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Things kind of took a nose-dive on the CGM front last week (much like, indeed, what happens to blog stats after a post: up up up, then two days later, down down down).

ANYWAY.

The damn thing was hardly ever within spitting distance of a fingerprick test. Of course, the delay is 15 minutes or whatever, so it won’t ever be the same, BUT it also failed to show trends accurately, once having a stellar moment of showing 6.5mmols all night — and in reality, E woke on 2.2mmols! Argh!

Then, seemingly arbitrarily, suddenly a number would be close, and showing accurate movement…. Sigh.

We are the process of trying to find out if there are methods of a) calibrating b)reading c) insertion that may help things. Any thoughts welcome!

In the meantime, our path down CGM land is blocked. We don’t have another one in. E has understandably declared it next to useless for him. I’m sure this is not irrecoverable. But it’s important not to waste goodwill: when we have a clearer idea how to help things, we’ll try again. Pressing experimentation on a teenage boy with lots of better things to do is just not a good idea.

As I said, understandably.

***

I’ve also got the hump because just as my sister arrives in town the weather goes grey and rainy. DAMN! We are having a lovely time nonetheless, but it’s a bit of a shame after two weeks of hot sunshine. Damn again.

***

And just so’s you know: I’ve created a ‘Place to Talk’ page. It’s, as E would say, pretty random I guess. But I wanted to make a spot for people to visit and just exchange stories, or say something, anything. No threads, no structure. Just a place to get something out, or celebrate, or commiserate, or observe.

It’s been there for a while, but Louise has started us off, so I thought I’d now mention it. Thank you Louise!

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Well, it happens all the time. Only each time, you think: I can’t do this. Anymore.

But you do. Because that’s what you do. That’s what humans do, every which way and in all states of mind and body.

We have the capacity to start again, whether that means picking up where we left off, like a thread lost — or whether we must indeed re-build from the ground up, after catastrophe or death.

All these things have come my way in the last 24 hours, one way or another. My stuff, but stuff too surrounding people I care very much about.

1) in a sudden and unexpected shift, the CGM now seems to be serving a purpose. Several times a day E looks at it when he wonders what he is. Saves him two or three finger pricks a day. Looks at it in lessons, out of interest and for reassurance, he says. He says, it’s worth it already. And I’m stunned. And so we start to look up, start again.

2) one of my very dearest friends has undergone a freak event at her old childhood home in the States: a tiny tornado destroyed it, when the whole family was sitting at dinner. No one was injured, but how do you know where to start? I guess the answer is, you start again. She knows I’m thinking of her, but in case she forgets: I am.

3) and a long-time friend and colleague of OH died peacefully two nights ago. Perhaps mercifully quickly, given the situation. But we feel for his family, and thank him for his friendship and real gentleness in life.

So. It’s been a time to reflect. On what is possible. How hard sometimes it is to get there, and to know this, not to speak of just plain carry on. But here we are.

Today it has been cloudy mostly, warm. And this evening, the sun manages to break through. Time to water the pots. You have to work at it everyday, but the rewards are of course flowers.

Pots in my garden

My hanging basket!

If you haven’t explored the Urban Dictionary, you might want to think about doing so. I say might, because if you do, you also have to be prepared to run across some shall we say colourful definitions. All the words are input and defined over time by readers….so some of them are decidedly wacky, and many of them are not fit for under 16s.

However. Having a 14 year old in the house does mean that these totally unheard of words enter common usage. Hench is one of them, and one of my favourites. For anyone who doesn’t click through to the dictionary, it means large, muscular, fit. As is the way with slang words, it’s also used with this kind of smart boy self consciousness. And it really does make me laugh. As in:

1) from OH: I’m going to go to the gym now, and get hench.

2) from E, while watching the World Cup, about the players in turn: hey Mum, is he hench? Well is he hench? How about him then?

3) from M, about our large fluffy white cat Schubert: he’s not chunky, he’s hench.

4) from E again, two nights ago, on the verge of inserting his first CGM sensor: this is one hench needle.

******

Yes, we have finally but finally ventured into CGM land. And the jury’s out so far. The sensor insertion is, I have to be honest, pretty grim. The needle is VERY hench, and scary for a slim boy with virtually nothing extra on him to fire it into. He really had to screw his courage to the sticking point. Did not want us to do it. And it was quietly a little heart-breaking to witness. Like the sil-sets, the needle goes in at 45 degrees, and like the sil-sets, the insertor sounds like a small firework being set off. Disconcerting if you’re not prepared for it. But by far the hardest thing really is the clunkiness of it all. It’s big on his stomach, with sticky tape over it, and that combined with a pump set… well, we will need to see how this goes. At the moment, it’s feeling invasive, and a little brutal, somehow. Perhaps this will pass.

We long for it to pay off, for his quality of life to be improved. It’s all worth it then, and he’ll learn to do it, exploit it, and live with it.

At the moment though, the readings are still up to 2mmols off and the hypos had in the first 24 hours weren’t picked up in the readings.

I suspect there is considerable skill to this, learning when to calibrate the machine for maximum benefit and accuracy, when not to.

For now, the best we can hope for is that in the next day or two he may be able to have a snack without testing. Or we may be able to get up in the night and look at the graph rather than wake him and poke his finger. This would start to feel like a promising path.

In another five days, there’s the prospect of the next hench needle to contend with. He doesn’t have much room on his stomach for the CGM and the pump, certainly not enough to guarantee good rotation of sites. So he’ll have to circulate the CGM elsewhere, to his leg perhaps. Which will be another leap of faith for him, and more courage. He has terrible memories of painful injecting on his legs.

Sigh. Every change and improvement in control and quality of life is preceded by a period of insecurity and SUCH hard work. And stamina, and courage. And belief. We’re in this together, but it ain’t half hard sometimes. I don’t want this for him. We don’t want this for him. Sometimes it feels like we would trade ANYTHING for him not to have to deal with this, day in and day out, morning noon and night… And when it’s like this, useless anger comes in waves: why, why why?

Sigh again. Just because.

It continues to be all-go in our household. There are times when I feel like a drill sergeant. Sigh. And I’m sure my family would say the same (!).

However. Good news from last week’s clinic appointment is that E’s HbA1c is once again back down to below 7%. This is approaching the high end of ‘normal’ (I love this word – NOT. It means here the high end of a non-diabetic person’s HbA1c). SO this is all good news, and confirms our suspicions that the vast majority of the blip last time was down to the dodgy sets, the missed boluses, and some plain wacky numbers. Two weeks later and those blips have disappeared more into his ‘blood history’, the measurement is 50% from the last month, and the proof is in the pudding. As it were.

It’s a wonderful clinic. Sensors for the CGM are arriving tomorrow, thanks to their help. The doctors and DSNs are open, kind, congratulatory, and we always come away having learned something — or at least with something to think about. This is incredibly rare nowadays for us: diabetes is such an individual condition, that what works for one may not work for another, and the pattern of x may not be the pattern of y. Not to speak of how things can vary day to day. So a new thought is, unfortunately, not usually one we haven’t already thought of. Nevertheless, in this clinic (our pump one, not local) we come away with food for thought. For instance: one of the doctors picked up what might be a pattern: E tends to have a hypo (below 4mmols), about 8 hours after changing to a new infusion set.

This may be nothing. But it may be something. What we would do about it is place him on a slightly lower rate of 95% of his insulin for that time. Maybe it will work? One of the lows was a severe low — the ol’ favourite, 1.8mmols of ten days ago. Ack. Each time, we count our blessings that he seems to weather these well. I am touching wood like mad for luck, but so far even these lows have not caused him to lose consciousness, fit or even become particularly disoriented. As I say, I realise we have been lucky.

And speaking of temp basals, it’s been ‘low insulin’ city in our neck of the woods the last two weekends. E is keen to earn money, so has been doing a lot of gardening work: sweeping the drive, weeding, hauling cut down branches to the bonfire. Etc. Last weekend he went onto a 50% temp basal to try to account for the exercise, and still had four or five hypos (I know, I know)… This weekend we tried a different approach. On Saturday, a shedload of hypos. One after the other. We reduced him to 0% for at least half the day. By evening he was stable again, though on 95% through the night, again to account for the exercise.

On Sunday however, we whacked on a low temp basal (20%) AND under-carbed his food. For instance: scampi and potatoes plus veg weighed out and added up to about 80g CHO. He bolused for 60g, thus receiving about 75% of his ‘usual’ dose.

Interestingly, this seemed to work (aside from two hypos in the morning, before we cottoned onto this new idea, sigh!), combined with the temp basal. We did the same for the evening meal — risotto, a slightly awkward one, that he normally doses at 25/75% (eg 25% up front, 75% spread out) over 7 hours. Again, no hypo.

What’s been useful to think through is that it makes a kind of sense that if the body is sensitive to insulin generally at a certain time, then it will also be sensitive in all instances: so any insulin going in during a sensitive time is bound to lower the blood sugar more than is desirable — whether it’s a ‘long-acting’ basal insulin, or a ‘short-acting’ bolus one.

This is not something anyone has ever mentioned to us. I’m mentioning it here, and will do so on the forum. But it makes sense, and worked.

Will it work the next time, however?! Ah, who knows….

***

The reason we have been so happy to let E work like a dog (and yes, I have a list for him after school this week!), is that we have about 30 people for dinner on Thursday. Eek. Spare a thought. The GREAT news is that the weather looks very promising: hot and sunny. (And DON’T even mention the possibility of a thunderstorm to break it, as is the tendency is this part of the country! Just keep it to yourself. Touch wood….)

Last year at the same party E had been on the pump for less than a month. We had lentils. And it sent his numbers all over the shop, being low GI. That would be very unlikely to happen this time. Incredible the distance you travel. We have travelled.

Touch wood.

copyright Tim Haynes

It’s been a shock to go from my peaceful mornings at the hut to a life punctuated by the fast train from Kent to St Pancras, but so it has been: external examining at Norwich University College of the Arts for three days, home examining at my own, then to York for a NAWE meeting, then three more days examining at my own institution again.

Ack. Meanwhile the sun has mostly shone, despite the cool wind. Like life of course. Mostly sunny, a more or less constant cold wind. That you just learn to get used to.

Three items for report (how many meeting have I been in the last ten days, you ask?!):

1) desperate cat Cleo is going on a singles’ holiday this weekend. Eg we hope for kittens in late August! Watch this space. The relief will be mutual, to be blunt. The poor girl spends some of every evening trying to settle in the bathroom, with bed, tray and food. Poor thing. Poor us. At its worst, we can’t hear ourselves speak. And her brother hisses at her all the time… Bring on some peace (and for her, satisfaction?!).

2) the Tooth Fairy has only just recovered from being in deep doo doos in our house. Not one, but two teeth languished under daughter M’s pillow. For a WEEK! I know, someone shoot that fairy. But the worst of it has been M’s eventual understanding, once the glowering passed. I know the tooth fairy has been very busy, she says. Eek, I can’t stand the guilt! Anyway, now the teeth are in the fairy’s castle, and M has not only £2, but a rather glittery bracelet (hopefully not made out of teeth…).

3) E’s numbers have been generally better. Again, some weird and wonderful nights: a drop from 8mmols to 1.8mmols once (yikes!), and another of a random rise… But these weirdnesses aside, things have eased. We are off to clinic for CGM instruction today. Another matter for report….!

***

Finally, at the gym yesterday (for the first time in two weeks…really, thank goodness the place doesn’t have cameras. I don’t think it does, anyway…), I encountered one of my favourite songs of the moment, by Jolie Holland. She is, if anyone is still around from my other blog, one of my favourite artists, but this song…I don’t know. I listened and thought you know, life is random. Life is harrying and harried. And is all about risk, about doing what you don’t and can’t know. And sometimes it works out, and sometimes it doesn’t. On Jolie Holland’s website, it says this about the song:

“Palmyra” is a prayer for the broken-hearted and traumatized, both individuals and communities. The first half paints a picture a love-lorn traveler pulling herself back together after a disastrous affair. The second half is lovingly and respectfully dedicated to the hard-pressed people of New Orleans’ Ninth Ward, hallowed estuary of some of the finest music the world has ever witnessed.

(But the real place to check her out is probably her myspace page, in which I have just spent several happy minutes…)

For me, the song’s somehow about strength. My OH and I met over 25 years ago. We married 22 years ago a week from tomorrow. He is my soul mate and best friend. And one of the very few people in my life that I haven’t had to leave for some reason, whom I haven’t left and hasn’t left me. A gift in my life I never really thought my life would hold or be able to hold. How very very lucky and blessed we are in this way. Just wanted to say that. He got the album this song comes from for me. He’s not mad on the music, but knows that I am, and lets me dance and sing to it in the kitchen. Even while he’s making dinner. What a guy.

Well, things have warmed up here in the SE of Britain — even the rain is warm now — and with my hut days finished (sniff! pictures to follow) — my attention is turning to a) getting another hut; b) the garden and c) external examining, planning for next year, my own exam boards and and and…

Guess which one of the above actually takes up the most time? Yes, it’s the last one (Eeyore-ishly said).

ANYWAY. I’m mainly on here today to say that much as I adore my fast-growing beanpole of a son — who since Christmas must have grown three inches and now stands substantially taller than me and taller than his grandfather and not a million miles away from his *father* — we feel locked in a bit of a battle with it.

Herewith: went to clinic on Friday and the ol’ HbA1c (complicated averaging of blood sugar levels over three months) is the highest since diagnosis, and outside of high ‘normal’ for the first time too, eg over 7mmols. Damn. And other, much ruder, words.

We think we know some reasons for this:

1) all the fuss with the sets messing up. We had some stupendous, recurring highs with those problems, and knew that this alone would affect this HbA1c. (The new Silhouette sets, I am pleased to report, are still MUCH better, despite having been yanked out again by accident — ouch — in a game of football at the weekend. We were all no doubt suffering from sunstroke, because in that sort of running around he should have had it off anyway, but oh well! Soon replaced, bravely.)

2) growth hormones. Bane of everyone’s existence blood sugar-wise, except that of course growing is good. Very good. But after a couple of weeks of high mornings, then suddenly we had another week of low mornings, then you guessed it, another week now of high mornings. Bit disastrous. We just begin to think we need to change the basal rate from 12am-3am, and bingo! The trend has reversed. This is probably almost exclusively down to growth hormones. And probably too indicates that in the night all kinds of highs are happening about which we have very little awareness. This is disheartening in itself, as we are trying so hard. But we suspect that this is at the root of his higher HbA1c. We simply aren’t catching the night highs well enough.

3) Being slightly more laid back about numbers. This is a good thing, again. Healthy and to be desired. But perhaps we have let a little too much slide? The increments of vigilance are just so tiny, yet seem to make such a difference. Damn. We are NEVER complacent. But taking our feet off the gas is something we have done a little… But maybe we have allowed the car to slow just too much in this 50 mph zone…. Argh. You get caught by the camera whether speeding OR going too slow….

***

So I won’t pretend we aren’t a little bummed from this recent number. The doc however says it’s still WAY better than most adolescents manage to achieve. Be that as it may, we are used to better.

So, again. What are we doing about it?

1) Last night we went ahead and raised the basal for a couple of hours. He had a steady night on 6mmols.

2) We are trusting that the new sets (with their clear stability) will impact the next measurement.

3) E is expressing a clear desire to try a CGM(Continuous Glucose Monitor). This device measures the blood sugar level via the tissue rather than a pinprick, and is in situ for 7 days at a time. It is not entirely accurate, and you cannot dose insulin or take any real action on the basis of what it reports to the pump…However, you *can* ascertain trends in blood sugar, which will be enormously useful to us in a time where we are suspecting that we are missing highs. It is extremely good for discovering patterns, and we are extremely fortunate to be funded for it in our area. This, we hope, will help, even in this seemingly pattern-less time of adolescence!

It is to E’s credit that he now is firmly for trying CGM. It involves another ‘thing’ in him at all times, and another 45 degree insertion, which is what put him off it entirely initially. Now that he is used to the other sets, he is stepping up his game, and can face it. This is his decision.

Once again, I am proud of him. We are proud of him.

Chasing all this all the time is a true pain. And incredibly inconvenient in his life. His sights are set though. He knows he wants good numbers. And we will do everything we can to help him get them for as much of the time as seems sensible and realistic — and not obsessive.

So in two weeks we will attend our other clinic, at our shared-care hospital, to learn how to do the CGM insertion and set up the sensors. Deep breath.

Setting sail

In November 2008 my 12 year old son was diagnosed with type 1 diabetes. The effect of this event on me -- and on our nuclear family -- was like being thrown overboard and watching the ship leave.

'Dealing with type 1' in the family has morphed into another sort of 'dealing' -- a wholesale resituating of parenting, of family dynamics...of life.

At my son's diagnosis I could not to locate a record of what living with a type 1 child in the family is like. I could not see myself or our family anywhere. I longed for a starting point, a resource and a sense of the future. Being a writer, my instinct is to write it. This space, I hope, is a start.

Blood Sugar Ranges (UK)

<4 mmols = low or hypo, life-threatening if untreated
4-8 mmols = within target range
8-13 mmols = high but not usually dangerous
14+ mmols = very high, or hyper, life-threatening if untreated

Bubbles

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Disclaimer

I am not a medical professional. Any view expressed here is my opinion, gleaned from experience, anecdote or available research.