For the last few years I have been consumed by work, my first and second daughter being born and relocating from Virginia to Maryland.  I have always been healthy, give or take 10 pounds or so.  I’ve been working out since my mid-teens and at times heavier/more frequent.  For a long time now, it’s been non existent.

In the last few weeks I have gotten back on the bandwagon with weight training and cardio at least 5 times a week, coupled with a tight diet of more greens, salads, and fewer carbs.  It’s no surprise that my blood sugars went from getting into the 200s on the daily, to having to tweak my basal rate because I’m going low a lot.  I am finding myself in the 80s, 90s, and low to mid 100s for the majority of my testing.

Seriously, this isn’t rocket science.  More exercise and a better diet can only mean good things for someone with diabetes.  For me, it’s such a wave of relief.  I was constantly asking myself why my sugar was going high so often.  Now I am correcting to keep from going too low.  Granted, I haven’t been going to bed until almost midnight because I’m working out after my kids go to bed.  But, it’s so amazing to see the 90s and 100s so often again.  Losing about 10 pounds and getting better control has me so motivated it’s scary.  I’m not giving in to complacency and my doctor saying I have “good” control.  I want excellent control.  I want to see my kids grow up and think of their dad as an inspiration instead of a statistic. 

The Holy Grail to winning the battle against diabetes is simply exercise.  No excuses, period.  If I can do it with a 3 year old, 8 week old and full-time job, you can too.

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Disclaimer – always consult your physician before changing your routine or introducing exercising.

In my last post, I discussed the need to code a blood glucose meter to the vial of test strips to ensure accuracy.  My question was, why did this need to be done?  Below is my e-mail to LifeScan asking this question with their response below my request.

“… My last post was in regards to test strips and the coding procedure that needs to take place. I currently use a OneTouch UltraLink meter.  The reason I am writing is because I found a large variance between when the code is correct between the strip vial and the meter versus when it’s not correct.  Furthermore, I don’t understand the need for coding especially when a wrong code can lead to significantly different results.” [Blogging Diabetes - Tony]

“In regards to your inquiry, as you are aware, if the code number on the meter does not match the code number on the vial of test strips, the test results may be false.

When the strips are manufactured, the membrane is passed through a chemical bath which coats the membrane.  This chemical coating is what causes the test strip to react to your blood sample.  Due to varying degrees of coating on the membrane which cannot be controlled and the biological variances of human blood samples, there is no established percentile difference from one code to the next.  This is why we recommend checking and changing your meter code to match your vial of test strips any time you receive a test strip vial with a different code number than what was used previously.” [LifeScan Customer Service - Jennifer]

I still don’t understand why there are some meters that do not require a code.  Did they figure out something that LifeScan has not?

It’s been over 40 years since we put a person on the moon.  We have nano technology that is way beyond me.  I can fit about 5,000 songs on my iPod nano which is almost paper thin.  Apple has a laptop that fits into an envelope.   There are cars that can run without gas.  We have amazing insights on DNA sequencing, chromosome mapping, etc.  I can talk and see someone thousands of miles away through my computer without costing me a dime (Skype).  The list goes on and on.

And yet…….

I still have to freakin’ code my meter every time I get a new bottle of test strips where the code is different than the one I’m using.  WHY?  Seriously?  I find it very hard to believe that this annoyance can’t be overcome very easily.  I also wonder if the code really matters.  For example, does putting in the wrong code and testing give a different result than the correct code?  This calls for a little experiment.

My Experiment

Below you will find the results of 10 consecutive blood glucose tests.  The first 5 were done using the correct test strip to meter code.  The second 5 tests were done where the code was not correct between the meter and test strips.  The results are interesting.

What immediately stands out is the variance between the average correct and average wrong test, which is 63 mg/dl.  That really blows my mind.  In essence, you could expect a 63 mg/dl swing down when the code is incorrect.  The second thing that jumps out is test 5 where the number went from being around 145 to 207.  A 61 mg/dl swing between two tests for no apparent reason is cause for concern.  Keep in mind the 5 tests were done within minutes of each other if not 30 seconds or so apart.  The results and variance is pretty scary because I would certainly treat a 207 differently than a 146.  I use the OneTouch UltraLink meter with LifeScan One Touch test strips.  I’m not trying to be critical of LifeScan or Medtronic; I’m simply trying to understand the accuracy and coding need.

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What They Said

This was the first time I actually read the little folder paper in the test strip box.  LifeScan has a caution in the writing that says:

“Matching the code on the meter and the code on the test strip vial is essential to obtain accurate results.  Each time you test, check to make sure the code numbers match.”   …”a clinical test was done and showed that the variability from test strip to test strip in blood tests was 3.2% or less.” [LifeScan]

Here is a quote from a study done that warns about miscoding meters:

“In this study, for certain miscoded meters, the probability of insulin error of plus or minus 2 units of insulin was 50% as compared to 8% for correctly, manually coded meters.  The probability of insulin dose error of plus or minus 3 units of insulin was 23% for the miscoded meters but only 0.5% for the manually correctly coded meters.”

Summary

My test using a very small sample size yielded a 6% variance mainly due to the test #5 that threw off the average.  Besides #5, the results were very close when the code matched from the meter to vial.   On average, there was a 63 mg/dl variance between when the meter was coded correctly and when it was not.  Make sure you code your meter correctly when changing test strip vials.  Seriously, this could mean a severe life-threatening episode by simply having the wrong code entered into the meter.  Although I still don’t understand WHY I still need to code (after 10 years), I do understand the importance of accuracy and will take extra care to ensure correct coding.  Coding may seem like an annoyance, but it could also cause a high/low just for the code being wrong.  We have enough to deal with as insulin dependent diabetics – can’t we get rid of the code?

Question

Does anyone know really why we still need to code meters?  They say it’s to match the vial of strips to the meter for accuracy, but WHY?  I know there are some meters on the market that are codeless.  Are they less accurate?  I doubt it. 

I wanted to take a minute to recognize someone truly special to the diabetes online community.  George, who writes a blog called The B.A.D. Blog (Born Again Diabetic) has utilized one of his talents and professionally recorded a song about his diabetes.  Also, you can check out an interview that Kerri did with George on the SUM blog. 

Please check out this song because it’s ridiculously good.  The sound and lyrics are tight!  You can’t buy much these days for a dollar, but you can be inspired and touched by spending the .99 to get this song on iTunes.  You won’t be disappointed.

iTunes – Not By Choice, by George Simmons

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“I should tell you that I chose the artwork [above] for a reason. The symbol I used is not a maze, but a labyrinth. A maze you can get lost in but a labyrinth is a single path, a journey. Sure it twists turns and you never seem to know when it ends but as long as you keep moving, you will get to where you need to go. Much like life.” [George Simmons]

This is a guest post submitted by Lorraine who is doing an excellent job managing her son’s (Caleb) type 1 diabetes.  I met Lorraine through twitter, which is an excellent medium to talk real-life diabetes.  From our first few conversations, I knew that she was doing a lot of things right for Caleb and keeping his A1c numbers near perfect.

I want to thank Lorraine for sharing her story and tips to help manage type 1 diabetes.  Thank you Lorraine and keep up the great work!  Caleb may be too young to understand, but someday he will thank you for all the hard work you put in to help him live a better/longer life.

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Managing Caleb’s blood sugar, from a self-admitted neurotic mom

Background:

My son Caleb was diagnosed almost 2 and a half years ago at the age of 3 (almost 4). With so few non-D years behind him, and so many D years in front of him, I have made it my mission to bank as many years as I can with near-normal A1Cs in hopes to minimize those ugly complications when he is older. Caleb has been pumping for just over 2 years, since about 3 months after he was diagnosed. I never set out to achieve a certain A1C.  All I know is I do whatever I can to keep his blood sugars in range.  I am often unsuccessful.  But lots of the time we achieve what we want to. I have never been given any specific guidance on targets or acceptable ranges.  Caleb’s Endocrinologist has always reviewed his results and found them acceptable and not mentioned what precisely they “should” be.

Guiding Principles:

1. I check Caleb’s blood sugar about 12 times a day, including overnight.  Sometimes less, sometimes more.  I check, assess and act.  
2. Everything he eats, I weigh and measure whenever I am able.
3. I do not limit what or how much Caleb eats.  I manage it, but I do not limit it.  There are foods I prefer to stay away from, but I won’t ever tell him he can’t have something because he has diabetes.  Even at school and birthday parties, he eats what the others do.  It usually means 100 plus carbs for a snack and a few extra BG checks, but he smiles as he shoves the cupcake and other junk in his face and that makes me smile.  Everything in moderation – that goes for him and my other, non-D kids.
4. Caleb typically eats 3 meals and 2 snacks a day.  That frequency allows me to be a little aggressive on dosing when I have unknown carb counts.  If I have an uncertainty, I will check and hour and a half after a bolus and if it’s lower than I think it should be, it’s usually around snack time and I can just decrease the bolus of what he eats to mitigate that low without disruption to his schedule.  
5. Caleb seems to go through “waves”.  His insulin needs creep up, up, up….plateau, and then go down, down, down…plateau, and over and over again.  Perhaps all diabetics are like this.  I attribute the waves to growth, but who knows.  In order to keep up with the waves and still keep his sugars in range without constant corrections, I track all his dosing and stats in a spreadsheet.  I used this religiously for months.  As I have learned from it and things have become more predictable, I do not use it as much – only in periods of lots of unexplained BGs.
6. I keep a pretty close pulse on his basal rates.  If there’s a low or high 2 days in a row and I am confident that food is not an issue, I will adjust basal rates.  I know that .05 will have about a 30 point impact on his BG.  
7. Food – Pizza, Ice Cream, Chinese, Bagels, Pasta, anything fried – they all break the rules.  I have charted Caleb’s BG’s for months when he eats these foods and have been able to develop specific extended bolus’ for each.  I keep them in my spreadsheet and in my cell phone.  I continue to tweak them since things are ever-changing, but I at least have a baseline and don’t have to completely freak out when we indulge.
8. Super Bolus.  Of course there are occasions when that nasty 300 pops up.  I don’t mess around.  I find John Walsh’s Super Bolus to be very effective: bolus the calculated correction plus the amount of basal to be delivered for the next two hours.  Then turn off basal for the next two hours.  This front loads the insulin to bring the BG down fast, but prevents bottoming out since the basal is turned off.  This has been particularly useful when we are about to eat a meal that would be awkward to delay (like at a party).  But I am careful with this at nighttime – not quite as aggressive.  For Caleb, I find I need to add a little insulin for those high highs – his normal correction factor needs a turbo charge to tackle those numbers – but of course YDMV.

Those are the highlights.  I’ve been thinking about this as we go through our days to make sure I have everything covered.  I think a big thing is keeping on top of things at night, particularly since that’s about 10 or 11 hours for Caleb.  I check a minimum of two times while he sleeps, but in times of change or when he eats a challenging food, I will check more.  And if a correction is needed, I will always check 2 hours after no matter what.

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One thing that quickly jumps out at me is the care and effort Lorraine puts in to managing Caleb’s diabetes.  She doesn’t just check and react.  There is much more planning, trending and analysis put into his diabetes management than I would expect most diabetics put in, me included.  The theme here is to not be complacent and just wing it.

If you are interested in providing a guest post, please contact me for more information.

“Winner, winner, chicken dinner”.  I hope you all had a nice long and relaxing holiday weekend!  As promised, here is my vlog that answers the question, “What did I do for the first time after 4 years on an insulin pump”?

Thank you all for contributing and to the winner of the Amazon gift card (watch the video to see who won). 

As we approach a nice long weekend here in the States, I wanted to pose a question to the Blogging Diabetes readers.  I’ve been on an insulin pump for almost 4 years now.  Just the other day, I had something happen for the first time ever on the pump. 

What happened?

Who knows, I might just throw an Amazon gift card at a random person who answers correctly.  I will probably post the answer mid next week.

A special thank you to Kerri at Six Until Me (SUM) for the opportunity to provide a guest post on her diabetes blog.  Kerri’s blog has been around for four years and provides exceptional insight and some humor into the life of someone with type 1 diabetes.  Check out Kerri’s blog and the guest post I wrote on 4 tips for a great Spring and Summer.

This is a guest post by Rachel who writes a great blog about parenting a young child with type 1 diabetes.  I enjoy these guest posts because they typically bring a different perspective and insights that I may not experience or know about.  I want to thank Rachel for sharing her story and contributing to the diabetes online community.

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If you peeked into our house, you would see what looks to be a normal family with a normal life. Unfortunately, our life changed forever a little over 4 years ago. Tristan was diagnosed with type 1 diabetes in March of 2005. He was 16 months. He is now 5 years old. I was asked by Tony to share what it’s like to parent a child with diabetes and how we manage the day to day routines that other parents just execute without really thinking about it.

At school

Entering Tristan in school was a joyful moment. Our baby was growing up. J It also brought on a lot of stress and worries. Most parents register their child, maybe meet the teacher once before the school year starts, drop their kids off on the first day and life is normal. They go to work and they come home. Pretty straight forward. For us, registering Tristan meant, 504 plan, meeting with the school principal, nurses, psychologist, parent coordinator and other people that I can’t even remember at this time. For us it meant educating people to make sure that they are aware of the potential danger, that they stay alerts to the signs and that they can react in any given situation. Another issue that came up this year is emergency evacuation of the school. The problem that came up was that Tristan can’t just be put on a bus, driven to another school without qualified personnel with him. After much stress and frustration, the conclusion was that Tristan would be with the nurse at all times. She would be in the bus with him and remain with him until either I or my husband could come and get him.

When at school, Tristan gets his blood sugar checked between 11 and 13 times per day. Before going to PE, he needs to have his blood sugar checked and most of the time, he needs to have a snack to tide him over. Unfortunately, he does at time have to miss things at school because of his blood sugar. He misses class time, PE, music etc. It is very frustrating for him and it makes him sad. I often get the comments from the nurses “I don’t know how you do it”. We don’t have a choice

At Home

The situation at home is a little different. Because there’s only him and his brother, we are able to pay closer attention to him. Therefore, at home, he usually only gets his blood sugar checked 8-9 times per day. Of course, we check him before any meal, usually 2 hours after meals, before we go to bed and around 3:30am. This does not include all the checks that we have to do it based on his behavior. When diabetes is not a factor, when a child has a temper tantrum or a meltdown, that’s what it is. Period. With Tristan, we never know if it’s Tristan acting up or if we are dealing with the big D Monster. So before any discipline can be done, we need to check his blood sugar to know what we are dealing with and handling the situation appropriately.

Tristan has been wearing an insulin pump for a little over 1 year. It does make life easier for us. It affords us more freedom when it comes to meals and snacks. The routine doesn’t have to be so strict. There is also less restriction on intake of food than when he was on shots. When he was on injections, we really had to think twice before allowing him a snack because it meant additional injections and he was already getting a minimum of 4 per day.

With the pump, he only has to deal with needles every 2 days when we change his site. The problem with the pump is if the site doesn’t go in properly. We then have to deal with changing the site again and the possibility of ketones.

Sick days are always very difficult. A simple cold for Tristan is not just a simple cold. Most of the time, it affects his blood sugar which in turn, has the potential of creating ketones. At that point, we have to deal with the cold, his blood sugar being too high or too low and ketones. It means extra insulin or extra food (trying to get a child whose not feeling well to eat/drink something is not a walk in the park), it means blood sugar checks every 1 or 2 hours and it means checking his urine every time he goes to the bathroom. Sick day are stressful and unfortunately, we can’t protect him from catching a common bug.

This week Tristan just started t-ball. Again, something that should be fun for us means stress and planning. We don’t know how his blood sugar will react to the excitement and physical activity. It’s another situation where we have to do trial and error to find the exact course of action that we need to take before, during and after to ensure that we maintain his blood sugar level where it’s suppose to be. It means pulling Tristan out when he’s having fun to figure out what’s going on. It also means having him miss out of some of the fun because he either needs to drink and/or eat something. But most important, it means that once again, Tristan is different. Let’s not forget the looks from other adults/parents that we have to deal with.

All of these things, as much as they suck, have become routine. It’s our life now. What is harder to get a handle on is the emotional aspect of it. Tristan is at an age where he feels different. He knows that he’s not the same and that we need to take extra precaution. The other night, after having tried his site in a different location, he was crying and telling me how much he hated being diabetic and how he wished that he wasn’t. When he was 2 years old after an injection that had hurt him, he looked at me and yelled “mommy you hurt me”. It’s hard. Those are scars that will never go away. I can learn to count carbs and give injections. I can learn what to do in an emergency situation. I can do all that because I know that I don’t have a choice. I need to perform these actions to keep him alive.

However, I can’t learn how to deal with the emotional aspect of the disease. My son has a disease that could possibility kill him. My son has a disease that he hates. My son has to deal with injections that hurt him. My son feels different from other kids his age. And there’s nothing that I can do about it!

Diabetes is a disease that not only affects the patient, it affects the whole family. We constantly have to find the right balance to deal with Tristan as a person, Tristan with diabetes and my other 2 year old son who does not have diabetes. I feel like in March 2005, I was also diagnosed with type 1 diabetes, right along with Tristan.

On top of all the stress of dealing with diabetes, we also have the concern of Connor, our 2 year old getting it. Because Connor has a sibling with type 1 diabetes, he has 5 percent chance of getting it. I know that you are thinking, 5%, that’s not much, it’s nothing. You right, in the big scheme of things, 5% is nothing. Tristan had less than 3% chance of getting diabetes! He got it.

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If you are interested in providing a guest post, please contact me for more information.

April was a slow month in terms of the number of posts because I took some time off as we welcomed a new addition to the family.  Our second daughter, Sydney, was born on April 16th and is an absolute blessing.

Even with the drop off in posts, we were able to capture another strong month in terms of visits, hits and page views.  We had a great guest post, with Gary discussing his tips on running with type 1 diabetes.  Another popular post that was well received was the Top Insulin Pump Advantages.

Also, we introduced a new sponsor – Discount Diabetic Sock Store on April 9th.  I thank them for the sponsorship and recommend you to check out their site. 

Early in April, there was a poll on Blogging Diabetes which asked the question, “what pertains to you”?  Below you can see the results.

I’ve got some great posts coming in May.  Thank you for visiting, passing the word on and for the great comments.  I really appreciate it! 

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