Monday, September 24, 2007

#1 with a Bullet(A girl, a Guardian, and the GCRC)

"Sorry I'm late," I mumble, as the RC's face lights up and she exclaims,"There she is!"(telephone in hand) It's 6:15, and I'm pushing the limits of having to reschedule the entire thing.
"Well, you are coming from far away-it's ok."
"Traffic was bad..."
"Don't worry about it."
Uncerimoniously dump overnight bag on floor, go off with nurse to have vital signs checked. 10 minutes later, time for blood sugar test(and supper). Sign RC's second consent form and she takes off for 3 weeks of blissful undisturbed solitude somewhere in the country of Spain. Well deserved(I might add), if I had to work nights and weekends I'd be ready for such a vacation too. Nurse puts in IV access #1, draws blood, lets me know my bg(167) and supper arrives.
Lemon pudding
1/2 baked potato
steak strips
diet lemon lime soft drink
"I've got to see you bolus for it," the nurse announces, firmly.
"WhaaaTTTT? You mean, all at once? Can't I split it up?"
"No, Dr. A. said you've got to bolus for all of it at one time."
This isn't good, my body isn't going to take to well to 9 units hitting En Masse,Immeadiente. I would do it if the endo were here, but she's not. I don't know if this nurse can handle hypoglycemia-I envision getting low,overeating,and skyrocketing from all the supper carbs catching up. I don't really need that (on the eve of the research study).
But I can't very well refuse. I bolus, she nods her approval, and I proceed to inhale my supper at warp speed. Pudding, potato,broccoli, steak. And juice, because I still think I'm going to get low.
At 9 pm, the resident doc comes in, gives me my black Cozmo, inserts the Guardian sensor into my abdomen, enters the first bg.(124) At 11:15, she enters the 2nd bg(130) and the numbers start appearing on the screen. I watch them march steadily upward till 12(170), and fall asleep.
3 am- "Wake up, you're high. Dr. A. wants you to bolus 2 units."
4 am- Something is shrieking, and I know its not my pump.(or rather, their pump)It sounds very simular to a dead battery alarm(on the Cozmo), but it has to be the Guardian. Flip light switch. Yeah, my sensor is having connectivity problems.(I forget the exact term) Notify nurse, turn off the alarm somehow.Clip the Guardian directly over the abdominal sensor. Sleep well, little one.
6 AM-"Wake up, you're still high.Dr. A wants you take another unit."
I bolus, resume slumber.
6:30 AM- More blood, another IV access put in. Give up on getting any more sleep.
7 AM- BG check(160)
7:15 AM-150
7:30 AM-142
7:45 AM-136
8 AM- Everyone's there by now: the endo,2 vampire nurses, blood runner, person running bg machine, and the graduate student.
"Morning, Heidi.You were sort of high last night- what's your basal?"
"The nurse has got 0.5 on here." She glances down, puzzled. "Are you sure?"
"That's what its supposed to be since 6 AM- 0.6. I haven't checked it on this pump."
"Give me your pump." She reviews the basal profile. "Oh, this is programmed for PM, not AM."
"You mean I've been getting the wrong rates since 9 PM?? No wonder I'm high, 0.2 units/hr is NOT me at 1 AM. I have pretty strong dawn phenomenon."
"She must have got them mixed up."
Great. Thank you, Dr.K.
"You're fine now, 130. We're going to try to keep you at that till exercise. We'll turn off your basal rates, and give you frequent boluses based on the algorithms."
This incites a small pandimonium as everyone has to adjust their timing to the time of the caught mistake. Takes a good 30 minutes to get straight.
Bg stays a nice 120-130 till 9:30, when the breakfast(1/2 bagel,a few scrambled eggs) sends it up to 190(despite an adequate bolus)
The nurse slides the needle into the port, fills a tube, discards that, fills another one-squirts it into small vial,caps it off, and yells "Bullet!" to the runner. That's my blood, headed to the bg machine. A bullet of blood. (Weird what they call some things)Two more tubes, get stuck in a container of ice to test endogenous and exogenous insulin levels. Every five minutes, till 1 am.
Time to calibrate the Guardian.
One Touch Ultra-170
Hospital machine-130
Lovely, it's at least 50+ points off.I'm not sure what I am, now-I leave it to the endo to decide that. She feels that putting the One Touch bg in the Guardian, will at least get it closer to the actual bg.
The hours pass, and "Top Chef" marathon fills the time. Unfortuantly, my bg isn't going down(stays near 200) and I have the urge to shoot a good 3 units but I'm not allowed to do that. It is stress that keeps at that range, despite frequent small boluses of 0.2-0.4 units.I'm not sure that Dr.A realizes that IOB isn't accurate,I don't think there's any insulin left(based on my bg not going down). I sure won't go low doing this. El Guardian has me in the 110-130 range, I want to shoot the thing.(I know I'm near 200,heck,I'm thirsty) Dr.K.shows up. I try not to think about food, but the food on "Top Chef" looks SO good. When my 4-H group took a tour of the Washington DC Culinary Arts School(and were subsequently cooked an exquisite dinner, I couldn't tell that it was cooked by students(it was all awesome). I know I have an untrained palate, but I think the judges on those shows are pretty rough on the contestants(it doesn't taste like compost,I'm sure).
1 pm- blood draws decrease to every 10 minutes.
1:30 pm-Exercise prep time. Strap on STS polar moniter, chest leads. Go down the hall to exercise room.Exercise physiologists show up.Attach leads to machine.
2 pm-2:45 pm.Ride exercise bike. Somehow survive.(the seat is hard,the moniter tight, and the room is about a million degrees)Definatly the worst part.
3 pm- Just an hour remaining. Graduate student leaves. Bg checks every 10 minutes. We continue watching Hour #6 of "Top Chef", having run out of things to talk about.(Weather, Weddings, and Whatever Else having been discussed Ad Nauseum)
4 pm- Dinner arrives.(salad,fruit salad, rice/mixed veggies, chicken, diet Lemon Lime) Despite being starved, its still way too much food! Food person asks me if I'd like some dessert. I cast a wary glance in the direction of the medical professionals and reply that fruit is a perfectly fine dessert. No one believes me, so they ask again later on, but I don't particurally like pound cake so I decline. Finish dinner, review discharge sheets, remove hardware.(it wasn't so hard giving up a Guardian that wasn't very accurate).
I'm not an expert, but I think if it had be calibrated more often it would have been closer to the actual bg. I also expected to see more numbers, not just a line and one bg on the screen. I think I'd like to try a Dexcom(I have no idea how, though,my D clinic doesn't have any) The Guardian, didn't exactly live up to my expectations.
The amount of blood taken(overall) was as much as a standard blood donation, so I can't give for a couple of months.

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