Untethered- The Perfect Hybrid

The past seven years of my diabetes care haven't been stellar. My A1C's were way beyond my comfort zone and they hit all-time highs that I thought I would never reach. I consoled myself with the fact that I was dealing with Hyperthyroidism and needed to focus on fixing that before I could attack tighter blood sugar control. In my experience my thyroid levels are intrinsically tied to my blood sugar levels. In January, I declared the thyroid problem fixed and spent the last six months training for my 4-mile leg of the Swim Around Key West. It was a hard six months of rebuilding a body that had been torn down to nothing. I thought that my blood sugars would respond as well as my cardiovascular and muscular systems did. And they did get better, but not nearly as good as I had hoped. While in Florida I learned that many of my traveling companions had given up the insulin pump in favor of Levimir and Humalog shots. This was mind blowing because I always considered the pump the only way. But these were well-educated, athletic diabetics who weighed their options carefully and chose to go back to shots. They were so convincing I had to take notice and ask myself if it was something that would work for me. When I returned from Florida I started to research the situation. I talked to my doctor (who was no help. He told me that the pump was the only way for me, but that I could take a pump break if I wanted.) I had concerns though. I am incredibly forgetful. I knew I would spend more time searching for my lost insulin kit than I would giving myself shots. And I would forget shots altogether. I have to stash extras of my thyroid medicine at work because I was sick of having to drive home during lunch because I had forgotten my morning dose. And my schedule is always changing. I may plan to have a workout in the afternoon, but that may change when Shea reminds me that she has a huge report due the next day, or that Eli breaks his arm. So to plan a lighter basal dose of insulin in the morning because I expect to workout just wasn't going to work. But I could not stay on the pump full time either. I was having huge problems with my 2+ hour swims that would leave me without any basal insulin. During the swim it was no problem. I would come down to 100 and stay there during the whole swim, but the moment I got out of the water I was in for a seven hour HIGH. Even with a 200% basal and correcting at 150% my usual dose, that HIGH would not budge. Until exactly seven hours later when I would go plummeting to 55.

I was also having absorption problems. I knew my basals were right because I would have a few great days in a row and then I would have horrible days that would not respond to corrections. I use a limited area skin for my pump sites which I share with my Dexcom sites so the tissue there is a little sick of working so hard. I thought I remembered a friend's son going on some sort of hybrid solution, so I texted him. He had been doing the "untethered regimen" put forward by Dr. Edelman. I researched it some more and realized it is the perfect solution to my problem.

It takes the best of both worlds and combines them beautifully. I now take 75% of my basal through a Levimir shot in the morning and one in the evening. So I can tie in the shots to bedtime and waking up, making them easy to remember. I don't ever have to take insulin with me and since it stays on my nightstand, I never lose it.

The other 25 % of my basal is through my pump which allows me to attain the huge differences I have in morning afternoon and nighttime basal rates that my body needs. It also allow me to detach the pump when I workout giving me just a 75% basal, which is what I would usually turn down my basal to during land based workouts. Now I have the basal in the water for longer workouts and the ability to time that to whenever I actually get to working out. It also gives me a backup if I forget my morning insulin shot. On my Minimed pump, I can have multiple basal profiles. So I kept my Pre-Levimir profile and if I forget my Levimir, I just flip back on the pump to the old profile.

I still get to bolus through my pump so I don't have to pull out a syringe at the table. I like the discreetness of the pump. I have shot up plenty in public and have no issue with it, but I like not having the extra attention directed my way. I'd rather be the diabetic super spy.

I started the new regimen July 2 and so far I have been very impressed with it. I have had days where my highest sugar was 180 which, for me lately, is incredible. I have had days in the past where I was in the high 300's for more than half the day. And I have yet to forget a dose.

I like bring able to be at the beach for four or five hours without having to take on and off my pump to get wet. I now can jump in the ocean anytime I want without all the hassle. I have another month before I can test out the real results with another A1c, but from what I've seen so far, I think they might be back in my I-love-it range.

And I think the process of switching things up has renewed my diabetic mind. I was excited about the challenge and the trial and error of getting my nasals right. And I like success. It has given me enough of a boost to take better care of myself. When was the last time you made a big change to your diabetes regimen?

My Diabetes Vacation

The idea of a Diabetes Vacation has been tossed around for years. It makes sense that a 24/7/365 disease would be exactly what we need a break from. And I would be the first to sign up if we really could take a vacation from Diabetes. But we can't just demand that a disease be gone for five days. We can't proclaim a working pancreas and all of a sudden, on day one of our vacation 'Ol Pancky finally shows up for work. So instead, some people choose to get away by reducing their management tasks for a given amount of time and that gives them break of some sorts. For me, that sounds like torture. Not test for a day? I would be so scared of an impending low or the dehydration and nausea from a high. Some people detach from their pump and go on shots. The moment I realize I might be separated from my pump due to mechanical issues, I am in tears and so fearful I cannot sleep. To bring this on purposely would not be a vacation from anything but peace and security.

The worst part of diabetes for me is not the shots or changing pump sites or CGM's or testing. It's the isolation of trying to do it alone. The lack of a compadre to commiserate or rejoice or brain storm with. It's having to leave a restaurant table to test and shoot up in the bathroom stall because I am not in the mood to explain myself. It's having to alter my plans when my blood sugar gets out of whack. Diabetes brings me down when I let it determine my life, my energy and my limits. When I feel like it controls me. On my Diabetes vacation I want to get away from the stronghold that diabetes has on my emotional life. And, boy, have I started planning this vacation. June 26th, 2014 I will take off for adventure and five days outside of the grasp of diabetes with a team of swimmers and crew to take on my next big challenge, The Swim Around Key West. And it has all five of the ingredients of my Happy Cocktail. 1. FUTURE PLANS - A recent study stated that vacations are not only a mood boost while you lie on a tropical beach, but they also provide a mood boost for up to eight weeks before you go. I need to look forward to something when the days grow short and cold. It fills my daydreams with sunny warmth and tropical breezes. Five days in the Keys will definitely give me something to look forward to. 2. SUNSHINE - No place better that Florida for sunshine. It should be in the 90's in June with ayer temps hovering around 86. It's so sunny that swimmers in this race have to coat themselves in Zinc Oxide so they don't burn to a crisp. 3. MUSIC - Going to Key West always fills my brain with the lyrics of those Jimmy Buffett songs that have been cemented there by repeated exposure over the last 25 years. training for hours on end looking at the black line on the bottom of the pool can get repetitive and boring without the right music on my iPod. So I have been filling it with happy music to liven up my workouts that will get up to 120 laps long. 4. EXERCISE- It's a given in training for a 42 mile swim. 5. PEOPLE (who I actually like) - Anyone crazy enough to swim 4.2 miles in the open ocean goes on my list of pretty cool people. I just have to make sure I fill the roster of 3 swimmers, 1 boat captain, 1 photographer/media captain, and any other crew with people ready to relax, slow down and create that vacation attitude that will recharge us all. The next six months will be filled with conversations about how to train and the obstacles that try to derail our training. We will discuss our travel plans, those must-see spots for each person. And we will try to solve the problems that being a diabetic swimmer presents. How do you test if you're not allowed to touch the boat and you're wet in the middle of the ocean for two to three hours during your leg of the race? What should our nutrition look like during that time? What procedures should we have in place to ensure everyone finishes safely and happily.

Racing will be exhilarating, but the five days surrounding the race will be filled with even more fun, starting with a 150+ mile drive down the backbone of the keys on Friday with the warm tropical wind in our hair, Jimmy Buffett on the radio and laughter from the future inside jokes brewing in the car. Saturday night we will stand together at the pre-race meeting, knowing the challenge that lays ahead of us the next morning is just a little tougher for us because of the extra burden we carry. Sunday morning, bright and early, we'll begin our race with seven hours on the water and in the sun followed by an amazing celebration dinner in one of the Key West restaurants in town (and if I have my way, that will probably be Margaritaville Cafe). And Monday is open to find someway to give back to the diabetic community in Key West (contact me if you know of one). Each day we'll be part of a team where we are the normal ones. Where pumps and CGM's beep freely, blood is tested and the table and where getting high is a sometimes unavoidable side-effect of being normal. We won't have to explain when we get overly grumpy due to a low, because we've all been there before. We don't have to feel like we're letting down the team taking time to test during a race, everyone will take that same time when it is their turn. And we won't be left alone to find solutions to the diabetic swimming problems. On this team, that is just how we roll. Tuesday we will go back to our normal lives knowing that we did something great. We kicked diabetes right in the arse. And we can use that confidence to make diabetes bend to our will, to test more, to analyze data more frequently, to continue exercising so we can live healthier, longer, happier lives. And we can continue to drink our Happy Cocktail each and every day. -

Happy Cocktail

I was recently sharing with a friend my recipe for dealing with the depression that diabetes and life in general brings. The big 5 ingredients in my Happy Cocktail are exercise, music, sunshine, people (good people you actually like), and future plans. You force those upon yourself and it will drag you out of the blues into Happyville. As we round the corner out of winter and into spring (although it is not much of a winter here in San Diego and I know spring seems a long way off for many in the US and worldwide) I am working hard to throw off my yearly winter blues. I've been surrounding myself with happy music, through a new free Sirius Satellite subscription continuously tuned to Radio Margaritaville. I have been reading outside int he sunshine during my lunch break. And I have been going out of my way to build the relationships around me. But I needed to find a place for the last two ingredients in my Happy Cocktail; exercise and future plans. And for me that usually means it's time to find a new adventure to train for. So it was time to dig out my Someday-I-Will list. It's too soon to conquer the WESTPAC, a 8-19 day sailing race from Long Beach, CA to Honolulu, HI. I can't be away form my kiddos for that long, yet. A multi-day Stand Up Paddle exploration of the Virgin Islands may be a bit beyond my experience level at this point (I've only Sup'ed a handful of times). Which only leaves the Swim Around Key West.

The 37th Annual Swim Around Key West is a 12.5 mile swim around the island of Key West in Florida on June 28, 2014. twelve and a half miles is too much for me to take on this June, but they do have a three person relay division. I can definitely do a 4.2 mile swim with six months of training. I've done solo adventures before, I want to do something with a team this time. Three swimmers, a boat captain, maybe even a photographer/media captain to share our journey along the way. This race will give me a Future Plan and a purpose to Exercise. For the next six months I can look forward to a trip to the tropics and a five day vacation with some amazing people. And it provides me with the accountability to get to the pool and the weight room and on the road for a quick run to the beach. Now the question is, will this adventure be those same ingredients for you? I am looking for people to join the team. Maybe even put two teams together. If this could be the two ingredients you need in your Happy Cocktail, you can find out more here. You can also fill out the INTEREST FORM to let me know you're interested.