Closing the Books on November

Here we are: November 30th. The last day of November. The last day of post-something-everyday month. I feel this year’s NaBloPoMo has gone better than last year’s, and I’m thinking about some possible tweaks for next year. Maybe I will take a little hiatus starting tomorrow, using the time to read books on my reading list and further purge the office of mental baggage. We’ll see when I’m moved to post write something new next.

One thing I had hoped to do a month ago was to clear out a bunch of the things I had in mind to post. I posted roughly half of them. Yay! This dispatch aims to tidy up some loose ends. It will probably be long, and it might be rambling. Beware! If anything turns out to be just a bit too long or important, I’ll break it out into its own post.

It’s a good time to clear the decks. Lisa is out for the evening, I’m streaming a concert by Cœur de Pirate (mp3), and I’m in the mood to write. In fact, I’m in the mood to do just about anything to take my mind off the fact that I’m basal testing and have to skip dinner. Fortunately, at lunch I had some of the very delicious Comté cheese that we bought in Montréal last weekend; I hope that it will fortify me for another four-or-so hours when I can eat a very late (10PM) dinner.

Oh, one more thing before I get going with the things I had intended to write about. I’ve been listening to (and loving) the new album by Caracol. Unfortunately, it isn’t available in the US yet. (Next year, she hopes.) But you can stream the tracks from the web site. It’s so good! In my book, it’s one of my Top 5 for 2011. Go check it out and tell me what you think and what albums/CDs/whatever you really liked this year.

On with the show.

Basal Testing: I hate basal testing. I don’t think anybody who uses an insulin pump likes to do it. Why would we? It involves eating a normal meal, waiting at least three hours since the last insulin bolus, skipping the next meal, waiting 4-6 hours after the normal meal time to eat again, and recording blood glucose every two hours (or so). And that’s just during the daytime. At night, the requirement is to go to bed without a snack and then wake up at 1:00 and 4:00 (for example) to test.

Ideally, you see an awesome, tight range of numbers that make you feel confident that your basal (background) insulin rates are correct. But if there’s too much movement one way or another, you have to stop. This means you get to eat early, but it also means that you have to make an adjustment in the pattern and then run the test again on another day. Plus, who actually does a basal test when everything is going right? No one except crazy people. No, you only do a test to figure out what is going wrong.

But in October I decided to bit the bullet and get my all my basal rates as correct as they can be. I was noticing a lot of trends in my CGM graphs and decided against just making changes willy-nilly. I still suspect that most of my problem is under-bolusing for meals, but I can never know without checking that the basals are correct first.

One big problem with basal testing is each day is a big ole cycle that leads straight into the next. Where do you start? Some people say, “Overnight. Get that right and then you can start your march through the day.” Maybe for them. My evenings are cray-cray, going high after my after-work training and then bouncing around after dinner before I give myself my final “well, I’ve messed up today pretty good” insulin and/or snack before bedtime. That makes overnight testing difficult.

For me, it’s been easiest to find a few mornings that seemed designed for testing—in-range BGs, flat/normal CGM graphs overnight—and skip breakfast. Then I tested my breakfast bolus ratio and timing. Then I skipped lunch for an afternoon basal test, followed by the lunch bolus test. And now here we are at dinnertime without dinner. Once I’m done here I can figure out a rubric for my afternoon/evening workouts and test that before taking a stab at dinner and (finally) the overnight basal.

One hard question I’ve had to answer is whether to exercise on days when I do basal testing. Since I train 5-6 days each week, I feel okay skipping one for the greater good. But then there’s the admonition that you should do what you normally do, which for me means exercise. Today I skipped a bike session in the basement, which is “okay” since I swam this morning, but it’s also torture because I really, really want to ride my new bike. Greater good.

By the way, to any CDEs, endos, etc., who might be reading this, please note: I’ve been on the pump for over ten years, and this will (hopefully) be the first time that my basal rates and bolus ratios are correct/proven. If you’re going to put someone on the pump, you need to (a) make sure y’all work together to get the settings locked down from the start, and (b) work on all of the behavioral issues that come along with multiple daily injection (MDI) therapy. Just saying.

I just hope that when I get through with this process, I’ll be able to translate all of this hunger into a baseline for making amazing observations about exercise+insulin+food.

Three hours to go.

Organized Bike Touring: I was asked several times right after my trip (photos) whether I would do another organized bicycle trip. Most of the people on the tour had done several already and were talking about which one they would do next. I always played coy. “Maybe.”

I enjoyed myself quite a lot. The scenery was great. I really enjoyed spending time with Mom in France. My fellow travelers were wonderful. The tour leaders were fantastic people. It was terrific having so many details taken care of; all I had to do was get on my bike and ride. And there was plenty of time to do things other than cycling.

But two things brought me down. (1) I wish there had been more actual riding. I could easily have gone an extra 20-30 miles most days, and I wouldn’t have minded a slightly faster pace. I certainly wasn’t expecting a race or even a hard ride each day, but I think the tour company we used was aiming at a more casual riding experience . . . which is totally cool, if that’s what you’re after. No judgement from me. Honest. And (2) Lisa wasn’t with me. I was having a great time doing and seeing interesting things, eating delicious food, and going to beautiful places that she would have also loved . . . just without the bike.

If only there were a way to bring Lisa, a noncyclist, along on a trip that involves some (longer distance or more intense) bicycling. Oh wait, maybe there is! Clearly it involves bringing a larger group of friends to France, some of whom ride and some who don’t. We’ll see what happens in a couple years. :^)

Two and a half hours . . .

Occupy This! will be posted tomorrow.

Two hours to go.

iOS v. Android: I have an iPod Touch. It’s great. I have all sorts of useful apps, and I use it all the time. It syncs with my Mac apps, including iTunes. It doesn’t make phone calls.

I have a Google Nexus One phone. It has a nicer-than-the-iPod’s input editor coupled with its not-quite-as-nice touchscreen keyboard. It has a couple of apps that I used when I was in France, only one of which was not already on my iPod. It kind of plays music. It shares data with “useful” Google apps on the web. It makes phone calls, is unlocked, and accepts normal SIM cards like the one I bought in France that let me call home at 4¢/min. (No shit! 15€ gave Mom and me so much talk time over two weeks that we had a bunch left over when we returned home.)

I wish I had a mythical, nonexistent, unlocked iPhone that supports pay-as-you-go and takes regular SIM cards. That would be perfect.

Are we there yet?

Before There Was Facebook: A Short, Subjective, Incomplete Insider’s History of PlanetAll will be posted Friday.

Almost there! By the time I write one more and then proofread, it should be “dinner time.”

Cyclocross: Early in the month I had thought about writing about how I was considering cyclocross as an off-season pursuit. But then I saw one and decided that it looked painful (and not in a fun kind of way). Although this did make me laugh.

Yay! I made it! I did my proofreading, took one more BG test, and had dinner while chatting with Lisa, who just arrived home. The results are mostly good news: I was incredibly stable until 9:00, at which time I started to drop slowly but steadily. That happens to be just an hour after my basal rate kicks up from 0.4 u/hr to 0.7 u/hr. That hardly seems like a coincidence.

This entry was posted in Cycling, Data-betes, Diabetes, General, MetaBlogging, NaBloPoMo, NaBloPoMo 2011, Travel. Bookmark the permalink.

2 Responses to Closing the Books on November

  1. Sara says:

    re: basal testing -

    When I got my first pump, my endo just programmed in my settings based off my MDI doses.

    They worked for a little while, but I guess I didn’t understand that I could change them myself.

    Now, 7+ years later I feel like I am adjusting them every few months particularly as the seasons change.

  2. Jeff Mather says:

    Sara: The more I think about my interaction with first endo, the more perplexed I get. I know that there are good doctors and better doctors (and the occasional bad doctor), and I’m trying to give him the benefit of the doubt.

    Getting an endocrinologist (instead of using my PCP) was recommended to me by my CDE when I was still a total newbie in-patient trying to learn the basics. And those basics were the hospital’s protocol at the time for new T1 patients: NPH only. So I went to him, and for more than a year that was my therapy: just NPH, twice a day.

    I wish that he had been with it enough to say, “You’re a new patient, and there’s a new therapy involving Lantus/Ultra that you’ll probably do better with. So, let’s switch you before you get too messed up.”

    If that had been the case, when I started the pump, it should have been easy enough for him to say, “Let’s take your long-acting dose, divide it up, and make it your basal; take your Humalog meal ratios and carry them over; and then tune it by testing.” But, no. Because everything was wrong, we just used the total daily dose (TDD) and tried to make that work, but that was already too high. (And by “we,” I mean the Minimed rep, my CDE, and I.)

    Years later, I’ve titrated myself down and found a new endo who spends much, MUCH more time trying to figure out what’s going on with me. But, wonderful as she is, I think she still has a little trouble believing that I had been winging it for so long.

    I’m totally down with changing my settings myself. I think not doing so leads back to the old NPH days where you either worked around the limitations of an ineffective therapy or didn’t trust the therapy (or both). We’re empowered patients, after all!

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