Testing for Accuracy, in Addition to Blood Glucose

This post originally appeared on Hugging the Cactus on March 21, 2018. I’m republishing it now because of a recent experience I had with my meter reporting inaccurate and inconsistent blood sugar levels. Has this ever happened to you? Drop a comment and let me know.

Blood glucose meters serve the sole purpose of checking current levels of glucose in the blood. Pretty self-explanatory, right? And it’s equally obvious that it’s crucial for all meters to generate accurate results so PWD can make the right treatment decisions based on those numbers.

Unfortunately, though, accuracy isn’t always what I get.

The other day, I was running low before bedtime. I corrected with an organic rice crispy treat (honestly, it was a million times better than the brand name kind). I waited nearly an hour for my blood sugar to come up. When my CGM wasn’t showing any progress, I tested: I was 47. It’s rare for me to be that low, so I tested again. 52. I believed it, especially since I was experiencing several hypoglycemic symptoms.

B. J. Palmer

I chugged a glass of orange juice and plopped down on the couch to wait for signs of improvement. Before long, I was freezing cold – a sure sign I was coming up, because I had been sweating 20 minutes prior. But I didn’t feel comfortable going to bed yet. I wanted to see if my CGM would show an up arrow. When it finally did, I made my way upstairs to brush my teeth and wash my face. In the middle of my routine, though, I decided to glance at my CGM again – and saw the dreaded ??? screen.

I decided then that the Dexcom should be out of commission, a.k.a. not trusted at all, for the remainder of the evening.

I ripped it out and inserted a fresh one, not really caring that it would wake me up in two hours to be calibrated. I would need to set at least two alarms for the middle of the night, anyways, if I decided to go to bed disconnected from my Dex. So it just made sense.

Once that was done, I tested again. I was pretty tired at this point and really didn’t want to have to eat something else, so I did it as quickly as I could. In my haste, I jostled my meter just so – enough that I saw the test strip, already marked with my blood, move slightly as it brushed against my PDM and was placed next to it.

113 mg/dL flashed upon the screen. Normally, I’d be thrilled! But I furrowed my brow. Something just felt…off about that reading. So I tested again.

206.

What?!

I tested a third time – 203. Okay, something was definitely wrong. Either that 113 was wrong (likely) or my meter had just produced two wildly inaccurate blood sugars in a row (less likely).

This is one of the many times that it’s convenient to live with another PWD. I asked my mom if I could borrow her test kit and see what result it generated. Seconds later…a twin 203 popped up on the screen, reassuring me that the 113 was a fluke on my meter.

Relief with the reality and irritation with the technology washed over me simultaneously as I went to correct the high with a bolus. I was glad I wasn’t heading down again, but irked that my meter had failed me. True, it was a bit of human error there, but aren’t we at a point in technological advancements where this sort of thing just shouldn’t happen? I put my life into the “hands” of my meter, Dexcom, and OmniPod. They should produce results that are undoubtedly accurate.

I guess we aren’t quite there yet.

How Working From Home Affects my Diabetes

Diabetes is a creature of habit. It rarely appreciates disruptions in its expected routine…so when they happen, it likes to make its displeasure known.

This probably explains why I’ve dealt with a number of diabetes curve balls since I started working from home (as opposed to an office) full-time.

I’ve been working remotely, 40 hours per week, for just about a month now. This was a choice I made as I prepared to move from Massachusetts to Virginia. I like most things about my job, from the people I work with to the skills it has helped me develop. But I don’t particularly love that my job forces me to be a self-described “cubicle rat”. When I work in the office, I’m parked at my cubicle for a solid portion of the day. As a semi-fidgety person, this was a tough reality for me to swallow nearly five years ago when I started my job. However, I was able to adapt to the old ball-and-chain that is my desk, and learned to break free from it every once in awhile. Before long, I discovered that getting up every 60-90 minutes to either wander into the kitchen for a drink, walk up the stairs to another floor in the building, or in nice weather, stroll around the building in laps, were all excellent ways to cope with my desire to move as well as keep my blood sugars at bay.

So that’s close to five years of having a very specific routine that my diabetes and I were used to…no wonder it was pissed off when I changed things up.

You are a rare gem.

Working from home affects my diabetes in ways that I expected and others that caught me off guard. First, the things that didn’t surprise me: I knew that I would likely be even more sedentary at home than in an office. I’m not walking across a parking lot, up a set of stairs, and down a long hallway just to set up my desk each day. All I’m doing is walking five feet into the living room in order to power on my laptop. So there’s a lot less daily movement, and I’ve had to work hard to incorporate as much of it as possible because my diabetes responds incredibly well to exercise.

I also knew that my relationship with food would change a bit. Since I was living with my parents before the move, I was lucky enough to have 99% of my food preparations done for me by them (thank you for feeding me, Mom and Dad). Not only would I need to take care of cooking my own food in this new situation, but I would also need to become responsible for making smart choices and stocking the pantries with healthful things…because when you work from home, ALL the food is available to you. And since there aren’t any coworkers nearby me to chat with and take my mind off snack time, it’s much easier for me to just traipse through the kitchen whenever the heck I want and eat a gratuitous number of chips, crackers, cheese, and any other sort of goodies I can find. I don’t like admitting it, but I don’t always bolus for said snacks…making it that much more of a struggle for my blood sugars.

But what I didn’t know about working from home and how it might impact my diabetes is that there’s an emotional side to it that almost certainly comes into play. The first few weeks of my move were absolutely draining. I was homesick and trying to adjust to this strange, new place at the same time, and honestly, I think it was all a little too much for my diabetes to deal with at once. There were three straight days in which I had to fight hard to get my blood sugars to come down from stubborn highs, and there was another string of days in which I felt like I had to eat everything in the kitchen just to keep my numbers up. Between the numbers that my blood sugars represented and my emotions, each day felt like a seesaw and I wasn’t sure what to expect next.

What took me by surprise the most, though, about my new work arrangement was how quickly I acclimated to it. By the end of week two of working remotely, I had a routine – with a few fluctuations here and there – that I’ve since tried to stick with: waking up around 6:30, exercising, showering, getting dressed, eating breakfast, logging onto work, working for 4 hours, eating lunch, taking a break to do household chores/errands, working for another 4 hours, then logging off for the day. So far, I’ve found that following this pattern helps me move around as much as I did when I worked in the office, and it establishes a flow that my blood sugars and diabetes can follow. I’ve also, for the most part, remained mindful of the foods I eat during the working hours, after making mistakes with a bag of pretzels and banana chips in the first couple of weeks.

Even though my diabetes wasn’t happy with remote work in the beginning, I think I’ve arrived at a place in which it’s coming to terms with it…and, I daresay, warming up to the concept.

Hot Yoga: A New Win for my Diabetes

Normally, if you asked me if I would willingly go into a 105 degrees Fahrenheit room for 90 minutes for a workout, I’d say ohh HELL nawwww before you had the chance to finish asking your question.

I’m not someone who has a passion for exercising. I tolerate it. I try to do it daily for two very important reasons: 1) It keeps me in shape and 2) it helps me manage my blood sugars better. Otherwise, there’s very little about exercise that I actually enjoy. I’m not a fan of feeling out-of-breath for long periods of time. I have a love-hate relationship with the post-workout soreness that floods my body after a particularly intense session. And I definitely cannot stand sweating – on just about any given day, I’d rather be freezing cold and wearing layers of clothing than dripping in sweat.

All that said, though, I willingly participated in a fitness class called Bikram yoga…which is also known as hot yoga because you’re in a temperature-controlled room heated exactly to 105 degrees for the duration of the workout. For 90 minutes, you slowly move through 26 poses, and that’s that.

I wasn’t worried about the latter; it was the former that had me sweating (both literally and figuratively). I wondered whether I’d be able to tolerate the heat for a full hour and a half. I also had concerns about my diabetes devices – would I be sweating so much that they would fall off? Would they be able to stay safely in the room with me, or would the heat be too extreme for them? And how would my body and blood sugars respond to the hot yoga, anyways?

I knew the only way to get answers to my questions was to show up for class and find out for myself.

IMG_2171
Me, post-class, dripping in sweat in my car. Next time, I’m bringing a change of clothes.

And that’s exactly what I did. I went to a morning class with my stomach empty and my backpack full of diabetes supplies. My blood sugars tend to respond better to exercise when I don’t have any food in my system or insulin on board, so I made it a point to wait to eat my breakfast after yoga instead of before. But I still wasn’t entirely sure if or how my blood sugar might react to a brand new kind of workout, so I wanted to be armed with several different low snacks. I felt fairly confident about its stability, though, as I headed into the class sitting pretty at 110 mg/dL.

In addition to extra diabetes supplies, I also thought to bring with me some water that I’d filled and frozen the night before the class so I could stay hydrated throughout it with water that was sure to be extra refreshing in the heat.

Even though I had all this stuff with me, I chose to leave most of it in a cubby outside the studio, save for my CGM receiver, a tube of glucose tablets, and my water bottle. I didn’t want to take any chances with my cell phone, PDM, or glucometer and expose them to the heat – I have firsthand experience with an overheated cell phone, and while it does eventually cool back down its own, overheating my devices is not something I’d actively seek to do. I was taking a bit of a risk with the CGM receiver, but since I have the Dexcom app on my cell phone, it’s not like I’d be at a huge disadvantage if something were to happen to my receiver.

So with my gear in hand, I stepped foot into the yoga studio…and immediately started sweating. Yes, that quickly! It was a heavy, stifling, and moist heat – the exact kind that I hate the most. I started to question whether I had the endurance to even sit in this heat for 90 minutes, let alone move seamlessly through yoga poses in it. In the minutes before the class began, I sipped water slowly and told myself that above everything else, I needed to listen to my body throughout the class. I started to feel better as I reassured myself that it would be perfectly acceptable to walk out should I start to feel light-headed, low, queasy, or anything else abnormal.

Fortunately, though, an exit plan wasn’t needed as I made it through the full class! That’s not to say it wasn’t challenging or extremely sweaty – seriously, my body was so covered in sweat that it looked like I’d just come out of a swimming pool – but I proved to myself that I could do it. And the best part was that my blood sugar behaved beautifully: As a reminder, it was 110 mg/dL at 8:30 A.M. Class started at 9 and lasted until 10:30 A.M. I was home by 11 and when I checked my blood sugar there, I was at 118 mg/dL. I couldn’t have asked for better pre-, mid-, and post-workout blood sugar levels.

Was it scary to try this new, moderately intense exercise? Yes. Was I concerned about my diabetes before, during, and after the class? Yes. But was it all worth it? I’d say yes. I overcame my fears and was met by blood sugar success, making hot yoga a diabetes win in my book.

Is it Possible to Eat Pizza Without Encountering Blood Sugar Problems?

My short answer to that question is YES. Yes, it’s absolutely possible to eat pizza – and just about any food, in my opinion – without experiencing turbulent blood sugars.

It all just comes down to serving size, timing, and method of insulin delivery. Piece of cake, right? (Or should I say, piece of pizza?)

Have a slice!

Well, it really isn’t THAT simple. Other factors include the exact type of pizza (Is it gluten-free? Are there toppings? Is the crust thick or thin?), whether or not other food/drink is being consumed with it, whether exercise or inaction will follow in the hours after eating it…truly, there’s all that (and more) that people with diabetes need to think about when eating any type of food.

But what’s different about pizza is that it has a particular combination of fat and carbohydrates that can make it a tricky food for people with diabetes to figure out how much insulin to take and when to take it. It’s a little easier for those of us who have insulin pumps, because we can utilize the extended bolus (or square wave) feature that allows us to give a certain percentage of a mealtime bolus at once, and select a time later on to receive the rest of the bolus.

If that last sentence didn’t make any sense, here’s an example of what I mean:

It’s dinnertime – 5:30 P.M. I have two slices of pizza that I plan on eating. One’s plain, the other has BBQ chicken on it. I figure that there’s 50 grams total of carbohydrates in the two slices of pizza. My blood sugar before eating the pizza is 130 mg/dL. I put that number into my pump, and also input 50 grams of carbs. My pump wants me to take 8 units of insulin to cover the pizza. Instead of administering the full 8 units at once, I hit the “extend” option and opt to take 75% of the dose now, and the remaining 25% an hour and a half from now. So I get 6 units of insulin at 5:30, and 2 units at 7:00. This extended bolus typically has the power to prevent my blood sugar from crashing and spiking hours after eating said pizza, and in turns, saves me from dealing with a massive headache and questioning why I ever ate pizza in the first place.

Granted, an extended bolus isn’t the end-all, be-all. It relies heavily on me and my ability to count carbs correctly and time my boluses perfectly. But I have had fantastic success using it, particularly in a recent situation in which I ate two large slices of whole wheat pizza, a side salad, and a bit of pita bread without spiking beyond 160. I can’t say whether it was the whole wheat crust that helped me out (maybe it has a lower carb count compared to regular crust?), or if it was just supremely accurate calculations on my end, but it really doesn’t matter to me in the end…because I know that I can eat and enjoy pizza – and again, virtually any food – without my diabetes ruining it for me.

 

How Moving to a New State Impacted my Diabetes

A few short days ago, I made the move from Massachusetts to Virginia…and just as I predicted, the whole process has been emotionally draining. I’ve cried more times than I can count. I’ve busted my butt trying to get settled as quickly as possible. I’ve been eating poorly as a way to cope with my emotions. And my blood sugars have been all over the place as a result…again, just as I predicted, but still a bit disheartening.

I knew to expect some diabetes turbulence from the get-go. After all, a seven-hour car ride doesn’t exactly bode well for anyone’s blood sugar. But surprisingly, the drive to Virginia was probably when my blood sugar was most stable. I was snacking a little (okay, a lot) on the drive because it gave me something to do other than cry and talk unintelligibly to my boyfriend (my trusty driver) and it was far from healthy snacks…think fast food breakfast sandwich, Reese’s cups, and trail mix. Could’ve been worse, could’ve been a whole lot better. I think that because I was well aware of the high carb content of my snacks of choice, it motivated me to stay on top of my blood sugars and give myself micro-boluses as needed.

So that was all well and good.

Then came the actually moving-in process.

You are a rare gem.

Box after box and bag after bag were transported from the car, up three flights of stairs, and down a long hallway. It’s no wonder that I went a little low from all that back-and-forth, though I did think that riding the elevator as needed would’ve prevented too much of a drop. And if I could go back in time, I’d like to address the day that I took off from work to do the bulk of my unpacking and adjust my temporary basal settings to something like a 50% decrease for six hours or so. That’s because as I sorted through clothing, emptied boxes, and organized all of my possessions, my blood sugar just did not want to stay put at a comfortable level. Over the course of the very long day that I spent unpacking, my blood sugar dropped low enough that I had to stop what I was doing to eat three times. It felt like I was constantly stuffing my face with food, which was frustrating and the last thing I wanted when all I desired was to get settled.

That’s the physical component of moving – a lot of labor; more specifically, lifting, tidying, hanging, folding, unfolding, and if you’re me, cursing.

But there’s an emotional side to it, too, that I would guess affected my blood sugar just as much as the physical aspect did.

I’ll be honest: Tears were shed. Anxiety felt like it would swallow me whole at points. Doubts ran through my mind as I wondered whether I was strong enough to be so far away from family and friends. I was feeling – and am still feeling, TBH – so many different emotional swings that I am fairly certain that I can blame my blood sugar swings on them.

I’ve said it before and I’ll say it again: I know I need to give myself time to adjust. I’ve got to take it day by day, hour by hour, moment by moment. I need to let myself feel the way that I feel and remember to be kind to myself, especially where diabetes is concerned.

It just helps to write it all down.

Is a Bleeder a Reader? My Take on a Bloody Dexcom G6 Insertion

This blog post probably shouldn’t be read by anyone who gets squeamish when discussing blood or when viewing photos that show any amount of it…my apologies in advance for a bloody gross blog post, but I thought this was a good topic for discussion. 

I placed the new Dexcom G6 sensor on my abdomen, hovering my index finger above the large orange insertion button. I pressed it, exhaling as I felt the minute needle pierce my skin’s surface. I looked down, and started to rub the adhesive in circles to make sure it was stuck, when I saw blood. Not just a drop, but a decent-sized pool forming beneath the sensor. Before long, just about the entire surface of the white adhesive was soaked in red.

Yeah, this was going to be a no-go.

It’s pretty rare for me to experience blood at the site of a Dexcom sensor. If I had to put a number on it, I would say less than 10% of my insertions draw blood. An even smaller amount – like, 2% – have caused me to bleed as much I did in the scenario described above. But I know I’m not alone in my bloody sensor experiences – it’s something that many other T1Ds who use a Dexcom have gone through.

There’s a bit of debate, though, that I’ve noticed in the past on Twitter threads and Instagram posts. What to do with a bleeder? Keep it and assume that it’ll read blood sugars normally? Or change it immediately and call Dexcom for a replacement?

Are bleeders readers? Or does it depend?

1B278EF4-8498-4968-81F9-9134870F3C1E
Do you think that bleeders are readers?

I’m going to go with…it depends.

Obviously, in that situation I described in the opening of this post, I decided that it wasn’t a good idea to keep the sensor on my body. There was too much blood and I didn’t trust that it would adhere well to my body. I didn’t know how long it would take for the blood to stop (only a few minutes, but still), and I couldn’t be sure that it wouldn’t mess up my readings. On top of that, I wasn’t trying to stain my clothing, if I could help it.

So in that circumstance, I did change my sensor right away, and was glad that the second try resulted in a much cleaner, blood-free insertion. I called Dexcom, explained what happened to the customer support representative, and got a replacement sensor mailed to me.

However, just about any other time I bleed upon a sensor insertion, it tends to be a minuscule amount of blood. I usually don’t even notice until it’s time to replace the sensor, and there’s a bit of dried blood left on the site. Other times, I’ll see small beads of blood forming underneath the spot where the transmitter snaps in. And there’s been a couple of occasions that I’ve bled a fair amount and been totally unaware of it until I caught my reflection in the mirror and noticed the blood staining the white adhesive. And in all of those cases, I’ve kept the sensor on for the full ten days, without noticing any discrepancies in my readings.

All that considered, in my inexpert opinion, I think that bleeders usually are readers and that they’re safe to continue wearing. Of course, there will be exceptions, like when there’s just too much blood to salvage the sensor. But every time I’ve kept using a bloody sensor, I’ve had the same amount of success with its functionality…so yes, I think that for me, bleeders are indeed readers.

 

A Pod Failure Won’t Foil my Fun

I had just zipped up my coat when I heard a faint, high-pitched beeeeeeeeeeep emerging from somewhere in the vicinity.

My mom and I exchanged looks. “Uh, oh,” we said simultaneously.

“It isn’t me,” Mom said, patting her pod.

“It can’t be me, it sounds too far. Are you sure it’s not the refrigerator door that was left open?” I asked, as I unzipped and peeled off my coat.

She didn’t have to answer the question, though, because as I took my coat off, the beeping sound grew louder. I looked down at my abdomen and cursed. Yup, my pod had just failed.

I wasn’t totally surprised that it happened. The dry winter air was triggering excessive static electricity that weekend, and the sweater I chose to wear that day seemed to be charged with it. I couldn’t move my arms without hearing little sparks going off. If I was smart, I would’ve changed my top to one that was less filled with static. But I had somehow managed to convince myself that there was no way my pod could possibly fail due to my clothing choices.

I know better than that.

The real kicker in this situation is that we were obviously headed out somewhere – we were hoping to go to our favorite bar for a quick drink. But with the pod’s failure occurring at basically the most inopportune time, we were left with a three choices:

  1. Stay home. Take out the insulin, wait a half hour, and resign ourselves to the fact that it just wasn’t a good night to go out.
  2. Go out, but take a syringe and a vial of insulin with us. That way, I could give myself a shot, if need be, while we were at the bar. We could head home after the one drink and I could change the pod once we were back.
  3. Go out and take a total risk by leaving all extra diabetes supplies at home, and just wait until after we had our drink to change the pod.
a63d7919-5495-497c-a8f0-30f16dcf421e
A cocktail by the candlelight.

I like living on the edge sometimes, but option #3 is just way too dangerous. So we went with option #2. If you’re wondering why we didn’t just opt to wait a half hour (insulin needs 30 minutes to come to room temperature before it can be put into a new pod), it’s merely because we didn’t want to stay out late. And yes, a half hour can make that much of a difference to me and my mom!

So we left the house with an emergency insulin vial and syringe in tow. And it’s amazing how much better it made me feel to know that I had both, just in case.

Fortunately, I didn’t need them. I monitored my blood sugar carefully during our hour-long excursion, drank plenty of water, and deliberately chose a lower-carb, whiskey-based cocktail that wouldn’t spike me. And I was able to enjoy every last sip of it before returning home and changing my pod soon after walking through the front door.

I do have to say, though, that under different circumstances, I’d absolutely make different choices. If we weren’t less than three miles away from the house, and if we’d planned on staying out for more than a single drink, then you bet your bottom dollar that I would’ve changed my pod before going out. But in this situation, I made the decision that felt right for me, and felt comforted by the fact that I had backup supplies in case I needed them.