Site failure - or a failure of patience.

I had written about what I had though was site failure.

When I shared my findings on another site, the observation was made that perhaps my basal rates had changed and I was being too impatient.

Well, I had not considered that, and had thought I had stumbled on the correct solution.

But false leads are common in science, and so I had to test to see if it could be, in fact, just a subtle change in basal rates.

The data is in, my basal rates have shifted. Perhaps this is due to the cold winter weather - or perhaps a small change in my diet? Not sure what is the cause, but I am now aware that my numbers have adjusted ever - so - slightly as to cause me a lot of confusion.

Which is the wonderful thing about diabetes. You may think you know it, at a precise degree - but will always be thrown a loop.

I am humbled.

TSD.

When sites begin to fail.

Here's the rut I am in.

After one year of pumping, using the same infusion sets and the same area of my body (of course I rotated - but it was only my abdomen) I am seeing this from my sensor.

It's a slow, hour over hour climb.

And when I bolus to correct, no reaction.

For the uninitiated, this is a site failure.

Insulin is no longer being absorbed as it should be.

What is frustrating is that I did not anticipate this, and so only recently did I begin exploring other infusion sets and other areas. I now have to speed up the exploration.

The good news is that we can rotate on our arms, legs and back - plenty of real estate to choose from. And the other infusion sets come in different lengths and angles.

Today, I am testing the Sure-T on the back of my right arm.

So lesson here, use as much of your body early so you are never in a pinch.

TSD

Exercise and Type 1 Diabetes

We all are told that exercise is supposed to be good for us.

As a pump and sensor wearing Type One diabetic, I have the data to support that argument.

About ten months ago, I decided to try and lose some weight. Although I do not look fat, technically I am more than fat - I am obese. So I became encouraged to so something about it.

I started off by examining the foods I was eating - so I taught myself to count carbohydrates and was horrified at what I found out - I was eating a huge amount of carbs - sometimes topping 100 grams in one meal! It turns out that eating out is probably the worst thing in the would you could be doing to yourself if you are becoming sensitive to carbs - and we unfortunatly ate out all of the time. Personally, I was disgusted by the huge numbers of carbs - and the awareness of what foods had in them (carb wise) encouraged me to go low carb.

What do I mean? Well, just avoiding carby foods like breads, rice, pasta, etc. And instead trying to find veggies, proteins, and other things to fill up on. I embarked with a goal of not exceeding 100 grams a day.

The insulin pump I wear, the Medtronic 722 with Sensor - keeps track of the amount of carbs I eat - as well as my blood sugar levels - so it was easy to run reports on my performance over the months. And I found that just slightly altering your diet - becoming aware of carbs and eating more of the other things - my blood sugars became easier to control.

And my A1C lowered.

And I was losing weight. About 25 pounds over the course of four months - which I consider to be a decent accomplishment. All from eating under 100 grams of carb a day (actually my average was 62.)

But I needed to sustain the results and my weight seemed to be plateauing. What could I do?

Exercise.

I started walking one hour a day - each and every day - and I did this for four months. I also ate the NutraSystem-D diet - which was /more/ carbs than my low carb diet - more on that later.

Walking at first was difficult - it was easy to try and not do it - but I remained motivated and did it each and every day - through the rain, and cold. It became easier as it went - and I increased my pace so that I was walking over an hour and hitting about 7 miles each walk.

Weight loss continued - and over the second course of months I lost another 15 pounds - which was an awesome result.

But something else happened.

I was needing less insulin - much less.

The one hour walk each day was somehow altering my chemistry or biology to the point that I was using insulin more efficently. My basal requirements (the insulin you need when not eating) was reduced by a shocking 20% !!!!! As was my bolus or food requirements.

I was stumped by this revelation. So as winter came and the snow and ice fell, I decided to stop walking for a period of three months (during the worst of it) to see what would happen. Which is where I am today.

The diet continues, I am eating about 60 grams on average of carbs per day.

My weight loss has stopped - but my weight is a constant. So pounds are gladly not being accumulated.

And my basal/bolus numbers are back to the pre-workout levels.

So exercise, in my experience, makes a Type 1 diabetic more efficently use insulin. And so I am now back to my daily walks, looking to reduce my insulin use and have a more stable experience.

TSD

The Ascent of Mt Carb

I have a weakness for chicken noodle soup.

I make it myself, home made, and it tastes wonderful.

But the carbs! Each bowl is a carb overload for me - 25 to 30 grams - and of course I must eat at least two bowls.

So I have had my carb filled lunch and am on Mt. Carb with my blood sugars. It's a summit I rarely climb - but here I am on it today. It stinks. I hate mount carb. I hate when my sugars are high. But I have a weakness, as I mentioned, for chicken noodle soup.

So I dial up more insulin, and I wait and test. The numbers climb, did I do my math correctly?

I sense a peak, and so I dial up some more insulin to start knocking my numbers down from the stratosphere. I want to be back in the nineties - but from the stratosphere, we have to use big numbers to knock ourselves back down. Perhaps I will fall too far - so I must test frequently; when the fall starts - I will be able to monitor when I stop falling. Orange Juice will assist me if I go too far.

I love chicken noodle soup.

I hate all the carbs and playing with big numbers.

TSD.

Infusion Sets: Try them all.

After pumping for a year, I quickly ran into a string of failures.

In general, the sites I was rotating were becoming less useful. It became a problem, with frequent highs and unnecessary rotations. What I needed to explore was not more real estate (although a rotation plan is key); what I found out I needed to do is try different infusion sets.

I had become quite frustrated with the one kind of infusion set - and I felt very limited on where I could use the set. The QuickSet has a large-ish nub on the end of it, where the hose can attach or disconnect. And I had reached all the way around my sides and all over my abdomon and had used about everywhere I could reach. I considered my legs for a moment, but the nub on the QuickSet is too large - I worried it would rub against my pants leg and become uncomfortable or worse, pop out.

When I reported the infusion set problem to my doctor, he asked me "Which other sets are you using?" I was horrified, none. "Well, " he reported "most of my patients use different sets, depending on where they are using them."

Interesting! So the big tip here is to not fall too much in love with your first infusion set; branch out and try the different ones out there. (Remember TSD Manifesto - point 5, try new things, be willing to question what you have been doing.)

Medtronic starts most of their patients out on QuickSets. Automatic insertion device, short 90 degree canula, its a nice easy set to start pumping with. But, in general the soft 90 degree sets have a short insertion length and are made of soft material that can kink/not flow. I like the QuickSets - however I needed options.

So I tested a few other sets.

Sure-T offers the same short 90 degree canula, however uses a steel needle vs the soft needle. So I tried them for a few months. In general, the Sure-Ts seem slightly more reliable - steel needle is nice - for example, if it pops out you can shove it back in - however there is not as much sticky to hold them down - so the will pop off easier after a few showers.

I like the Sure-Ts - they seem to me to be a good option for exploring the upper outside legs. No special tools are needed to inset them, and they seem reliable. The largest con is the 90 degree angled very short length steel canula.

The other interesting feature of the Sure-T is how flat it is compared to the QuickSet. The Sure-T has no large plastic nub - it sits flat at the site - and has a less large disconnect a few centimeters away that also tapes down nice and flat. It seems to me ideally suited for use on the upper legs - and I am confident that they will not want to pop out while running - so now we seem to have more options.

At some point, you will want to get away completely from the 90 degree infusion sets.

The other major set I have been using is the Silhouette. I would first say that the Silhouette is not a beginner set. They do offer a special spring loaded inserter - which probably makes the insertion process easier if you become intiinated by it's very large insertion needle.

The Silhouette is set to 45 degrees - and like the QuickSet has a steel needle for insertion, when removed the insulin infuses through a soft canula. The Silhouette comes in much longer lengths than the QuickSet and SureTs - so they seem to be able to be used in all sorts of areas. Also, there is a load of tape on the top of the Silhouette - I would think these will end up sticking the best over swims and showers. And like the Sure-T, they disconnect away from the infusion site and have a second tape down area at the disconnect - which can act as a relief if you tend to lose your pump and find in hanging every now and then.

Like I said, there is an optional inserter that I purchased - but I was able to man up and insert the first one on my own. It's not at all difficult once done and seems to be a very secure and functional set.

The Silhouette also lacks the large nub at the infusion site and like the Sure-T seems to tape down very flat. Because of it's longer needle lengths I suspect they can go "further" and into areas the 90 degree sets might not reach. And because you inset the Silhoutte by hand - you are not confined to 45 degrees either - you can use them deeper or more shallow - hence far more options and areas that can be used. Oddly they come in 13 and 15 needle / canula lengths - after testing the 13, I am frightened to think of the 15 - but it is good to know that very very long length is also available.

Now I am bask to thinking more about real estate and the options I have available. The pump seems less limited with more infusion set options. I will be testing the Sure-Ts on my upper legs, and the Silhouettes seem able to reach all kinds of areas with extra reach.

Each pump manufacturer has their own spin on these sets - be sure to try the different options.

TSD Mainfesto

Firstly, I am not a scientist by trade. If anything, I am more of an arm-chair scientist.

But personally, I feel there can be a little bit of a scientist in each of us.

I am in fact a diabetic. I was diagnosed as a Type 1 diabetic over 23 years ago.

Over the years, I have followed certain practices that, when added up, become a certain diabetic manifesto.

Many of these practices have their roots in science - in some sloppy measure following the scientific method.

A few of my beliefs:

1,) Diabetes complications are additive, compounding over time. To me, this means in simple english that the more time I spend in the normal human blood sugar range (70-140) the better off I will be in the long term. And that time spent high or low, for example 4 hours each day, adds up to significant numbers over the longer term. For example, I would not want to be in a high blood glucose range (say 230) for 33,580 hours, but that is what happens if I was to be there 4 hours a day over 23 years. So paying close attention to staying normal on a DAILY/HOURLY basis is important if you are concerned over the longer term health of your body.

2.) Type 1 diabetics can eat food with the belief it will have no consequences. I call this "eating without consequence." I think that this phenomena is actually a very bad thing; let me explain. If you accept my fist belief, then the goal is to stay within normal range as much as possible. When you have Tyoe 1 diabetes, you must inject insulin for any and all foods you eat - and to do this you must learn how much to take with certain volumes of food. The science of diabetes treatment has evolved to the point where we can now calculate our insulin doses based on the volume of carbs consumed, and so we each learn our personal carb ratios - mine is 6:1 - or for every 6 grams of carbohydrate I consume, I must take 1 unit of insulin. Easy - so where is the problem? Well, for this to work - I have to count food in 6 gram units, and the more grams I eat - the more units I must take - and hence the problem - EATING LOTS AND LOTS OF FOOD creates a problem where you have to take more and more insulin - the larger doses allow for larger errors in getting the numbers right, Meaning take too much or too little - you are out of your normal range again. So as a result - I try and not eat without consequence - reducing the margin of error.

3.) Test, test, and test again. Without a meter, a Type 1 diabetic is blind to his or her blood sugars. Testing is so vital, it needs to be done before you eat - and before you ever inject. Never guess your blood sugar based on how you feel, because all too often you may be wrong.

4.) Keeping records, every once in a while, helps us stay on track. I try to keep a log for a week, every few months, and I record every gram of food eaten, every meter test - and every injection. Keeping a log book is invaluable for making adjustments and ensuring you are staying on course.

5.) Do no be afraid to question what you have been doing in the past / your past beliefs / be willing to embrace and adopt new ideas or techniques. For example, I was on MDI - or multiple daily injections - for years and was under the belief that keeping your A1C between 6.0 and 7.0 was the idea. TIME CATCHES UP. Now days, there are MANY diabetics who achieve A1Cs between 5.0 and 6.0. So you must consider that your thinking could be out dated, and be willing to test / try new ideas. This model will allow a more open thinking / approach and allow you the ability to contually question and test / try new things. I am now using the Pump / Sensor technology - and love it. Although I was perfectly happy on MDI, being open to change has helped me achieve slightly better results. So keep an open mind!

6.) Listen to others, but with a skeptical ear. There are many voices on the internet - many other Diabetics who will proclaim that they have eaten without consequence, have A1Cs in the 7s (if they are willing to share) and other not conventional ideas - like eating the sugary Acai Berry juice as a potential cure. I take the time to read their ideas, but I also read even conventional thinking with a skeptical eye. Not keeping your sugars in check, for example, may not have caused you any visible complications to date - but is not doing everything you can to control your disease really the best approach? I have managed tight control, and I too show no visible complications. But as we know, microvascular complications are additive, cumulative, and will progress unseen for many many years. Know that there are voices that suggest diligence is not required. Many of those voices have yet to see complications that could be waiting to catch up. Knowing you did everything possible, to me, feels better than slacking off. And it is a given that we are all not perfect - just do not fall prey to slacking off as a norm.

7.) To become a better diabetic, we must be willing to become a little bit of a scientist. Willing to test, document, and observe. Willing to call things into question / question conventional thinking, willing to embrace new ideas. And we must strive to read and learn from others observations.

Here, I hope to share my personal observations, with the stated goal of helping other Type 1 diabetics.

TSD