Lemonade Life

Monday, September 04, 2006

New Discoveries

Discovery #1: Adventures in DexCom

Last Wednesday I was given a trial of DexCom by the Nice Folks at OHSU. Now, the insurance company pays for it for 3 days, but since the third day was a Saturday, and it's Labor Day weekend, I actually get to wear it until tomorrow. Six whole days of DexCommy good fun.

Or was it?

Ok, so last week, Amy commented that people were firmly planted in the Upstairs or Downstairs group with little room for movement. For the first couple of days I was definitely in the upstairs group.

Here's why:

1) It's a FREAKING CONTINOUS GLUCOSE monitor. Which is quite possibly the greatest diabetes invention since the pump. And anyone who say otherwise is either a cynic or stupid.

2) It trends nicely. Want to know if you're going up or down after a meal, Dex can tell you. This has proved exceedingly useful in the realm of Symlin and alcohol and it showed that neither is as predictable as one might assume and/or hope. In fact, part of me wants to give up Symlin entirely as I discovered that I could essentially not take insulin for two hours after taking Symlin and be just fine. And those lows with Symlin may not have had been bad carb counting, but the Symlin actually dropping me. 10 units of Symlin with dinner, no insulin, and in one hour I went from 250 to 115. Watching the blood sugar while drinking has also proved beneficial, though slightly confusing, and it's nice to see where you are headed without having to test every 15 minutes.

But after a few days, I'm starting to feel myself walking down the stairs. Here's why:

1) First and foremost, accuracy. It's the issue on everyone's mind, and while the trends were always right on, Dex didn't necessarily know where you were coming from and where you were going, just that you were, indeed, going. Some of the readings were within 10 pts, which fits with the standard variation between meters, but most of the time they were 20-30 pts. off, and sometimes as much as 50-60, especially the higher I got.

2) It's a second contraption. I know being on the pump should make me somehow adaptable to carrying around gadgets all the time, but honestly, bringing that Dex around is kind of cumbersome. The thing is not small (it's bigger and wider than a pump, but it is thinner) and the thing has the dumbest case in the world with a clip that doesn't really clip.

3) Losing signal. It didn't happen so much Wednesday, Thursday and Friday, but as soon as Saturday hit, I started receiving gaps in readings. I don't know how common this is, since no one has mentioned it before. I have also had to restart the sensor twice (in addition to the usual 3-day restart that you do get more life out of a sensor). Because of this, I'm not sure how it affects the accuracy of the Dex.

4) Information overload. Honest to God, looking at the numbers for the first day or two is really, really cool, but after awhile, I think I'm starting to get a little more freaked out. You see every single little change in blood sugar. Up and down and up and down and up and down. I don't know where half the change is coming from but boy does it like to change. And with aforementioned accuracy issues, I don't even know if the changes are actually occuring!

Edit: I forgot one more.
5) The sensor essentially stopped working in the middle of the night on Saturday. I wasn't sure what it meant so I tried to restart it and do the calibration again, but it basically was way off for all of Sunday. It still did the trends fairly good, but the numbers were ridiculously off, and there was nothing I could do because I didn't have another sensor to use.

So those have been my 5-day observations of the Dex and although the Downstairs points seem to outweigh the upstairs, I think I might be the rare breed of the Sitting on the Stairs Folk.

I like CGMs. Really, I do. It's definitely given me some useful information about how my body reacts to Symlin and to alcohol and hopefully I'll be able to figure out how to integrate this into my plan.

And perhaps some of these issues would work themselves out if I had more time to get used to the Dex. I am only on it for 5 days, which really isn't a fair assessment of a CGM.

There are major bugs to be worked out and hopefully The Next Generation of DexComs and Guardians, and the impending Navigator, will yield more promising results. It's kind of like signing up for the very first insulin pump... And if any of you have seen pictures of that monster, all I can say is: Scary!


Discovering #2: Alcohol Is Verrrry Tricksy

I'm glad that I'm finally legal and can talk about this without worrying about the legal ramifications of discussing underage drinking on a public website.

One of my very good friends, Julia, turned 21 yesterday (Happy Birthday to Julia!). And of course, we went out and drank. On Saturday and on Sunday.

Both nights fucked up my blood sugar.

Saturday, one drink dropped me two hundred points in two hours and on Sunday, two drinks brought me up 150 points in about two hours.

Now, I know that really the only way to figure this out is to do a very scientific experiment of drinking the same thing each time to see how different insulin amounts affect it. I know the kind of drink, the food I'm eating, etc. etc. all affect blood sugar.

But I was hoping the, uh, older people of the O.C. could help me out a bit by giving me some suggestions, tricks, carb counts, basal settings that might work... Anything.

The recommended (to me at least) 60% basal for 2 hrs per drink fails miserably. I'm in the 300s after an hour and I don't crash until hours later, if at all.

I tried 80% for 4 hrs on Saturday, and I ended up at 78 after 5 hrs. Since I was having twice as much to drink, I tried 70% for 7 hrs, and I woke up at 336.

There has to be a happy medium to this, and dammit, I will find it!

But suggestions are always appreciated.


At September 04, 2006 7:25 PM , Blogger Keith said...

Please be careful with the alcohol thing. You are a brillant, talented young women poised to launch your ship onto the sea of life. You have the attention of the D community and appear to have the attention of several D business people, too. I would hate to see some difficult scenario (diabetes related or otherwise) come your way because of something as non-essential as alcohol.

Wishing for you the best!

At September 04, 2006 7:28 PM , Blogger Allison said...

That's very sweet of you to say, Keith, but unfortunately it's a little early in the game for me to give up drinking entirely! I rarely had alcohol before I turned 21, and now that it's here, I'd like to give it my best effort before giving up entirely. I know diabetics can have alcohol as long as it's planned out (just like everything else in life), so I'm going to try to intelligently work the occasional drink into my system before calling it quits.

But I appreciate the compliments! It always means a lot.

At September 04, 2006 8:26 PM , Blogger MileMasterSarah said...

I drink red, dry wine and set a 3 drink limit, or I do a 3 drink limit on light beers. Anything else is too screwy, with the initial jump and then later on the drop in glucose. I don't have to take insulin with the wine or the light beer, so very little sugar, so it works perfectly. I say keep experimenting until you find something that works for you, but set a limit on number of drinks, because once you go past a certain point, you aren't going to be much use in figuring out those sugars.....

At September 05, 2006 11:15 AM , Blogger Lori Rode said...

I can't offer much help, because of course, I'm Type 2, which is so different. I would remind you (and me!) that booze is not required to have a good time or to enjoy myself. I have to watch the sugar content, because I don't like beer or wine. I like booze that tastes like Kool-Aid. Hang in there, and do your experiments in a controlled environment when possible. Says Lori, who was drinking coconut flavored rum with pineapple juice just last night on her own couch. DH had pina coladas. Yummy. It did screw up my sleep patterns though...

At September 05, 2006 12:58 PM , Blogger jill said...

hey i'm 21 too! don't let D limit your ability to go out and have fun! if i drink light beer, i've found that i don't have to bolus at all b/c the initial high is countered by the drop later. i do correct for mixed drinks that have fruit juice in them, but i generally cut my correction factors in half. if i'm high before i go to bed, i only take half of my normal correction dose. it's trial and error and everybody's different, but figure out some drinks that are predictable and be a normal college student from time to time :)

At September 05, 2006 12:59 PM , Blogger jill said...

and also make sure that you have someone around that really understands your diabetes, so they'll know how to help you if you need it :)

At September 05, 2006 9:52 PM , Anonymous Em said...

I prefer beverages that don't taste like alcohol which means they also contain more sugar. The one consistent reaction I have is a delayed crash, skydiving down to the 30s hours later (usually in my sleep). Unless I stuff my face before bed and then wake up high, and even then I still crash sometimes. So I am curious to see what advice everyone gives you.

I think I read somewhere that exercise earlier in the day can contribute to the lows after drinking because your glycogen stores have already been depleted from the exercise.

Sucks that we have to constantly be responsible and not just have fun. Occasionally, the fun is worth the accompanying roller coaster. Enough rides and maybe we'll figure it out.

Good luck!

At September 06, 2006 1:05 PM , Anonymous anja said...

being a typical university student in Denmark, I must say I've had my (many!) experiences with alcohol and heard of even more stories.
It rarely goes really bad - but be sure someone knows to call an ambulance if you pass out:-)

Anyway, I prefer beer - we don't have light beer, so I go for the regular. I don't do drink limits, but usually I'll be in the 300s at 3 am or so, take half correction and party on. Then I don't go low. Otherwise, I do my normal night shot of Levemir and go for mixed drinks with diet soda and a few regular drinks. Works ok for me, but also because I accept that blood sugar can't be perfect when I'm drunk!

Watch out for vodka shots, btw. They make you act stupid - and this time you won't necessarily be able to blame it on lows;-)

At September 08, 2006 3:04 PM , Blogger GaryK said...


I had a big *advantage* when I discovered drinking; the drinking age was 18, and I wasn't diabetic until several years ago at age 39.

Having spent 6 years in the Navy until age 23, I got it all out of my system then, and toned down the drinking. A diabetic CAN enjoy social drinking, just not the kind of binge drinking common now, and also 30 years ago when I started, as you know, of course.

I now enjoy 1 or 2 glasses of red wine with dinner, an occaisional beer, and mixed drink. I don't however have to take a bolus OR adjust my basal rates. My MAX limit though is 3 drinks. That's for me of course, a 165 pound male.

A trick I learned in my bar-hopping days in my 20s and 30s: Alternate water with alcohol, drink *slowly*, and always with food over a long period of time.

Good Luck!

At September 09, 2006 9:36 PM , Anonymous Tiffany said...

Hey, this Diabetic has enjoyed binge drinking since she was a teenager. (18 is the legal age in my corner of the world) And moreso when she was a teenager...lol.

Drinking falls firmly in the YMMV category so you have to figure out what works for you, Allison. But here's what I do:

Always ALWAYS eat something before/during/after drinking. High protein and complex carbs are best for both maintaining BG levels and aiding with glycogen storage.

I rarely drink beer when I'm out at the bar; I usually hit the hard stuff like gin and vodka. Since some of the drinks are mixes containing high amounts of sugar (like paralyzers) I don't temp basals either before or during the alcohol fest. I do bolus for mixed drinks, but I cut that bolus in half. And I make sure that I have a big glass of ice water at the table.

When you get home it's a good idea to eat (prior to going to bed, especially) and have another big glass of water. Best thing you can eat is bread with some protein; bread soaks up any remaining alcohol and the protein helps to slow digestion and prevent BG drops. Again, I use 50% less insulin for the bolus (factoring in BG level, of course). Prior to going to bed, I generally run a 50% lower basal rate for the estimated amount of time I'll be sleeping.

In my case, this routine generally works well in keeping BG's stable. Of course, blips are always possible so testing often throughout the night of revelry is a must.

And I always make sure that I have lots of glucose tablets on my person (while I'm out and after I've gone to sleep) and that I have a friend/family member with me who is aware of my condition.

Maybe the Dexcom will help you figure out the alcohol situation?

Happy birthday to your friend, Julia! And good luck, Allison!

At September 23, 2006 5:41 AM , Blogger art-sweet said...

Wellll, now little lady. Back in the 1800s when I was a young thing like you...

I did most of my partying before I was on the pump. Now that I am a sedate old lady I have a glass of wine or a beer (none of this light crap thank you very much) with dinner and don't notice much of an effect on my blood sugar. If I'm having a cocktail with lots of sugar like a mojito, I'll throw a few extra carbs into the bolus wizard just for fun.

Now did I tell you how I walked to school barefoot in the snow and it was uphill both ways?


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