“You want to go get some ice cream?”
I like ice cream. With some foods, I never quite know what will happen with my blood sugar (i.e. pizza or a bagel), but I SWAG (Scientific Wild Ass Guess) for ice cream with a confidence that I rarely have with other sweets. So, the answer was a resounding yes and with The Kid firmly set on John’s shoulders, we marched a block to the local ice cream shop.
Peanut butter fudge ice cream with peanut butter sauce. Small cup. BG was going up a little (Snacks at the park - Pirate Booty), but manageable. I dosed and enjoyed every minute of that peanuty goodness. We walked back to the car, chattering away about birds and cars that go beep. I checked my graph on the Medtronic MiniMed 530G and it was stable.
The freefall happened within 20 minutes, and it was my fault. The idyllic day called us outside and an impromptu walk around our neighborhood. The magic number said 173 mg/dl with two arrows pointing down. We weren’t going far and weren’t going for long. A casual meander. Fifteen minutes later, it said 82 mg/dland I was not feeling content anymore. We got home and as we walked through the door, the alarm started to chirp. BG 72 mg/dl and falling. Meter said 62 mg/dl and I said juice. Drank it. Felt better.
It was my fault that I didn’t suspend the pump. It was my fault that I didn’t check 15 minutes later. It was my fault that I snuggled down into the couch and began to watch TV. I got sleepy. Thought I needed a nap. Stood up, waved at John and motioned to our bedroom, mouthing that I was going in.
Did I check before I went in? Nope. But the alarm kept going off on my pump and I ignored it. The threshold suspend feature kicked in and through my haze, I realized that this was not a drill.
I vaguely remember wandering into the kitchen, walking past my family and pouring myself a glass of juice. I was intent on getting “just eight ounces” into the cup, holding it up to analyze my measuring capabilities. I didn’t guzzle it down, but casually sipped at it as if I was at a cocktail party and didn’t want to pay $10 for another drink. John’s voice was fuzzy…or was it me that was fuzzy?
“Oh, yes. I’m fine. I’m not fine. I’m low, but I’m fine. I’m drinking my juice and I’m going to be fine.”
He knew that I wasn’t fine. He verified that the pump was still suspended and told me that he’d come back in and check on me in ten minutes. (He checked on me in five minutes, but was in the next room in case I needed him.)
I drank my juice. I ate some things. I came up slowly. I shuffled past my peeps and back into bed, mumbling that I was tired but my blood sugar was coming up.
And up it did. You know the drill. Overtreat. Bounce. Soar. Dose a few units to stop the rise past 400 mg/dl.
When I went to bed, my blood glucose was 132 mg/dl.
Threshold suspend happened again around 2am. 54 mg/dl.
It was my fault. I take blame for this one for my choices of nourishment and my failure to check. I thank the pump for catching not one, but two sucky hypoglycemic reactions in twelve hours. (And yes, I know about the increase of more hypoglycemic reactions after a serious low. It’s my fault that I didn’t take more precautions when coming down.)
So, this morning, I’m running on fumes. And a BG of 97 mg/dl.
This disease is not my fault.
My choices are my own, and when they’re incorrect and cause issues with my disease…
it’s my fault.
Control. It’s a concept that people with diabetes wrestle with… control over what we eat, our blood sugars, our lives in general. When you’ve done everything in your power to keep this disease in check, and yet, you see a high (or low) blood sugar on the meter, it’s frustrating.
So, I take control whenever I can in my diabetes, which includes needle insertion. I’m not a huge fan of “auto-insertion” and never have been. From my very first injection in 1983, I would slowly insert the needle into my selected spot. If I was halfway in and it began to hurt or I felt a twinge, it wasn’t uncommon for me to pull the needle out and start in another spot. Quirky? Guilty as charged. There are times that I am jealous of those who jam a needle in and quickly inject and move on, but I prefer having control over at least, inserting the needle. I use a Silhouette insertion set for my insulin pump because I can insert it manually…under my control.
The Medtronic Enlite® Sensor uses a insertion device that doesn’t allow for the rate of needle insertion. (The Dexcom G4 sensor insertion device uses a plunger, so yes, I totally take my time pushing that plunger down.) I didn’t have a positive experience with the Sof-Serter sensor insertion and truth? Freaking out about putting in the Enlite® on Friday was actually raising my blood sugar. I was… scared. What if it hurt just like the Sof-Serter? What if the needle hit a spot that was tender and it bled? What if it came time to put that inserter onto my skin and I chickened out.
The Ca-Chunk Factor
Then there’s the Ca-Chunk Factor. That sound that the inserter makes when the mechanics release and the spring load snaps and something happens. If you’ve had diabetes for a while, you’ll remember the “Ca-Chunk” sound with the Autolet lancet device (a.k.a The Guillotine). I dread that sound. Sends shivers up my spine. I sweat a little in anticipation.
I had my training session with the Medtronic trainer on Friday and after the polite introductions, I spilled my guts. “I’m scared about the insertion pain and the accuracy and the Ca-Chunk Factor, but right now, it’s the insertion pain. I’ve been told that it hurts much less than the Sof-Serter, but I have nightmares about those insertions, so…”
Lisa, the trainer, was incredibly cool about it all. (I think I may not have been the first to express these fears.) We talked about the difference in needle gauge sizes (the Enlite® introducer needle is significantly smaller) and how many individuals had expressed surprise at how comfortable the sensor felt after insertion. She asked me to explain the Ca-Chunk Factor. She offered to have me practice using the inserter, but I took a deep breath and said: “Let’s just do this.”
Here’s how the insertion of my first Enlite® Sensor went for me.
Lisa: “You don’t need to pinch skin at all. Just place the inserter directly onto the skin and don’t press the inserter hard. Most people find it comfortable to stand up when they do the insertion.”
I nervously stand, whipping my shirt up and searching my abdomen for a spot that would have the least potential for an “OWW!”.
Me: “OK. Wait! Where should I have the green button?” (The green button is what you press and release to insert the Enlite Sensor.) I turn the inserter around on my abdomen, trying to find a comfortable way to hold it and the button and begin to feel that sweat beading on my forehead.)
Lisa: “When you’re ready, press the green button.”
Deep breath. Moment of truth. I push the green button.
I think to myself: ‘Wow. She was right! That didn’t hurt at all! Jeez, I have no idea why I was freaking out about this.’
Lisa: “Now, release the button.”
Me: “No problem.”
As I released the button, I heard…
I had been fooled by the Medtronic Enlite® Sensor serter. It drives the needle in upon the release of the button, not the push. And because I was lulled into the concept that I had already done the hard part, it came as a surprise. What was more of a surprise was that it didn’t hurt when it really went in.
My first fear - squashed. Annihilated. (Next week when it’s time to put a new sensor in? I’ll have to trick myself, but I know it won’t be as painful as I thought it would be.)
After the insertion process was complete (There are more steps, including a complicated process of taping the sensor down onto your skin…), I told Lisa that I had been duped by the inserter. Happily duped.
Right now, a few days into this, if you asked me where the sensor was on my abdomen right now, I’d have to think hard. No pain. No twinges. (I’ll talk about the accuracy in another post.)
Control. I could give up a little for this…