Tidbits and Tricks

Today's Prompt: Learning. Share something you learned from another Health Activist (that everyone should know!).

First of all, I am not a licensed medical professional. I'm not trained to give advice on anyone's diabetes but my own.

That being said, I want to share a revelation that I picked up online that changed the course of my diabetes. It changed my blood sugar spikes. It lowered my A1c. I credit this piece of advice more than any other in getting my body ready for pregnancy. It changed everything.

It matters when you take your insulin.

Online we call it pre-bolusing.

The last few years, continuous monitoring has taught medical professionals a lot about how insulin works in the body. When the newest fast-acting analogs came to market, we were told we could take them right on top of meals. When my doctor started me on Apidra just after it was approved by FDA, we thought it would help me because I usually bolused after meals and this insulin would supposedly accommodate that habit.

Fast-forward to the days of continuous monitoring.

We now know that the "fast" insulins are not as fast as we thought. When taken on top of (or worse, after, meals), Humalog/Novolog/Apidra miss the post-prandial (post-meal) spike entirely. They should be taken earlier. I won't give advice on how early, as I think it can vary from person to person, but I know how many minutes before the first bite of food works for me at most meals.

The pushback I get from most people when I suggest pre-bolusing involves one of the next two arguments: 1) But what if I go low before the meal? and 2) But who knows how much little Timmy will eat? It's easier to bolus afterward.

I'll address each of these valid concerns.

Meter, Meter, Pump, and Meter

Meter, meter, pump, and meter,

Too much data would defeat her.

Threw up her hands, said what the hell?

And there she left it very well.

Sometimes you realize why they always say, "Just pick a meter and stick with it."

I have been using Abbott Freestyle products since they were Therasense Freestyle products - 8 years? 9 maybe? They have a tiny blood sampling size, they have a light on the test strip port. They changed their meters to Lite meters - I kept mine. I have 3 or 4 Freestyle Flashes. I championed their continuous glucose monitor; then they bought it back from me. They changed their strips; I stayed loyal. I used the Cozmo Cozmonitor (a Freestyle meter), then the Omnipod PDM (a Freestyle meter).

But I had to go and stir the pot.

I'm planning to switch to the Tandem t:slim this fall and I heard that it will be shipping out with Lifescan's new One Touch Verio IQ meter. I can't stop hearing about this meter. I know the background music for their commercials (it plays during every commercial break for Dora and the Bubble Guppies - because my two year old should be asking "What does your blood sugar meter tell you?"). Several of my bloggy friends are liking it.

Okay, I'll start using the Verio then. Big whoop.

So I checked my blood sugar on it for the first time when I was having hypoglycemic symptoms. The number came back over 30 mg/dL higher than my Freestyle Flash and Omnipod PDM. That's weird, I thought. Tried it again. Same.

Tried it while stable. Same. Tried it while high. Same. Every check was between 30-60 mg/dL higher than the Freestyle readings. I called One Touch. They promptly sent me a new meter. Same.

So what's going on here? Will I go ahead and switch to this meter?

I decided I'd test all the meters I have against the blood draw my endocrinologist would be sending off to the lab at my quarterly checkup...just to satisfy my curiosity.

Now, there's some discrepancy between plasma values and fingerstick values. And the BIG (and I do mean BIG) issue is that FDA allows a meter to be +/- 20% off from the plasma value. You can blame FDA, but FDA says that meter companies are not asking them for tighter. There are groups lobbying for +/- 15%. I'd like to see +/- 10% personally, but anyway...

My point is that I'm no quality control expert and I wasn't conducting an error-free experiment. I just wanted to see.

I loaded up five meters with test strips. I washed my hands. I pricked my finger and got one big drop of blood and began to disperse the blood across all five strips.

Win Some, Lose Some

It's been a while since I provided a Weight Loss update. :)

I've been on and off the Weight Watchers wagon for the last 6 weeks, but I've continued losing weight regardless. (Thank you, breastfeeding.)

My original goal by my August 3rd endo appointment was to go from 183.2 lbs to 173 lbs. Result? 170 lbs. Thank you. :)

My second goal was a drop in pants size (from 16). I'm in a 14 and sometimes a 12, depending on the alignment of the cosmos.

My third goal...my A1c. I wanted to see a drop from 7.0% to 6.5%.

[shifts feet, kicks dirt, checks fingernails for something interesting... Is that the phone ringing? What's that behind you? That's a weird place to put a piano.]


7.7%

Sigh.

The highest I've seen in 6 years. siiixxxx yeeeaars. It's not high. It's not even in my greatest hits of high A1cs. It's an average of 179ish. But it's not what I was aiming for this time.

what went with me to the endo appointment

That being said, I can't say I'm surprised at all. My meter average was reading 190, my standard deviation was a whopping 70/80+. That's out of whack even compared to my usual game of chutes and ladders.

In four months, it rose .7%. So I have to check some of my habits before this runaway train hurtles itself into eightsville.

I believe that switching back to my Cozmo pump almost a month ago has helped. I can see at a glance on its handy Therapy Scorecard screen that I'm wasting a lot of insulin in corrections - 20-30% of my TDD. I like to keep high blood sugar correction doses below 10% of my total insulin usage. That was a red flag for me to start adjusting my post-partum basal rates and make them just normal people basal rates. I waited too long to make those adjustments.

We are continuing to follow our Weight Watchers (which for those of you wondering is a makeshift "free Weight Watchers") plan. My next A1c check will be in mid-December... Goals?

As far as weight is concerned, I haven't been below 160 pounds since I was 16. So I'm not setting that bar any lower. Let's say 163. Yeah, 163. And my size 12s should feel roomy.

For the A1c, I'm going to strive to get it back in the other direction. Nudge it. Skooch it. Shimmying down toward 7 again. I'll take whatever I can get.

Weight Loss Update: 3 Weeks

For those of you following my journey, Hubster and I just completed our third week of Weight Watchers (the old Points program, not Points Plus).

so hungry i could nibble those cheeks?

My current stats as we start Week 4 are:

Estimated A1c (based on 30 day meter avg): 6.6%
Weight: 175.4 lbs
Pants Size: 14

The weight is flying off. I have already netted a loss of 7.8 lbs (down from 183.2). In just 3 weeks!

I'm already in the jeans size I hoped to be in by August. (But I won't count it as a success until my shorts fit without me having to suck in. Wedgies are a public health issue, people.)


But the real question might be What's going on with your diabetes?

I'm glad you asked.

I have been logging my data pretty consistently with the iBG Star app. I miss some readings here and there, but I try to go back and enter them retroactively.

I am a lot better with carb counting when I am stopping to weigh and measure portion sizes so that I can determine my Points values.

I am a better shopper, too, looking at the label before it goes in the cart, evaluating the "opportunity cost" of foods that are neither good for my waistline nor my blood sugars.

And OMG Nestlé makes a 120cal snack-sized drumstick ice cream cone that my two year old and I think is snacktacular!!!! Thank you, @parenting!

Anyway, the big change is that I'm eating more mindfully, reviewing my data (because it's actually logged somewhere), and not allowing the fact that I have a new baby to derail my efforts at self-care.

Speaking of which, roly poly Dibbs is a whopping 18 lbs 6.5 oz at only 3.5 months old. o_O The boy is massive.

So at least we know my calorie reduction isn't affecting the smorgasbord that is the Dibbs lunch truck.

Weight Loss

Hubster and I have decided we are going to do Weight Watchers again.

I am exclusively breastfeeding a small human milk tank, so I am allowed as many points as Hubster. This makes me deliriously happy.

My starting weight is just one pound over what it was when I started WW before, back in April of 2008.

Then, I lost about 30 lbs in 6 months and lowered my A1c by 0.8%. Those efforts help me get green lighted for pregnancy with diabetes.

Since then though, I've given birth to two precious bebés - one of whom was over 10 lbs. My body took a beating with him.

After Sweetie's birth, I bounced back within six months to my pre-preg weight just by breastfeeding. Something tells me that recovering from Dibbs is going to take extra effort.

So far, everything about my chunky monkey takes a little extra effort.

Anyway, I am approaching the program with a few attainable goals:

1) eat more reasonable portion sizes of the things I already eat
2) lose a little of the baby weight
3) reduce my A1c by necessarily reducing my total intake (and by extension, carbs) at meals
4) make a renewed commitment to my blood sugar control

You have no idea how quickly and easily that can slip away from you. If I look at my blood sugars from this weekend alone (see screenshot), my A1c could be climbing a whole 1% higher than it was a month ago. That's HUGE. And it means I've got to get my butt in gear.

So, internets, to keep me accountable, I'm going to disclose my current stats here.

A1c: 7.0% (April 2012)
Weight: 183.2 lbs.
Pants size: 16

Hubster has never told me I looked ridiculous before.
Then he saw the outfit I chose to go walking in tonight.
What's wrong with 80s shortie shorts and navy socks?

When I get my A1c checked again in August, 3 months from now, I would like to be closer to the following:

A1c: 6.5%
Weight: 173 lbs.
Pants size: 14

I'll update you on my efforts with specific attention to how my food choices affect my insulin and blood sugars.

As you can see in the picture, I am also playing around with the iBGStar Diabetes Manager App. I am on the fence about whether to purchase and begin using the accompanying meter (which docks onto the iPhone), but so far I think their interface is deliciously slick.

Seeing my high pre- and post- meal numbers in the logbook screen was the kick in the pants that I needed. It's time to pay attention. Again.

The Long and Winding Road

Today's Prompt: A Diabetes Snapshot.

I'm taking that literally. Here is a snapshot of my A1c over the last 21 years.

(Click for larger)