We stopped at a beach off Route 1 near Pescadero, CA, to watch the sunset. In the east, a full moon was rising at the same time. It was a spectacular sunset on this first day of 2007.
Tuesday, January 02, 2007
Starfish Trail
I took this photo at a beach north of Santa Cruz, California on New Year's Day, 2007. We watched as the starfish, with its stiff pink arms, glided along the bottom of this tidal pool. He was cruising right along. Underneath the star arms were lots of little whitish legs. You can see the mark one his arms made in the sand as he moved along. The seagulls seemed to fancy eating these creatures, or at least catching them.
Tuesday, December 26, 2006
NY Times article on diabetes in the workplace
Today on nytimes.com is an article, "Diabetics Confront a Tangle of Workplace Laws," by N.R. Kleinfield. The author describes cases of discrimination towards diabetics at the workplace, and the laws that may or may not protect them. For example, the article describes a UPS worker who, after being diagnosed with type 2 diabetes and starting insulin, was fired because he could no longer obtain an interstate commercial driving license. (At the time, diabetics on insulin were forbidden from obtaining these licenses.) Even though he had not actually needed one of these licenses in the 13 years as a mechanic for UPS, it was company policy and they would not make an exception for him.
I have been fortunate to have very understanding coworkers who accommodate my diabetes graciously. Also, I try to control it in such a way that it interferes minimally with my work. But I can see how these issues could arrive in a work environment different from my own.
I have been fortunate to have very understanding coworkers who accommodate my diabetes graciously. Also, I try to control it in such a way that it interferes minimally with my work. But I can see how these issues could arrive in a work environment different from my own.
Wednesday, December 20, 2006
It's Winter in San Francisco
And by winter, I mean cold December, not foggy August. We've had a couple weeks of really cold temp's here. This morning on our run, we even came across some black ice! This was in San Francisco! Although I grew up in Utah and lived on the East Coast for many years, I became a complete weather wimp after one year in California. I've decided that we near the coast out here just aren't ready for cold weather. I just don't believe that it can really be that cold, so I don't dress appropriately. Whereas, if I looked out the window and saw snow falling, I would know that a hat and heavy coat just might be appropriate. Maybe we just need a little snow around here.
On Saturday, we stopped by Ocean Beach down near the SF Zoo to watch storm clouds rolling in. The Big Storm actually stayed off shore, and we didn't get much rain as had been predicted. But it was really windy! Walking outside was a painful affair, with sand being blown off the beach into my face. I took a couple shots with my phone's camera. Here they are:
On Saturday, we stopped by Ocean Beach down near the SF Zoo to watch storm clouds rolling in. The Big Storm actually stayed off shore, and we didn't get much rain as had been predicted. But it was really windy! Walking outside was a painful affair, with sand being blown off the beach into my face. I took a couple shots with my phone's camera. Here they are:
Okay, Don't Blame the Syringes
Well, after my recent post quetioning why syringes these days seem so wimpy, I have reconsidered and now agree with others who suggest that it may be the rubber top on the Symlin that is the cause of the problem. I think it is thicker than that on insulin vials and it seems to dull the needle even with one pass-through. Amylin Pharmaceuticals may want to consider a re-design on that, since anyone using Symlin would be using the same syringes as they use for insulin. One may assume Type 1's are impervious to pain but I, for one, still cringe whenever I get the flu shot. Ouch! And let's make things as painfree as possible, no? There's enough needle-poking and blood-letting going on already.
Vent Your Road Rage
I saw this website mentioned in sfgate.com this morning: platewire.com. It's a site where you can leave comments, good or bad, about other drivers you may come across.
Here's an example from Nevada:
It may not make a difference to the guy in the Nissan, but let's hope that the guy who posted it can relax the next time he comes across this driver.
I was in a hit-and-run traffic accident on May 19, 2006, and a witness caught the license plate of the driver. I think my insurance made some feeble attempts to contact the car owner, but the police wouldn't even pursue it. They said I should feel lucky, because if they (the police) were pursuing the case, it would mean I was either missing a limb or dead. (Those were the detective's words.) I thought about pursuing a civil case against the car owner, but decided that it wasn't worth the stress. But I am careful whenever I see a red and grey early 90's GMC Suburban with California plates driving by. And I check for damage on the front left panel...
Here's an example from Nevada:
| | Nevada 804-XXX |
| | Wednesday, December 20, 2006 |
| | Blue NISSAN |
| | Las Vegas (Nevada) |
| | This guy drives in the leftmost lane of a three lane road for miles and miles every single day holding up traffic and making people pass him on the right over and over. MOVE OVER YOU IDIOT! Slower traffic keep right. Have you never heard that? |
It may not make a difference to the guy in the Nissan, but let's hope that the guy who posted it can relax the next time he comes across this driver.
I was in a hit-and-run traffic accident on May 19, 2006, and a witness caught the license plate of the driver. I think my insurance made some feeble attempts to contact the car owner, but the police wouldn't even pursue it. They said I should feel lucky, because if they (the police) were pursuing the case, it would mean I was either missing a limb or dead. (Those were the detective's words.) I thought about pursuing a civil case against the car owner, but decided that it wasn't worth the stress. But I am careful whenever I see a red and grey early 90's GMC Suburban with California plates driving by. And I check for damage on the front left panel...
Wednesday, December 13, 2006
What happened to syringes?
I've been on the pump since 1993 and hadn't used syringes much since then until I started using Symlin in October. What happened? I can hardly use one more than once without it becoming dull or even bending when I try to stick it into the vial. I used to be able to use a syringe for a week or more if I recall correctly. And these syringes hurt more, I swear. I do not ever recall feeling pain before. I don't think I've just suddenly become a syringe wimp, but I guess it's possible. The syringes in reference are a very popular brand, and the same ones I used to use back in the day. Despite the cost, who needs the extra trash?
Friday, December 08, 2006
Cookie Campaign
Earlier this week in San Francisco, the "Got Milk?" people launched a new campaign. The idea was to stick cookie-scented strips at bus stops that would get people thinking of cookies, and then, of course, of milk! The campaign was over in 36 hours. Some people complained about allergies. Some people said that homeless people would be sad because they would smell the cookies but couldn't eat them. Some said that this is all we need when we are fighting a losing (well we wish) battle against obesity. Some teenager said that the bus stops would smell like "cookies and bums." (Disclaimer: these are all rumors and I haven't verified any of them! But the campaign was real and I heard these rumors from other, mostly reliable news sources.)
My initial reaction was that it's just not fair to try and manipulate us with our sense of smell! But then, how is marketing using scent any different than imagery or sound? It's just another sense. But somehow it seems even more powerful. I vaguely remember from grad school learning how our sense of smell might be more closely linked to our memories by its the proximity of the olfactory bulb and cortex to the hippocampus. But I'm spreading rumors again. Anyway, here's a paper that might be a good starting point: "Odor Memory Induces Brain Activation as Measured by Functional MRI" (Levy, Lucien M.; Henkin, Robert I.; Lin, Chin S.; Hutter, Alf; Schellinger, Dieter).
I guess the more important question is this: would people really make the connection between cookies and milk, or would they just eat more cookies? When I see those huge chocolate chip cookies in the cafeteria at lunch, I don't think about milk. If they were Oreos, maybe I would. I guess at some point that one was drilled into me.
My initial reaction was that it's just not fair to try and manipulate us with our sense of smell! But then, how is marketing using scent any different than imagery or sound? It's just another sense. But somehow it seems even more powerful. I vaguely remember from grad school learning how our sense of smell might be more closely linked to our memories by its the proximity of the olfactory bulb and cortex to the hippocampus. But I'm spreading rumors again. Anyway, here's a paper that might be a good starting point: "Odor Memory Induces Brain Activation as Measured by Functional MRI" (Levy, Lucien M.; Henkin, Robert I.; Lin, Chin S.; Hutter, Alf; Schellinger, Dieter).
I guess the more important question is this: would people really make the connection between cookies and milk, or would they just eat more cookies? When I see those huge chocolate chip cookies in the cafeteria at lunch, I don't think about milk. If they were Oreos, maybe I would. I guess at some point that one was drilled into me.
Morning Ride
In anticipation of a rainy weekend, I decided to hit the road early this morning for one of my favorite rides. Yep, it was another Sunrise Over San Quentin.
How did D (Dexcom, diabetes) behave?
I put a new Dexcom sensor in last night, to replace the one that hadn't worked at all after 3 days. I was happy to see this morning that it had been spewing out readings during the night. I woke up really hungry around 3 AM with a BG of about 100. I decided to go ahead and eat a Luna Bar in anticipation of my ride. I took 1.15 U insulin. Shortly after, my BG had fallen to about 60. I ate a few Clif Blocks (or "cubes" as I like to call them) and went back to sleep. When I woke up at 5 AM, my BG was 228, so I guess I overdid it with the cubes. Anyway, I ate 4 more cubes and took 0.6 U insulin at about 5:10. When I got out the door at 5:30, my BG had gone up to 248. I chose to not take any additional insulin, since 0.6 U is a lot for me to have floating around on a ride. I could see an immediate rise at the beginning of my ride, but after about 30 minutes, it plateaued and then started a pretty rapid decline. It seemed to be leveling off around 160 about 1h45min into the ride. I probably should have eaten something here but I wanted to finish the loop around the Tiburon peninsula before eating a gel. (Sometimes I am too impatient to eat.) Once I got to Tiburon, I pulled out a Hammergel and also noted that my Dexcom was showing a not-so-gradual decline. I was somewhere around 140 then quickly to 130. Also, I was feeling a little low and I suspected that the Dexcom was reading higher than my actual BG, so I began to munch on another Luna Bar. By about 2 hours into the ride, I started to feel a little better but decided to shut the pump off for 30 minutes. This was probably a good idea, because after finishing my ride an hour later, my BG was 131. Nice! About 45 minutes later, it was 100.
Things I learned on this ride:
1) Don't wait to eat if you see a downward trend and have more than the normal amount of insulin floating around;
2) It's better to eat at least once an hour, anyway!
3) Remember that turning the pump off is an option to attack dropping BGs;
I was really pleased with the Dexcom on this ride. It allowed me to keep going without having to check my BG, which is a pain on the bike. I do have to keep it in a Ziplock baggie to keep it dry in my pocket, though! I wish I could somehow mount it on my bike, but where would it fit with my humongous light, my bike computer, and my extra-large Bento box (which is completely occupied by my bike light battery)?
Other notes from the ride
I saw a few interesting things on my ride.
At the southern entrance to the bridge, was a group of people singing Christmas songs. I don't know who the audience was at 5:50 AM but hey, it was nice all the same. Some TV truck was there recording the whole thing. One of the singers, in a Santa hat, gave me a strange look, like he knew that the whole thing was a little odd.
Once on the bridge, I noticed a pedestrian, who just seemed a little out of place. He seemed a little despondent and I started wondering if he was planning to jump. I said, "Hi there," and he gave me no reaction (which could have been just because he thinks people who ride bikes in bike clothes are weird). I thought I was probably over-reacting but considered stopping at one of the many emergency phones on the side of the sidewalk. I passed one but stopped at the next and spoke to the bridge patrol. I mentioned the pedestrian and he asked, "What are you doing on the bridge?" "Biking," I said and then he cheered up. He said that the guy shouldn't be there and that he would check it out. I guess pedestrians aren't allowed on the bridge that early in the day.
But the best part of the ride was definitely sunrise. This picture from my cellphone didn't capture how brilliantly orange everything was glowing. But it's scenes like this that keep me riding and keep me paying my ridiculous rent (which actually isn't nearly as bad as it could be around here).
Oh, and the Christmas singers were still there when I crossed back over the bridge!
How did D (Dexcom, diabetes) behave?
I put a new Dexcom sensor in last night, to replace the one that hadn't worked at all after 3 days. I was happy to see this morning that it had been spewing out readings during the night. I woke up really hungry around 3 AM with a BG of about 100. I decided to go ahead and eat a Luna Bar in anticipation of my ride. I took 1.15 U insulin. Shortly after, my BG had fallen to about 60. I ate a few Clif Blocks (or "cubes" as I like to call them) and went back to sleep. When I woke up at 5 AM, my BG was 228, so I guess I overdid it with the cubes. Anyway, I ate 4 more cubes and took 0.6 U insulin at about 5:10. When I got out the door at 5:30, my BG had gone up to 248. I chose to not take any additional insulin, since 0.6 U is a lot for me to have floating around on a ride. I could see an immediate rise at the beginning of my ride, but after about 30 minutes, it plateaued and then started a pretty rapid decline. It seemed to be leveling off around 160 about 1h45min into the ride. I probably should have eaten something here but I wanted to finish the loop around the Tiburon peninsula before eating a gel. (Sometimes I am too impatient to eat.) Once I got to Tiburon, I pulled out a Hammergel and also noted that my Dexcom was showing a not-so-gradual decline. I was somewhere around 140 then quickly to 130. Also, I was feeling a little low and I suspected that the Dexcom was reading higher than my actual BG, so I began to munch on another Luna Bar. By about 2 hours into the ride, I started to feel a little better but decided to shut the pump off for 30 minutes. This was probably a good idea, because after finishing my ride an hour later, my BG was 131. Nice! About 45 minutes later, it was 100.
Things I learned on this ride:
1) Don't wait to eat if you see a downward trend and have more than the normal amount of insulin floating around;
2) It's better to eat at least once an hour, anyway!
3) Remember that turning the pump off is an option to attack dropping BGs;
I was really pleased with the Dexcom on this ride. It allowed me to keep going without having to check my BG, which is a pain on the bike. I do have to keep it in a Ziplock baggie to keep it dry in my pocket, though! I wish I could somehow mount it on my bike, but where would it fit with my humongous light, my bike computer, and my extra-large Bento box (which is completely occupied by my bike light battery)?
Other notes from the ride
I saw a few interesting things on my ride.
At the southern entrance to the bridge, was a group of people singing Christmas songs. I don't know who the audience was at 5:50 AM but hey, it was nice all the same. Some TV truck was there recording the whole thing. One of the singers, in a Santa hat, gave me a strange look, like he knew that the whole thing was a little odd.
Once on the bridge, I noticed a pedestrian, who just seemed a little out of place. He seemed a little despondent and I started wondering if he was planning to jump. I said, "Hi there," and he gave me no reaction (which could have been just because he thinks people who ride bikes in bike clothes are weird). I thought I was probably over-reacting but considered stopping at one of the many emergency phones on the side of the sidewalk. I passed one but stopped at the next and spoke to the bridge patrol. I mentioned the pedestrian and he asked, "What are you doing on the bridge?" "Biking," I said and then he cheered up. He said that the guy shouldn't be there and that he would check it out. I guess pedestrians aren't allowed on the bridge that early in the day.
But the best part of the ride was definitely sunrise. This picture from my cellphone didn't capture how brilliantly orange everything was glowing. But it's scenes like this that keep me riding and keep me paying my ridiculous rent (which actually isn't nearly as bad as it could be around here).
Oh, and the Christmas singers were still there when I crossed back over the bridge!
Friday, November 17, 2006
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.
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.
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