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A day in the life of a diabetic

The challenge question:

Monday 5/10 - A day in the life . . . with diabetes. Take us through a quick rundown of an average day and all the ways in which diabetes touches it. Blood tests, site changes, high and low blood sugars, meal planning, anything that comes along. This can be a log of an actual day, or a fictional compilation of pieces from many days.


Surprisingly, I have never really given much thought to what it is like to live with diabetes. Perhaps that has been the result of simply having it for over a decade now. Or maybe it's just something that I'd prefer to ignore. This first challenge has been for me to stop and reflect upon everything I have had to do in one day that was in some way diabetic related. I picked the data from last Friday, 07 May 2010, to use which was the date that I started this blog in response to the challenge.

Equipment



Every day of my life I have to carry or wear certain equipment. No matter where I go or what I do the following items have to be with me, or readily accessible. The first of these is my MiniMed Paradigm Insulin Pump. That's the item on the right in the photo. It contains a reservoir that holds enough insulin to last for three days or so. From the reservoir runs a small tube about three feet long that connects to a plastic cannula which is inserted about an inch or so into my body. That constitutes the infusion set.

The location of the infusion set varies as I have to switch it every three days or so. Right now, on the day in question, the cannula is inserted into my left side, right in the "love handle." I'll give more description of that process later.

The second item I always carry is in the left of the photo. That is my glucometer or blood glucose meter. That is not attached to me physically, but it something that I always carry with me in a small black bag. My man-purse. Along with the meter I also have to carry a lancet device (which is used to prick my finger so I can get blood for the meter) and a vial of test strips for use in the meter. My man-purse has special spots for both of them, it also has a small pocket in which I carry a small needle syringe (in case of pump problems) and four glucose tablets (in case I get a low blood sugar reading).

The third item I carry is an iPod Touch. I use an application called Diabetes Pilot on it to look up foods in its database so that I can determine what their carbohydrate level is. I also use the program to record data I collect on amount of insulin given, blood sugar readings, etc. While you can also record this data in the glucometer, I chose to use the iPod because the glucometer has no food database so I'd have no idea what the carbohydrate content would be.

That constitutes the equipment that I take everywhere. And I do mean everywhere. I sleep with the pump and have my man-purse right by the bed. When I am in the courtroom at work I have it with me. When exercising or traveling I have to keep it within reach. Safe to say it is as much a part of me as my wallet.

Data

After I collect the data in the Diabetes Pilot program, I can export it in a number of different ways. What you see below is the graph data for Friday, May 7th:


So that you can get an idea as to what MY life is like on a daily basis (and since the above is all but illegible), I'll explain the above data and what my thought process was before and after the individual events.

My morning usually starts at 7:00 am. That is when I do my first blood sugar test. That involves pricking my finger with a lancet, drawing some blood and having the meter tell me what my level is. The photo on the left is an example of that. That's not my finger, btw. The sides of my fingertips are dotted with hundreds of small black dots from the tests I've given over the years (e.g. just 1 test per day x 10 years = 3,650 pokes!). Also, I rarely poke in the middle of the finger. I use the sides as it hurts less.

This morning my blood sugar was 144. That would be a bit higher than it should be in the morning. I try to have it around 100. The meter is connected via radio frequency (RF) to my MiniMed pump so the reading showed up in the pump. I pushed a button on the pump and after it did some internal math calculations using an algorithm, it told me that I needed 1.2 units of insulin to get the 144 down to 100. So I gave myself that much insulin (called a bolus) from what little remained in the pump reservoir and when it was finished, removed the infusion set from my body. I had exhausted the use of it and needed to insert another one.

During my shower the site where my infusion set had been itched a lot, likely due to a combination of reaction to the adhesive and keeping it on too long. It's recommended to change the site every two days but I can't afford to do that as the infusion set costs, after insurance, about $10 or so. Under my insurance plan (a quite good individual one), test strips costs me out-of-pocket about 0.10 cents each. Insulin comes to about $3 dollars per day. These are all after insurance costs. It's no wonder why pharmacists love diabetics.

After getting showered, I begin the infusion set insertion process. The photo on the right shows how the infusion set inserts into the body. The blue part is contains a needle which is removed after the cannula has been inserted under the skin. Incidently, that is not a picture of my side. In addition to being a lot skinnier than my own (not to mention likely a female's due to lack of hair!), mine is covered with red bumps, welts, dry skin patches and other consequences of a decade of infusion sets being inserted and taped to my skin. Doesn't look the best at the beach.

So the insertion process is quite simple: fill the reservoir with new insulin, clean the location with an alcohol wipe, insert reservoir into pump, prime, thrust into side, remove needle and throw all the sharps in my "sharp container" so that my kids don't get poked by them. The whole process takes about 5 minutes or so from start to finish. Of course, I don't know if the infusion set site I chose is a good one until later, around breakfast time, when I actually try to bolus some insulin. If it doesn't work (an on-going problem), then I have to run upstairs and do the whole thing again--at a $10 cost, mind you--and hope THAT site works. That's why I put "site change" on the report, letting me know that I changed on that day. Since it doesn't reference a number (such as "2 attempts", I know it worked on the first try. Yeah!!)

Once I get dressed and changed, it's down for breakfast. I eat a handful of different breakfasts, each already entered into my Diabetes Pilot program so I can simply call it up and it tells me what the carb level is. On another screen it gives the details (on this day, 1 scambled egg, 1 third of an avocado, 1 cup of Oat Meal squares cereal, 1 cup of rice milk, 8 oz of coffee and 1 pack of splenda) but I usually make a note as to what the carb was I ate for quick reference later. The whole meal was 76 carbs and the pump algorithm told me 10.8 units, so that is what went in. There was no dreaded "beep beep beep" sound that indicated an infusion set problem so I know it all went it. I took the kids to school and went to work.

2 hours later my pump beeped that I needed to check my "after breakfast" level. I finally got a chance to do so about 30 minutes later, only to find that my blood sugar reading was a high 213 instead of the 100 - 125 I had expected. What happened? This is the fun part of being a diabetic, trying to figure out what exactly happened to cause your blood sugar to go up or down in some unpredictable manner. Since I didn't eat or drink anything that morning nor exercised, I figured it was likely due to the avocado which, being high in fat, might have caused an issue with the insulin absorption. Or maybe it was the infusion set location, as some of them take more insulin than others. Or perhaps it was the insulin as it was the last of the vial so might have lost some of its potency. Satisfied, I bolused the 3.4 units as instructed by my pump and went about my morning.

I didn't bring anything to eat for lunch that day so I thought I'd grab a BBQ sandwich at a local BBQ joint. Since it isn't a chain store, I had to look up the data in my Diabetes Pilot. There wasn't an entry specific to BBQ pork sandwiches, so I had to make a quick decision as to whether or not I would take the 5 minutes to do detailed calculations (how much pork, how many carbs, what kind of bread, hmm... what about the sauce?) or just wing it using the closest entry in the database. That's what I did. I input the potato chip info from the bag so that was accurate enough (and it was now a part of my database for future use) and added a diet coke. Total carbs: 65.

Looking back, I can see that that was clearly a low carbohydrate amount. I might have calculated it incorrectly, or didn't factor in the sauce. Keep in mind that I was hungry, my food was getting cold, and I didn't have all day to figure it out as I had to get back to work, and you'll get a good idea as to my state-of-mind. So the 9.2 units of insulin (as per the algorithm) turned out to be insufficient. 2 and a half hours later, my after lunch test indicated my blood sugar was 257. Damn. The pump told me 6 units would bring it down to where it needed to be, so in went six more units.

I didn't get a chance to eat dinner until later that night, at about 7:30pm. My wife and I went out for Mexican food. My blood sugar level at that time was 82, which was a bit low (I get nervous when it is below 100) but certainly appropriate for getting ready to eat. After ordering I dutifully input my mean into the Diabetes Pilot database (1 cheese enchilada, 1 beef tamale, 1 cup refried beans, 1 cup spanish rice, 10 chips, 1 diet coke, 3 tablespoons salsa) and at 126 carbs, injected 17.1 units of insulin.

During the meal I should have paid more attention to the quantity of beans and rice given (maybe 1.5 or 2 cups each?), and I had forgotten to include the sour cream and guacamole, but I only ate 7 or 8 chips instead of the input ten. I also knew that the carbs in the refried beans would be a longer releasing carb than usual, not to mention the cheese in the enchilada might slow things down.

Before bed I checked again, at 11:13 pm. Oops. Blood glucose reading was too low, 68. I would have to either eat something more or use some glucose tablets to raise it. Of course, given the issue with the delay with the bean/cheese combination, I couldn't tell if I was going to spike a high blood sugar reading later in the night or if I had overbolused for dinner and given myself too much. I ended up taking 4 glucose tabs, for a total of 16 carbs, which should have been enough to raise it up past 100.

At 2:35 am I awoke in a cold sweat. This info is not on the record above as it appears on the record for Saturday since it was after midnight. It is still part of Friday, however, so I thought I'd add it. The cold sweat and feeling in my stomach told me that I was having a low, so I turned the screen light of my pump on so I could see, pulled out another test strip, poked my finger and took a reading: 53. Too low. Now the question, what do I do to raise it? I can (a) stop my pump for a period of time; (b) take some more glucose tabs, or (c) go eat something. Always a great decision to have to make at 2:30 am when your blood sugar is about half of what you'd like it to be.

Since I'd already tried the glucose tabs earlier, I decided to go eat something. So downstairs I went, and ended up having a cup of oatmeal squares and a cup of rice milk for 44 carbs. But when I input the carbs into my insulin pump, the algorithm told me to take an additional 3.1 units of insulin. So it's 2:30 in the morning, blood sugar at 53, ready to eat a bowl of cereal when I'm not particularly hungry and am being told to inject more insulin into my system. Which, of course, I did. First check the next morning: 128.

That's a day in the life of a diabetic.

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