Saturday, August 26, 2006

This and that

It has been a while since my last post now. Work has kept me busy, and for most part the D has “behaved” nicely. Anyway, this post is going to be a lengthy one, with more about the issues on soccer playing with the pump, general management of the BG and my experience with the Guardian RT.

The last couple of weeks have been quite hectic. I have been awaiting a sports belt bag for the pump to use when I play soccer. It arrived a week ago on Friday, so Tuesday I wore the pump throughout practice for the first time. I had reduced my basal rate to 50 % for an hour before starting, but when I tested before going out I was only 3.7 (67), despite having eaten a banana without blousing for it 25 minutes earlier. Therefore I had 6 glucose tabs and set a temp basal of 50 % for the first hour of practice. I should probably have postponed the starting of practice a little, until the BG was back up in range, but as usual I was eager to get started so I just hit it. I did not feel too fit though, and had to quench a bottle of juice during the practice, still ending it at 3.3 (59).

After practice I had dinner with Jimmi, nothing out of the ordinary, but when testing before bed I had an unbelievable 17.4 (313)! I have no idea why I got that high, so I just corrected, 4 U, to get back in range. That was probably too much, or maybe I should just have reduced the basals throughout the night, although that just did not seem obvious considering the level of my BG when going to bed. Anyway, I woke up at 1:30 AM a bit confused, noticing that Jimmi was not in bed with me and the light was on in the kitchen/living room. At the same time my pump alarmed and I found that it had been suspended. Just as I resumed infusion, I could hear Jimmi showing two Falck-men (the Danish equivalent to paramedics) into our house. In a minute they were in the bedroom, much to my resentment. There wasn’t much for them to do, though. They tested my BG – 2.3 (41) – before watching me down a couple of glucose tabs, a piece of rye bread with cheese and a glass of milk, leaving me at 4.8 (86) afterwards. I tried to bolus for the carbs of the bread and milk, knowing that before the arrival of the Falck-men, Jimmi had loaded half a pack of glucose tabs (7-8 pieces) into me, and thus I anticipated a large rise in the BG. It came, and despite a 2.5 U bolus at 1:50 AM, I was 17.8 (320) at 6:00 AM :-(

The rest of Wednesday as well as Thursday my readings were mostly in range, though. To avoid starting practise on the low side Thursday, I reduced my basal to 50 % an hour before, ate a bit more without bolusing for it, and had a BG of 6.3 just before practise. That was perfect. For the first hour of practice I then ran a 75 % basal, feeling quite good. We played an interval game for the last half an hour, something that is quite strenuous though still a lot more fun and relevant to the games of the season than just running intervals between cones. Thus I was very sweaty at the end of practice, and when wanting to use the lower part of my t-shirt, a part not completely wet, to dry my face, I noticed that my site had come out. I guess the adhesive couldn’t cope with the excessive perspiration. It was up for a change anyway, but afterwards I couldn’t help wonder for how long it had actually been out. Not that the BG was that high afterwards, 7.9 (142), but within half an hour it had climbed to 9.9 (178), so I felt I better increase the bolus for my dinner just a bit to avoid the highs that I became familiar with following the matches of the spring season. That may have been a wrong decision though, as I was only 2.6 (47) when getting ready for bed. I ate a banana and some chocolate, figuring that would due the trick. Apparently not.

The next morning I could hardly wake up, and when I managed to test before Jimmi left for work, I rang in with a stunning and frightening 1.1 (20). I had an appointment with Alice, my diabetes nurse later that morning where some of the obvious topics were how to set the basals during and after practice/games, and keeping the site in place.

In spring I used to just disconnect during practice. This did not generate a need to reduce the basals during the following night, but I have also changed the night basals since then, and when not disconnecting during practice, I guess there is reason in running a slightly lower temporary basal on the nights following practice (the only problem in this is just to remember to do so, but I will get back to that later). Securing the site should be fairly easy with Tegaderm® or an equivalent adhesive. I got a stack of two different types to try. So far the winner is Tegaderm®, because it is much easier to apply, and also remove afterwards, than the other alternative.

Our first match of the tournament was coming up on Saturday, and when I expressed my frustration about having to figure out the insulin requirements for games in the dark, Alice offered me to wear one of their Guardian RT’s for a game day. She had one available so we agreed to just go ahead with that for the game of that weekend. When placing the transmitter on my stomach, she stated that the adhesive on it was very strong, so we wouldn’t need to secure that, just the part were the sensor entered would be sufficient. Again, not true!

For the game Saturday afternoon my newly acquired sports belt back came in handy. It is roomy enough to hold more than just the pump, something I appreciated when also having to carry the Guardian during the match. Both my pump and the Guardian fitted nicely into the back, and despite it being a bit bulky, it didn’t bother me during the game. I was to start as a substitute, but took part in the warm-up at equal intensity as the 11 starters. During this time my BG cruised nicely at 5-5.6 (90-100) with the pump going on 55 % basal. I kept it that way during first half, and having a 5.6 (100) just before entering the game at the start of the second half, I decided to play safe and keep the basal at 55 %. Just after the game the Guardian had me at 7.9 (142), but when I got out of the shower my meter told me 12.3 (221) in contrast to the 8.5 (153) of the Guardian. I didn’t have time to go through the records of Guardian at the time. Jimmi and I were to be at his mother’s at 6 PM, celebrating her birthday, and that meant a 6.5 km bike ride for me (depending on traffic that would be around 20 min). I was out of the locker room at 5:15 PM and needed to go home and secure the transmitter properly, as its adhesive had given in during the game, making it dangle from the Tegaderm®-secured sensor site. So much for the strong adhesive on its back :-)

I have had the opportunity to wear the predecessor of the Guardian sensor 3 or 4 times before, so I found it very advantageous that the Guardian is wireless and enables BG trace-tracking while wearing it. Still, with the 3 days I wore it this time, I wasn’t that impressed with the precision of the device. I am aware that there is a lack in time and therefore slightly different glucose levels in the blood and interstitial fluid is only to be expected, but it seemed that if one was to wear it more consistently, one would have to figure out this approximate lack in order to fully benefit from the low and high BG alarms that the system offers. I would usually test lower than Guardian would have me at when it alarmed for a low. I only had one high alarm (above 10 (180)), one that I did not test for because I expected it, but generally found that when I tested 8-12.5 (144-225), Guardian would show me a 7-9 mmol/l (126-162). The more levels entered into the system, the closer it seemed to get at my meter values, though.

I went to get a download of the Guardian data on Tuesday this week. In general I was pleased with the fact that – despite the differences between meter and Guardian-values – it seemed I was generally below 11.1 (200) during those days. What surprised me the most was the effect of the game. Despite being very consistent at 5-5.6 (90-100) before the game, during the warm-up and the first half that I saw from the touchline, the moment I entered the field, my BG started an ascent to more than twice these levels! Talk about an adrenaline surge! I honestly did not think it would be that pronounced. About 8 h after the game, the effect of the exercise seemed to turn in, lowering my BG to levels and making the Guardian alarm (I didn’t hear it, but Jimmi heard it and acted upon it). Thus, once again I had a low BG-start of the day, this being something that could have been avoided if I had been able to think constructively before going to bed at midnight the night before. Besides the soccer game, my Saturday had 36 km of bike riding on the exercise account, so I guess I ought to have foreseen up-coming hypoglycaemia, but apparently I was too tired to do so.

This week has been only work and practice. We have two games next week, Monday and Wednesday, so it is nice to relax a bit this week. Practice went well both Tuesday and Thursday this week, but Tuesday night I forgot to reduce the basals during the night, so I had a 2.3 (41) to start the day with on Wednesday. Thursday I remembered, and decided to try running a 90 % basal throughout the night. That gave me a 7.1 (128) Friday morning so that was pretty successful.

Tonight we are watching Jimmi’s younger brother, Steffen. Steffen is 11 years old and he recently started to show interest in cooking (much to my delight as he used to be a very picky eater), so he is going to cook for us tonight – he offered that himself, we are not forcing him to do it ;-) Last time we had him here for a sleep-over, he made homemade pita breads with a variety of vegetables and ham. This time the menu is a vegetable soup with homemade bread rolls, so right now he is busy in the kitchen. A thunderstorm is above our heads right now, so I guess our plans of playing soccer after dinner should be revised. Maybe we will just end up watching a good movie and enjoying the banana-cake that I made earlier today – we are allowed to spoil him a bit, when he is with us :-)


Chrissie in Belgium said...

Hi Heidi,

We are back from Sweden and when i read you post I really was jealous about the fact that you too have gotten to check out a CGM! My D doctor is SO uninterested. Also I felt for you with your roller coaster ride of BG values. Although I do not wish this on anyone - you are not alone! And I am so jealous of you being able to eat all the things you speak of. Me, I cannot just count carbs. If I vary my foods all hell breaks loose. I can NEVER eat real food after a hypo. I must just drink coke. Think to be able to eat all that stuff....... I changed the kind of whole wheat bread in Sweden from that I eat in Belgium and everything got messed up. Since the bread was causing me such a hassle I tried soup for lunch because that I thought could correctly bolus. What I discovered is that my basal in the afternoon was covering part of the whole wheat bread that I use to eat for lunch. My hourly basal is basicly only 0.2U. I HATE being so sensitive to insulin and teeny amounts of all kinds of food, including proteins. THANKS FOR LETTING ME EXPLODE A BIT.

Hej that is really nice having someone who likes to cook in the household!

Exercise and T1 diabetes are really hard to balance. That is all I can say. It is a never ending battle. Sometimes the adrenalin/stress makes the bg increase and sometimes the bg falls like a stone, but how do you guess when it is going to do what?


PS I have asked my family physician (since my D doctor was totally uninterested) to consider what tests I should have done - but I have gotten no answer yet!

Scott K. Johnson said...


Wow! A lot of scary lows there! It's such a game of trial and error isn't it! Sounds like you have worked through some other things to try, and I hope that they will work out good for you.

I bet it was nice to get to use that Guardian RT to collect some data on what the games do to your BGs! Interesting adrenaline surges! I would love to see what happens during my lunchtime basketball sessions.

And other than the adhesive at the end, it didn't sound like the sensor & other equipment didn't create too much of a problem for you. That's great!

Thanks for the update! Hope to hear more soon!

Heidi said...

Chrissie – good to hear from you again! Yeah, I guess that we are pretty lucky in Denmark, being able to try some of these tools without having to invest money in them. I think that is a very good thing, although I would guess that it is something that is not granted all Danish diabetics, but primarily those attending the big diabetes centres and/or university hospitals. Anyway, I am glad that I had the possibility to try the Guardian out in order to have an idea about what to do with the insulin dosing during games.

Food sure can be a bit of a hassle, especially following hypos. I am sorry you had so many difficulties getting things to work in Sweden.

Scott - I think I have had more hypos than I dare count. The nocturnal ones, however, hasn't been an issue before getting on the pump, which is somehow very annoying.

It sure was great to have the Guardian recording my BG throughout a match. It would be impossible to acquire such extensive information on finger sticks alone. I feel so much better prepared to the other games of the season with the result of this experiment in mind :-) Also, I am getting use to wearing the pump during soccer. The investment in that sports belt back really made a big change. Now the presence of the pump doesn’t bother me too much when I play.