Thursday, September 27, 2007

The Great Gym Motivator

Oh yeah, I'll be there. Probably doing little more then just sitting on the bicycle but that's at least better then sitting on the couch,scarfing potato chips + getting fatter by the minute,right? I do expect to burn a few calories..
(no cable here-so that's where I gotta go to watch the premiere!!!!)

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.

Sunday, September 23, 2007

Youtube(How to test your cat)

I found this to be quite informative-heck, I don't know much about diabetic animals.
The only time I ever anything to do with one was during a brief summer job
stint in a vet's office.(and that was just checking the urine for sugar) I think
that animals,like humans,deserve better then that!
(and what do you feed a hypoing cat,anyway?)

Friday, September 21, 2007

3,2,1- outta here

It is over.
(Thank God)

That's all I have to say about that for the present, I am exausted. CGMS certainly was nothing like I'd expected.

Monday, September 17, 2007

A Freudian Self- Analysis

I had a dream last night

Dreaming about tomarrow.

And while the needle, jammed into my flesh

Demands that fantasy, mix with pain

I'll still believe in Tomarrow.

Bittersweet, this nightly transendence

Into the mind's eye

Leaving the cares, the sorrows, the tears behind

However briefly.

But dreams don't stop reality from rushing in

Like an icy wave, slapping against the naked chest

Taking your breath away.

Wide awake- the pain now has a name

An infusion set gone south.

Yank cannula from leg,

And as bright red blood spurts against the once-white sheets

(Old Faithful-look at that gusher!!!)

the stress of the dream melts away.

Well, since I'm already awake, might as well check the o'le blood sugar

After changing the bedclothes.

No high, no low, graces that early morning scene.

132 mg/dl- precisely where it should be.

And yet, I marvel at the abilitity of diabetes

To steal shut-eye in another unusual way.

Sometimes, I know I have diabetes (in my dreams)

it manifests itself by frantic eating (lows)

and drinking water (highs)

Some weird form of ESP, no doubt

but this dream was just a sense of un-nameable pain

that I couldn't fix, couldn't help, couldn't wake up from.

I think that dreams,(be they subconsious, or conscious) in general, must cope with

said "thorns in the flesh"

reality bites, but life's like that.

They must coexist- you may never be a millionaire, might not make it to 100.

(statistically speaking,just not likely to happen)

Yin and Yang- pleasure and pain.

Because you can't stop dreaming, even if you wanted to.

Sunday, September 16, 2007

CGMS & ME ( Part II)

The piece of black leather lies lifeless before me, waiting to be cut, shaped, and sewn into some useful accessory.

"Think of what features you'd like to have, and incorporate those impulses. Experiment, have fun!" the group leader's voice inflects wildly, attempting
to channel her excessive charisma into group spirit.

I sigh heavily- the materials I have aren't sparking any creative genius.(as of yet)
Perhaps I should check out what other people are doing, it may give me a few ideas.

To my left, a teenager has ditched Project #1 entirely and is now meticulously arranging minuscule red and white sequins in an American Flag pattern.(to be applied to Project #2) Cute, but I think I'm a little old for decorations of that nature. And across the table, an engineer dad is building his pre-teen son the best sample pump case I've ever seen-ever bit as good as the real thing.(side packs,able to stand up on the table by itself) None of us can match that, least of all me. This session(in Friends 4 Life,2007) is not exactly the most popular, only about 15 people in the room. We are the ones who chose this class by process of elimination(Carb Counting 101, "Strike the Spike", and Managing Diabetes During Sick Days were not really something we'd wanted to sleep through for the next 2 hours). Few of us have much of an idea of what we're actually supposed to be doing. In the absence of inspiration, I leave Project #1 and go to Project #2(decorating the provided nylon clip-on case) I boldly apply red and green fabric paint, and leave it to dry.5 minutes later, I knock the case on the floor and it smears together into a Impressionalistic, Picasso wanna-be creation. Rather then start over, I just back to Project #1- decorating obviously just isn't my thing.

The teenager, 3/4's done with applying the decorations on her own case, looks over at mine.
"Can I see yours?"
"I dropped it on the floor," I reply, showing it to her."Not going to do it over."
Predictably, she isn't impressed, and returns to her own work.

Now to think of what I want in a pump case...
Material: Leather. Gotta be durable.

Color: Black. I don't like wild stuff.

Style: Waist-pouch. I don't have any, and on certain occasions it would come in

Other features: Clear plastic over the case, so I can see through to bolus/change
basils.Zippered pull. Monogrammed.

I can't design, and I can't draw, but between the sheet of paper and crudely constructed prototype, I manage to convey my wishes. I include my phone # though(just in case they have questions).

Several months later..

Tues., Sep.4. I return from my holiday travels to find a large package from Pump Wear sitting on my front porch. Rip it open, and there it, the case I designed! Not exactly(no monogram) but I'm pleased that A. they sent it and B. it looks pretty good, for something I created. Just what I want. The case, slides around on the belt. And it will come in really handy for the below scenario.It's functional, and that's precisely what I want.


Friday, was the initial meeting at the RC(Research Center), about 3:30 pm. Stuff was winding down for the weekend, and I was the last scheduled patient. The nurse took all the standard vital signs and EKG and then, the research coordinator came in to go over the entire consent form. Since they changed the amount of blood drawn from 18, to 19 tablespoons they have to make up an ENTIRELY new consent form(also to be signed). Seems pretty stupid to me,but I don't make the rules. Well, I discovered that graduate students are going to be suggesting my insulin doses based on their algorithmic models-which will either be accepted/rejected by the study physician, I'm still not to enthralled by the whole idea. She'll probably be pressured to accept at least some of their calculations,(part of the point of the study) and I'll go low and have to chug juice. Whereas, last time I was in blissful ignorance of my blood sugars/insulin doses, this time I will not be.(CGMS will tell all) Still, I can't make my own adjustments, the study doc will be doing that(someone else fiddling with the pump, weird concept)based on the grad students calculations. My new case will make it easy for her to access the pump.
Also discovered I have to do another blood draw since I'm not on Humalog.(and have to be on it 24 hours prior. Which means, getting up at an insanely early hour(3:30-4 pm) to be able to get there and back before work begins.(Tues.morning) Ugh.(I'm not a morning person)
The study doc came in, rehashed a few things, checked feet, etc. I don't particularly enjoy peeling off my (usually cotton) socks-weird white fuzzies
always fall out and I'm embarrassed. I'm sure endos don't enjoy the process either.

Then we got down to the #1 concern on both of ours' minds.
"You know, you can't be in it if your magnesium or potassium is to low."

Yeah, I know.Ever since she walked through that door,I've been expecting this.

"How's that been?"

"Ok, I haven't had it checked recently. I do have to take the supplements periodically but I've not had a bad dip in the levels in a long time.You know I've
got that leak, like Bartter's Syndrome.I guess I never told you that officially, since the end of that study."

"Last time, the real problem with the sudden drop in your levels was from the IV insulin clamp-with the pump, that won't be so much of an issue. I want you to really load up on those supplements, to further minimalize those chances. Also, your iron levels were a bit low last month so we need to recheck that, you can't be in the study if those are too low either."

CGMS alarms will be off, so I guess I won't know if I'm low/high from any of the alarms..The bg goal is 130 all morning, and 100 all afternoon. She said their next study will be with the Navigator/Cozmo- a closed loop system.(no time frame on when that would be) I bet that will be interesting.

Levels came back acceptable, so I'm on for Thursday night at 6 pm!

Thursday, September 13, 2007

The Power of a Low

Last night, I had a low. And it wasn't so much the actual blood sugar number, it was the amount of carbs I had to eat/did eat to feel right again.

Like most lows, there wasn't much of a reason for it-I'd bolused .5 to correct an 188 an hour previously.(Those numbers can go either way) That was the only bolus I'd had since lunch(4 hours before).

Sweats, wake up from nap. Stumble out to kitchen, eat entire (72 carb) bag of cotton candy. I'm aware that I should stop now, I've just overtreated this low by 42 carbs. But my brain says to keep eating, and I figure I can just make this an early supper too.

BG: 70 mg/dl. Some people wouldn't even consider that low..

Get started on monster-sized bag of potato chips, polish off 1/2 of that. Ham sandwich- why not. A tomato-cottage cheese sandwich sounds great as well. And grapes, shoot, can't leave those out. Topped off by a Diet Coke. At some point, I cease to care what the resulting fallout bg will be, I just need to eat.
In the end, I've consumed over 300 carbs(about 1.5 days worth in a single meal) to treat this low. And the final bg...

350. It should have been worse, much worse. I've never in my life eaten that much.(I think the last time was 120 carbs for a 19 mg/dl, 5 years ago)
It was really freaky.(after eating the cotton candy, I didn't even feel low anymore-just hungry!)

Monday, September 10, 2007

The Diabetic Dummy

It is the night of the State Test, and already, the line stretches to the set of double doors.

No, not THAT line. That line has several hundred extremily nervous, nail-biting, coffee-chugging maniacs in it. This is the other one- the volunteer line. And only slightly less nervous then the test takers.

"Come with me, please," one of the instructors, his cold, beady eyes sweeping the assorted mob, snaps out. "Probably can't use you all, but we'll see what we can do."
Heels clatter, shoes stomp, following him down the narrow middle school corridor-and we enter a teacher's lounge,now converted to a makeshift strategy room.

Victim #1 is chosen, receives her instruction sheet and moves off to an adjoining room for makeup. The rest of us stare in nervous fascination at the "gunshot wound with bone protruding" job on her right leg. Bone and blood ooze together in a very realistic representation of the real thing. (We are students, and impress easily)

Victim #2 is in anyphlactic shock.Multiple brown dots adorn his cherry red face.

And I am Victim #3. As I receive my instruction sheet, my eyebrows shoot up(practically to the hairline) and I think it is something more then coincidence that I will be role-acting the hypoing diabetic. (not that I'm not VERY good at it, I've had so much practice) It must be true, I must really look like one..Either that, or its because I'm small(and more easily lifted).

My makeup job is a chalkwhite face, complete with beaded drops of glycerin rolling off the forehead(to simulate sweat). I look very much the part(and am just sorry that Halloween was over two weeks previously, I could have had some fun with this).

As I leave the room with the designated scenario instructor, my EMT teacher looks at me and laughs. "Did you tell him you really are D, Heidi?"

I hadn't quite gotten that far in the intros- I glance over at the instructor, who is standing stock still(a glazed expression spreading across his pained face).

"Yes. I promise I'll do this RIGHT."

"I bet you will, but please don't do it for real!!!!!"
(Cross my heart, hope to die. NOT likely.)

We get to the classroom, finalize certain instructions, and the fun begins.(After confirming that I'm nowhere near hypoglycemia, at 149 mg/dl)

The first two test takers enter the room. They are exceeding nervous, as am I. I'm doing this for the experience, but I don't know what their instructor has(or failed to) taught them.

"Hey, we're Jack and Jill*- what's your name?"

The instructions say I'm allowed to state my name, the last meal of the day, and that I take insulin. Other then that, I'm supposed to act confused/answer the questions wrong.
So I respond, and promptly shut my eyes. Fake reactions are so much easier then real ones. I can moan + thrash around to my heart's content, make these kids really nervous. I can't simulate the shaking though. Jill takes my blood pressure, which is off a good 30 points from what it is actually. Not good to guess on ANYTHING, instructors know all. You'll fail the scenario.(they did)

Every group is different with the questions asked, procedures performed. One group thought an adequate treatment for my shock was a pillow under the head. While being thoughtful, it wouldn't have done anything for the hypoglycemia. I had a hard time not waking up from my coma and telling them they'd just killed me. (that was just the one group, all the others made the correct diagnosis) Another group of firefighter guys asked me what kind of insulin I took.(that's not exactly a crucial piece of info-most emergency personal leave it at "Are you on insulin?" My diabetic autopilot spat out "Novolog" before I could consider if I was supposed to answer that for real. They didn't know, but it obviously marked me as a REAL D. It was a timed test, with alot of steps to cover.

At the end, my own blood glucose rang in at 329 and I was somewhat cranky at the blood pressure cuff torniquet attempts, shined lights in eyes, and the stress of lying on the hard floor for 2 hours. Yes,I'd learned enough to be more relaxed/expectant of what my own test would be like(the following month) but if you're going to be the dummy patient for a group of (any) students, don't be the diabetic dummy. Go for something more a broken leg.(as long as you don't have to backboarded)

And speaking of life on the other side of the gurney,I've got to complete all my continuing education(CE) hours(to be turned in by Dec.2008) so I don't lose my certification.(I do not want to go through another 3 month class/state test) If I can't get accepted to any of the spring nursing programs, I will definatly be completing the CE stuff.(at least)

Friday, September 07, 2007

Dashboard Confessional

I'm really, really psyched- my years of being a guinea pig have climaxed up to fufillment of The Dream Come True.(Kinda)

The phone rang, the 4th call in 10 minutes. Sigh. Pick up.

"Hi, Heidi. This is "X"- would you be interested in doing another study?"

As she explains what all is involved, it occurs to me this will be the very last study I'll be able to do for them. Darn, I'm gonna miss that. Plus the pay, of course.Bethesda studies don't pay at all.(good research place, they just don't pay their participants!)

"You're one of the very few(12, to be exact) people to qualify for this study, based on the one you did in 2002 AND the Boost Test. If you had a cpeptide, you wouldn't qualify."

"That's good, I'm glad I don't have a c-peptide."(mild sarcasm)

Visit #1- paperwork, bloodwork. The usual.

Visit #2. Overnight(23 hour) admission to the Research Center. Gotta use their pump(Cozmo, with Humalog). I am a Novolog girl myself but it won't kill me to use Humalog. It'll just be, interesting. Haven't used it in like 4 years. IV, heart moniter attached.

But I get to wear a Medtronic REALTIME Guardian!(or a Dexcom-its a random decision) for 21 hours.(more or less) I don't think I'll sleep, I'll be too busy looking at my beautiful blood sugars.
And I can see what its like.

Next morning, its the typical overkill testing(ever had your blood sugar taken every bleepin' FIVE minutes? for 6 straight hours) that I went through in 2002 so I know what to expect. Then,from 2 pm-2:45 I ride an exercise bike and at 3:45 I get "lunch"(if you could call it that,more like an early supper) and that's the end.

I only wish I could keep the CGMS....

Saturday, September 01, 2007