Fine Tuning

I have recently moved my infusion sight down to my outer thigh and have been having huge problems with it. I usually rotate the site locations depending on the season. Spring and summer, when I am in a bathing suit more than not, require that I hide the site under a bikini so it goes into my upper butt between where the pocket of my jeans is and the waistband.

Fall and winter make it easier to put it into my upper thigh since I spend most of my days in jeans and skirts and the only place I get into a swim suit is at the Y to get in a workout so I am less concerned with my appearance.

After three successful years of this, I have found my system faltering. My butt has developed scar tissue which hinders the insulin from getting from the infusion set to my blood stream where I can actually use it. I thought it might be time to make the switch to the upper thigh to give my butt some time to heal.

As soon as I did I started pulling out sets when I changed clothes. I had to train myself to be careful of the new spot and then I would be fine, I told myself. After a week and ten different sites being pulled out, I got the hang of it and stopped accidentally pulling out sites. But then I started to notice that the sites would go bad after only a day.

When I first started using an insulin pump the sites I used, like mini IV's, would stay open and useful for seven to ten days at a time. I loved not having to poke myself or remember to change a set for a whole week or more. As time has worn on that period of time has been reduced greatly, mostly due to scar tissue.

I have had to abandon using my stomach due to the scarring and now my thighs and butt are both showing signs of deterioration as well. I just wonder how many more body parts are viable options. Am I, in ten years, going to have to affix this thing to my ankle?

Luckily my ankles have very little fat. But of course this means I can't use them as an infusion site. Maybe my chest will have to do, though, I am not sure how much Tony will like the looks of that one.

So what are those other sites I have been overlooking, ones that I will not pull out easily,but have not scarred up ye?. Or maybe there's some new technological advance to erase the scar tissue so I could go back to the old reliable sites?

Managing Diabetes On Board

BREAKFAST

As I get closer to launch day for my sailing trip, I have been focusing more on my diabetes management plan. One of the things that I have been concentrating on is my breakfast. It has always been one of the harder meals to get right because of the different hormones that circulate in the body and bring you from a sleeping state to a fully alert state. Most of these hormones make the body less sensitive to insulin. The result is that you usually need more insulin to cover the same amount of food eaten at a later time in the day. The other problem I have is that I love breakfast foods. I would eat them for breakfast, lunch and dinner if I could (and sometimes I do).

I’ve changing the ratios of my breakfast foods and have achieved some degree of success lately by making breakfast a low-carb, high protein meal. This has lowered that morning spike in my blood sugars and also leaves me feeling fuller. After four weeks eating the new protein based breakfast and finding much success with it, not only in better controlled blood sugars, but, also with the bonus of weight loss. SOME RESEARCH

I came across a study published recently. It was a study of type 2 diabetics (different from type 1 diabetes, I know, but interesting all the same). In the study, the researchers gave the patients a high-protein, low-carb breakfast and found that it lowered their morning blood sugars, which should be obvious.

We have all known that carbohydrates have a far greater impact on blood sugars than proteins do. But what they also found out was that the meal caused their body to replenish their glycogen stores with the sugar instead of storing that sugar as fat.

So the way the body reacted to the sugar changed in addition to there being less of it. If the carbs were later added to a morning snack the patients did not see the same blood glucose spike as when they ate the carbs as their first meal of the day.

I always have to laugh when scientists spend thousands of dollars and hundreds of hours of time to figure out the same thing I figured out in two weeks with my own body. It is nice to have real evidence to back me up, though. And, of course, they can publish their work and make safe recommendations to other people based on their science. I can only change what I am doing, knowing that every diabetic is different and may not react in the same way I did to changes in their diet.

PROTEIN IN THE HEAT I want to continue this high-protein breakfast on my trip, but it presents some slight problems. One of my main morning proteins is eggs. Eggs, however, are very hard to eat if you don’t have a stove or any source of heat. I am all about protein, but I am not going to go Rocky-style and down them raw. I tried that once when I was eight and never will again. I could do a protein shake but after consuming those for breakfast and lunch for four weeks, I have found them very hard to swallow without gagging. So, I have settled for a cheese stick wrapped in turkey slices as my plan for now, but I don’t know if that will work in the long run and I’m not sure that sounds too appetizing first thing in the morning. LUNCH AND DINNER My other meals will certainly include carbs. I am in no way opposed to carbs; as an athlete, there is no way I could be. I will just have to include some of those high-carb breakfast foods I love later in the day.

SITTING STILL One of the other morning issues I will be facing is one that I have more experience with in long car trips early in the morning than I do with sailing. Sailing involves a lot of sitting around. Your body becomes more or less sensitive to insulin based on how active you are throughout the day. I have found that if I take a long car trip starting early in the morning, my blood sugars will race up very high and stubbornly stay put no matter how much insulin I give as a correction bolus to bring them back down. Once I get out of the car and start moving around for an hour or two this problem is quickly remedied. To fix this, I simply have to put in a good workout before getting in the car, and stop every two to three hours for a quick five to ten minute burst of exercise.

PLANNING FOR ACTIVITY While in the Keys, I will have to work-out each morning before I take off for the day. Most days I will go for a quick three to five mile run. When I stay at Fiesta Key for the second night, I get to use their Olympic size pool to put in a quick mile swim. One of the rules of the trip is that I won’t stop until I reach port each night, so I will have to find some way of doing those ten minute bursts of exercise on board. I won’t be able to run or even be able to walk around much as the cockpit on a 22’ Catalina is only about 6 feet long and has the boom of the main sail about 4 feet off the deck.

As a result, I am stuck with calisthenic type exercises that can be done in very little space. To maximize the effect of each exercise I will need to use the largest muscle groups and use as many as possible in each exercise, all while holding onto the tiller so the boat does not go spinning in circles or run aground on one of the many sandbars lurking just below the surface of the water. Included in my workouts will be squats and lunges, which recruit a lot of the larger muscles of the body. Adding to the exercise schedule will be calf raises, which will round out the lower half of my body. I may be able to pull off some push-ups on the seat of the cockpit while holding the tiller still with my foot. EVENING WORKOUTS To round out the exercise regimen, I will need to get some activity in after I dock for the night. This shouldn’t be much of a problem since I will be in search of a warm meal and a view of the old Keys, Florida as it used to be.

Even with all of this physical activity, I will still have to make some adjustments to the basal rate of the insulin, constantly supplied by my pump, to take care of normal bodily functions. The first day I will try a bolus increase of 125% and adjust as needed. FINAL ANALYSIS Each night I will go over my blood sugars and my maintenance plan and will reassess for the next day. Hopefully by the end of the trip, I will have developed some sort of protocol that I can use in future sailing trips, so I won’t need to use myself as the living guinea pig. WHAT'S NEXT As you plan your next adventure, you might want to do two things. First, analyze what you do at home and figure out how that will change as you take off to new places. Second, make a plan to keep your activity level and food roughly the same so you can avoid those whoops! moments while adventuring.

Diabetes by the Numbers

252 - Last blood sugar reading 684 - Highest blood sugar on record- although it may be a bit inaccurate since the new meters don't go higher than 599 28 - Lowest blood sugar on record- They say you're supposed to pass out at 30 102 - Favorite blood sugar- high enough not to worry about lows and not the "perfect 100" that everyone else strives for 15 - Pounds dropped at diagnosis 19 - pounds gained after starting insulin 8.3 - Last A1C blood test 5-6.9 - "good" A1C range 7.0 A1C I want 5.5- A1C that I would "shit bricks" over 9+ - A1C that makes me cry 36 - Number of A1C test results I have had to endure 8 - Mini boxes of candy I had last night on Halloween 10 - how much I hate Halloween on a scale of 1 to 10 because of the constant temptation of packages of candy just small enough not to register on the "to avoid" list

1,460 - Number of shots I took before giving up the shots and getting an insulin pump, never to look back 42,340 - Number of times I have sliced a tiny hole in my finger to extract enough blood to give to the machine who will grade my diabetic efforts for the last few hours and give me a result that will either make me smile or make me curse, but either way will better inform me of my enemies tactics and how I can outsmart him. 2,867 - Number of curse words spilled from my mouth in reaction to diabetes 1 - Number of entire boxes of Rice Krispies almost poured over my head in a state of low blood sugar 528 - Number of crying spells brought on by my enemy 2 - Number of E.R. visits due to freakishly high blood sugars 1 - Number of official D.K.A.'s because a box of recalled pump infusion sites got out to me and happened to get used at the same time I was battling the flu (and yes I am pulling out every reason in the world that this one was NOT MY FAULT) 2 - Number of crazy docs who thought they knew more about my body than I did and set me up to do or believe down right stupid things like I would never be able to walk barefoot or that to have 7 different basal rates on a pump is "not necessary" 3- Number of amazing docs who know I live with my body and my enemy daily and who work with me to sharpen my battle plan, who give advice on new research, new tests or new technologies to fight the bastard 14 - years I've had diabetes 12 - years I spent trying to battle diabetes on my own 1,000's friends I feel like I have through Insulindependence.org who help lend support and comfort as we fight together 20ish- the actual number of friends I have made through Insulindependence, though their support makes it feel like more 764 - the Number of times I've said to myself, "Now why didn't I join Insulindependence sooner?" and replied to myself, "Oh, Yes, That's right, they've only been around since 2005!" 864,357- people I wish I could tell to become a part of Insulindependence- It will change the way you attack the enemy 62 - boxes of pump supplies, glucose monitor supplies, sensors, tapes, I.V. Prep, glucose monitor strips and other assorted supplies in my closet/pharmacy 42,120- used blood glucose monitor strips I've sent to the landfill 24 strips currently in various crevices in my car 56 strips currently in my wallet/monitor case 138 strips in the trashcan in the bathroom 2 strips in my running bag 33,476 words written in my slightly humorous (but only to the warped minds of the world) memoir on life with diabetes and sailing solo through the keys 16,534 words to write by November 30 to be a winner in the NaNoWriMo or the National Novel Writing Month 551.13 words per day to write to meet that goal 665 words written so far today, oh wait make that 674. 16 Times I've said since I committed to NaNoWriMo last night, "Oh Crap! How am I ever going to be able to pul this off?" 14 sailing books I own and have read- most of which end in hideous disaster and ruin 3 boats I own, though the largest of the fleet is 15 inches long and attached to a stand so it doesn't tip over on my desk 12 - number of feet of the boat I will build this Spring Break 2- number of children who will help me build it 22- feet of the boat graciously donated for me to use for my trip this February by the Key Lime Sailing Club, my favorite sailing club in the world 4- days I will spend sailing alone int he Florida Keys 100- nautical miles I will cover from Key Largo to Key West 480- GPS waypoints beamed to the satellites and then back to mapmytracks.com where anyone can follow along as I sail 168- messages sent to the social networking sites to update everyone of everything I am doing, seeing, hearing, smelling and eating along the way 7500- dollars that I am trying to raise to benefit the oceanic recreation branch of Insulindependence.org 765- dollars I have already raised (thank you, by the way, to all those amazing people who have helped out in this) 105- days left to raise the additional $6735 64.14 -dollars to raise each and every day until I sail 872- times I have said "Oh Crap! How am I ever going to be able to pul this off?" 4696 miles to fly 63 miles to drive 5 sunsets to watch 3 manatees to talk with 82,354 skeeters to avoid 459 pictures to take 152 minutes of HD video to take so I can edit it down to the 3 minutes I am not looking like a total dork 6840 minutes I will be truly enjoying myself as I seek to take some time away from my everyday life to reflect on what diabetes has done to my life and what the fight against letting it take over has done for my character and my life 40,000 words I will have left to write to finish the memoir expressing those new revelations I am sure to have while spending 6840 minutes alone on a boat in the middle of the sea (well, ok, maybe not the middle of the sea, but far enough away from land that it will feel like the middle of the sea) 17 minutes I have just forced you to read far too many numbers 63 useless numbers that have now been stored somewhere in your brain taking up valuable space that could have been used to remember your telephone number when you move into the retirement home when you are 89 1 person you have now far too many unrelated details about that may come together to form a slightly clearer picture of (sorry Mrs. Fullenwider for ending that one with a preposition)