesive was starting to lift on the current sensor, which still had six days left before requiring replacement. In an effort to keep from having issues, I added additional bandages to keep the damn thing in place. Next thing I know, my pump gives me a message indicating that the sensor was “updating” and not to calibrate. It was also nice enough to tell me that this process could take up to three hours. Lovely…

When it finally allowed me to test my blood sugar and calibrate, it didn’t accept the reading and told me to wait 15 minutes and test again. I did just that. Instead of accepting the calibration, it once again told me that it was “updating” and not to test. I checked my instructional guides and didn’t find any reference to this. In my frustration, I sit tight and wait for this so-called update.

The pump finally tells me that the sensor is not functioning and to replace it. I blow air through pursed lips and install a brand new sensor. I get the typical message advising me that the warm-up may take up to two hours. It’s almost ten o’clock in the evening and my wife heads off to bed, wishing me good luck in getting my CGM working.

After the two hours, I provided two calibrations before having the damned thing tell me that the sensor isn’t working and to replace it. I’ll admit that I totally lost my shit and tore all of it out. I turned off the CGM option on my pump and installed a leftover FreeStyle Libre on my tricep. I made it to bed shortly after 1 o’clock in the morning with firm thoughts of telling CGM to go fuck itself. But I digress…

It just goes to show that issues with Diabetes aren’t limited to the body. The technology that’s meant to make our lives easier can very much be a problem as well. I have fourteen days on the current FreeStyle sensor, so I’m taking a break. Perhaps once I’ve had a break, I’ll return o it and try with a renewed sense of purpose. For now, it appears that my Diabetic journey towards becoming part machine has ground to a halt. ☯

Laziness is insidious… Once it gets its greasy claws into a person, it can be pretty difficult to shake ’em off. There are ALL sorts of explanations for laziness, including psychological issues ranging from lack of self-esteem or fear of success, all the way to physical deficiencies that include lack of certain key vitamins like B vitamins, Vitamin D or certain mineral salts.

In the case of someone with Type-1 Diabetes, laziness takes on a whole new meaning. For some, it’s an unintentional result of how they deal with their condition. Fluctuating blood sugars, stress from treatment or lack of rest (since we never tend to sleep all that well) can contribute to feeling sluggish and lethargic. These feelings can often be contributed as laziness by the unaware, and it’s a label I faced often throughout my school years.

Years ago, way before the advent of frequent daily testing, carb counting and my trusty insulin pump, I would often suffer high blood glucose levels during the school day. Especially since lack of education made it so that I never assumed there was a problem with “sugar free” foods, despite their high carbohydrate count. I would often find myself sprawled on my desk, snoring softly as a teacher would walk over and crack a metre stick on my desk. Sometimes it wouldn’t even wake me. I wonder how much more I could have accomplished if I had better control of my levels, back then.

But every now and again, I would encounter someone who is genuinely lazy, for no medical reason, and simply chooses not to bother with their own care. I encountered such a woman over a decade ago. I was dating a woman whose mother had Type-1 Diabetes. She suffered from a leg discrepancy and was only in her early 50’s. We were at her home for a family meal the one night, when someone came in with a 2-litre bottle of soda. She immediately requested a large glass of the soda, to which I “helpfully” pointed out how much sugar it contained and asked when the last time she had tested her blood.

She laughed at me. In fact, the entire family joined in her laughter, as though the concept of testing her blood sugar was anathema in her household. I watched in horror as this woman quickly gulped down almost 50 grams of carbohydrates as though it was water, followed by a full meal. Whether she was using long-acting insulin injections or not was a mystery, but she certainly didn’t inject herself BEFORE the meal. If I consumed that many carbs without an insulin adjustment, my blood glucose levels would skyrocket dangerously (and I’m currently only in my 40’s).

Sadly, the woman in this story passed away just a couple of short years ago. I’ve wondered how much longer she could have lived, with better health and better quality of life, had she simply taken her self-care in hand and worked to keep control of her Diabetes. And this is the important takeaway: having Diabetes means you can’t afford to be lazy. There are too many fine details we need to pay attention to, including maintaining supplies, knowing what foods we’re eating and keeping a tight control of blood sugars and other complications.

I’ll admit that I’ve been guilty of waking up in the middle of the night to a pump with only a few units left and rolled over, content to change out my set once I woke up. Despite my best efforts, laziness hits me occasionally as well. But considering that someone with type-1 Diabetes already has a shortened life expectancy, it’s important to test blood sugars often, work out frequently and do your best to maintain your health. You not only owe it to yourself, but to your family. ☯

I tend to harp on Diabetes a lot and complain about the many complications that accompany the disorder. And rightfully so, considering how many issues Diabetes can cause in one’s daily life. Just one day can be a chaotic turmoil of problems that can affect other areas of your life. Enter: last Saturday night…

I started Continuous Glucose Monitoring about a week and a half ago, in anticipation of turning on the Auto Mode on my new insulin pump. Auto mode is pretty sweet as it takes a lot of the guess work out of trying to keep blood sugars in range. Working in tandem with the CGM, auto mode tracks your blood sugars every five minutes and makes adjustments on that basis. If it sees that your blood sugars are starting to climb, it’ll increase your basal rate. If it’s starting to drop, it’ll reduce your basal rate or suspend your pump until you even out.

The reviews have been quite positive, considering this particular Medtronic pump has been in use in the United States for the past couple of years. The benefit has been that Canada has gotten to take advantage of their findings without suffering all the trial and error up here. The only active involvement on the user’s part, is the occasional finger prick throughout the day to calibrate the CGM and telling the pump how much carbohydrate they’re eating.

I feel it’s about as close to having an artificial pancreas as one can get, although I have no doubt that the next twenty years could yield some even better technologies. But Auto Mode does require a number of things. For one thing, you need to have a certain amount of sensor data accumulated before activating it. As previously mentioned, you also need to check your blood sugars through a traditional finger prick at least two to four times a day to calibrate the sensor, which is a pain in the ass.

Anyway, I’ve explained all the bell and whistles associated with my new pump before (Presenting, New Medtronic 670G), so you can click on the link for more info. But as with any new technology, there will ALWAYS be trial and error. And that’s what happened to me last Saturday. Let’s examine the timeline, shall we?

Monday, June 22nd: I attend the local MEDEC Centre for CGM and Auto Mode Training. MEDEC means Metabolic & Diabetes Education Centre. This is where I obtained all of my pump training and is also the office my Endocrinologist works out of. Once the training was completed, I was walked through the process of installing CGM and did so in the office, prior to my departure;

Tuesday, June 23rd: Less than 24 hours after first installing CGM, I removed it. Issues late in the previous evening caused a sensor error that couldn’t be corrected. It requested a second calibration and subsequently requested that I install a new sensor. My pump trainer was contacted and we discussed everything from possible scar tissue to simply having bad enough luck to have installed a faulty sensor. He also recommends installing a new one. My fears at letting a machine control my well-being are renewed and I stubbornly refuse to install a second CGM. Not today, SkyNet…

Wednesday, June 24th: After a full day of negotiating with myself, I decide to install a new sensor. I also did it while accompanied by my wife, since she would be the one who would need to apply the adhesives in the event I choose the back of my arm as a sensor site. I cycled a 60k with one of my friends the previous day, which I felt justified my not installing a new sensor right away. I’m pretty good at convincing myself…

Thursday, July 2nd: I’ve worn a sensor for a full week at this point and the pump is now requesting that I replace it. I marvel at the perks I’ve enjoyed during the week, including the pump suspending itself if I hit lows and spending much more time “in range” than I’m accustomed to. I feel somewhat better physically, but I’m absolutely exhausted, either by the hot weather mixed with thunder storms or because my body is finally staring to relax. Or maybe it’s the fact I’ve effectively cut out energy drinks (I say, as I compulsively scratch my forearms and rock back and forth);

Friday, July 3rd: This day taught me an important lesson. I started the morning by doing some intensive yard work in the sun. I followed it up by doing a MetaShred Workout and 30 minutes on the punching pad a little while later. Two workouts, two showers and extended time in the hot Sun taught me that sensor adhesives have a distinct limitation on how well they can stick to a grown man’s belly. In my hubris, I didn’t make a nice, smooth seal of adhesive all the way around the sensor. The result was water getting under the adhesive and drying/evaporating, which ultimately dried out the adhesive and caused the sensor to lift. It lost its footing in my flesh and popped out. One day into a new sensor and I’m forced to replace it because I rushed through the installation. Lesson learned…

Saturday, July 4th: When installing the new sensor last night, I took extra care in applying all the adhesive pads. I basically treated it something akin to putting a new diaper on my newborn, Alex. If I don’t ensure the edges are covered and the bands stick properly, he’ll introduce me to a new level of hell by spewing a volcanic jet of baby waste out the sides. So I essentially treated my sensor with the same amount of attention. And they say that you can’t learn anything from diaper changing! But it’s during the evening and overnight that the proverbial full diaper hit the fan…

• 4:00 pm: My wife bakes a banana bread. My wife’s banana bread is my kryptonite! If I could sit with the pan in front of me and eat the entire thing, I would. Hence, the reason she cut the recipe down to a third of the sugar. A fact I was made aware of AFTER I bolused for my usual two pieces of bread;
• 4:50 pm: My pump alarm goes off and suspends due to a low. I mention it to my wife and become aware of the lessened sugar content. I’m frustrated at the low but tickled pink that the pump is doing its job and I get to keep eating, so I cut myself two more pieces of banana bread. This was a mistake I would pay for later…;
• 8:00 pm: The low and the accompanying correction I dealt with is followed up by my usual feeling of fatigue. My wife is also quite tired and we agree to go to sleep early after getting both kids to bed. I think to myself that I may ACTUALLY get a solid 8 hours’ sleep for a change. Then, I realize that my blood glucose is skyrocketing and a correction is necessary. It takes over an hour to finally fall asleep;
• 3:10 am: I am awoken by a beeping I can’t identify. In my sleep-induced haze, I check my phone before realizing it’s coming from my pump. It tells me that it’s lost sensor signal and to move the pump closer to the sensor. I swear and mumble softly as to not awake my wife, since both items are tethered to my stomach. How much closer do they need to be??? But I had apparently rolled onto the sensor, which caused a problem. I decide to ignore it and allow the problem to correct itself. I go back to sleep;
• 3:30 am: Damn it all to hell! I just manage to fall asleep and the pump starts blaring at me that it needs a calibration. Apparently, my timing was off and I should have tested right before bed. I decide to be lazy and press the pump’s “snooze” option;
• 4:30 am: The pump once again tells me to get up and calibrate via finger prick. I give my pump the proverbial middle finger and hit the snooze button again…;
• 5:30 am: GET UP AND CALIBRATE YOUR DAMN PUMP, SHAWN!!!! Fuck you, pump! You’re not the boss of me! I’ll do as I damn well please… (as I get up, walk downstairs to my office and test my blood sugar) I curl back up into my blankets, give my pump a last cursory glance to ensure no issues. Blood sugar is normalizing and I feel my eyelids getting heavy. I go back to sleep;
• 6:30 am (roughly): Baby Alex starts crying as he realizes that its morning and he considers it a firm injustice that we have the temerity to leave him in his crib. My eyes pop open with the cartoon sound of smashing glass and I fight off the urge to start weeping. My wife, who is the ultimate champion of our household, musters from her slumber and rescues the baby from the torture chamber that is his crib;
• 8:30 am: I awake to the dulcet sounds of Joe Satriani’s Always With Me, Always With You for only the second time in many months, since I usually awake before my alarm goes off. I step away from the bed with an accumulated two or three hours’ of sleep. My wife made coffee. She rules.

Lovely, eh? The life of a Type-1 Diabetic is sprinkled with these lovely days of difficulty and lack of rest. I’m confident that once I get used to it and the Auto Mode is in full swing, I’ll feel better about it and things will get easier. When I first started the pump, I had all sorts of difficulties and there were days I was ready to chuck it out the window. But I couldn’t imagine life without an insulin pump, now. As long as my patience holds out and I stick with it, Auto Mode may just be the ticket to getting my Hemoglobin A1C’s below 7.0, for the first time in over a decade. Here’s hoping… ☯

Summer is upon us, and I couldn’t be more exhausted. Or miserable! This time last week, we reached temperatures in the low and mid-30’s (Celsius) and I’ve been hiding out in the cool recesses of my basement ever since. I know, I know… I should stop complaining as winter temperatures in Saskatchewan can often hit -50 degrees Celsius and then there’s the shovelling. But I don’t function well in the heat, and would opt for an Alaskan cruise or deep-cave exploration as opposed to laying on a hot beach.

Diabetes doesn’t like heat, either. In fact, according to an article posted by the CDC, people with either Type-1 or Type-2 feel and experience heat a lot more than the average person. Why? Quite simply, nerve damage caused by Diabetes can affect the sweat glands, making it more difficult for Diabetics to cool themselves as efficiently. We also tend to dehydrate much easier, since when the heat starts to dehydrate us our blood sugars rise, we urinate more and lose more fluids… Wash, rinse and repeat.

The other issue is that heat simply slows down the will to move and you tend to want to lay in the shade and do nothing. This is one of the reasons why people in South America tend to go “siesta” in the afternoons, when the sun is at its peak and temperatures are highest. Maybe they have the right idea. Besides dehydration and other typical complications, high heat will also affect how your body processes your insulin doses, so more frequent blood glucose testing (if you aren’t using CGM) may be required to ensure you don’t hit too many highs and lows.

Your equipment carries an entirely different batch of issues. Insulin is the biggest problem, as it requires an ideal temperature range to be effective. Having insulin in direct sunlight or extreme heat will not only damage its effectiveness, but it may cause the medicinal ingredients to evaporate and turn your insulin into nothing more than very expensive water! But your equipment is no different, including insulin pumps, glucometers and even test strips will be adversely affected by the heat. So it’s important to keep these things packed in a cool receptacle when travelling outdoors for any period of time.

Yes, the summer season is nice to get out and get fresh air and enjoy the outdoors. But the heat can sure throw a monkey wrench into the daily life of someone with Diabetes. Especially since kids find themselves out of school and your routine may be royally shot to hell. But as long as your drinking plenty of fluids (non-alcoholic), using sunscreen and have a cool, air-conditioned environment to take breaks in, you shouldn’t have too many problems. Stay cool! ☯

No, this isn’t a post about inner beauty and about how everyone is beautiful! I’ll save THAT conversation for another day, as I do have some definitive thoughts on it. But if you’ve had Diabetes for the amount of time I have, you’ve been through some shit. And you’ve put up with some shit. Diabetes is shit… That’s the takeaway! But in all seriousness, the topic of today’s post are physical scars, which are mostly inside. And having Diabetes or using the associated therapies can leave a number of different scars.

Let’s begin with the digits, shall we? The fingertips… Part of effectively treating Diabetes is the frequent testing of one’s blood sugar levels. Although I was limited to testing only once a day when I was first diagnosed, as a result of financial constraints and my parents being unfortunate enough not to know better, the ideal situation is to test at LEAST five times a day or more. This would include when waking, before every meal and before hitting the sack at the end of the day.

As I got older and took control of my treatment, I started to test my blood sugar more and more in order to avoid many of the complications I had as a child. The result of this is that my fingertips lost sensitivity and accumulated hard, shell-like scarring. This type of scarring is true scarring, same as you’d get from an injury or a wound. It happens due to the accumulation of a fibrous protein called collagen, and is the body’s way of helping to heal the wound. Although the scar tissue may soften over time, it never truly goes away. Even if I have feeling in my fingertips nowadays, you can still see the scar tissue if you look closely (especially since I still do finger pokes.)

The more problematic scarring (because let’s be honest: as long as the needle pokes through the tissue and draws blood, fingertip scarring is no kind of a big deal), is Lypohypertrophy. You can check that term out on Google or Wikipedia if you wish, but the gist of it is a visible lump under the skin near your insulin injection sites. Besides being painful, it can also affect how your insulin is absorbed and the length of its effectiveness. I’m just going to refer to them as “Lumps” for the rest of this post…

People forget that insulin is a growth hormone and because of that fact, the Lumps you find at your injection sites are often an accumulation and/or growth of fat tissue. This is generally caused by using the same injection site repeatedly, but does go away over time. Depending on the severity of the Lumps, it can take several days, weeks, even years in some cases for them to completely heal and disappear. But they generally do, over time.

Here are a few ways to avoid developing Lypohypertrophy:

1. Rotate your injection sites: This is something you should be doing anyway, but you want to avoid using the same spot over and over without allowing it some time to heal. In fact, my pump trainer was telling me about a Type-1 who only uses one side of his abdomen per month, allowing for a full calendar month for the other side to “heal” and for Lumps to disappear. I don’t go to THAT extreme, but I do switch sides with every new infusion set;
2. Use a fresh needle: I used to be EXTREMELY guilty of this one. Either from laziness or trying to be cost-saving, re-using the same needle over and over can be terrible for you flesh (see illustration below). Even after one use, the point of a needle begins to warp and change shape, requiring more pressure to breach your flesh and causing more damage on the way in. This can lead to actual scarring as opposed to just Lumps. It will also increase the chances of inflammation and infection;
3. Leave some space: If you are injecting on the same side and are close to the previous injection site, make sure you leave at least an inch of space between your current site and the new one. Like I said, insulin is a growth hormone. If you inject too close to the previous site, absorption and effectiveness can still be an issue;
4. Give yourself time to heal: Alright, this one may be riding on the coattails of #1, but it’s important. Like anything else, injection sites need time to heal and get better. No matter what you may read online (this blog included), your body is unique and your healing time will be yours alone. So make sure you’re giving it the time it needs before poking into your preferred injection area.

Obviously, if things seem kind of wonky with a previous injection site, such as discolouration, throbbing or pain or the tissue is hot to the touch, you should seek medical attention as it could be an indication of a worse injury or even infection. I’ve just complicated matters for myself, since CGM requires a second injection site and is supposed to last for seven days. So I get to yo-yo two different injection sites with different change times and try to prevent reusing those sites too frequently.

At the end of the day (or week), those Lumps will disappear as long as you stay true to fresh needles and fresh injection sites. You may develop Lypohypertrophy on occasion even IF you do all these things, so don’t be surprised if you get the occasional Lump. Just be sure to take care of them properly and you’re good to go! ☯