Tuesday, August 23, 2011

High Blood Sugar and DKA

I have talked a few times about low blood sugar, so now I will go to the opposite end of the spectrum and talk about high blood sugar.

For me, High Blood Glucose (Hyperglycemia) can happen because I haven't taken enough insulin, I am stressed out or sick.  The main symptoms are increased thirst and frequent urination, but when my blood sugar is high I also can get lethargic and/or crabby.

Hyperglycemia happens to all diabetics at some time.  This is normal.  The problems occur when your blood sugar is high continuously.  Hyperglycemia can bring on a very dangerous problem called Diabetic Ketoacidosis (DKA.)  DKA occurs when the blood sugar is high because of an insulin deficiency (which makes sense, because without insulin a diabetic has no way to bring their blood sugar down.)  Rather than trying to explain it myself, here is a definition from mayoclinic.com:

"Sugar is a main source of energy for the cells that make up your muscles and other tissues. Normally, sugar enters your cells with the help of insulin. If you don't have enough insulin in your body, your body won't be able to use sugar for energy. This prompts the release of hormones that break down fat as an alternate fuel. In turn, this process produces toxic acids known as ketones. Excess ketones accumulate in the blood and eventually "spill over" into the urine."

Symptoms of DKA include:  frequent urination, excessive thirst, vomiting, dry mouth, confusion, increased heart rate and rate of breathing, and the most distinctive, a fruity odor on the breath.  DKA can be confirmed at home by taking a simple urine test using a urine test strip.  Spilling ketones into your urine is serious and you should contact your doctor if this happens.  Normally, if you are able to bring your glucose level down to normal, you will stop spilling ketones.  However, this is sometimes more easily said than done, especially if you are ill for a few days in a row.  If left untreated, DKA can be fatal.

Complications of long term hyerglycemia include:  blindness, amputations due to nerve damage, heart disease and kidney disease.

Ugh.


Sunday, August 7, 2011

Matt Saves the Day!

Last night Matt and I went to our neighbors house, sat on their porch and had some drinks.  We got home at about 11:30.  I knew my sugar was running high (from my Dexcom) so I tested and needed to take 3.75 units of insulin.  I only took 1.75 units because alcohol tends to make my sugar go lower.

I woke up at 1:30 to my Dexcom BEEP BEEP BEEPING at me, I grabbed it and looked at the screen and it said that I was low (under 70 mg/dL.)  I got up out of bed, mad, tired and just plain irritated.  Came downstairs and remember we didn't have any orange juice or Capri Sun left in the fridge (which is just plain dumb of us) so I opened the cupboard to grab my glucose tablets and remembered that I had left them in my van (I had gone to Zumba in the morning and had taken them along with me.)  So now I am really crabby, grab my keys, go out to the van, get my tablets and sit down at our island and start crunching them.

Meanwhile my hubby had gotten up and was going through the cupboards looking for something to give me.  He was asking if a sandwich would help, or a cookie.  I kept saying "NO!!!" and yelled at him more than once (low sugar talking.)  He stopped and looked at me and said, "Stop yelling at me!"  I had taken 4-5 tablets and started in on eating some peanut butter crackers (rule of thumb for treating a hypo: fast acting sugar, followed by carb + protein) and all of a sudden I can feel this wave coming over me.

I am starting to sweat.  It started with my forehead, then my arms, then I could feel it dripping down my chest.  I looked at Matt and told him, "I need something, these tablets aren't working fast enough!"  Now the back of my neck is sweating and I can feel my hair getting wet.  He looks at me, takes the keys and drives 2 blocks to a local bar to grab some pops.  He was gone for 5 minutes at the most.  By the time he got back, my shirt was completely drenched, my hair was drenched, my shorts around my waistband were soaked, and I had sweat dripping off of me onto the island.  I had my head in my hands and I just wanted to lay my head down and sleep.  He walked in and gave me a Pepsi, I couldn't even open it, he opened it and I slugged 1/2 of it down.  Within seconds I could feel the difference.  The sweating let up. My head started to clear.

It is amazing how fast it came on.  Thank goodness my Dexcom woke me up!  I took another swallow of pop, then we turned out the lights and went back upstairs.  And, I thanked Matt for getting the pop, and apologized for yelling at him.  Told him I didn't really mean it.  Luckily, he understands and doesn't take it personally.

Wednesday, August 3, 2011

My Buddy Chase

Today Chase and his brother Nolan came over to our house to spend the day.  Like me, Chase has T1 diabetes.  He is 6 years old and was diagnosed at age 3.  He also has a One Touch Ping insulin pump and glucose meter.  This kid is amazing!  He tests his sugar and does his own boluses all without complaining.  The kids all wanted to have a Flavor Ice, and since I did not have the original box I wasn't sure how many carbs there were in one popsicle.  I hopped on Google and found out one Flavor Ice has 6 grams of carbohydrates.  I told Chase he could have one because I figured out how many carbs it has and he said, "It has 6!"  DUH.  I should have just asked him to begin with!  Being around Chase today made me see (again) that you just have to move on and deal with it.  Yes, we have diabetes.  Yes, it is hard work.  Yes, it stinks.  However, we can see, hear, walk, talk and think.  It won't stop us from living a good life, having fun and being happy!!!

Here we are with our matching pumps:

 

Hooray for One Touch Pings!

Tuesday, August 2, 2011

CGM: Continuous Glucose Monitor

In May, I got a CGM (Continuous Glucose Monitor.)  It keeps track of my glucose level 24/7.  I use a Dexcom Seven Plus.  It consists of 3 parts:  sensor, transmitter and receiver.

The sensor is a small, round, flexible wire about the size of 2 human hairs.  It is inserted under my skin by a small needle into my stomach or love handles, and looks like this (the small wire sticking up in the air:)


The transmitter is like a mini computer.  It sends all of my glucose information to the receiver.  The transmitter snaps into the sensor and then adheres to my skin.  It looks like this:


    
The receiver is what collects and displays my glucose information.  It is about the size of a cell phone and I usually keep it in a pocket, purse or sitting next to me.  It needs to be within 5 feet of the sensor in order for it to work or else an "Out of Range" error message will display on the screen and it BEEP BEEP BEEPS!!!  It looks like this:






















The CGM has been wonderful for me!  As I mentioned in my last entry about hypoglycemia, I have hypoglycemic unawareness.  This means I do not get symptoms when my sugar is getting low.  I have had 4 serious hypoglycemic events  in my years with diabetes.

The first was 4 years ago.  I was supposed to go to a wedding shower out of town, so my Mother-in-Law was coming over to pick up 2 of my children for baseball.  She came in and asked the boys where I was and they told her I was still in bed.  She came upstairs and said that she could smell my sweat (The Sweat Fairy visited!!!) before she even came into my room.  I was incoherent (and don't remember anything...) but with some help from Matt's Grandma they were able to get me to drink some orange juice and I came around.

The second was about 3 1/2 years ago.  Again, it happened in the early morning hours.  My husband ended up calling home and my oldest son answered the phone, and told him I was still in bed.  My son brought the phone upstairs and my husband could tell by my speech (slurred, almost like someone that is drunk) that I was low and he called my neighbors who are EMT's and they came over and were able to give me glucose gel and I came around.  Of course, the sweat fairy had visited again!

The third time was almost 3 years ago.  I remember it was a Friday.  I got up and got busy around the house and didn't eat breakfast or lunch.  The last thing I remembered was that Days of our Lives finished (2:00) and then when I woke up I was in the ER.  Matt said I called him at work at 4:00 and asked him to pick up a pizza for dinner and he brought it home at about 6:00 and found me unconscious on the couch having a seizure.  He immediately called the ambulance.  I got IVs of glucose because I couldn't swallow anything.  This was the scariest of the events because I have no idea what I did all day.  I don't remember anything past 2:00 and yet I called Matt and had a conversation with him at 4:00, and he did not notice that anything was wrong.  I have no way of knowing what time I went on the couch, but from 2:00-4:00 I know I must have been awake...what did I do? 

The fourth time was just in January.  We had a 2 hour delay from school because of snow.  I remember getting the first phone call from the school which was around 5:30 am.  I told Matt that there was a delay and went back to sleep.  I heard Matt get up and leave for work.  Then the school called again (around 8:00??) and said that school was canceled.  I remember yelling, "BOYS!  School is canceled!" and that is it.  When I woke up again there was commotion in my room, Matt was there, our old neighbors (the EMT's) were there and I had no idea what was going on.  I remember drinking some orange juice.  Matt said I was crazy, combative and hitting him and yelling at him.  After I drank a few swallows of juice (he said I refused to open my mouth for anymore ~ don't remember any of it) he tested my sugar a few minutes later and it was 34.  That was AFTER orange juice.  I got taken out to the ambulance and to the ER again.  I started to come around a little bit when I was getting put into the ambulance and did have a conversation with the EMT's.  I was sent home about 2 hours later, extremely embarrassed, clothes still wet...stupid sweat fairy again.

Every single one of those times I was so lucky.  Lucky that someone came over and found me or called.  I truly believe that if Matt hadn't shown up when he did the night he brought the pizza home, I would have died.  What scares me the most is that each of these times I was at home alone with my 3 kids.  Thankfully my kids are very independent and the older two take good care of their little brother. 

My CGM beeps at me when my blood sugar gets below 70 mg/dL.  It will beep at me again if it gets below 55 mg/dL.  It wakes me up during the night so that I won't have major problems with low sugar in the morning (which is what caused 3 out of 4 of my major events.)  If I was unable to wake up and push one of the buttons, it would continue to BEEP BEEP BEEP so that it would wake Matt up and alert him that something was wrong with me. I still need to check my sugar on my regular glucose monitor (in order to calibrate my level with the CGM) but I don't mind doing that because having my CGM has definitely made me feel more secure, even if it is a little more work!

Thursday, July 28, 2011

Gonna Go Low, Low, Low

Low blood sugar ("hypoglycemia") is when your glucose level is under 70 mg/dL.  This can happen for different reasons:  taking too much insulin, exercising or not eating.  Symptoms include: sweating, shaking, fast heart beat, hunger, confusion and feeling nervous or jittery.  Here is a chart which shows the categories of hypoglycemia:

Category Blood Sugar Level
Normal 80 - 120 mg/dL
Border Line Hypoglycemia 70 mg/dL
Fasting Hypoglycemia 50 mg/dL
Insulin Shock Less than 50 mg/dL

To treat hypoglycemia (and bring your blood sugar up to at least 70 mg/dL,) you need to consume a sugar that is easily absorbed so that it works in your body quickly.  Some ideas are: juice, non-diet pop, life savers or glucose tablets or gel.  I usually drink 8 oz. of orange juice, suck down a Capri Sun or eat 4 glucose tablets.  After 10 minutes you should check your blood sugar again and if it is still not above 70 mg/dL then you would treat again.  If it doesn't come back up after 3 treatments, it is probably time to take a trip to the ER.

Insulin shock occurs when your blood sugar level falls quickly and leads to unconsciousness.  It is the severest form of hypoglycemia and it is considered a diabetes emergency because if left untreated it can be fatal.

Like all diabetics I have experienced hypoglycemia at some point.  It is not a pleasant feeling.  I have had times where I get confused and can't think straight.  I remember a time right after I had started taking insulin that I woke up in the night and knew my blood sugar was low.  I knew that I needed to get a glass of orange juice.  But, I could not make myself go downstairs and get that stupid juice!  I woke my Mom up and told her I need o.j. and she and I went to the kitchen together.  If you are ever around me and notice that all of a sudden I get quiet, can't seem to focus or remember what our conversation is about, or if I tell you, "I can't remember what I was saying," my sugar is probably low.  Just ask me, "Are you low?  Do you need some juice?"  I won't mind you asking.

About 17% of T1 diabetics suffer from hypoglycemic unawareness (which simply means you do not feel any symptoms when your sugar gets low.)  I happen to fall into that 17% the majority of the time.

Now that you are educated on hypoglycemia (low blood sugar,) you can understand the name I chose for this blog.

"A Visit From the Sweat Fairy" is a diabetes term of endearment.  As I said earlier, a symptom of hypoglycemia (a "hypo") is sweating.  So a visit from the sweat fairy simply means that your blood sugar is low enough for you to feel sweaty.  When you get a visit from the sweat fairy during the night (a "nypo"), you wake up with your shirt and sheets soaking wet, and usually freezing cold.  Sounds pleasant, right?

Tuesday, July 26, 2011

Meter Reader

Yes, I moonlight as a Meter Reader.   My meter reads my blood glucose level.  I put a test strip into the meter, poke my finger with a small needle (lancet) and put a drop of blood on the test strip.  The blood gets sucked into the strip and in a few seconds the meter "reads" what my blood sugar level is and displays a number on the screen.  According to WebMD, a fasting blood sugar (not eating for 8 hours) should be 70-99 mg/dL, a postprandial blood sugar level (2 hours after eating) should be 70-145 mg/dL and a random blood sugar level should be 70-125 mg/dL.

My blood sugar goal is 100 mg/dL.  It seems like I rarely meet this goal.  OK, I hardly ever meet this goal.  In fact, I hardly ever meet any of those recommendations.  I am supposed to check my blood sugar 4 times a day (fasting, before lunch, before dinner, before bedtime.)  Some days I do this and some days I don't.  Let's just say that I do much better testing myself when I am on a schedule during the school year (having the summer off tends to make me get a little bit lazy!)

The wonderful thing about my meter-remote (One Touch ping) is that it works together with my insulin pump.  "Blood glucose results, bolus calculations, and bolus delivery instructions can be sent from the meter-remote to the insulin pump from approximately 10 feet away.  In fact, the meter-remote can actually calculate a bolus, and then tell the pump to deliver it - so your pump can be tucked away when you choose.  There is no need to pull out the pump - it can stay clipped to a belt, tucked in a pocket, or stashed under clothing" (http://www.onetouch.ca/english/prodsubpage_detail.asp?cat=1&gr=3&pid=60&prs=19.) 

Basically this means that I can give myself insulin by just using the buttons on my meter-remote, without even touching my pump!  This is a new feature to me, since I got my One Touch ping pump and meter in February.  I love, LoVe, LOVE this feature!!!

Here is my meter-remote


And here are my test strips (the bottom part goes into the meter and the blood goes into the top)













Thursday, July 21, 2011

I'm a Pumper!

All quotes are taken directly from the American Diabetes Association (http://www.diabetes.org/.)

“In type 1 diabetes, the body does not produce insulin. Insulin is a hormone that is needed to convert sugar, starches and other food into energy needed for daily life. Only 5% of people with diabetes have this form of the disease.

Inside the pancreas, beta cells make the hormone insulin. With each meal, beta cells release insulin to help the body use or store the blood glucose it gets from food. In people with type 1 diabetes, the pancreas no longer makes insulin. The beta cells have been destroyed and they need insulin shots to use glucose from meals.”
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From 1999-August 2002 I took insulin shots.  I got married in June 2001 and became pregnant 2 months later.  I had our first son in May 2002.  Having diabetes and being pregnant is a whole other blog entry…I will get to that eventually.  My OB/GYN strongly suggested that I consider going on an insulin pump after the baby was born, especially if we wanted to have more children (which we did.)  So when Ethan was 3 months old, I started on my first insulin pump, a Mini Med Paradigm 511.

Insulin pumps are EXPENSIVE, just as about everything else having to do with diabetes.  My first pump was in the range of $6,500.00.  Luckily, since I had just had a baby, I had met all of my insurance deductibles and so my out of pocket cost was $0.00 and all of my other supplies were covered at 100% for the rest of the year.  Having a good insurance plan is a MUST for diabetics!

I got trained on my insulin pump and in no time I was pumping away!  It was much better than taking anywhere from 3-5 shots a day.  With an insulin pump, the insulin is given from the pump through a clear plastic tube into a catheter, which is under my skin.  You are supposed to “change the site” of the catheter every 3 days (called an “infusion set”; using a needle to insert the catheter) but I don’t do it that often.  The catheter can be placed in my stomach, love handles, or the top of my thighs.

I am on my third pump (they are warrantied for 4 years) and now I use a One Touch ping.


Here is how I am wearing my pump today, the catheter inserted into my right love handle. 


The tubing can be removed at the catheter site at any time (for showering, swimming, etc.)


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“An insulin pump can help you manage your diabetes. By using an insulin pump, you can match your insulin to your lifestyle, rather than getting an insulin injection and matching your life to how the insulin is working.

How do insulin pumps work?

Insulin pumps deliver rapid- or short-acting insulin 24 hours a day through a catheter placed under the skin. Your insulin doses are separated into:
  • Basal rates
  • Bolus doses to cover carbohydrate in meals
  • Correction or supplemental doses
Basal insulin is delivered continuously over 24 hours, and keeps your blood glucose levels in range between meals and overnight. Often, you program different amounts of insulin at different times of the day and night.

When you eat, you use buttons on the insulin pump to give additional insulin called a bolus. You take a bolus to cover the carbohydrate in each meal or snack. If you eat more than you planned, you can simply program a larger bolus of insulin to cover it.

You also take a bolus to treat high blood glucose levels. If you have high blood glucose levels before you eat, you give a correction or supplemental bolus of insulin to bring it back to your target range.”