Category Archives: Data-betes

Closing the Books on November

Posted on November 30, 2011 by Jeff Mather

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.

Posted in Cycling, Data-betes, Diabetes, General, MetaBlogging, NaBloPoMo, NaBloPoMo 2011, Travel | 2 Comments

Heart Rate Training?

Posted on November 29, 2011 by Jeff Mather

How do you get faster at any endurance activity? Ironically, you get faster by doing it faster than usual. If you run every run at one pace or do every ride at the same tempo, then you’ll never progress. You can only build up so much aerobic capacity, since you can only move so much blood and oxygen around. What you need to do is to work harder so that the muscles themselves are stronger and capable of giving more.

My running plan includes plenty of tempo running and interval sessions. And I’ve finally gotten to the point where there’s “normal swimming” and “harder swimming.” But how do I know how hard to work when cycling?

I think the answer is heart rate training, which is new to me. Have any of you had success doing this?

I’ve figured out several of the basic calculations based on my computed maximum heart rate (183 bpm) and resting heart rate (52 bpm). According to an online calculator, these are my target heart rate zones:

Zone 1: 118-131
Zone 2: 131-144
Zone 3: 144-157 (Aerobic)
Zone 4: 157-170 (Anaerobic)
Zone 5: 170-183 (Maximal)

Now, where do I go from here?

Posted in Cycling, Data-betes, Fodder for Techno-weenies, NaBloPoMo, NaBloPoMo 2011 | Leave a comment

Titration

Posted on November 20, 2011 by Jeff Mather

titration: (noun) the process of gradually adjusting the dose of a medication until optimal results are reached.

I remember doing titration in high school chemistry class and not really enjoying it. You wait and wait and wait for something to happen while adding more and more and more reagent to a flask in the hopes that it will turn a pretty color. Or rather, after a game of rock-paper-scissors, your lab partner adds the reagent to the flask while you write down measurements and try to stay awake. Even though I loved learning about chemical reactions and trying to recreate some of them at home—how did I not burn the house down playing with purloined magnesium tape?—I think the titration lab was the one where I realized higher-level studies in chemistry weren’t for me.

It feels so similar now as I try to titrate the correct dosage of insulin to give when I exercise. It’s still the process of running multiple experiments involving adding a known amount of chemicals—in this case food and insulin—coupled with a lot of record-keeping. The big differences of course being that (a) I’m the flask to which the chemicals are added, (b) I have to wait a week between experiments, and (c) there are reagent strips I use with my blood glucose meter that together tell me the values and keep track of them for me. And, of course, the really big difference: If I mess up the experiment too badly I can’t just poor the contents of the flask down the lab desk’s drain.

After all this time, I still don’t really like titrating—it’s scarier to mess with insulin than it is to burn magnesium tape—but I also don’t like these other things when I’m training:

  • being hungry
  • running out of energy
  • experiencing hypoglycemia
  • having high blood glucose
  • not knowing what’s going to happen

Unfortunately, in this lab experiment, each apparatus person with diabetes is different. Otherwise I would just ask my awesome internet friends. Even I probably won’t give the same results from one week to the next. That being said, last week’s experience of going way up during the first 45 minutes of my long run and then holding steady for the next 45 minutes (eating beforehand and along the way) was the same as today’s.

Next long run (in two weeks) I’m going to add some bolus insulin and see what happens. I’m going to start minutely small and go from there. I have about sixteen weeks until Around the Bay, and I don’t feel any particular need to approach the problem via bisection. I’ll just use the normal titration method, starting small and gradually adding more until I find the “right answer. . .” or something near it.

Today’s run was actually quite good, elevated BGs notwithstanding. The weather was beautiful in the Bay State this weekend, and I got up early enough that I didn’t feel rushed to get home before we went to see the film “Martha Marcy May Marlene.” (It’s good, but bleak. Wicked bleak. “Winter’s Bone” bleak. Life lesson: stay away from John Hawkes.) I picked the 10-mile loop with three mile-or-longer hills, and I threw about fifteen minutes of tempo running into the middle of it. I figure I’ll gradually keep adding longer stretches of high intensity as I add more distance.

And Tuesday I’m going to see a guy about a bike.

Posted in Data-betes, Diabetes, NaBloPoMo, NaBloPoMo 2011, Running | 1 Comment

3600 Yards

Posted on October 24, 2011 by Jeff Mather

Here’s a quick update about yesterday’s race: I’m a bit sore.

Was it the lack of arch support in my spikes? The dehydration? Maybe the exertion of running three miles before digging deep to find a kick that helped me pass five or six people in the last tenth of a mile? (I forgot to put that into my “Snap out of it! You should feel good about your race” calculus last night.) Who knows for sure? Not me. Whatever the cause, it’s here—slight, but here.

When I got out of bed today, my first thought was (as always) “OMG, it’s early!” The second was that I’m glad today is a swimming day instead of a running day. There was the aforementioned (mild) soreness, and also I knew I wasn’t going to run after work, since we have a customer visiting from 6:15 to 8:15.

When I realized on Friday that I was going to work later, I decided that I would also go to work later. This presented me with an opportunity: swim extra long. Most Monday, Wednesday, and/or Friday mornings, I swim for about thirty to forty minutes, starting at 5:45. Despite my early departure, the pool is open until 7:15. The longest that I had ever swam before was back when Lisa and I would swim for an hour on Saturday afternoons, but that was a while ago. I decided to see how far I could swim in an hour and a half.

Actually, my goal was to see if I could swim two miles. I had swam about 1.25 miles before, but most of my swims are about a mile. One day at the reservoir, somebody sprang the idea of swimming an extra mile, doubling our normal route. I really wanted to take them up on the offer, but I wasn’t ready. Physically I knew I could probably do it, but I was worried about the diabetes part. I didn’t have extra snacks with me—though I usually carry a gel or two in the ankle of my wetsuit—and I didn’t know what my blood sugar was going to do on a swim that long. I declined; September came around; it got colder, darker, and rainier; and I thought my chances were gone until next summer. Then today came along!

I was also going to use this swim to see what happens to my blood sugar on long swims. I brought a small chamois towel to dry my hands and my “exercise” meter with me onto the pool deck, along with a bottle of water. (Swimming is thirsty business.) A half hour earlier I had turned my pump down to 0% and eaten an obscenely large banana. At the time, my BG was 121. (Yay!) Half an hour in, Lisa had to leave to go to work. I took a break, gave her a goodbye smooch, drank some water, and tested: 161. (Yay!) Another half hour later, at around 1.25 miles, I tested again: 115. (A bit of a drop, but . . . Yay!) Finally, at 7:15 I stopped, looked around, saw that I was the last person in the pool, and tested: 120. (Woo-fucking-hoo!) When you take out the time when I was testing, I swam 2 miles in 1:21. And I did it all while rocking the happy BGs.

What a difference a day makes!

I’m still not a very graceful or efficient swimmer. I’ve swallowed my pride and started doing a few drills from the Total Immersion system, and I can start to feel a few changes coming on. In particular, I’m trying to be more of a “front quadrant” swimmer. Instead of being a whirligig-like wind-up swimmer with windmilling arms, I should try to keep one hand out in front of me longer. Lengthening out my body should help keep me streamlined and tilted correctly in the water, and I can already feel it starting to change where my power is coming from, as it moves from just my shoulders to include my core. It’s slow going, making these changes. I’m glad I have the rest of the winter to work on my form.


p.s. — My Internet-friend—hopefully one day my have-met-in-real-life-friend—Céline has been swimming a lot lately. It’s fun to watch someone have many of the same experiences that I’ve had.

Posted in Data-betes, Diabetes, Life Lessons, Running, Swimming | 3 Comments

Things You Should Be Reading

Posted on August 12, 2011 by Jeff Mather

Hey, everybody. It’s that time again. The time to clean out a bunch of links that I’ve read and share them with you because I think you might find them interesting.

Posted in Computing, Cycling, Data-betes, Diabetes, Software Engineering, Worthy Feeds | 1 Comment

My Insulin Pump Hacker Name is “Glux0se”

Posted on August 10, 2011 by Jeff Mather

Victoria wrote an excellent piece on her site about what’s become known as “pumphackingate.” In it, she gives a brief recap of the facts and some of the reactions that have appeared on other blogs. Here’s an even briefer recap, in case you don’t know anything about it: Some hacker/builder dude created a device that can control some insulin pumps remotely along with gathering data from them. Based on a comment I left over on Victoria’s site, here’s my take on the issue.

First off, I’m not surprised. Like any device that transmits and receives wirelessly, the signals from pumps and CGMs are interceptable. Furthermore, like any other device that communicates with limited access control—you just need to know (or sniff out or be able to guess) the six or seven digit code that’s used to connect with another device—they’re essentially open. From there it’s all just figuring out the protocols and the format of the data as it’s passed around. As someone who spent about ten years working with and occasionally reverse-engineering formats, I can tell you, it’s all just a matter of trial and error and careful observation. (If I were a hacker, my handle would be “gluX0se.”)

So, in a world where relatively few people have these medical devices—unlike, say, mobile phones or bluetooth devices—the device manufacturers essentially did the easy thing, which was to assume we use our medical devices in a trustable world where people don’t mess with medical devices. (BTW, who knew there was a free Vulnerability Management for Dummies e-book?)

There’s been a lot of unease in the community about the way that the information was presented to the press and the way that some outlets sensationalized it (e.g., “Black Hat: Lethal Hack and wireless attack on insulin pumps to kill people”). It’s hard not to agree with a lot of the criticism there. But I can’t criticize looking for security holes in medical devices. Nor can I fault the impulse to hack into own’s own medical device—even one that keeps people alive—or to help other people hack their devices. Not all hacking is scary villainy, but this incident certainly exposes some problems.

Using the AP to share this information leaves a bad taste in my mouth, but presenting the findings at the Black Hat Conference seems like the most appropriate way to publicly disclose this research. (And it is, in my mind, legitimate personal security research that should be shared openly.) I would have preferred that Radcliffe work more closely with the device manufacturers leading up to the announcement. (I’m assuming that he did not.)

On the other hand, just presenting the findings to the device manufacturers—as some would have liked—violates the hacker ethos, both the black hat and white hat versions. Part of hacking—the part that I can get down with—is when motivated hobbyists exploit technology to solve a problem (real or imagined). I have thought many times how great it would be to sniff the unprotected data that’s transmitted by my pump/CGM and skip the middleman of uploading data to a web site. I’ve even gone so far as to seek out the information that Radcliffe presented, but it wasn’t available at the time.

Device manufacturers limit our access to our own medical data and tightly control the way that we can interact with our devices. It’s understandable given the limitations put on them by the FDA, their own desire to help (not harm) customers/patients, and their lawyers’ desire to limit risk exposure. It does mean, though, that the enormous potential for third-party, patient-focused tools goes untapped. Those tools could benefit so much from being able to present data the way that their users want to see them: A dashboard light in a car, a desktop computer widget that display CGM values, a mobile app that records all of the data for later use, a device that calls parents of children with diabetes when something happens, an awesome mood ring displaying BG, etc.

I suspect (and once again I’m assuming here) that Radcliffe was intrigued by the rather obvious possibilities of unprotected communication, and that’s getting lost in the whole “malicious people ruining diabetics’ lives” reporting. I fear the notoriety this incident is garnering is going to scare manufacturers into closing exploitable security holes without providing a secure, replacement method for getting at all of that data. And that’s a shame.

Posted in Computing, Data-betes, Diabetes, File Formats, Fodder for Techno-weenies | Leave a comment

Exercise Data

Posted on August 4, 2011 by Jeff Mather

I mentioned last week that I’ve been journaling about exercise for over a month now. With all of that data—over forty events—it’s finally time to sift through it for patterns, to see what worked and what didn’t, and to come up with a new round of “experiments” to do as I swim, bike, and run.

So, into Microsoft Excel it went. After sorting and grouping the data, here it is:

Diabetes Exercise Data

Believe it or not, I am really more of a narrative person than a numbers person, and I already worry that looking at the data this way will obscure other important details or magnify the importance of data over context. (That’s actually why I hate the way many endocrinologists approach diabetes management, though I understand why they do it that way.) Nevertheless, I hope this different view into the last five weeks will illuminate trends. We shall see what comes from all of this.

Posted in Data-betes, Diabetes, From the Yellow Notepad, Life Lessons, Reluctant Triathlete | Leave a comment

Write This Down

Posted on July 27, 2011 by Jeff Mather

A key aspect of athletic training is mindfulness. For the most part, you don’t just go at it willy-nilly. You need a well thought out plan in order to progress, and any activity that involves technique or correct form requires paying attention to what you’re doing. [1] So why would I expect that managing my diabetes during exercise, which involves a lot of thinking about where my blood glucose is and where it might go, should be any different?

I’ve never been very good at BG journaling, though. Like many people with diabetes, I’ve started multiple times to write everything down only to quit after a few days. But I’ve been very motivated following the BAA 10K to try for more consistently awesome BGs before, during, and after exercising. Journaling, I suspected, was the only thing that was really going to work.

Having less than stellar BG logging experiences before, I went into the process with my eyes open and my mind working on how to make it successful. The result was that I gave myself four guidelines:

  1. Be focused on what I want to change.
  2. Be free-form.
  3. Record it on the day it happened
  4. Don’t spend too much time (i.e., less than 5 min/day)

So, since June 26th I’ve been writing down all about my BG, insulin, and food during (and before and immediately after) exercise. Each swim, bike, run, and hike gets its own page in a small notepad. Even though they aren’t entered into a form and don’t conform to a rigid pattern, they have the same basic structure:

  • What happened earlier in the day? One or two sentences about BGs and whether I did anything crazy like eating a big-ass burrito for lunch leading me to go wicked high and leading me to decide that this bike ride is going to be all about driving that as close to a perfect 104 as I can in 45 minutes. (Not that such a thing has ever happened . . . within the last few days.)
  • What I set my temp basal rate to and when I did it.
  • Whether I had a snack before going out and how much.
  • A sloppy looking timeline of what my BGs were, when I ate, when I exercised, and whether I bolused at all, etc.

If I’m feeling really ambitious, I might add a “compare/contrast with these dates” section. I’ve really only done that for swimming, when I was making some serious attempts at testing the right time to eat my energy gel before getting in the water.

But that’s it. While I might record a middle of the night BG that I took before an AM run, I try to stay really focused on the period lasting from an hour or two before I start to no more than an hour after my training is over. Anything else is (a) going to take too long to record and (b) isn’t really going to help me look at what’s happening with the exercise.

So far it’s been working well. I’m coming close to nailing down the things that I do a lot: swimming before work, running or biking after work, and long bike rides on weekend mornings. [2]

What do you do to keep track of your diabetes data when you’re trying to improve something that’s not to your liking?


1 — Technique is currently the tricky thing about swimming. Being mindful about how to effeciently move through the water is where I’m putting my mental energy now (instead of worrying about whether I’m going to stay afloat or how long it’s going to take to get back to the beach). Progress! [Back . . .]

2 — Except that today my endocrinologist and I decided we’re going to make lots of changes to my basal rates and bolus ratios to get me to a happier A1c—my last one was 8.3—so I might not have those so well nailed down in a couple weeks. [Back . . .]

Posted in Data-betes, Diabetes, Life Lessons | Leave a comment

BA-D-Mofo, Or The One That’s Not Really About Swimming

Posted on July 5, 2011 by Jeff Mather

Hi, y’all! It’s been a few days since I wrote here. In the meantime, Lisa has returned home from Oregon, and we have spent some time together hiking Mt. Holyoke, hanging out in the new backyard hammock, watching the new Woody Allen film, running a bit, and eating ice cream. [1] It’s been quite enjoyable!

I had briefly contemplated writing about swimming each day for a month. I’ve been doing a lot of it recently—and have even posted a little about it here—but, as Lisa said, “That’s a lot of swimming.” The problem with committing to writing daily on a particular subject being that it’s hard to find time to write about anything else. “Life is choices,” and all that.

Thinking of choices, last week was the first one in quite a while where I didn’t race or partake in a long run. Instead, on Sunday morning I started building up my cycling mileage again. Last year I was a riding fool, but this year I had been much more focused on swimming and running, almost to the exclusion of the bike. Why did I ever cut back? I was so glad to be back at it; a few times as I watched the world slide by during my 50-mile outing, I found exclaiming aloud, “This is fantastic!” You would think I hadn’t been riding in years. (Not coincidentally, about 35 miles into the ride, my sit bones let me know that they were going to need a bit more saddle time before they would be truly happy.)

So now I’ve switched over from training for a better run time to getting my cycling legs back. I will need them for the Sharon sprint triathlon in mid-August and for my trip to Provence a month later. Hopefully there’s a way to keep my running ability near where it is now without putting in the same amount of miles. I’m thinking that if I keep with my tempo and interval workouts and go for an easy run a couple times per week that could work. Who knows? Perhaps I should look at a triathlon training plan. [2]

The book I was reading in the hammock between bouts of cloud-watching was Sheri Colberg’s Diabetic Athlete’s Handbook. It’s been on my reading list far too long—so many books languish there—despite some pretty clear evidence that I need to learn from it. I’m pretty close to finishing it and will be sure to share some of its wisdom here soon.

The book is a nice complement to some observations that I’ve been making since last Sunday, the day of the BAA 10K. I don’t really like blood sugar journaling because it takes up so damn much time, but I really want to make this part of my diabetes experience better. My hope is that if I can limit the data and observations to one specific area (i.e., exercise) it should be an easier habit to keep. I’m a little intimidated by the prospect of sorting through the raw log data in order to determine what to do differently next time; surely it’s going to involve some guessing, but at least I’ll have something to compare against.

And that finally gets me around to something I’ve been ruminating on a lot recently: how to be a badass diabetic mofo, or BA-D-Mofo.

For the longest time I’ve only been making haphazard changes to my diabetes management for exercise. Now is the time, though, to treat diabetes like swimming. I have to jump into the deep end. Or rather, I have to jump into the open water where I can’t see the bottom and where I’m far away from land and where all that I have around me is the water and my insecurities and the hopeful knowledge that I can do this because I’ve done this before. I have to gather up my courage and take a risk, make the observations about insulin and food and exercise, bolus for things I eat before exercise, and eventually (hopefully) arrive at a place that’s more manageable (if not always comfortable).

To quote Mark Twain, who would totally have been a BA-D-Mofo: “Courage is resistance to fear, mastery of fear—not absence of fear.”


[1] — I know, I know! I used an Oxford comma there, even though Oxford says it’s no longer good style. I just can’t seem to break the habit. We become old-fashioned slowly and without really meaning to, by snickity. [back . . .]

[2] — I guess I am a triathlete after all. [back . . .]

Posted in 101 in 1001, Cycling, Data-betes, Diabetes, Life Lessons, NaBloPoMo, Reluctant Triathlete, Running, Swimming | 7 Comments

The Test Strip Rebellion

Posted on April 6, 2011 by Jeff Mather

The “test strip rebellion” is a grass-roots movement to access our health data from our diabetes self-management devices: meters, pumps, CGMS, online apps, etc. It’s our data, and we’re going to take it back . . . one way or another.

Stay tuned.

Posted in Data-betes, Diabetes | 1 Comment

Baby Steps Toward Less “Winging It”

Posted on April 6, 2011 by Jeff Mather

I have previously mentioned that I wing it . . . a lot. My endo and I have devised carb:insulin bolus ratios based on some prior experiences, and I settled on my basal rates by testing — days and days and even a night or two of hungry, grumpy testing. And having done all this work, what do I do? I ignore it. Still.

Months after saying I wasn’t going to be so scurred of dosing the appropriate amount of insulin, I still don’t always feel confident giving all of the insulin that my pump’s bolus wizard suggests. And I also see lots of times where I set a temporary basal or treat incorrect basal rates with extra food.

It occurred to me this afternoon that I can use my pump’s data (via CareLink) to find my effective carb:insulin ratios and probably my insulin sensitivity for corrections, too. I saw when I was parsing the CSV file I downloaded from CareLink that it contains the full bolus wizard info, including estimated carbs, suggested bolus amount, and actual insulin delivered. Now that I can parse the file, I can get those values, compute the carb:insulin ratio for each bolus, and see whether my BG values behaved as I would have liked. Given enough data, I hope to see what ratios work the best. And then, of course, program those into my pump settings and (hopefully) use them with more confidence. Less winging it.

I like having a mini-project to help keep larger projects moving forward.

Posted in CGM, Data-betes, Diabetes | Leave a comment

Winging It like a Penguin

Posted on April 3, 2011 by Jeff Mather

Last Thursday, I saw my endocrinologist. We all agreed that my 7.8% A1c should be lower. Not in the sense of “Hey, you know you should lower your A1c,” rather “Your BG readings and CGM data look great; I don’t know why your A1c isn’t lower . . . yet.” There was general agreement that if I keep going the way that I have been for the last couple months, my A1c should show actual improvement the next time we meet in late July. I want to be optimistic, but it’s been so long since I’ve seen the low 7s or — g-d help me if I dare to dream — the 6s, that I think I’ll just keep my feelings low-key. After all, my heart got a little broken last week, when I saw a more-or-less unchanged A1c result in my labs.

They — my endo and her newish physician’s assistant — thought it was great that I ran a half-marathon and that I’m doing a triathlon in five weeks. And they thought my lipid profile was probably as good as it could possibly get. (My HDL and LDL were almost identical at 66 and 67.) They also made sure that my education order form got sent to Joslin so that I could see an exercise physiologist there this coming Friday.

I’ve been trying to see an exercise physiologist at Joslin for a while, because I need a little help. As I told my endo and PA, “I love all of the exercise and training for events, but I feel like I’m winging it on the insulin and nutrition front.” Where I am now has come mostly through trial and error. Sometimes, like during the half marathon it isn’t quite right, and other days (like today) everything works out really well.*

I don’t like winging it. I don’t expect rainbows and unicorns every time, but it would be nice to understand a little bit more of what’s going on and what I can do to maximize my chances of success, how I can make sure most of workouts are quality ones, and what post-exercise things I might do to prevent lows.

That’s why I want to get some professional help. So far, I’ve mostly been trying to repeat what works — and fortunately most of what I’m doing these days seems to work, even if it feels sketchy — and to learn as much as I can from the days that don’t go quite right.

Last Friday, the day after my endo appointment, is a good example. On Wednesdays and Fridays, I wake up at 5:00 to go to my local high school pool and swim laps. It’s early, and I usually feel tired, but I know that it’s what I’ve got to do, so I go. This particular Friday, though, I didn’t get the chance to swim the laps because I had hypoglycemia before I started. Since I had eaten like I normally do before going swimming, I decided to see what happens has to my blood sugar from the food when I don’t actually swim. How long does it really take those carbs to hit my bloodstream? When should I eat them so that they actually help me when I’m working out?

Here’s the data:

2:01 - 83 mg/dL - Uh oh, better eat a tiny bit
5:03 - 88
5:15 - Energy gel (22g) and 2 glucose tablets (8g)
5:30 - Shovel snow for 10 minutes (grr . . .winter in April)
5:50 - 59 - Treat with 3 glucose tables (12g)
  No swimming :'^(
6:22 - 157 - Going up! Better correct w/ 0.5u
7:27 - 302 - Oy! Better correct some more, plus I'm hungry.
  1.9u (correction) + 6.6u (for the food)
7:51 - 289 - Well, a man's gotta eat despite the BGs, so I did.
10:15 -143

What do I take away from this? Not sure exactly, but here are some thoughts.

  • The amount I corrected was almost exactly what I would have bolused for the 22g of the energy gel. Yay?!
  • Use a lower basal overnight after days that I do crazy awesome half-mile repeat running workouts.**
  • Leave all of the shoveling for Lisa. Have a snack before shoveling.
  • Try moving my energy gel consumption about 15 minutes earlier to about 45 minutes before exercise.
  • Consider lowering my AM basals on days when I swim.

We’ll see what happens when I go swimming tomorrow morning to make up for last Friday.


* — I had never thought I would ever say, “I just did an easy 11 mile run,” but that’s what happened today. Yeah!

** — I haven’t run 800m repeats since high school; I don’t think I’ve run a timed half-mile since there either. But running them was on my training plan, so I did four sets, and I was pleased to see the results: 3:13, 3:15, 3:15, 3:25. Boo-yah!

Posted in Data-betes, Diabetes, Reluctant Triathlete, Running, Swimming | 3 Comments

App Update

Posted on April 1, 2011 by Jeff Mather

Today a bunch of my online peeps were in California visiting Medtronic. I wish I’d been invited to go to, but that was not the case. Had I been there, I would have squealed like a little schoolgirl at the pre-announcement that they’re rolling out support for uploading and using CareLink on a Mac next week.

Not only is that great for me when working with my own data, it will make developing my app easier. People may still need to take the extra step of downloading a CSV file containing their data, but at least they’ll be able to do it on their platform. Not perfect, but better.

In an ideal world — the one that I would have advocated for at pump/CGM HQ — third-party app developers (like me) would be able to ask the online CareLink database for a person’s diabetes data via an application programming interface (API). Mobile app developers could then hold on to that data for offline or mobile use without ever needing to talk directly to the medical devices themselves. Frankly, writing code to connect directly to a life-preserving medical device is quite risky and something I would like to avoid; it’s also the kind of thing that requires rigorous, time-consuming, expensive FDA approval. Not very appealing when all I want to be is a data consumer.

I’m hoping that Medtronic provides a mechanism to open up this data soon, because I’m getting close to being able to benefit from it. And when I say “this data,” I mean “our data” because it really is ours. We’re the ones who generated the data through our self-managment decisions, and we’re the ones who will benefit the most from using that data to make decisions. All I’m really asking for is a way to log in to CareLink without using a web browser and to retrieve data securely.

I’ve been working on my pump+CGM data visualizer a lot recently — most evenings in fact. On my Mac, I can extract events from a comma-separated value (CSV) file generated on the CareLink website, and I can pick out “interesting” events that are relevant for self-management. Now I’m working on being able to store those interesting events in a form that I can send to my iPod. (Then there are the tasks related to visualizing the data, but I’m starting small.)

It’s taking me longer than I expected to build this application. Objective-C isn’t hard, but learning the ins and outs of any new framework library is always a bit involved. (Turns out I’ve been using a lot more C++ than I had expected . . . not that there’s anything wrong with that.) And I realized that I actually need to build two applications: one part that sits on a “traditional computer” that can talk to CareLink and the other that visualizes the data on an iPhone, iPod, iPad.

Here’s a little example of the raw data that I will eventually use to generate graphs and an annotatable logbook:

3/30/11|16:20:00|GlucoseSensorData|AMOUNT=106, ISIG=10.2
3/30/11|16:25:00|GlucoseSensorData|AMOUNT=98, ISIG=9.71
3/30/11|16:30:00|GlucoseSensorData|AMOUNT=98, ISIG=10.59
3/30/11|16:35:00|GlucoseSensorData|AMOUNT=100, ISIG=10.66
3/30/11|16:40:00|GlucoseSensorData|AMOUNT=102, ISIG=10.94
3/30/11|16:45:00|GlucoseSensorData|AMOUNT=102, ISIG=10.6
3/30/11|16:50:00|GlucoseSensorData|AMOUNT=102, ISIG=10.56
. . .
3/30/11|18:14:01|BolusWizardBolusEstimate|BG_INPUT=195, BG_UNITS=mg dl,
  CARB_INPUT=0, CARB_UNITS=grams, CARB_RATIO=8, INSULIN_SENSITIVITY=50,
  BG_TARGET_LOW=110, BG_TARGET_HIGH=110, BOLUS_ESTIMATE=1.7,
  CORRECTION_ESTIMATE=1.7, FOOD_ESTIMATE=0, UNABSORBED_INSULIN_TOTAL=0,
  UNABSORBED_INSULIN_COUNT=2, ACTION_REQUESTOR=pump
3/30/11|18:14:01|BolusNormal|AMOUNT=1.7, CONCENTRATION=null,
  PROGRAMMED_AMOUNT=1.7
Posted in CGM, Data-betes, Diabetes, Fodder for Techno-weenies, Software Engineering | Leave a comment

What’s on My Pump’s Mind?

Posted on March 28, 2011 by Jeff Mather

Sorry for the geeky/nerdy digression, but I’m just so pleased that I’ve been able to start to parse through the data from my pump. It’s nice to make some progress.

According to the CSV file generated from my Medtronic CareLink data, this is what my Minimed Paradigm pump thinks about. The number is how many times the keyword appears in the log.

carelink_parser_2 - There are 14121 items in the array.
1 AlarmPump
154 AlarmSensor
99 BGReceived
393 BolusNormal
35 BolusSquare
391 BolusWizardBolusEstimate
315 CalBGForGH
502 CalBGForPH
4 ChangeBGTargetRange
4 ChangeBGTargetRangePattern
18 ChangeBatteryEnable
18 ChangeBatteryEnableGH
2 ChangeBolusWizardSetup
4 ChangeBolusWizardSetupConfig
12 ChangeCarbRatio
4 ChangeCarbRatioPattern
8 ChangeInsulinSensitivity
4 ChangeInsulinSensitivityPattern
1 ChangeMaxBolus
1 ChangeParadigmLinkID
35 ChangeSensorSetup
70 ChangeSensorSetupConfig
15 ChangeSuspendEnable
7 ChangeTempBasal
2 ChangeTempBasalPercent
1 ChangeTempBasalType
1 ClearAlarm
3 CurrentActiveBasalProfilePattern
3 CurrentAlarmClockEnable
3 CurrentAlarmNotifyMode
3 CurrentAudioBolusStep
3 CurrentAutoOffDuration
3 CurrentBGReminderEnable
3 CurrentBGTargetRange
3 CurrentBGTargetRangePattern
21 CurrentBasalProfile
9 CurrentBasalProfilePattern
3 CurrentBatteryStatus
3 CurrentBeepVolume
3 CurrentBolusReminderEnable
3 CurrentBolusWizardBGUnits
3 CurrentBolusWizardCarbUnits
3 CurrentBolusWizardEnable
3 CurrentBolusWizardSetupStatus
9 CurrentCarbRatio
3 CurrentCarbRatioPattern
3 CurrentChildBlockEnable
3 CurrentDisplayLanguage
3 CurrentErrorStatus
3 CurrentGlucoseHistoryPageNumber
3 CurrentHistoryPageNumber
3 CurrentInsulinActionCurve
6 CurrentInsulinSensitivity
3 CurrentInsulinSensitivityPattern
3 CurrentKeypadLockedEnable
3 CurrentMaxBasal
3 CurrentMaxBolus
3 CurrentParadigmLinkEnable
9 CurrentParadigmLinkID
3 CurrentPumpModelNumber
3 CurrentPumpStatus
3 CurrentRFEnable
9 CurrentRemoteControlID
3 CurrentReservoirWarningUnits
3 CurrentReservoirWarningValueInsulin
3 CurrentSensorAlarmSnoozeTime
3 CurrentSensorBGUnits
2 CurrentSensorCalFactor
3 CurrentSensorCalReminderEnable
3 CurrentSensorCalReminderTime
3 CurrentSensorEnable
3 CurrentSensorHighGlucoseAlarmEnable
3 CurrentSensorHighGlucoseLimit
3 CurrentSensorHighGlucoseSnoozeTime
3 CurrentSensorLowGlucoseAlarmEnable
3 CurrentSensorLowGlucoseLimit
3 CurrentSensorLowGlucoseSnoozeTime
3 CurrentSensorMissedDataTime
3 CurrentSensorTransmitterID
3 CurrentTempBasal
3 CurrentTempBasalType
3 CurrentTimeDisplayFormat
3 CurrentTotalRemaining
3 CurrentTotalToday
3 CurrentTotalYesterday
3 CurrentVariableBasalProfilePatternEnable
3 CurrentVariableBolusEnable
9427 GlucoseSensorData
3 GlucoseSensorDataHigh
2 JournalEntryPumpLowBattery
35 JournalEntryPumpLowReservoir
39 Prime
48 ResultDailyTotal
20 Rewind
2 SelfTest
57 SensorCal
200 SensorCalFactor
10 SensorError
130 SensorPacket
34 SensorStatus
26 SensorSync
60 SensorTimestamp
20 SensorWeakSignal
1669 UnabsorbedInsulin

As far as I can tell:

  • UnabsorbedInsulin is metadata that’s used to compute active insulin for the bolus wizard.
  • SensorPacket is data from the sensor during the warm-up period before it starts streaming GlucoseSensorData.
  • BGReceived is data that comes from a paired meter, which always updates the sensor calibration (for my pump) since they’re paired with CalBGForPH. (I guess that’s why you’re supposed to turn that feature off.)
  • I have no idea (yet) what the difference is between CalBGForPH and CalBGForGH.

Don’t worry. I’m not going to flood users with most of this data. I just needed to know what it is possible to show.

Posted in CGM, Data-betes, Diabetes | Leave a comment

Seriously Now. Let’s Start Coding.

Posted on March 2, 2011 by Jeff Mather

Okay, I’ve picked up a smattering of Objective-C, learned about a few of the frameworks, and sketched some of the interface. I’ve contemplated the data model, and I’ve worked out a few of the interactions.

Isn’t it about time to put aside my “iPhone developer impostor” feelings and just start coding? Yes it is. I’m not going to build this app unless I start writing it.

ABC: Always Be Coding.

Posted in Data-betes, Life Lessons, Software Engineering | Leave a comment