Fact: You Can Do This.

Blunt Lancet rocks in professional work settings too.

Advocacy comes in many forms. In this instance, it fits in in a space about 8.5 inches wide by 11 inches tall.

Have a nice weekend.

One..Two..Fee...Fo...Fi...Fum?

Routine is something that diabetes doesn’t take too seriously. The same amount of insulin for the same meal at the same time of day will likely render diametrically opposite end results diabetically speaking. It’s a shame really. A disease like this takes a toll on us mentally, especially when things consistently do not make sense. An absence of logic is one of the few things I can rely on when it comes to managing this disease.

There are a few things I can control despite the ups and downs of blood glucose readings. It’s simple and probably a bit juvenile, but I always put six fresh pen needles in my right pocket before I leave for work. Each time a needle gets used it gets magically transformed in to used-needle state (far left) and then moves to the left pocket.

On a good day I will go through three needles by the time I get home. One for my morning Lantus shot, one for breakfast’s Humalog and one for lunch’s Humalog. In theory the other needles are there for the days that lack logic, and blood glucose control. Some days I’ll head home without a single fresh needle to use. Those days suck. But at least I’m not afraid to correct any more. There was a time when I saw a 1 or 2 unit correction as a “waste of a pen needle.” I’m glad those days are behind me.

I’m sure this post does nothing for the pump users out there, but I’m sure you all have similar packing routines in the morning before work, right? Help me out here. I can’t be the only one that behaves this obsessively.

Before.

Maybe there’s a part of me that wants to remember these moments so I stay humble during the rare “easy” moments with diabetes.

Maybe I think there’s some greater good in sharing the low moments of diabetes, to let the occasional passer-by know that they aren’t alone in dealing with this nonsense.

Maybe I ran out of time before the day ended and I didn’t have anything else to post.

Maybe I just really love Ben & Jerry’s Ice Cream.

Maybe, and most likely, all of the above.

This blogging thing is a funny adventure. The willingness to open up and share moments where I’m at my weakest with the rest of the world is a strange phenomenon. I genuinely believe there is a kind of pay it forward aspect to stuff like this. You never know who may come across this or someone else’s post like this and reach some kind of acceptance with their disease. This speaks beyond just diabetes, even if that’s what this blog is supposed to be about. Acceptance was a crucial step on my path to a healthier life. If showing pictures like this has the chance to help someone else to take that step then it’d be selfish to not share these kinds of experiences.

Maybe that’s going a bit far, but I owe enough to the diabetes online community that I feel it is my duty to try to contribute in whatever way possible. Today’s contribution is ice cream. We’ll see what happens tomorrow.

After

Across the Internet you will find countless success stories about the Dexcom CGM. Scary lows avoided, A1c’s lowered, pregnancies a little bit easier to manage (because giving birth is easy, right ladies?), and ultimately quality of life has been raised. For those of us with insurance living in the now, this thing is great. I know Dexcom is working on, among other improvements, a 10-day sensor but that isn’t what I want out of the next-gen Dexcom. Although, the thought of getting a single sensor to last a full month does sound like a nice achievement.

Since Dayle and I started hanging out way back when, diabetes has always been something of a shared experience with us. We’ve dealt with failing OmniPods, forgotten test strips, I’m-out-of-lantus-pen situations, and plenty of low blood glucose readings. We both work pretty damn hard to get things right diabetically speaking. It’s her “fault” I’m eating healthier and ultimately using the Dexcom CGM. I’d like to think I’m part of the reason she switched to insulin pens after a number of consecutive bad experiences with her OmniPod. If one of us forgets our CGM charger on our way to work, there’s a good chance the other has one in their bag (She saved me on that one today). Included with this shared experience are the Dexcom alarms.

Despite what the pictures I post on Twitter may suggest about my diabetes management, I’m not perfect. Highs and lows are a frustratingly persistent recurring theme of my life with diabetes. I do what I can to minimize the bumps in the road, but it’s never a smooth or easy process. Most of the time it’s “Oh, you’re low, would you like some juice?”, “Can I have a (pepper)mint (patty)?” or the dreaded “that’s your high alarm. Again.” That last one is the kicker.

During the day I can do a pretty solid job of staying on top of my blood glucose. I think being at work helps focus on the important things of the moment, namely 1. whatever report I have to complete at the moment and b. what my blood glucose reading is. By the time I get home, make and eat dinner and watch last night’s Jimmy Fallon my brain is fried and I need sleep. It’s those hours between 11pm and 5am that lack my full attention diabetically speaking – naturally, I’M TRYING TO SLEEP. The last thing I want to do is (half) wake up, find an insulin pen needle and deal with another injection at 2:30 in the morning. Sometimes I treat high or rising blood glucose levels immediately and with swift justice. Other times I just acknowledge the alarm and try to make the most of sleepy time before the morning routine begins.

If I don’t treat the high or at the very least acknowledge the alarm then the Dexcom receiver gets angry and starts yelling. BEEEEP BEEEEP. Sometimes I hear it. Sometimes I don’t. Sometimes Dayle hears it. Sometimes she doesn’t. No matter what happens, there’s a chance I may wake Dayle up and that’s not fair. We may share some of our diabetes experiences, but this is one I wish I could bear on my own. Yes, my blood glucose is high. I’ll deal with it at some point but please leave her out of this.

What I want, back to the point of this post, is a way to set alarm thresholds and alerts throughout the day based on the time – much like basal rates for an insulin pump.

During the day I could probably do well to lower my high threshold from 180 mg/dL to 160 mg/dL, assuming I have the motivation to stay on top of things. But at night I want a little more flexibility. Not that high blood glucose readings should ever be tolerated but let me move the threshold up to 200. Or, let me keep the high threshold at 180 and have a secondary “okay, you really need to do something about this” threshold set above that – like the 55 mg/dL on the low side. Give me an initial high threshold of 180 with a 2 hour snooze and a Super High threshold of 200 from the hours of 11 to 5, or something like that and we’ll be set.

Yes, I can manually change these settings each time I wake up and before I go to sleep but you pump users aren’t manually changing your basal rates every hour, are you? It’s not unreasonable to think the same is possible with a CGM, is it?

If I can manage the different thresholds depending on the time then maybe nights would be a little more restful and more importantly I can respect the fact that I’m not the only one having my sheep counting disturbed at night.

So what do you think? Time-based Dexcom alerts that you set and manage similar to a pump’s basal settings?

[Girlfriend's Note]

Hi. Dayle here. Three things I’d like to add:

1. Let’s not forget that my CGM goes off in the middle of the night, too, and no doubt wakes you up from time to time, so it goes both ways. Although I don’t think that diabetes is what keeps us going (despite my grandma’s comment last month as we pulled out our insulin pens at the dinner table that “those who stick together, stick together”), I do think it’s nice that if my CGM is going to wake up someone else in the middle of the night, at least it’s someone who understands a gazillion %. I know that you won’t judge me for rolling over and snoozing another five minutes. Not sure if that’s because you wear a CGM, too, or if that’s because you’re you – and the best man I know.

2. While I like the idea of time-sensitive threshold shifts, I also like the idea of controllable volume settings. Combine the two, and you could have the volume change for the hours at work, at home, in class, and while you’re asleep. Maybe rather than worrying about waking up our significant others, the “while you’re sleeping” alarm could be more assertive and really say, “Wake up Chris, you need to do something.”

3. To take the idea a little further… if Dexcom doesn’t want to take their technology in that direction, maybe they could create a buddy system with mobile health tools. They are probably looking into bringing readings up on a cell phone already (as the FDA continues to define what a mobile medical app is), but what about alarms? Maybe I like my job too much, but there really could be an mHealth opportunity here: program the CGM to trigger the phone, with its advanced ability to buzz and make all sorts of sounds with volume control, so it’s your mobile phone that wakes you up. Might not be as direct as we’d like, but it’s a thought. You could even combine it with our boy Jimmy Fallon’s mobile app so that when you’re blood glucose gets too high, it’s Jimmy Fallon calling you and telling you that it’s time to get up[and take a correction bolus].

And, for the record, both you and keeping your blood glucose in range are worth waking up for – any time of day or night.

Keep up with the latest in Quinn’s world on her website at quinnnystrom.com and on Twitter @QuinnNystrom.

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That book is pretty funny. You should check it out.

I know the only thing you really need to keep is the senor packaging for identification purposes but it just seemed like the natural thing to do to keep everything together.

In less-weird news, Dayle and I booked our flight, stay and car rental in Orlando for Friends for Life. I had a rather green hue about me during last year’s conference following everyone’s tweets, status updates, blog posts and photos. I’ve made so many connections over the past few years that it feels like a genuine disservice to the community to not participate in something as entertaining as Friends for Life. Sure, there are financial considerations to factor that prohibit some people from going – I’m not taking away from the real world. But what good is all of this social media stuff if we’re not Social?

I may not get to every meetup in the world, but I try to make the most out of the opportunities I have. Even if it’s only for a few minutes.

Look who we found – @Diabetic_Iz_Me! (@hellocupcakedc) twitpic.com/8aww9r—
Christopher (@iam_spartacus) January 23, 2012

Con: That means twenty-one straight days of insulin injections on the same side of my body.

Somewhere on the way to twenty-one the mentality of getting the sensor reaches a boiling point. Normally the mentality focuses on getting the sensor to last because these things aren’t cheap and it’s economical to stretch the life of a sensor if the data remains reliable. For me, any length past twelve days signifies a well-used Dexcom sensor. Fourteen means I applied additional tape or adhesive at the right time and in the right places to ensure maximum stick-to-me-ness. After that I’m just getting greedy.

Then the reality sets in that I’m approaching the mythical beast that is twenty-one. Do I publicly comment on it and risk jinxing myself? Do I apply more external adhesive and brute force my way to the legal drinking age? Do I do nothing outside of the norm and hope that the status quo is enough to get me to the promised land?

Odd that these are the thoughts that occupy my mind. Not, did I properly bolus for that brownie? Should I have a second piece of bread with my spaghetti? Is a piece of bacon chocolate really required tonight (YES, yes it is). I suppose this means that things are going well for me diabetically speaking. I suppose.

What it does mean is that I’m able to brush the frustrating moments aside with relative ease. They happen. Often. But I’m doing a better job of not letting them get to me for extended periods – even if the highs stick around for way too long.

So take that diabetes. And thank you Dexcom.

Bolus Worthy

And you know that something like this will happen.

This was a wild ride.

But sometimes going through something like this

This was a wild ride.

Is worth the trouble for something like this.

Bolus Worthy

I’m not sure if ends justify means or anything like that, but that bread pudding sure did taste like heaven.

For me, a “resolution” has the unfortunate characteristic of being abandoned at some point in the year. It’s nice to have them, but I don’t expect to real goals that are arbitrarily set just because the calendar says January 1. It’s a rather cold view of the world, yes, but it’s my view of things.

Losing weight, exercising more, eating better – while vague, these are all components of proper diabetes care, regardless of what day it is. Once I figure out what works for me, I can set intermediate goals of losing 5 pounds, putting down 3 hours a week on the elliptical machine, always having at least one vegetable and fruit serving with dinner – but I have to do these in my own time if they are going to work. I’m not trying to be all “stupid conformists” but my brain just doesn’t work like the rest.

So yes, I do plan on working my A1c down a bit more from my last visit by better utilizing my Dexcom data. Yes I want to fit into my suits, comfortably, again. And maybe, I’ll better build my healthcare team to the point that they don’t just spit out prescription slips. But for me the motivation has to be stronger than “Happy New Year.”

Re-reading this post, I come off a bit heartless. It’s not that resolutions and goal setting is bad or a fruitless endeavor – I just find my motivation elsewhere and that is what dictates how/when these goals will be set and ultimately met.

Because I’m definitely going to meet them. Head on.

I’ve been losing too much time trying to put captions and descriptions on all the photos I’ve taken and uploaded over the past…forever.

Taking a global look at the moments I choose to capture, specifically with my phone, it’s clear 1. I have diabetes and 2. my CGM gets way too much attention.

I know Dexcom is working on getting a sensor that is approved for 10 days of use through the FDA, but they really need to work on an extension of their USB cord that automatically captures an image of your 24-hour display. If it were part of the data capture process, I think a great number of people with diabetes would be more connected to the stream of data that is collected and (in my case) mostly ignored.

Using this device as a retroactive learning tool is the real power of the CGM. That’s where diabetes management takes the “next step”. But honestly the whole process doesn’t appeal to me. Sad as it is to say/type – I, a guy whose job is ANALYTICS, have minimal interest in the data collected by my CGM.

But.

If this data was passively and somewhat automatically collected each time I connect my CGM to my computer with the primary purpose of capturing another 24-hour graph, my excuses would dwindle.

It could happen.