Monthly Archives: November 2009

Goaaaaaaal!!!!

I’ve been thinking about goals recently. I have about a million things I want to do in my life, and I find that if I don’t write them down, the most important ones tend to get missed.

We people with diabetes have our own goals, frequently imposed on us by other people. “Have an A1c less than 7.5% 7.0%,” says the ADA.* “Have blood glucose readings in the range 80-150 mg/dL,” say the doctor. “Check your feet everyday,” says the nurse educator and Diabetes Forecast.

While these are all fine goals, I often don’t find them very actionable. Plus I’m better at meeting my own goals than other people’s. (It’s probably a character flaw, I suspect.) So I’ve made a small set of goals for myself:

  • Fix my basal rates — This one is almost done!
  • Determine my correct bolus amounts
  • Always use the bolus wizard on my pump (instead of manually picking an amount)
  • Have ⅔ of my readings in the target range(s)
  • Achieve an A1c <7.0%
  • Start most exercise sessions below 150 mg/dL and finish above 100

(As I mentioned earlier, I have a ton of different things that I want to do. You can see a few of them on my “To Do” list.)

If you have diabetes, do you have D-related goals? What are they?


* — The American Diabetes Association seems to be the only group who recommends this value, with most of the rest of the world recommending 6.5%. Researchers have found that most doctors don’t really recommend making changes until their patients’ A1Cs are a full percentage over the target, which in this case of the ADA number means 8.5% 8.0%.

Update — Someone from the ADA sent me a personal message to set me straight on the organization’s position. It’s 7.0% not 7.5%. My mistake! The AACE and the International Diabetes Federation do recommend 6.5%, though. More info: general and position paper.

Posted in Diabetes, NaBloPoMo, NaBloPoMo 2009 | Leave a comment

Jeff Mather’s Random, Space-filling, Gotta-post-something Weblog Entry

Hey, y’all. (“Comrades!” is how I usually start e-mails like this at work.)

Just a short post today, since it’s already past 10:00PM. Lisa and I have had a good day: slept in a bit late, swam a bit, shopped a bit, went to dinner with some friends and their sweet baby girl, and am now watching “South Park.” (I know! Don’t judge me.)

Anyway, it’s World Diabetes Day. I hope you enjoyed it and wore something blue.

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Using Root Cause Analysis with Diabetes

My workgroup had a training course on root cause analysis (RCA) earlier this week. (We’ve actually done several RCAs, but now we’re finally getting our training.) The idea behind RCAs is to find the actual cause behind a problem, and solve it instead of just fixing the most obvious problem. It’s actually quite a powerful technique for improving processes, although I suspect many people at our company look upon RCAs primarily as a quality improvement technique.

An RCA is essentially an act of self-reflection or team reflection, as is often the case. The primary activity of an RCA is asking “Why?” repeatedly. The answer to each question is a cause, and the last answer is the “root cause.” A rule of thumb is that you shouldn’t stop asking “why?” until you’ve done it five times. Knowing all of these causes isn’t any good unless you create countermeasures to prevent them from happening again. So, it’s just as important to ask “What now?”

It occurred to me that diabetes is a natural fit for RCA. Something is always going a little (or quite a bit) off — we have plenty of opportunities for “self-reflection” — and we can (and should) make lots of small changes to improve our ability to manage our blood sugar. And I’ve read enough from other people with diabetes on the Internet to believe that we can get pretty good — although not perfect — blood glucose readings.

So how does this work? Let’s take an example.

  1. My blood glucose was very high. Why?
  2. I didn’t bolus enough insulin for my food. Why not?
  3. I was worried that I would go low if I bolused the full amount. Why?
  4. I’ve gone low a lot recently. Why?
  5. I usually had too much insulin on-board. Why?
  6. Until recently my basal rates were too high.

My blood sugar was too high because I didn’t trust my carb:insulin ratio because I had the wrong basal rates for a long time. So that explains a lot. But if I don’t fix these causes I’m going to keep under-bolusing. So let’s figure out some countermeasures for each cause. For each problem, what should I do.

  1. Take a correction bolus.
  2. Take the recommended bolus amount from now on.
  3. Stop using food as medicine. Use insulin to cover food.
  4. Let go of the memory of all those previous lows. It’s not helping.
  5. No countermeasures here.
  6. Finish running tests to correct my basal rates.

It’s possible to do an RCA and create countermeasures for just about any problem, but they are very useful for large classes of related problems.

Posted in Diabetes, Life Lessons, NaBloPoMo, NaBloPoMo 2009 | Leave a comment

Implementing Lean Software Production

Just a short post today, dear readers, seeing that it’s a bit later than I’d expected.

A coworker and I decided today that we really want to try our hand at lean software engineering. Our team has been moving this direction for a while in fits and starts — thinking about waste, preventing defects, and doing root cause analysis — but this is our first time at getting to the heart of truly “lean” production. Fortunately, we have good management and team members, who aren’t afraid to optimize processes; and it wasn’t hard for us to get the approval to investigate how we work.

We’ve never taken a really hard look at the “value stream” of our product development before. The first step involves examining all of the things that we do to get a product out the door: from the time that we decide to start working on a feature until it’s in our customers’ hands. In the next step, we’ll identify all of the things that don’t actually contribute to the feature from a customer’s point of view (i.e., the parts that aren’t “value”) and try to eliminate or at least minimize the time that we spend on those tasks.

We want to make this a whole team activity, but right now my coworker and I are just starting to read The Toyota Way and Implementing Lean Software Development so that we can lead the process effectively.

I’ll keep updating you on our progress. And if you have any advice, please leave a comment.

Posted in NaBloPoMo, NaBloPoMo 2009, Software Engineering | Leave a comment

Swimming and Embracing my Suckitude

I swam a half mile yesterday. It’s not the first time I’ve gone that far, but it was certainly the easiest and the first time that I did it quite so quickly. (About 32 minutes, says the eagle-eyed Lisa, who can read the clock on the wall without glasses.) The quickness was rather unexpected, since I told myself I was going to focus on my form and swim slowly. I guess it is the case that trying to do it “right” counts for something.

This is a big deal for me, dear readers, since I am not good at forcing myself to do things I’m bad at. I like to succeed, and I hate to look silly. Consequently, starting something new — like swimming — is hard for me. “Insecure much?” you might ask. Yes, a bit.

Swimming is something I’m certainly not very good at doing right now. But the woman who shares my lane at the pool doesn’t seem to mind. (Thanks, Lisa!) And the better swimmers usually stay in the one roped-off lane for “fast” people. I’m also extremely nearsighted without my glasses, and not being able to see the other swimmers somehow makes it easier to epicly fail at swimming. I’m slowly building up what Merlin Mann called “tolerance for courageous sucking“.

Swimming isn’t the only thing where the courage to look awkward/foolish/amateurish in front of other people is a key part of eventually succeeding, of course. Just about any activity other than breathing qualifies.

For me, diabetes is a place where I’ve recently given myself permission to make mistakes while I improve. As I wrote yesterday, sometimes I just have to try lots of experiments before I find the solutions that work best. I’m pretty sure that my HbA1c test (which measures the approximate amount of glucose in the blood over 3-4 months) will not be as good as it was over the summer. We’ll see how my endocrinologist responds. (She’s been fabulous so far. . . .) And I hope that the basal rate tests and exercise tweaking I’ve done over the last two months will reap dividends in the coming years.

Nevertheless, it’s been difficult for me to present to my doctors a lot of really high numbers, to show them that I pretty much suck at staying in my target range, to admit that the rules — they’re really more like guidelines — are so far from working that I haven’t followed them. In the back of my wee diabetic brain, I’m worried that the doctor will say, “Look, you’ve got to decide what you want: good numbers now or the desire to exercise whenever you want. What’s it going to be?” And, while that seems unlikely, doctors have this way of letting you know that they’re not happy with the way things are going. (You might not think you do, doctors, but you do. Trust me.)

So, here’s to the courage to suck at diabetes (or swimming or whatever) in the short term. Here’s to looking bad in front of our peers (including doctors) with the knowledge that one day we’ll have mad skills.

Posted in Diabetes, Life Lessons, NaBloPoMo, NaBloPoMo 2009, Swimming | Leave a comment

Dear Pancreas/Paperweight…

Written earlier today. . .

Hey there, Pancreas/Paperweight. Most days I love you, but today I’m not so sure. So, Sweetmeats, if you’re listening, I’m going to give you another chance to send some love back my way tonight.

I know we’ve been working on our communication and the basal rates a lot recently. The first twelve-or-so waking hours of each day have been (mostly) great over the last week, but can we get it together with the whole exercise thing? I’d really, really, Really love it if you could just point me in the right direction with some simple rules like “If you’ve got this much active insulin, eat that much carb to counteract it” or maybe “Lower your basal to this rate that many minutes before exercise” or perhaps “If you eat this many carbs at dinner, take that much insulin with it so that you aren’t wicked high before hopping into the pool.”

I know it sounds like I’m whining, but I work hard so that you can have nice things. See, I’ve even made you a little worksheet where we can enter all of those details that you love:

A worksheet with spaces for blood glucose readings, temporary basals, insulin, exercise, notes, etc. (blank - 7 days)
(Click for downloadable PDF version . . . .)

Here is one of them that I filled in with seven days of exercise at different times of the day when I’ve gone running and swimming. Look, there’s all of the various things I’ve tried, the blood glucose readings, the food I’ve eaten, the temporary basal rates, even some notes about how much my blood sugar changed during exercise.

A worksheet with spaces for blood glucose readings, temporary basals, insulin, exercise, notes, etc. (sample - 7 days)
(Click for downloadable PDF version . . . .)

I mean sometimes we have a lot of fun. Remember that Friday morning in Kansas when we went for a half-hour run, starting out at 104 mg/dL and ending at 128. That was so great! And that Saturday morning a week later in Arizona — going from 184 mg/dL to 154 — that was a good time, too.

So, what do you want me to do next, Punkin?

XOXO

Me (a.k.a., Low-Sugardaddy)

p.s. — Going from 180 mg/dL before dinner tonight to 290 a couple hours later when I hit the pool, well that’s something I should do better about; I mean I did only give myself 2.0 units as a bolus for about 60 grams of carbs. But dropping 140 mg/dL while swimming with only 2.0 units of active insulin, couldn’t we try to find a happy place in the whole “I need food. I need insulin. I need exercise. I need to stay in the target range.” dance we’ve got going?

Posted in Data-betes, Diabetes, NaBloPoMo, NaBloPoMo 2009, Running | Leave a comment

On Hypoglycemia

This post is all about hypoglycemia — also known as “a hypo,” “low blood sugar,” “going low,” “driving the magic bus,” or “kibitzing with Buddha.” (People without diabetes, the next time you see someone blessed with diabetes acting strangely, drop one of those last two into the conversation. “Hey, Jeff. You look a bit . . . vacant. Are you driving the magic bus?” Trust me, we love this. Just don’t tell any other PWDs that I’m teaching you our secret language.)

The human body is a truly amazing thing when it works well. But when it’s just a little bit off, things get unpleasant. Maybe you have uncontrollable nausea for nine months straight. Maybe there are arcs of light crossing through your field of view. Maybe you get a goiter-shaped neck-warmer. Yup, the our bodies like things a particular way and can get really obnoxious sometimes.

When it comes to blood glucose, the body likes it to be somewhere in the range of 70 to 140 mg/dL. What kind of measure is that anyway? At least here in ‘merica we use metric units we can understand, unlike y’all in the rest of the world who use mmol/L. Now that’s messed up: a purely dimensionless quantity divided by a volume. (Just kidding, Rest of the World! You know I love ya.)

Anyway. If blood glucose is too high, there are unpleasant long-term consequences that are usually hard to notice until they’ve arrived, although there are some more subtle and immediate indicators of elevated blood sugar. For me these signs include crabbiness, muscle pain, weakness, crabbiness, a kind of paperiness to my palms, and crabbiness.

But hypoglycemia is a truly amazing bodily sensation. And when I say “amazing,” I mean amazingly unpleasant. The brain consumes roughly 25% of the glucose used by the body. So hypoglycemia is primarily a brain thing and, as a result, is a bit trippy. And for those of us lucky enough to feel our lows, blood sugar doesn’t have to go much below 70 mg/dL before we notice its effects.

I’ve heard someone trained a service dog to identify hypoglycemia (SQUIRREL!!) and tell its companion to go have a snack. Other than a cold nose lovingly nuzzling you toward the fridge to get some orange juice, what are the symptoms of hypoglycemia? As with so many things related to diabetes, I suspect that it depends.

For me, here are the various things that clue me in:

  • A warm feeling in the tops of my legs.
  • An inability to concentrate, especially when I’m reading.
  • The awareness that I’m touching my head a lot. You know, just to make sure it’s still there.
  • Ringing in my ears.
  • A realization that I can hear all of the ambient noise around me.
  • The feeling that I’m hearing sounds coming down a tunnel. (Think, really cliché techno music.)
  • A sense of panic.
  • A vibrant, glowing white spot that hangs out right in the middle of my vision like an enormous stop-shoveling-snow-and-go-eat-something indicator light.
  • Losing my balance.
  • Sweatiness.
  • Shortness of breath.
  • The sensation that my eyes and my brain are trying to trying to trade places. (I kid you not!)
  • Needing to hold onto my desk so that the room and I are spinning at the same rate.
  • Saying loud, embarrassing, utterly bullshit things such as “My wife beats me!” in the background as she talks to her mother on the telephone.

Well, you get the point.

Posted in Diabetes, Life Lessons, NaBloPoMo, NaBloPoMo 2009 | 3 Comments

Mount Greylock Ride

Me after riding to the top of Mount Greylock with the War Memorial Tower in the background

The last time I rode my bike up a mountain was almost twenty years ago. That is, until today when I took on the eight miles of Mount Greylock.

I have to admit that I was a little nervous before setting off on my ride, since hills have been my nemesis this year. But I’ve been wondering what it might be like to do some mountain riding in a few of the national parks in the West. So I decided to give into Greylock’s siren call.

When I arrived at the state park visitors’ center in Lanesborough, I found the road over the mountain closed due to Friday’s snow. The volunteer at the center told me I could go up — “We’re probably going to open the road at noon, anyway” — and he showed me the “tricky” spots on the map. Evidently it hadn’t snowed very much, but the concessioners closing the lodge at the summit packed the little bit which did fall, turning it into small icy patches. Yesterday was warm, and today was supposed to be even warmer, so I decided to try it out.

An hour later, I arrived at the top and had the summit all to myself — except for the dozen-or-so University of Rhode Island students who were on a weekend backpacking trip, as well as a few concessioners who passed me on the way up in a U-Haul truck at the slushiest part of the climb (of course). I wish that every ride could be on closed roads, since it’s fun to ride down the middle of the road and even cross-over to the “oncoming” lane to avoid a “tricky” spot.

The ride really wasn’t that bad. There were about a half-dozen icy spots in thin strips that I could almost completely avoid. In fact, there was no snow anywhere, except at the very tippy-top. And I had plenty of energy, and it felt easy, although I spent a lot of time in my wussy lowest gear just because I could.

A little bit of snow on Mount Greylock

(I couldn’t help thinking of Errol Morris’s recent series of articles about a controversial photo of the dust bowl when I took this picture.)

There was one other guy at the top: the mayor of NIMBY-town. I passed him as he ran up, and at the summit he told all of the URI students to oppose the “Wind Energy Siting Reform Act.” It (allegedly) would change the law to make it easier for the Commonwealth to permit wind power, making it not subject (they say) to the by-laws of local jurisdictions. (We have 351 of these, you might recall.) And on the way down, as I passed him again, he ran to catch up with me while I negotiated the trickiest icy patch. I told him I would look at his group’s grassroots website. Personally, I’m with the URI kid who, when the runner had gone out of ear-shot, said, “I like windmills.”

Free of distractions, I picked my way down over the terrain I just covered. One of the best things about riding up a mountain is riding down it again. Preferably at a fast pace. Because of the slushy parts, I couldn’t really do that for the first half. But, even though I’m certain that I didn’t touch 50 MPH like the last time I rode down a mountain, those last four miles didn’t take very long at all.

Posted in Cycling, NaBloPoMo, NaBloPoMo 2009, This is who we are | Leave a comment

I Just Can’t Read 55

I’m going to take a break from diabetes today — writing about it, at least.

I rearranged my reading list this morning, finally acknowledging the fact that it had spilled over onto another shelf and that it wasn’t shrinking nearly as quickly as I had hoped.

Two full shelves of books to read
Fifty-five books. (Click for larger. . .)

There would be fifty-six, but this afternoon I finished a short book on the life and works of Gustave Courbet, the nineteenth century Romantic/Realist French painter, bad boy, and Communard. This continues a trend of reading about notable French painters: Eugène Delacroix, Jean-Auguste-Dominique Ingres, and Édouard Manet. If you look closely, you can see Ross King’s The Judgement of Paris there on the shelf. I’ve read about a third of the interesting — if somewhat passion-free — book about Meissonier, Manet, Monet, the revolution in French painting, and the birth of Modernism and Impressionism.

The truly sad thing is that shortly after I finished reading the aforementioned book about Courbet, instead of picking up The Judgement of Paris, I went to Amazon to see what books I could find about Jacques-Louis David. This, if nothing else, demonstrates that I’m a depth-first learner. When I get interested in something — 19th century French painting, for example — I tend to get really into it. But as you can see from my reading list that spans two freakin’ shelves, I get distracted (or maybe “burned out” is a better phrase) and move on to something else.

(Fortunately, there really are very few books available about just J-L David. So one day I’ll get myself over to the Newton Free Library and settle in for an evening of reading about a truly revolutionary figure.)

I’ve been thinking about this aspect of my personality recently. I don’t have this “problem” of amassing too many books and then losing interest in subjects at work. Well, not anymore. Ever since I switched over to a leaner, “just in time” learning mindset a few years ago, I’ve been doing much better. So why can’t I do that away from the office? Why doesn’t that whole Getting Things Done ™ mindset carry over at home? Who knows?

Anyway, I feel like I should do something about my reading list — short of just shelving the books elsewhere in the library. I don’t read quickly enough to read a book a day. Reading one a week might be pushing it, but it seems like a worthy goal.

Ask me after Christmas how I’m doing.

Posted in Book Notes, General, NaBloPoMo, NaBloPoMo 2009 | Leave a comment

Insulin and exercise

Mount Greylock weather update: A park ranger says the road over the mountain is currently closed due to snow. It may reopen tomorrow afternoon. Let’s hope the roads are dry by Sunday morning.

I had a nice run today. Well, the run was nice, though my blood glucose readings are still a major pain. If I exercise in the morning, no problem. But the afternoon is a different story.

It’s all about the insulin, people. In the morning, I usually don’t eat much before exercising, and I certainly haven’t given myself any insulin. But by the afternoon, I’ve eaten a couple times (at least) and I’ve taken some insulin to cover the food. Oh, that insulin-on-board! Obviously I can’t make the active insulin go away; it just hangs out in the blood stream waiting to lower my blood glucose. It keeps me alive, but it’s really crimping my style.

Let’s take a couple minutes to discuss insulin. Here’s the little bit that I do know.

  • Insulin is an enzyme that is (normally) produced by the pancreas. It’s used to metabolize glucose in the cells.
  • People with type 1 diabetes don’t produce any insulin, so we have to replace it by injection or pump.
  • There are fast-acting, long-acting, and peakless insulins; but you only use fast-acting versions (like Humalog) in an insulin pump.
  • The action profile of fast-acting insulin peaks quickly and has a tail of 4-6 hours.
  • Insulin has a half-life. I don’t know how long it is, exactly; I’ve read anywhere from 26 minutes to 1 hour for Humalog. Anyway, it means the more you take, the longer it stays active (albeit with diminished power).
  • Because insulin is injected/infused below the skin, it takes a little while to get to the cells in the rest of the body where it’s needed. But activity can make it absorb more quickly.
  • If you don’t have enough insulin in your system, your body will convert fat into ketones, a kind of fatty acid.

When people without diabetes exercise, their muscles first use blood glucose (briefly) and muscle glycogen. (Glycogen is a kind of simple sugar stored in muscles.) After about 15 minutes, insulin levels drop, and the body switches over to burning fat predominantly. The rule-of-thumb for people without diabetes is to consume 1 gram of carbohydrate for every minute after the first 45 minutes of exercise.

What’s the right balance between active insulin, basal insulin, food, and exercise? I’ve been trying to emulate as much of this “normal people behavior” when I exercise. I try not to bolus for about four hours before going for a run or ride, and I lower my basal insulin by about 50-60%, starting about an hour beforehand. This should reduce the amount of insulin in my bloodstream that could lower my blood sugar. And I eat a little something right before exercising to try to prevent a dip. So far, the right balance is elusive.

I have been recording a lot of data over the last month using a special logbook, which I’ll show another day. But here’s what I did today — just remember it didn’t work as well as I’d hoped.

12:44 - Bolus 4.4u for lunch
13:25 - Bolus 2.7u for "Friday cookies"
15:45 - 204 mg/dL
15:45 - Start temp basal of 0.2 u/hr
16:30 - 15 gm of carbs (sports drink)
16:50 - 279
16:50 to 18:37 - Ran 5.5 miles
17:40 - 86

Obviously, my pre-exercise readings are not great. I’m not embarrassed to show them here, though they certainly aren’t what I’d like. Managing diabetes is all about living with the unpredictable and experimenting until you find what works, and then you turn it into a habit. My big goal is to be able to start exercising with a reading below 150 mg/dL and finish above 100. Today I started at 279 and ended at 88. Tomorrow I’ll try something new and get closer to what works.

Update: Five months later, I’ve learned a lot.

Posted in Data-betes, Diabetes, NaBloPoMo, NaBloPoMo 2009, Running | Leave a comment

Just a Guy with Diabetes on a Bike

We just got back from the pool. You can find Lisa and me there almost every Tuesday, Thursday and Saturday. I’m still not a very accomplished swimmer, but I’ve come a long way since that first time a couple months ago when I had my ass handed to me by the pool. Last week I was feeling very energetic and swam a full half-mile; but usually (like today) I swim a bit less (about 750 meters).

My first time to the pool swimming, I was slow but not surprised. Starting back in March, when I did a bit of running to get ready for my Utah backpacking tip, I discovered that I had squandered all of the conditioning I had built up over the years. I was slow. I wasn’t just slow; I couldn’t run a full mile, which really did surprise me. Endurance activities had always been easy for me, and this was quite humbling.

Months later I was still struggling. Running wasn’t going anywhere — literally — so I took a chance and bought a bike so that I could at least feel like I was going somewhere. I loved it, even though the hills were killing me and my head still felt like it was going to pop. And on top of it all, the world was a bit bright and sparkly after my long weekend rides.

Vitamin B12 deficiency anemia. That diagnosis in August explained a lot: the weakness, the head-popping, the post-ride wooziness, the inability to run. Daily mega-doses of B12 seem to have fixed me . . . although we still don’t know for sure, since my doctor has been really blasé about getting my follow test results back to me . . . grrr.

But all of those months exercising with anemia, combined with my diabetes, provided me some real perspective. I don’t need to be as fast as those other riders I see on Sunday mornings. I’m never going to be as fast as my coworker who ran a 2:28:44 marathon last month. I may never even be as fast as I was six or seven years ago when I ran a sub-48 minute 10K. And Lisa may always be faster than me at swimming, doing five laps for every three of mine.

And I’m alright with those things.

One day earlier in the summer when I was out riding, a guy not much faster than I was passed me. He never got too far ahead of me, and over the next five minutes, he kept looking back to ensure that I wasn’t gaining on him. I couldn’t stop smirking. My internal monologue went something like this: “Dude, I’m just a guy with diabetes on a bike out for a forty mile ride.” He eventually got the distance he needed when I stopped in the center of Dover to check my blood sugar.

And that’s where I am now. I’m just an anemic guy with diabetes who loves to run and ride. (I don’t love to swim, but I do it because I want to be able to do it well when we go to Australia. And on the rare occasions when my form and breathing are working for me, it’s almost fun.)

Despite just wanting to have fun, I do have a few goals, which I’ll mostly keep to myself. But I’ll let you in on a couple of them: I’m working on my endurance and learning to manage my diabetes well enough to run a half-marathon in the spring. (Tomorrow is long run day, by the way). And on Sunday I plan to drag my diabetic self over Mount Greylock on a 40-mile loop before going to a museum or two in Williamstown and North Adams. And I wouldn’t mind setting out on another backpacking trip, preferably free of the near-disasters of the last one. Stay tuned!

Posted in Cycling, Diabetes, Life Lessons, NaBloPoMo, NaBloPoMo 2009, Running | 4 Comments

Oh the places you’ll go…

Lisa and I recently booked our tickets to Wyoming for the week of Thanksgiving. We hadn’t expected this trip — we had thought we would be hosting holiday festivities — but I’m very happy that we’ll be in the Cowboy State again so soon. Then, a month later, we’ll be in Oregon for Christmas.

It seems like we’ve been traveling a lot this year. If you’d asked me after our western adventure last year, I wouldn’t have expected any of this (except maybe Christmas and the cruise in February). Here’s what we’ve done this year so far.

Denver International Airport (January 2009)
Denver International Airport (January 2009)
Downtown San Jose (January 2009)
Downtown San Jose (January 2009)
Aboard the Carnival Destiny (February 2009)
Aboard the Carnival Destiny (February 2009)
Can you find me?
Can you find me?
Notre Dame - Paris (March 2009)
Notre Dame – Paris (March 2009)
Paris from the Arc de Triomphe
Paris from the Arc de Triomphe
The Champs Elysees - Paris
The Champs Elysees – Paris
At the Louvre - Paris
At the Louvre – Paris
Place de la Concorde - Paris
Place de la Concorde – Paris
Monmartre - Paris
Monmartre – Paris
View from the Eiffel Tower - Paris
View from the Eiffel Tower – Paris
Musee d'Orsay - Paris
Musee d’Orsay – Paris
View of the Seine - Paris
View of the Seine – Paris
View of the Pont Neuf - Paris
View of the Pont Neuf – Paris
Notre Dame - Paris
Notre Dame – Paris
Inside Notre Dame - Paris
Inside Notre Dame – Paris
Place des Vosges - Paris
Place des Vosges – Paris
Jardins des Tuilleries - Paris
Jardins des Tuilleries – Paris
Parisian sunset
Parisian sunset
Crocuses (March 2009)
Crocuses (March 2009)
National Gallery of Art - DC (April 2009)
National Gallery of Art – DC (April 2009)
Cherry Blossoms - DC
Cherry Blossoms – DC
Cherry Blossoms - DC
Cherry Blossoms – DC
National Air and Space Museum - DC
National Air and Space Museum – DC
Temple Square - Salt Lake City (April 2009)
Temple Square – Salt Lake City (April 2009)
Salt Lake City Temple
Salt Lake City Temple
Packing in Moab - UT
Packing in Moab – UT
Arches NP - UT
Arches NP – UT
Canyonlands - UT
Canyonlands – UT
Canyonlands - UT
Canyonlands – UT
Canyonlands - UT
Canyonlands – UT
The Hobos - UT
The Hobos – UT
Looking out over Canyonlands - UT
Looking out over Canyonlands – UT
Our friends' baby (April 2009)
Our friends’ baby (April 2009)
Courtney - Boston (May 2009)
Courtney – Boston (May 2009)
Hitting on proto-feminists - Boston
Hitting on proto-feminists – Boston
Walk for Hunger - Cambridge (May 2009)
Walk for Hunger – Cambridge (May 2009)
Kerry and Lisa - Worcester (May 2009)
Kerry and Lisa – Worcester (May 2009)
My father's apartment - Des Moines (May 2009)
My father’s apartment – Des Moines (May 2009)
Humboldt - IA
Humboldt – IA
Great-aunt and uncle's farm - IA
Great-aunt and uncle’s farm – IA
Family reunion - IA
Family reunion – IA
My cousin and her cutie - IA
My cousin and her cutie – IA
Hiking Mount Monadnock - NH (May 2009)
Hiking Mount Monadnock – NH (May 2009)
Hiking Mount Monadnock - NH (May 2009)
Hiking Mount Monadnock – NH (May 2009)
Hiking Mount Greylock - MA (July 2009)
Hiking Mount Greylock – MA (July 2009)
Norma and Kerry - Boston (July 2009)
Norma and Kerry – Boston (July 2009)
At Fenway Park - Boston (July 2009)
At Fenway Park – Boston (July 2009)
Happy Tooth Day - Boston
Happy Tooth Day – Boston
Kitty (July 2009)
Kitty (July 2009)
At Sail Boston (July 2009)
At Sail Boston (July 2009)
Aboard the U.S.S. Eagle - Boston
Aboard the U.S.S. Eagle – Boston
National Gallery of Art - DC (August 2009)
National Gallery of Art – DC (August 2009)
Farmer Jeff's meager haul of beans (August 2009)
Farmer Jeff’s meager haul of beans (August 2009)
Hiking in the Great Blue Hills (August 2009)
Hiking in the Great Blue Hills (August 2009)
Taking a break from riding - Medfield (August 2009)
Taking a break from riding – Medfield (August 2009)
Toilet repair (September 2009)
Toilet repair (September 2009)
Setting off from Salisbury, CT (September 2009)
Setting off from Salisbury, CT (September 2009)
Rendez-vous in Pittsfield - MA
Rendez-vous in Pittsfield – MA
Too much traveling? - Winfield, KS (October 2009)
Too much traveling? – Winfield, KS (October 2009)
Relatives' shoes - KS
Relatives’ shoes – KS
Lisa's new BFF - KS
Lisa’s new BFF – KS
Steve, Lisa's brother - KS
Steve, Lisa’s brother – KS
Lisa and her dad - KS
Lisa and her dad – KS
Family portrait - KS
Family portrait – KS
At the Sonic - KS
At the Sonic – KS
Checking in for another flight - Tucson, AZ (October 2009)
Checking in for another flight – Tucson, AZ (October 2009)
Tucson Mountain Park - AZ
Tucson Mountain Park – AZ
Ocotillo = Ouch - AZ
Ocotillo = Ouch – AZ
A brief respite - AZ
A brief respite – AZ
At the reception with Mary - AZ
At the reception with Mary – AZ
Adam, the groom - AZ
Adam, the groom – AZ
Heading out to ride around the Quabbin (October 2009)
Heading out to ride around the Quabbin (October 2009)
In New Salem, MA
In New Salem, MA
Taking a break in Hardwick, MA
Taking a break in Hardwick, MA
Quabbin Hill Road - MA
Quabbin Hill Road – MA
Our traveling tires out Kitty (October 2009)
Our traveling tires out Kitty (October 2009)
Metropolitan Museum of Art - NYC (November 2009)
Metropolitan Museum of Art – NYC (November 2009)
Posted in City of Light, Cycling, Europe, NaBloPoMo, NaBloPoMo 2009, Photography, Travel, USA | 3 Comments

I Heart My Pancreas/Paperweight

Sorry, dear readers. I had planned something a bit more substantial for today; but after making dinner, getting a haircut, swimming laps at the pool, and talking to my mom on the phone, the time just isn’t there. But here’s a picture of the T-shirt Lisa made me for my D-Day celebration birthday this year:

I love my pancreas/paperweight T-shirt
Click for larger…

That is all.

Posted in Diabetes, I am Rembrandt, NaBloPoMo, NaBloPoMo 2009, This is who we are | 1 Comment

Afternoon (basal) delight

This post is inspired by Anna in Montréal, who is adjusting her basal rates.


A Side-effect of Exercise

I have a bike. This shouldn’t be a big surprise, as I’ve written about my border-to-border and Quabbin Reservoir rides recently.

I love riding my bike, and during the warm months with lots of sunshine I rode it almost everyday. I like the sensation of rolling along, with the wind whistling in my ears and the scenery blurring by. I don’t even mind the hills anymore, even though the wind stops whistling as I crawl along.

All of that riding has been great at lowering my blood glucose reading. In fact, it’s worked a little too well. Insulin — the enzyme that helps transport glucose into your cells for energy — becomes much more effective when you exercise. And when your muscle cells slide past each other, they basically act as pumps and can work (almost) without insulin. (But not completely without.)

When I ride, I carry a waterbottle full of sports drink — Gatorade if you care to know — but I was still having hypoglycemia more often than I’d like. If you don’t have diabetes, this is commonly referred to as “cracking,” “bonking,” or “hitting the wall.” Your muscles have spent their glycogen (a form of glucose usually found inside of muscles), and your body can’t convert enough fatty acids into energy. You feel tired and find it hard to keep going.

If you have diabetes, hypoglycemia has all of these same attributes. Of course, for us it also means that our brains don’t get enough glucose either. So we’re not just tired, we can also pass out. And stopping for a little while doesn’t fix the problem. We have to replace it right away. So I try really hard not to have hypoglycemia. And as someone trying to take off a few pounds — which is going quite well, thank you very much — I want my body to turn fat into fatty acids and leave my blood glucose more or less alone. And I don’t like to drink a lot when I run, which I’m doing now that it’s dark in the evening. But, as I said on Halloween, hypos scare me.


Time to Fix the Basals

So I pulled out my copy of Smart Pumping. “Oh look! I should probably fix my basal rates as a first step.” Well, it was time to do that anyway.

For those of us with insulin pumps, basal insulin is the continuous trickle of background insulin that keeps our blood glucose in the happy/normal range of 80-150 mg/dL, counteracting the steady release of blood glucose from the liver. Why the liver does this, I don’t know. I read in my book that basal insulin should be about 40-50% of your average total daily dose (basal + food/correction boluses). Mine was about 55-60%. A sign of problems. Fixing these rates requires skipping meals and testing every couple hours. Skipping meals is hard. And if one reading is too much different than the one before, you have stop, make adjustments, and start another day.

But I wanted exercise to be easier (and last longer). And (more importantly) I was coming up on my 10-year anniversary with diabetes and had told myself that I wasn’t going to go five or ten more years just “getting by.” I was starting to be quite unhappy about all of my hypos and high readings. And I had a supportive, active new endocrinologist who wanted to help me improve my readings and my ability to predict them.

After figuring out my morning basal rates — which involved about four or five skipped breakfasts — I began my afternoon tests in late September. When I started, I was getting 22.0 units per day. (A unit is 1/100 of a mL. A vial of insulin has 1000 units.)

Four weeks, seven tests and seven adjustments later, I think I’ve figured it out. I have just one more afternoon test to go — I hope — but I think my new rates are correct. For the curious people with diabetes out there, here’s a bit of the data.


Numbers and stuff

On 26 September, my basal rates were

00:00 - 07:00 = 0.9 u/hr
07:00 - 09:00 = 1.0
09:00 - 20:00 = 0.9
20:00 - 00:00 = 1.0
(22 units per day)

The first or second test:

6 October 2009
Last basal: 4.0u at 7:42 (active insulin at 12:30 is 0.4u)
11:39 - 143
12:54 - 79
Stopped

8 October 2009 - Attempt #2 or 3
Last basal: 4.3u at 7:22
11:20 - 155
12:56 - 97
Stopped

I was checking more often than required in those early tests, because I could actually feel my blood sugar moving. I kid you not, and I had suspicious that I was going a scary place.

By 12 October, I had changed my rates to

00:00 - 0.9 u/hr
07:00 - 1.0
09:00 - 0.7
15:00 - 0.8
20:00 - 1.0

13 October 2009 - Attempt #4
11:38 - 133
13:00 - 93
14:00 - 78
Stopped

19 October 2009 - Attempt #5
11:27 - 216
12:54 - 188
14:45 - 138
15:47 - 111
Stopped

After this, I was feeling close to being there, and before my last test had already knocked off a lot of insulin.

00:00 - 0.9 u/hr
07:00 - 1.0
09:00 - 0.7
11:00 - 0.5
15:00 - 0.6

27 October 2009 - Attempt #7
Previous bolus - 07:51
10:44 - 256
11:53 - 234 (Active insulin 1.1u)
13:36 - 226
16:01 - 180
18:01 - 153

I know that last test started out with high readings, but I just wanted to get the damned thing done, and I knew that having higher readings would give me a good cushion for seven hours of testing.

Currently, here’s where I am:

00:00 - 0.9 u/hr
07:00 - 1.0
08:00 - 0.8
09:00 - 0.7
11:00 - 0.5
20:00 - 1.0
(18 units per day)

These basal tests are all about gradual refinements. If your BG readings change by more than 30 mg/dL up or down over any two hour period, adjust +/- 0.1 unit/hour starting 2-3 hours before the dip/bump. The Pumping Insulin authors also recommend redoing all of your basal tests (overnight, morning, afternoon, and evening) whenever you change exercise patterns, your weight changes 5-10%, or you suspect they’re wrong because of fasting highs or lows.

Posted in Cycling, Data-betes, Diabetes, From the Yellow Notepad, Historical Record, Life Lessons, NaBloPoMo, NaBloPoMo 2009 | Leave a comment

Metropolitan Museum of Art

I love paintings by Vermeer. So when I heard that his “Milkmaid” was on loan to the Metropolitan Museum of Art from the Rijksmuseum, I knew I would have to go there to see it. Today, Lisa and I took a day trip down to NYC.

It was everything I had expected. Better. It is, in fact, a truly beautiful painting: sculptural, brilliantly colored, sympathetic, honest, compelling. I’m so glad that we had the chance to see it.

Here are some photographs from our outing. Click for a larger version…

Grand Central Station
Grand Central Station

Choir Screen at the Metropolitan Museum of Art
Choir Screen at the Metropolitan Museum of Art

Modern art
Modern Art

Van Gogh self-portrait
Van Gogh Self-portrait

Rembrandt self-portrait
Rembrandt Self-portrait

Sculpture of 'Nydia, the blind flower girl of Pompeii'
What’s that, Nydia?

Temple of Dendur
Temple of Dendur at the Metropolitan Museum of Art, looking out over Central Park, New York

We also just barely missed seeing the lead women run through Central Park at Mile 24. Oh well, some other time.

Posted in NaBloPoMo, NaBloPoMo 2009, New York, Photography, Travel, USA | Leave a comment