Playing with the super bolus

Now that I’ve got Charlie, I’ve been feeling more confident about trying new tricks in managing my diabetes.  Specifically, I have been using the super bolus.  Actually, to be more accurate, I have been using what GiR and I like to call a super correct.

From what we can guess, it’s EXACTLY like a super bolus, but it’s just used to correct a very high blood sugar.  Just like a “correction bolus” is just a meal bolus without the meal, a “super correct” is just a “super bolus” without the meal.

I have found that if my blood sugar is above 200, a “2 hour super correct” does the trick.  I take 2 hours of basal ahead of time as a bolus, then reduce my basal to 0 for those 2 hours.  If I’m hovering in the 160-ish range, a “1 hour super correct” is fine.

HOWEVER!  I will guarantee you right now that I am not doing this correctly.  According to Bernard, the basal portion of the super bolus should be taken via the “fill cannula” method so as to not mess up IOB calculations.  I do not do this.

My #1 biggest fear about using the fill cannula method is the fact that my Cozmo defaults to the last amount used.  For example, if I use the fill cannula to deliver 1.2 units of basal, then the next time I go to fill my cannula, 1.2 will be auto-filled.  Now, when I switch out my infusion set, I do this VERY FAST.  I have got this down to a science, people.  So, imagine with me the horror of accidentally delivering 1.2 units instead of .2.  This spells serious trouble.

I know for a fact that delivering the basal portion directly via the correction mechanism really messes with my Delivery Summary.  So according to my pump, I have occasionally taken a LOT of correction, when in fact some of that has been basal.  Of course, my diabetes control should take into a large number of factors and not just my Delivery Summary, but that’s a discussion for another time.

So what do I do?  Right now I am doing my own vague mental calculations of IOB, but that’s not very effective.  I suppose I could learn to slow down and pay more attention to filling my cannula, but that will be a hard habit to break.  Any tips/suggestions?

Charlie in action

I’ve had Charlie for a couple weeks now, so I figure I should share some of my general thoughts and experiences.

At first, I was checking Charlie ALL THE TIME.  Needless to say, I ran through the batteries pretty quickly.  =)  I’ve gotten better about checking only when I need to.

Accuracy has been hit and miss.  Some days, it seems like everything is completely spot on.  So accurate I could bolus off the sensor values.  Other days, it seems like Charlie will consistently have me 20-30 points lower than I actually am, and no amount of calibration will get it to work.  Overall, it’s still a great way to see trends.

My alarms are set at 70 and at 160.  This has let me catch lows and highs before they become big issues.  Over the past couple weeks, I have stayed in that range about 90% of the time.  Not too shabby.  =)  Eventually, when it’s time to start thinking about having kids, I would like to lower the upper bound to 140, then again to 120.  But for now, I’m happy with staying under 160.

It’s been mildly annoying to be attached to 2 medical devices all the time.  They take up a lot of real estate on my waistband.  However, I have long abandoned hope of hiding Lucy on a daily basis, so adding another device isn’t a huge deal.  I’ve already come up with a fun answer if people ask me what they are:  “Well, this one’s a tricorder and this is my my personal web server.”  =D  Also, I like the idea of not being attached to my purse.  With Lucy on one hip and Charlie on the other, I feel like I’m ready for anything.

Fed up

So, I’ve been having a problem with my dinner numbers for a loooong time now.  I brought it up at my last diabetes appointment (not with my endo, but with a diabetes educator) and she had absolutely zero clue as to what to do.  So, time to ask the blogosphere!  Here’s the deal:

• for most of the day my basal rate is at .55 units/hour
• 6:30 pm Blood sugar’s fine (90-110), bolus (1:10 I:C ratio) and eat dinner (varies).
• 7:00 pm LOW LOW LOW, usually around 65-70.  I try VERY hard not to overtreat; usually just have 1 or 2 Starburst and that’s it.
• 7:30 pm basal rate gets kicked up to .75 units/hour
• 8:30 pm Typical 2-hour after dinner test yields a moderate blood sugar (140ish) with just about the right amount of insulin on board.
• 9:30 – 10:00 pm  HIGH HIGH HIGH, easily at 170+ with practically no insulin on board.  Correct heavily and go to sleep, hoping I don’t overtreat and go low overnight.
• 10:00 basal rate goes down to .60 units/hour for overnight

So, fellow PWDs, what’s going on?  At first I thought it was a combo problem with eating a high-fat meal (i.e. need less insulin up front and more extended insulin to combat fat), but I find this pattern no matter what food I eat.

I’ve thought of decreasing my I:C ratio to maybe 1:11 or 1:12, but I still worry about going high later.  Also, I wouldn’t think that a I:C ratio problem would show up as quickly as 1/2 hour after eating.

I’ve also wondered if the resulting high is a reaction of my body because of the low.  I do try very hard not to overtreat, but maybe my body is still freaking out anyway.

I suppose I could do a combo-style bolus at dinner, but that probably means there’s an underlying basal problem.  However, my last dinner basal test with similar rates (not quite exactly the ones I’m using now, but very very close) yielded steady numbers.  I can probably try a dinner basal test again, which will be much easier with Charlie, but other than that, I’m out of ideas.  Thoughts?

Proper introduction

I know I’ve mentioned it already, but I am hooked up to a fancy Dexcom CGMS. It’s been almost a week and I loooooove it so much. The data is just fantastic and I can’t imagine being without it ever again. Anyway, I apologize for the crappy picture (GiR is not one for taking good photos), but I would like to introduce you all to Charlie!

(Normally I have my devices more to the outside of my hips, but my pajama pants do not have a sturdy waistband, so they tend to slide towards the middle.)

As a side note, Charlie is female. She also has a slight identity crisis as part of her is on my stomach (sensor and transmitter) and part of her is on my hip (receiver).

Having Charlie around is a very interesting experience. At times, I feel like I am totally consumed by diabetes data. Am I high? Am I low? Do I have enough insulin on board? Time to check Lucy. Time to check Charlie. Time to coordinate everything with my regular meter.  It can be very overwhelming.

Then there are the times when my fears and worries are calmed by the beautiful flat line on Charlie’s screen.  I got totally excited when I successfully combo-bolused for Mexican food at a party.  I am relieved when I see consistent blood sugars overnight.  I have prevented highs.  I have prevented lows.  I can go an entire day without being out of range (70-180).

I may feel like a techno-dork who carries around tons of electronics on her belt, but I wouldn’t give up my 2 girls for anything.