Save the Fingers!

I finally ordered the Dexcom7 and am now eagerly awaiting its arrival early next week. This should cut down on the testing I do while at work, when my blood sugars are typically very stable or dropping (as of late), and should also make things easier on the bike. During Ironman Coeur d'Alene last year, it was working well enough for me to stop using the BG meter for a couple hours. And that was the STS version--I think the 7 should be even better. Also, I am excited to be able to prevent some of the lows that I have been having lately. With the increase in exercise load, and the drop in weight, things are in constant flux. Adjusting my nighttime basal rates should be easier as well--I know from previous experience that it is possible to be decent at 2-3 AM (when I often wake up and test) and still have significant fluctuations at other times. The next hurdle will be to get some reimbursement from my insurance, which may be more difficult than my 100-mile ride on Saturday.

Update on CGMS, Symlin

So now that it's been over a month since I started using the Dex and nearly a month since starting Symlin, I thought I would give an update.

Dexcom
I have enjoyed having the Dexcom, but have also experienced frustration with it. When it works well, I don't have to check my BG as much, and I use the data to reign in my BG swings and uncover trends. But when it is not working well, I want to hurl it across the room. I get pouty and refuse to look at it. But then I put in a new sensor and, lo and behold, it is working well again. I love it! Right now Dex and I aren't talking. Or, rather, Dex isn't talking to me because all I see on the screen is "---" meaning that for some reason, the sensor isn't picking up any readings fit to report. Ask me again in a few days and I'll probably tell you it's the best diabetes gadget since the pump. (Note: Dexcom has been very good about replacing sensors that don't work well, whatever the cause.)

I have been able to use it successfully on many bike rides at this point, and it has tipped me off to rising BG's long before I would have caught it with my BG meter. Also, it has helped to uncover some high BG trends that I have following swimming. I discovered that, although my BG could be decent immediately following a 70-minute swim workout, it then tends to rise rapidly. This is due to the fact that I disconnect my pump while I swim and shower, so I go about 1h40min without any insulin (other than the small bolus I take immediately prior to disconnecting). I have modified my regimen to take a larger bolus after swimming, and am experimenting with taking a larger bolus before I get in the water.

Also, I have been able to get a lot more overnight data, which has helped me to bring my overnight highs in a bit better.

This all, in principle, should make my A1c better, right? Unfortunately, after a recent check, it seems to have risen in the same period of time since I got my Dexcom. That was a sad day for me. But I suspect that part of the reason is that I have been fiddling around a lot with basal rates and Symlin, which leads me to my next update.

Symlin
I have tolerated the Symlin well. I increased the dosages as recommended and am now taking the full 10 unit (60 ug) dose, 1-2 times per day. I never experienced any nausea or other symptoms at the lower dosages, but do sometimes experience it at the current dose. When I do, it is very mild and is more of a feeling of fullness than nausea. I went out to eat one night and, after an amount of food that I would typically eat at this restaurant, felt like I would seriously throw up if I ate even one more bite. This is not a typical feeling for me. So, in general, I would say that it has mildly suppressed my appetite after a meal. I wonder if this will be a lasting effect, or if it will fade with time.

With regard to keeping my post-meal BGs under better control, I'm not so convinced. I need to do a few more controlled tests to see how it is working. It may be helping after breakfast, but there are other variables, such as insulin delivery timing, that might also be playing a role.

I did realize though that I have gotten used to not taking shots! I hate it! And it seems to hurt more than I remember. What happened? I used to not think twice about it. I'm convinced the needles are less sharp than they used to be! And why am I dutifully following the instructions to use a new syringe for every injection? I never used to do that.

So far I haven't been able to decrease my insulin bolus for breakfast; when I review my total daily dose history on my pump, though, it does show a reduction since I started on Symlin. I suspect this is due more to a reduced appetite than to a reduction of insulin for a given amount of carbohydrate.

I'm hoping the claim that Symlin reduces the amount of glycogen released by the liver is true and will somehow save me more energy for exercise! I suspect any effect would be minimal.

I have noticed on 4-5 occasions a sort of strange feeling in my chest approximately 5-10 minutes after taking a Symlin shot and have had some paranoid diabetic hypochondriac thoughts that it is going to give me a heart attack or somehow result in cardiac complications. But maybe this is more likely to be the result of me keeping my heart rate at 185 for 20 minutes while climbing King's Mountain on my bike! It is a new drug, though, and sometimes I do worry about unknown side effects.

Biking with Dex

One of my major motivations for purchasing a DexCom was to help me improve my BG management during my training for and racing of Ironman Couer d'Alene. I've been able to use it on a few bike rides now, and a couple of runs. I am withholding final judgement on its performance at this time; although I can say I have experienced both enthusiasm and disappointment.

This past weekend, I had a wonderful ride in the Bay Area, starting near Woodside, CA, riding up and over Skyline, down to the Pacific Ocean, and back up and over and down again, back to Woodside. The ride starts out with about 15 miles of rolling, mild grades, followed by about 4-5 miles of a moderately steep climb (Old La Honda for those who know the area). Once up on Skyline, the descent is long and fast and fabulous (maybe about 15 miles)! We kept up a pretty high cadence during the descent along 84W. After a quick ride along Highway 1-North, we started back up the mountain through Tunitas Creek--a very steep 3-mile climb followed by another 3 miles of climbing a more moderate pitch. Down we went on King's Mountain Road and then wound our way a few miles through Woodside and back to the start along Canada Road. The total distance was about 52 miles.

I'm including a graph showing the DexCom values and my BG values during the ride. I ate a banana around 8 AM and took about half of my regular dose. Later, after noticing that my BG's were rising more than I was happy with, I took my full dose. We started riding around 9:20 AM. Unfortunately, the software doesn't have any other graphing options for the time axis, but somewhere around 10 AM I noticed that my BG was falling, much more than represented by the DexCom. I ate a Luna bar + 1 GU and didn't take any insulin. You can see the large peak from this snack. I am so worried about dropping low when I exercise that I often end up having some hyperglycemia. I didn't take any insulin for the rest of the ride, but did eat another Luna bar and a couple more GU's at some point. We finished riding sometime around 1:30 PM.

What I might do next time is eat just the Luna bar or the GU and then eat again in another 40 minutes. I've learned that I do often overreact to falling BG's and that it doesn't always take a huge intake of carbohydrates to correct it. I have had an experience in a race where I ate several GU's, a PowerBar and a bag of Skittles and still had a hard time keeping my BG in a decent range. But this was probably due to eating too little earlier on, given the intensity of my ride. I think that, as long as I haven't had a huge insulin bolus recently, I can probably keep my BG's stable on an ride with carb intake every 30-60 minutes, depending on the intensity of the ride.

My Kind of Crackberry?

If you haven't heard, many people give the popular phone/PDA Blackberry device the nickname of "Crackberry." Here is a good description of why the Blackberry earned such a nickname: "CRACKBERRY: Another name for the Blackberry that refers to its addictive nature and the inability of its users to focus on anything else for more than 10 seconds." Another article by ABC compares the Blackberry addiction to other serious addictions like alcohol or drug abuse. There are even rehab programs developed for people with email addictions.

It's been 2 days with the DexCom now and I have to wonder if I can leave it alone for more than 10 seconds... or at least long enough to check my email.