Diabetes Art Day 2012...

Portion

Control

'You are special'... Not Really.

To see this year's other entries to Diabetes Art Day for 2012 click here.

Questions from a six year-old... Continued...

Hello Everyone,

For those of you that posted responses to the questions from the little girl that just started on an insulin pump, I just wanted you to know that I corralled all the responses, put them in a PDF, and sent them off to said six year-old. Since other people were so generous as to post their answers, I thought it only fair to post mine. Here they are:

1. Has your pump ever fallen off/out while running/jumping /playing sports etc? What did you do?

It's not happened to me... Running it usually stays on okay, but during sports it tends to pull my pants down (eek!)... so I wear it in a Spibelt (http://www.spibelt.com/spibelt.php or http://www.diabetesexpress.ca/spibelt-m-3.html) around my waist.

2. Do people still ask about it/want to touch it/want to know what’s wrong with you, even when you’re a grown up?

Yes, always and forever. I tend to wear my sites on my arms, 'cause they are most comfortable for me there. So, I maybe get more attention than I would otherwise. Sometimes people are kind of weird about it, but mostly people are just curious. I don't mind of people are just curious.

3. Do you have lots of marks (I think she means scars…she’s starting to get a few), by the time that you’re old?

I find some sites leave scars and others don't seem to leave any marks. The angled infusion sets left scar marks on my skin. The 90 degree sites have not. I use the metal sites now, because I have an allergy to the soft plastic ones. The metal one's are more like a needle. They don't seem to be leaving any marks so far.

4. Do adults ever forget their diabetes bag (one with blood sugar testing/emergency snacks etc)?

Absolutely. Those things are so everyday for people dealing with diabetes... it's kind of like forgetting to brush your teeth when you're in a hurry... And, actually, I've forgotten to put my pump back on twice in the past five years that I've been wearing it. I realized pretty quickly. It was more a pain than anything, because I had to go back home to get it. My biggest worry is not having food/glucose on hand if I go low. So, I have little key chain fobs with glucose tabs on my bags and one on my glucometer, so it makes it harder to not have some low supplies around in case I need them. They look like this:

I also keep a bit of money in my glucometer case, just in case I forget my wallet and need more food than I have to treat a low.

5. Have you travelled lots and lots? Any problems? (She’s a big world traveller)

I don't travel a super amount. The bit that I have has all been good. I just make sure I have extra supplies, both in my luggage and any carry-on (if I am going on a plane.) I find going through security can be a bit intimidating with the pump. I've had some issues (because I’m silly and forget to take the clip off... so I end up setting off the metal detectors), but everyone else I know has had no problems.

6. How old were you when you could do it all yourself (testing, operating pump etc.)?

I've always done everything myself, because I was diagnosed at 15 years old. I've met some kids five years old who did everything themselves, but a lot of people take a bit longer to start doing it themselves. A lot of my friends with diabetes didn't start doing everything (or at least most things) themselves until they were around ten. It can be a lot to do on your own, but sometimes people start small... like they start testing their blood themselves and work with their parents to figure out how much insulin to give.

Questions from a six year old...

I received an email from a friend that is a nanny. The little girl she looks after was diagnosed with type one in the past year and just went on an insulin pump. Seeing that I too wear a pump my friend the nanny asked if she could forward me some questions. Feel free to chime in:

1. Has your pump ever fallen off/out while running/jumping /playing sports etc? What did you do?
2. Do people still ask about it/want to touch it/want to know what’s wrong with you, even when you’re a grown up?
3. Do you have lots of marks (I think she means scars…she’s starting to get a few), by the time that you’re old?
4. Do adults ever forget their diabetes bag (one with blood sugar testing/emergency snacks etc)?
5. Have you travelled lots and lots? Any problems? (she’s a big world traveller)
6. How old were you when you could do it all yourself (testing, operating pump etc.)?

Hanging out with insulin pumper extraordinaire, Dr. John Walsh...

(And by 'hanging out with' I mean 'in the audience of a presentation by'.)

So, yay! John Walsh was in Toronto last week doing a few presentations. I packed my bags and travelled for a whole hour out to a convention centre around Pearson Airport for his last session... at 9am on a Saturday morning. Despite the early rise, however, the room was pretty packed and I had trouble finding a spot to sit.

The early presentation began in pretty much the same fashion that every person with diabetes starts their day: numbers. The first topic for discussion was the Actual Pump Practices study, whereby the data of 396 pumps with meter results input were analyzed. The data was divided into three categories depending on the average blood meter glucose results: 

• Low Third- 144 mg/dl (8.0 mmol/L), 
• Mid Third - 181 mg/dl (10.0 mmol/L),
• High Third- 227 mg/dl (12.5 mmol/L.

The results were kind of interesting (even without caffeine), because in terms of behaviour all three groups were similar. 92.7% used the bolus calculator to cover meals and 96.5% were using the calculator to correct high readings. People in the lowest blood glucose group were testing their blood an average of 4.73 times per day; while, similarly, those in the high group were testing 4.01. The only noteworthy differences between the lowest and highest groups were that the latter tended to be using greater amounts of insulin, and infusion set failures/occlusion errors appeared to significantly raise blood glucose averages. From this there was a conclusion that high blood glucose results were not necessarily a matter of people not trying to manage, but rather those people needing more insulin, or losing insulin from set malfunctions.

The next topic my new BFF Dr. John Walsh discussed was how to go about fine tuning your pump settings in order to gain the best control you can of your diabetes. On paper, this looks like:

1. Stop lows first
2. Find an iTDD (improved total daily dose- using chart from the new Pumping Insulin)
3. Set and test basals
4. Set and test Carb Factors
5. Lower post-meal blood glucose
6. Set and test Correction Factors

However, in real life my new BFF Dr. Walsh likened all the data needed to analyze and manage diabetes to a Jackson Pollack painting. It was funny...

The rest of the presentation was essentially about steps 1-6... But here are the points that struck me the most:

• small carb factor changes make a big difference- ex., a person 73kg (160 lbs) has a TDD of 40 U (<--- I don't actually know what weight has to do with anything, but I wrote it down, so I feel like it was important somewhere?) Said person changes from 1U per 10g CHO to 1U per 9g CHO. On avergage people from the APP study ate 190 grams of carbohydrate a day. Assuming this average, changing that carb factor puts another 21 units 2 units (forgot subtraction!) on the person's TDD.
• try not to eat if your blood glucose is over 8 mmol/L (144 mg/dl)
• half of the protein you eat turns into carbohydrates
• some fats seem to provoke insulin resistance (I heard something about cheeses and then I tuned out, because I can't eat dairy. Sorry)
• setting the duration of insulin action on your pump is important, because setting too short a time is a recipe for later lows 

And this one made the whole room gasp: A woman asked how she could avoid so many bad infusion sites. New BFF Dr. Walsh asked if she used a set with an auto-inserter. She said yes. He said stop using those... because they way that they are cocked means that they are difficult to get to go in straight and without kinking. (And from my experience those suckers tend to bleed into the canula more times than not.)

With respect to infusion sites, there were also these recommendations:

• Sure-T/Contact Detach, Sof-Set, and Silhouette are more reliable infusion sets
• always anchor the line with 1 inch tape to reduce irritation and tugging that can cause insulin small leaks at the site
• suggested tapes were: durapore, transpore, hypafix
• when you have a site failure and your blood glucose shoots up (to the sky) don't forget that you were not getting basal along with whatever you carbs you might have bolused for... you, therefore, will likely need more insulin to get your blood glucose down to target.

So, that was that. In a nutshell (<--- no carbs!) My favourite part was during break when a woman went up to ask about her up-and-down blood glucose readings that she'd been trying to get under control with the help of her CDE. He asked her a few questions and then asked if he could look at her pump settings. Occassionally he would look up and say, "Do you have x, y, z happen?" and she would respond, "Yes, that's exactly what happens." And he'd change a setting and explain. I like to think her blood glucose is a constant 5.5 mmol/L now and forever. She should probably never wash her pump again.

They gave away a few copies of the new 5th edition of Pumping Insulin at the end of the morning. I didn't get one. I kind of imagined that after the draw someone would stand up and pull an Oprah, yelling for everyone to look under their chair to find a copy of the book... "AND YOU GET A BOOK! AND YOU GET A BOOK! AND YOU GET A BOOK!" And we'd all lose our shit, just like on the show... But that didn't happen either. 

In the end, though, I was just really happy I got to hear from what could maybe be define as the rock star of pumping insulin (too much?) He was pretty engaging and generous with his knowledge. Even during break he didn't stop to get anything to eat or drink, but instead made sure he got to everyone's questions. I hadn't realized that he also has diabetes and has been on what seems like every pump imaginable over the years. Because of that he would make the occassional reference to diabetese, like the Pollack-type BG graph joke or talking about type 3's (aka 5.5ers or support people without diabetes.) So, despite the early start time and the rather obscure location and the no free book under my chair issue, I found it was really good times and learning.

It's been a while...

Sorry, friends. I've been neglecting you. I needed a diabetes break. A long one... well, as much of a break as you can get from diabetes. It was just that after writing my research up for my Master's and participating in real life diabetes relations and trying to keep up online... I got really REALLY sick of thinking and talking about diabetes ALL the time.

After hanging out at this year's Slipstream I'm feeling a bit better about things. So, I thought maybe it was time to start posting things again. I hope you forgive me for being away so long and without any notice. I promise to be better about keeping in touch.