Category Archives: Diabetes

A low

30 minutes ago, I had my first low blood sugar while awake in years. I’ve had one hypo relatively recently where I woke up with a 3.9 which I fixed and promptly fell back asleep. I haven’t had any in the middle of the day since some time in 2010.

My blood sugar was trending downwards for most of the afternoon as a result of my correction from 12.3 and when it got to two hours post bolus (8.3) it looked like it would be borderline as to whether I would go low or not with the insulin I had on board. My CGM had double down arrows but had only got as far as 5.0 when I started feeling a little strange. My hands started to shake a little and my thoughts were starting to get fuzzy. I decided to test. The countdown seemed to take forever.

3.7

I’d been dreading going low for years. For a while it was the scariest thing I could imagine. I was surprised by my reaction when I saw that I was low; I calmly got up, went to find my lucozade, took a few swigs then went off to help my wife with the dinner. My hands and arms were trembling, but my thought processes were clear and there wasn’t any anxiety at all. I’ve had panic attacks about going low that were so bad that I couldn’t string two words together properly yet when it actually happened I was incredibly calm.

I couldn’t resist the urge to test after about 7 minutes and I was very pleased to be greeted with a 4.2; The lucozade worked and I managed not to eat every carb in the house 10 minutes before dinner was ready. I ate my dinner and only bolused for half of it. The method of treating lows I was taught is 15g carbs, wait 15 minutes then test again. If you are under 4.0, repeat, if not have 15-20g starchy carbs. I took half of my dinner as the ’15-20g starchy carbs’ and bolused for the rest.

The post-low spike doesn’t seem to have appeared like it used to either. The highest I’ve seen on my CGM is 11.0 at about 90 minutes post dinner so I don’t think I over-treated either.

I am very glad with how I dealt with this and now that I’ve proved to myself that I can cope with hypos properly I hope I don’t have to again for a long time.

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Impressed

I am very impressed with my current Enlite sensor. The largest gap between CGM and meter today was 0.3 mmol/l, well within meter error. It tracked my blood sugar perfectly overnight, no dips caused by lying on the sensor even though it is positioned so that it is underneath me for most of the night. I actually think that these sensors are approaching the accuracy required for a closed-loop system. I’m not sure how these sensors compare to the Animas system; I’ve heard they are very good. I don’t see how sensors could get much more accurate than the one I’ve got in at the moment though.

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More on new Enlite sensors

The second sensor from my box of improved Enlite sensors was even worse than my first. I inserted it before bed and activated it the next morning. I was very pleased with my fasting BG of 6.2  (111mg/dl). My pump was less pleased. The sensor isig was only 6.1 and it usually needs an isig about twice the BG reading to calibrate properly. After the calibration error came up I tried again, only to be greeted by a “Sensor Error” – the sensor had died before it even started.

I called Medtronic support straight away and they were very helpful. They took my details and checked I’d inserted the sensor properly as well as requesting that I send the sensor back to them to be looked at more closely. They have also sent me out another sensor free to replace the one that died early.

I replaced the dead sensor and the new one is working far better. It is tracking my blood sugar very accurately and the new design does seem to have solved the problems I’ve had with sleeping on the sensor causing hypos. I will be incredibly happy if the new Enlite carry on functioning like this one. I hope I was just unlucky with the first two.

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Bleeding sensors

After just 4 days, I decided it was time to replace my sensor. It hadn’t really been accurate since day 1 and it was missing high BG levels which I really wanted it to catch. My blood sugars has also been creeping up, which I attributed to an aging pump site. This evening I replaced them both.

The new pump site seems to be working well, with my pre-dinner correction and meal bolus doing pretty much exactly what they were meant to. The site was only just 4 days old but there definitely does seem to be a tail-off once you hit 3 days.

I won’t know about the CGM until the morning as I tend to leave it in overnight before starting it.There was a “good” sign though; The sensor made me bleed when it was inserted. There wasn’t a lot of blood, and it stopped bleeding very quickly, as well as no pain.  This generally seems to be a good thing for a CGM sensor. The ones that don’t bleed at all are sometimes okay, but they tend to be the ones that die early. On the other hand, you don’t want the sensor to bleed too much as that would involve pulling it out and starting again.

It probably sounds strange saying that you hope something makes you bleed, and bleeding doesn’t guarantee a good sensor but it certainly isn’t something to be worried about.

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Lower numbers

Lower blood sugar levels don’t take long to get used to, it would seem. It has been a little over a week since the events which prompted my new drive to control my blood glucose. My average BG for the last week is 9.2 – both sensor and meter! My newest sensor has been over-reading quite a bit, so I suspect my actual average is lower. The first on my ‘new’ Enlite sensors is still in; It seems to have got a new lease of life. It isn’t particularly accurate but I can’t quite bring myself to pull it out when it is still giving some numbers.

Today I had a rather large lunch that was heavier in carbs than I should be aiming for. It caused my BG to spike up to ~17. Just a week ago, 17 wasn’t far from my average blood sugar and I felt like I could function normally while I was that high. Not any more. I felt like I used to feel when I hit the mid-20s. I am pleased that my body is adjusting to lower blood sugars this quickly. I feel much better with in-range BG levels, although my anxiety still niggles at me when I need to bolus for a large meal while my blood sugar is currently 4-6. It is something I am working on.

Wednesday will be the last chance I give this current sensor. Either it starts to give me more reliable numbers, or it gets replaced. 3 days isn’t very long for a sensor – I’ve had some last up to 12 days before, but I think I need my CGM to be giving me accurate numbers to be able to get the level of control I am after.

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That’s…interesting

My new CGM sensor seems to have decided that its isig is going to sit between 7 and 15 when my BG is somewhere between 6 and 13. This isn’t high enough to allow the CGM to calibrate properly, so this sensor is dead less than 24 hours after I started it.

The odds of the next sensor being bad too can’t be too high … can they?

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New Enlite sensors

I got a letter a few weeks ago stating that Medtronic have made a few improvements to their Enlite sensors:

  • Increased comfort; The sensor adhesive has been ‘optimised’ to reduce irritation and the tubing around the electrode has been removed to reduce inserted volume by 80%
  • More consistent performance; The electrode design has been modified
  • More reliable data connection; The connection between the transmitter and sensor has been improved

I was looking forward to these changes and I finally managed to get hold of my new sensors this week.

Medtronic put a lot of effort in to changing the box...

Medtronic put a lot of effort in to changing the box…

The only difference to the external packaging was a yellow “new” sticker

This isn't a big needle, it is a very close needle.

This isn’t a big needle, it is a very close needle.

This is the (now tubing-less) insertion needle. There isn’t very much inserted that isn’t required for the sensor any longer. The electrode does look slightly different to the old model.

The insertion went well with no pain at all. One thing I only noticed after I inserted the new sensor is that one of the few problems I did have with the old Enlite sensors has been fixed! Previously, the top of the tape which held the transmitter down used to be sticky which meant that it was topped with a small piece of plaster backing. The corners of this used to scratch at my skin and make it irritated. The adhesive on the top of this strip has now gone, so no more scratchy plastic!

No more scratchy plastic!

No more scratchy plastic!

I’ve been using this sensor for a few hours now, and so far it seems spot on. I’m hoping that it will be even better than my previous Enlites!

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I can do this

It’s been 5 days since my hospital appointment and I think I might be able to keep my Diabetes under some level of control. I’ve gone back to slightly tighter control on how much carbohydrate I eat. I’m watching my calories too as I have a some weight to lose. I am far happier with my blood sugar levels this week than the previous week.

Blood sugar for last 2 weeks
Date Carbohydrate Sensor Avg BG Meter Avg BG TDD insulin
8/3/14 145 8.7 8.9 32.2
7/3/14 100 8.8 8.4 25.0
6/3/14 120 8.7 10.0 32.0
5/3/14 117 8.2 9.1 31.8
4/3/14 155 8.0 9.2 33.0
3/3/14 92 12.0 10.3 25.7
2/3/14 115 9.8 9.9 25.7
1/3/14 155 13.8 14.8 40.0
28/2/14 194 15.2 14.1 39.7
27/2/14 176 17.3 17.0 44.0
26/2/14 150 14.9 15.2 39.5
25/2/14 140 14.7 18.4 44.4
24/2/14 120 N/A 16.9 35.5

I feel there has been a big improvement. I’m very unhappy with how I was doing before my appointment (on the 3rd March). A few tweaks to my insulin:carbohydrate ratio as well as slightly more monitoring have made the difference I was looking for.

My next goal is to get used to the idea of pre-bolusing for meals when my blood sugar is under 7 or 8. This is something I struggle with at the moment but I believe that being able to give my insulin a 5-10 minute head start on the food will help to reduce my post-meal spikes. I was particularly pleased with how my blood sugar was after dinner on the 4th. Pre-meal blood sugar was 6.4, with further readings of 6.2 at 2 hours post meal and 6.3 at 4 hours post meal. If I could work out how to replicate that I would be ecstatic.

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It’s been a while…

Wow.

I might have forgotten this site existed…

My diabetes control has been up and down this year. I’ve managed to get full funding of CGM by the NHS, which is awesome (and saves me about £250/month). It has helped me with my anxiety issues, to the point where I am living what approximates a normal life again. Since the last post here I’ve managed a trip to America, which I never would have done without the CGM.

My a1c has been creeping up again. At my most recent hospital appointment it was 9.1%. It wasn’t unexpected, but it doesn’t make me happy. So, as with about a year ago, I am trying to put in some real effort to getting my blood sugars under control again. Hopefully it will last longer than last time. I do have a stronger motivating force this time.

Retinopathy.

Last week I had retinal photos taken. I was expecting a letter back in a few weeks telling me that I have background retinopathy and that they’ll see me in a year. This is the same letter I’ve had from every retinal screening appointment since I my diagnosis 5½ years ago. Not this time. They have referred me to a local hospital for closer monitoring due to ‘changes of diabetes’. Reading this letter made felt like I had been hit by a ton of bricks. I had got used to the idea that I had background retinopathy and that it wasn’t progressing. It would seem that I was wrong. I called the screening center to find out some more information the next morning. They told me that it was still classed as background retinopathy although the changes were large enough to need closer monitoring. This eased some of my worries but I am still terrified of this progressing further. So I am hoping that this will be the motivation I need to keep me on track.

I am looking forward to trying out the new Enlite sensor which medtronic have just introduced. They claim that the sensors are more accurate and they have reduced the size of the part that is inserted by 80%. My first box of the new sensors should be waiting for me tomorrow.

I must try to keep this thing updated.

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Basal Testing

Over the past 6 weeks my control has improved dramatically, with my average BG dropping from around 16 to 10 (with some days under 10). One of the difficulties I still encounter is random rising or dropping of BG levels. A peak in my BG levels around 8am (before I woke up) and a rapid drop around 5pm (long after lunch bolus should have finished) led me to try some basal testing.

Having a CGM, the morning rise was relatively easy to fix; Look for the start of the rise on the CGM graph and lower the basal rate around 2 hours prior to that. After a couple of days of minor adjustments I managed to stop the morning rise.

The afternoon rate was a little more difficult to fix (and I still haven’t managed to get it totally correct). From previous testing I know that my boluses tend to last for around 4 hours. Because I bolus for lunch around 1230 the only active insulin in my system after around 1630 should be my basal. Between around 1700 and 1830 my blood sugar level was dropping from 8 or 9 to 4 – 5. This is far too much for basal alone. To avoid any possibility of my lunchtime food and insulin doses I had to skip these, which led to a very hungry afternoon.

The first day I tried this I noticed that the BG drop actually started much earlier, around 1430. I actually had to stop the test early because I had hit 4.5 by 1700. I reduced my basal rate a little from 1230 with a larger reduction from 1430. With these reductions, the second basal test went much better – I dropped from 8 at 1400 to 5 at 1800, with the majority of the drop coming after 1630. I further tweaked my basal rates as a result of this and most of the drop has now gone. My afternoon rates still need some adjustments, but the decreases in blood sugar are far more manageable; There are only so many days of afternoon fasting that I can put up with in a row!

With my morning and afternoon blood sugars more stable, I have found it far easier to maintain constant sugar levels throughout the day.

One thing I have found very useful to keep in mind when adjusting basal rates is that a ‘healthy’ person tends to have one peak in basal requirements and 1 dip, which implies that if your basal rates have more than one peak or dip then the basal might not be correct and is instead being used to cover other things like a lack of bolus.

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