Having My Cake and Eating it Too!

So, like a lot of people, I tend to get higher blood sugars after breakfast (which I rarely eat) or morning coffee (which is a “must have” every day) than after any other bolus in the day.   Until about 6-12 months ago my post-meal highs were something like 150-160.  Lately, though with all the other variables I’ve introduced (post-pregnancy, nursing, hormones, stress, etc) it was getting to be like 250…even 300 some mornings.  I always felt guilty about it but did I give up my morning joe?  Heck no!  I’ve just been keeping the problem on the back burner for several months knowing I would eventually have to deal with it.  Now is the time.

Realistically, I need to reassess my entire insulin regimen including my basal rates (but for me that’s phase 2 after hormone-adjustment phase 1), so for now I’m experimenting with less conventional ways to bolus in the morning that might make the difference.  It looks like I may have found one!

Having my cake and eating it too

For the past several days, I’ve been giving myself a square-wave bolus over 30 minutes and then actually drinking my morning cappuccino starting at minute 45.  Look at these CGM results:  On this day, I took my bolus about 7:45 and drank my coffee about 8:30.  The little bump you see about 9:30 never got over 140.

It’s not the most ideal but it’s working for now so I’ll take it!  What do you do for post-breakfast (coffee) highs?

D.W.T: Driving While Tabbing

Today on my lunch hour I headed home and loaded up my 6-year old daughter in the car to take her to her first day of lego summer camp (fun!).  Normally I would have checked my BG before driving at lunchtime but I’ve gotten kind of reliant on my CGM and it said I was fine at 87, so I didn’t bother with a finger prick.  We’re half way there and I start to feel just a little funny, so when we hit a stop sign I whip out my kit just to be sure…53.  Grr! Thanks for nothing CGM!

I suppose the appropriate thing to do would be to pull over, tab-up, and wait for my BG to rise.  What actually happens is this:  driveing-while-tabbing

That’s an open container of glucose tabs I’m holding while also shifting gears (no, I didn’t actually take the pic while I was still driving…I’m not crazy!).

Why did I drive-while-tabbing instead of pulling over?

Because in my world a BG of 53 (being treated) isn’t terrifying or dangerous.  In my world it’s just another, albeit wearisome, inconvenience.  In my world you don’t pull over (literally or metaphorically) for the big D unless you really have to….you just don’t.

Instead you adapt, and learn to overcome new challenges.  Dealing with D becomes part of life and you figure out how to get the job done anyway.  For me, popping a few tabs in the car occasionally, while not ideal, has become equivalent to opening a box of crackers for my kid while driving or feeling around on the floor of the car for the baby’s pacifier while driving (you know we’ve all done that one!).

You adjust to how your life is different.  Like when you have kids and your life changes.  It’s still “your life” but now it’s also “your life with kids” and this change brings with it lots of wonderful and not-so-wonderful moments.

My life isn’t only “my life” anymore, now it’s also “my life with diabetes” and my life with diabetes happens at home, at work, on vacation, and yes…sometimes even in the car.

First Things First: Hormones and Insulin Requirements

TI diabetes, Grave’s disease, then early menopause….Geeezzz, what’s next?  Apparently, it’s not only pretty common for people with an autoimmune disorder to develop a second autoimmune disorder but also for women with T1 to have early menopause (or premature ovarian failure-POF).  Like my autoimmune disorders, I developed POF suddenly and acutely.  I was only 35 years old.  Without estrogen, my blood sugars skyrocketed and I was advised by multiple Drs to start hormone replacement therapy (HRT), and stay on it until I was 50 or 55.

I’m the kind of person that doesn’t believe a pill will solve all my problems (I wish!) and sometimes that we, as a culture looking for a quick fix, tend to take medications we don’t really need without considering long-term side effects.

I researched painstakingly to find the most bioequivalent (not the most convenient) versions of HRT available, settling on the Vivelle dot skin patch for estrogen coupled with cyclic Progesterone in the form of Prometrium…and (drum role please) they worked!  My blood sugars and insulin requirements went back to normal, I lost weight, and generally felt great!  Until 3 years later when I got pregnant…WHAT?!

So, despite my acute POF, my non-existent FSH (follicle stimulating hormone), and crazy-high LH (luteinizing hormone), miracles do happen.  Now, about a year after my healthy, happy son was born, both my hormones and my blood sugars are a bit choppy.  In the past, I used my consistent blood sugars as a barometer to determine what dose of hormones I needed to be on to get back to my pre-menopausal self.   But, since the pregnancy my blood sugars aren’t the shining example of regularity they once were, so this time I’m attempting to adjust the hormones first and then concentrate on the insulin requirements.  I suppose it’s a bit of a “Which came first, the chicken or the egg?” situation.

Diabetes_chicken_HRT_egg

I’m currently on the same dosages of Vivelle and Prometrium that I was on pre-pregnancy, however what used to work so well for me….just isn’t working at all now! (Don’t worry I’ll save you the gruesome girly details).  The only difference in the HRT is that my insurance Co. started opting for a generic version of Prometrium and I’ve been on that since Feb.  My first step in getting the HRT right is to switch back to the Brand version and see if it makes a difference.  Here’s to hoping that it works and frees me up to move on to adjusting my insulin dosages!

Site Rotation Save Me

So, I’ve always been guilty of not rotating my pump sites enough, in fact you could call me downright resistant.  I guess when I find something I like, I just want to stick with it and after all, I do ask my Endo about it occasionally and he always replies in his usual fashion “All looks good Julie”.

Pregbelly

And this pic is only my 7th month…yikes!

For years, I used to use my belly for my Omnipod and rotate through about 6-8 sites but last year, during my pregnancy, I had an enormous belly and a lot of discomfort with my pump, so I started relying on only two sites.

Since then (it’s been 13 months!), I guess I just got lazy, or caught up with putting life ahead of routine diabetes management…we’ve all been there right?  Frankly, I still have 28lbs of baby weight to lose and the old sites (which were largely around my waistband) just aren’t comfortable anymore.

Well, I started noticing that it looked my insulin needs were increasing?!  It didn’t make sense:  I was breastfeeding, not overweight (technically), active, hadn’t changed my eating habits, other medications, etc.  WTH?!

It finally dawned on me that maybe my poor old sites were just worn out.  I Googled it and came across lipohypertrophy and then got scared out of my pants by doing an Image Search for it (fyi, don’t click on this Image Search unless you’re fully ready for the unsettling consequences).  Enough said…site rotation here I come!

Now, I don’t have any signs of lipohypertrophy yet but when I was pregnant, my insulin needs tripled and it makes sense that my insulin absorption rates for those belly sites might have taken a toll.

backpod

I’m currently a proud wearer of a back Omnipod…day two 😉  It has it’s issues and will take some getting used to (especially when I try to carry a backpack)…but my sugars have been much lower, while everything else has stayed pretty much the same (same insulin rates, same diet and activity, same morning and afternoon coffee, same evening glass of wine…you get the picture).  So far this experiment is a success, Phew!

Stay tuned for more pod placement experimentation…