Perfect Storm

So, Cat has been using the t:slim with Control IQ in the clinical trial for about a month. Here are my thoughts:

I do love the fact that it corrects a high blood sugar with 60% of our correction factor once per hour if we underestimate the carbs or don't pre-bolus early enough. That's a nice feature! However, sometimes I wonder if our correction factor is right...the pump uses the data that *I* put in, so if I put the wrong info in the pump, then she will not have a good correction for highs. Honestly it seems sometimes like it's driving her a little too low, so I'll continue to keep an eye on things. We might need to change the correction factor on our end. Also, we love the Dexcom G6 more than anything. It's SO wonderful not to have to calibrate and poke fingers to find out her blood sugar. Once we are finished with the trial, she will go back to her Medtronic 670g pump with 2-3 calibrations a day and at least 2 fingersticks per day. I really hope that Medtronic gets it together with their sensor for the next generation pump and makes it more like Dexcom. The Medtronic CGM that pairs with the 670g pump is awesomely accurate. It just sucks to have to calibrate it twice or more a day. Believe me, I know ALLLLL about it since I'm living it!

Here's just a little info..nothing to do with this particular pump or with the t:slim infusion sets: If your insulin pump infusion set needs to be changed (which is is supposed to be changed every 2-3 days), there is nothing you can do about higher blood sugars until you put in a new infusion site. (Side note: once you've had a foreign object inserted into your skin, in particular a metal needle that infuses insulin under your skin, your body naturally tries to reject it and it does what it is supposed to do to try and heal that wound. Sometimes the insulin is just not absorbing well under the skin due to the area being inflamed from having metal stuck into it.) This particular day was a one of those days for Cat. And of course it always seems to happen at the most inopportune times! Like when I promise her we will go to the frozen yogurt bar after school and get a MEDIUM cup of Fro-Yo with whatever toppings she wants!

We've been talking all week about going to our favorite used book store (The Recycled Reader) and a treat at Berri-licious Frozen Yogurt. We tried to go last Saturday, but Cat was throwing up and having diarrhea after her soccer game, so that kind of dampened our plans. Anyway, last Saturday, we were able to finally go! We both found some cool books that I wanted and we got a pic of her with her JDRF OneWalk shoes for the fundraiser that Jane and her husband Bud so graciously agreed to support!

Anyway, after her Fro-Yo (which I totally guessed the carb count because...what the heck? How can you carb count all that stuff?) and afterwards she started going up and up and up and up, but gradually, so it wasn't like off the charts crazy high.

 I gave her a correction but she still was going up. I changed her site and gave her more of a correction. She needed a site change anyway. This seemed to help.

When it was time for dinner, she was trending down, so I bolused her and hoped for the best. Now she's going down down down...it's like the insulin started working all of a sudden! Sooooo irritating. And the worst part is, the Dexcom lags behind actual blood sugars by about 15 minutes. I just checked her with a fingerstick when I got an alert on her Dexcom, and her actual blood sugar was 80. Not an emergency at all and that does not need to be treated. That lag time stresses me out!

Graph after Fro-Yo and mystery bolus

So, in the end, it wasn't a huge deal. We had a tall mountain peak of high blood sugars that came down relatively quickly and it all ended well. Still...seeing that giant spike always stresses me out. Fortunately it doesn't happen often!

Until next time....

Soccer practice! (short post)

Tonight we had soccer practice at 6:30 PM. We typically eat dinner very early (4:30 or 5PM) on these nights to avoid having too much insulin on board during activity and then dealing with a subsequent low blood sugar.

But today was crazy. I had an after school obligation that kept me from getting home till after 5:30. Husband was at Lowe's trying to purchase a new fridge after ours died from the power surge after Hurricane Dorian. It was just NOT a relaxing afternoon where we could fix an early dinner and get it done in plenty of time before practice.

So about 30 minutes before practice, Cat had a quick and easy dinner consisting of a grilled cheese sandwich, baby carrots and a fruit cup. This might be our "go-to" dinner on soccer practice nights, just sayin'.

Instead of the normal 50g of carbs that I would normally bolus for that meal (25 for the grilled cheese, 20 for the fruit cup, and 5 for the carrots), we bolused 40g and then right before soccer practice started she turned on the "Exercise mode" on her pump. This mode on the t:slim with Control IQ keeps her blood sugar at a higher target range in order to prevent lows. I believe Exercise Mode range for blood sugars is 140-160.

And she had practice for about an hour and a half (it ran over because of a scrimmage with another team). I had forgotten to remind her to bring her phone (not really a phone because it's only used for sharing her Dexcom numbers). So I really wasn't watching her blood sugars at all during practice.

When soccer was over and we were in the car on the way home, I told her to turn off Exercise Mode. And when we were back in the land of Dexcom Share, I saw that her pump did a BEAUTIFUL job of keeping her in range during some pretty strenuous activity! Winner winner chicken dinner! I felt really good about how things worked out and how she was able to remain stable during activity! Especially with insulin on board!

I will say, as far at the graphics on this pump compared to the Medtronic 670g, I'm not a huge fan of how it looks on the t:slim screen. I don't love the big red lines that show insulin was suspended. For some reason, that looks punitive to me....like I did something wrong and now a big red line is reminding me about my wrongness. I much prefer the LACK of pink dots on the Medtronic 670g graph when basal is suspended. I also prefer the blue shield of the Medtronic 670g that just displays the current BG value. I don't care to see the graph unless I want to see the graph. It does not need to be on display all the time.

I do like the touch screen to enter values or change delivery settings on the t:slim though. That is a REALLY nice feature rather than pushing buttons to scroll up and down.

Not unhappy with this graph at all! See how the insulin was suspended during the period of major activity, but no rebound high blood sugar!

11th year Diaversary

I just realized that last month, August, was my 11 year diaversary. For those not in the know, a diaversary is the month and day that you were diagnosed with diabetes. Specifically Type 1 Diabetes (although I guess you could also have a diaversary for Type 2!). People sometimes celebrate this milestone! I always forget about mine until it's over!

Sidenote: Type 1 diabetes is an autoimmune disease. It's not caused by diet or lifestyle. I repeat, if you eat total crap and live on the couch, you will not get Type 1 diabetes because of these lifestyle choices. I wouldn't advocate that you live on the couch eating crap, but it won't cause T1D. Read more about Type 1 diabetes here. 

Anyway, I don't actually remember the exact date in August 2008 that I was diagnosed with diabetes. Maybe it was because on that day, I was incorrectly diagnosed with Type 2 diabetes. I guess it was because of my age. I was 38 years old (almost 39), and who has ever heard of a 38 year old developing Type 1 diabetes! That's just for kids, right? (spoiler...it's not. Type 1 diabetes can be diagnosed at ANY age).

Well, that Saturday sometime in August, 2008, I remember finally deciding that I needed to see a doctor about my constant need to pee. I had googled what that symptom meant, and read that along with extreme thirst, which I also had, it could be a sign of diabetes. Surely not though...it was probably just a urinary tract infection. My husband and I drove to the doctor (they opened for walk-ins on Saturdays till noon) and I waited to be seen. I had been SO tired that summer too...I napped nearly every day after I worked mornings only, four days a week. I remember saying to my husband, "It could be diabetes, but I'm sure it's not!".

The nurse that called me back to be seen was an acquaintance of mine from church. I explained my symptoms and she assured me that it was probably honeymoon cystitis. A urinary tract infection! No worries....we can clear that right up! Let's just do a little urine sample! And my gosh, I had lost some weight, hadn't I? No? Well it sure looked like it!

Five minutes later she and the attending nurse practitioner came in with grave looks on their faces. They needed to check my blood sugar, as the urine test had come back positive for glucose. A fingerstick confirmed a blood sugar of 365 (normal is around 100). They asked me what I had eaten, and when I had eaten last. My breakfast, 2 hours prior, had consisted of a single banana and one hard boiled egg. Hardly a carb-fest! (And even if I HAD loaded up on pancakes and syrup, a blood sugar that high would have never occurred in someone without diabetes.) 

Well, it's Type 2 diabetes, she (the NP) said. Let's give you a shot of insulin to lower your blood sugar for now, and here's an oral medication that you need to start taking. Come back Monday for fasting blood work. Oh, and here's the American Diabetes Association diabetes meal plan (at that time, full of processed food and junky carbs). See you soon!

That following Monday, my bloodwork showed that I was definitely diabetic and that my average blood sugar over the past 3 months was 214 (9.1). Y'all, that's 2x the normal blood sugar for a non-diabetic. Coupled with the fact that I was not overweight, I was not sedentary, and I ate pretty well compared to the standard American diet. This was a ginormous RED FLAG that the NP should have realized, but nope, her "medical opinion" was Type 2 diabetes and that was that. Yes, I do realize that Type 2s can be thin and healthy, but this is NOT the norm. Statistics, y'all.

Over the next month, I worked closely with the diabetes educators and registered dieticians at the local diabetes clinic. These amazing women were the intelligent, educated practitioners that noticed what I was eating and how my corresponding blood sugars did NOT add up to Type 2 diabetes. They encouraged me to request further testing for Type 1 diabetes. When I called the original NP to ask for this blood test, she basically blew me off and would not entertain the idea for additional testing.

Fortunately, a church member and friend of the family was a doctor in that same practice. I spoke with her about my concerns and she agreed to order the testing for Type 1 diabetes. I could tell she was skeptical as well, but she at least listened and ordered the tests!

Fast forward a couple weeks later when the test results, the autoantibody test (GAD 65) came back EXTREMELY positive for the type 1 diabetes antibodies. I was referred to an endocrinologist, who wanted to see me THAT day, and I got started on an insulin therapy immediately. This was approximately one month after my original diagnosis of Type 2 diabetes, and so maybe THIS month, September, should be my diaverary month. It is the month that I was correctly diagnosed with Type 1 diagnosis and started on medication (insulin) that ultimately save my life.

Side note: Although there is no official diagnosis, I've diagnosed myself with LADA. This is a slower-developing autoimmune diabetes that occurs in adults. It's treated with the same insulin therapy as Type 1, and insurance providers don't have a code for LADA, so it's just called Type 1. Read more about LADA here. 

The moral of this story is: Type 1 Diabetes can be diagnosed at ANY age. And health care providers should not automatically assume Type 2 diabetes because of age or any other factors. I know that I am not the only adult that was originally misdiagnosed with Type 2 diabetes, because I've heard the stories. I'm sure I'll write more on this topic later, as it is so important to know this statistic. But that's all for now!

T1D Strong after 11 years!

Also, I want to say that I am SO THANKFUL for my T1D online community. I wouldn't be the person I am today without all of you.

A little over one week with Control IQ

A Week in Review: 

Dashboard Summary from the last week of our t:slim Control IQ trial. 

A full week + one day has passed since Cat started the t:slim pediatric trial. At first, I wasn't sure what to think about it. She had some highs and some lows over the first couple of days, to the point where I wasn't sure I'd made the right choice, having her participate in the trial.

And then school started the Monday after she started wearing the pump. I shared her graphs and how much time she was spending with her insulin suspended (because of the increased activity at school) in my last post.

But after a full week in, and I think we are settling into a new normal. The pump seems to be figuring it out. I honestly can say that this pump/CGM combo has us thinking less about diabetes than we ever have. When things are going well (no pump site failure, like earlier this week), I don't even worry about her numbers. She's had some highs overnight the last couple of nights.  Not sure why (growth hormones? Fat/Protein rise from dinner or dessert?). But I haven't had to get out of bed to correct her because the t:slim does that for me. By morning she's in range and ready to go. In fact, I haven't corrected her at all or even touched her pump except to bolus or to suspend delivery for swimming, etc.

The fact that the Dexcom G6 has NO CALIBRATIONS and NO FINGERSTICKS is more amazing and liberating than I ever thought it would be. Like, a huge stone has been lifted off of my chest. There have been so many times that I have stressed out about when to calibrate on the 670g because blood sugars need to be stable, so that means you don't calibrate after you eat. But if you forget to calibrate and then you eat....then whoops! You might be without CGM data for a few hours till your blood sugar stabilizes. With the Dexcom G6, you just don't have to worry about that at all. I know Cat's dad loves this feature because he was ALWAYS forgetting to calibrate when I was out of town, leading to increased anxiety about loss of CGM data.

Now what I don't love is the Dexcom Follow app. Yes, I know that sounds crazy. But when we were on the 670g, we used Nightscout and it was AMAZING. I could see all sorts of information from her pump besides her blood sugar graph. More about Nightscout later on, but for now, I'll share some of her graphs from T:connect. Oh, and yes, I love T:connect SO MUCH MORE than Medtronic Carelink. SO MUCH MORE. <3