Saturday, April 30, 2011

Who Knew Sunlight Could Be Life Saving?

We know that lack of sunlight can cause depression called SAD (Seasonal Effect Disorder) but I didn't know that not having enough Vitamin D in our body could shorten the diabetic Lifespan.  What gives?

There's been much evidence that lack of sunshine is somehow linked to the increase in Type 1 diabetes, especially populations residing in the northern hemisphere. 

A study by Mohr and colleagues who looked at 51 regions world wide,and examined the link between Sun (Ultraviolet B) exposure and the incidence of Type 1 diabetes. This is what they concluded:
An association was found between low UVB irradiance and high incidence rates of type 1 childhood diabetes after controlling for per capita health expenditure. Incidence rates of type 1 diabetes approached zero in regions worldwide with high UVB irradiance, adding new support to the concept of a role of vitamin D in reducing the risk of the disease.
If you prefer a visual aid to illustrate the above:




A recent article written by Joergenson and company published in Diabetes Care, May 2011 issue studied the possible link between low levels of Vitamin D with Micovascular complications and Mortality rates in Type 1 diabetes. They concluded:


In patients with type 1 diabetes, severe vitamin D deficiency independently predicts all-cause mortality but not development of microvascular complications in the eye and kidney. Whether vitamin D substitution in type 1 diabetic patients can improve the prognosis remains to be investigated.
So do we supplement or not?  This study by Lee and colleugues not only explains the multiple benifits in having adaquate levels of  Vitamin D in the body but adds this regarding supplementation:
A study of 340 children ages 10 to 17 years found that increasing the intake of oral vitamin D 10-fold, from the currently recommended dose of 200 to 2,000 IU daily, was required to reach a 25(OH)D level of 30 ng/ml (the lower end of the optimal range)  The investigators concluded that doses equivalent to 2,000 IU of vitamin D3 daily were not only safe for adolescents, but also necessary for achieving the desirable vitamin D levels.
Time to stock up on Vit D and move somewhere south of my current parallel.  Any ideas?

Trev


Sources:

S. B. Mohr & C. F. Garland & E. D. Gorham & F. C. Garland
The association between ultraviolet B irradiance, vitamin D status and incidence rates of type 1 diabetes in 51 regions worldwide.

Christel, Joergenson, MD, Hovind, Peter, DMSC, Schmedes, Anne, PHD, Parving, Hans-Henrik, DMSC, Rossing, Peter, DMSC. Vitamin D Levels, Microvascular Complications, and Mportality in Type 1 Diabetes Diabetes Care 34:10811085, 201.


Lee et al, Vitamin D Deficiency; An Important, Common, and Easily Treatable Cardiovascular Risk Factor? Journal of the American College of Cardiology, 2008.

Friday, April 29, 2011

Post Lab Visit - What Ifs...

Well, I decided since I was booked to see my Physician on Monday it was time to get my blood work done.

It has been harder and harder to get this done.  Not the act of getting the blood drawn, but finding the time to get to the lab, wait, fast, etc.  I always find excuses not to get it done.

I did manage to make it to the lab, pee in a cup, get the three vials of red stuff sucked out of me, and back to work with my morning coffee in tote. 

Diabetes, and its time suckers I tell ya. Normally a trip to the lab takes 1-2 hours out of my day. Today was a good day, in and out in an hour. I am glad to get it done, but a little worried about the result. I haven't been a well behaved PWD over the winter. Oh well, we shall see in a couple of days.

It is the what ifs that haunt me while I wait for the results.

Like What if....

-I'm spilling protein in my urine, called Microalbuminuria.....
-my Lousy Cholesterol(LDL) is increased.....
-my HgA1C completely blows...
-my kidney function (tests) worsens

 I pretty much worry about every single lab result and what it means and how it could potentially effect my lifespan.

When you've had the big D for a long time, these things start to seep into the thoughts, and consciousness, as you contemplate mortality with diabetes.

One things for sure is the DOC has numerous stories and people who have been dealing with D for decades and are living proof that it is possible to live a long, complication free life.

 I know the research(DCCT Trial Info) states it is possible to reduce complications, but I want to avoid complications not just reduce.

Well until Monday the fingers are crossed. 

Have a great week-end!

On a funny,  not so serious note, check out my new VLOG below of my toddler providing music on my daily commute. Note this is on the way there and the way back.

Thursday, April 28, 2011

Top Ten List: Things We Are Told Not to Do But Do Anyways


1.  Over Eating to Correct a Low

2.  Leaving the Infusion Set in "Just one More Day"

3.  Leaving the Lancet in your Finger Poker for Waaayyyy toooo Long.

4.  Re-Using Syringes, to the point where it really does hurt

5.  Eating when High - y'all know it's best to wait

6.  Chasing Numbers - AKA treating a food reading with another bolus of insulin

7.  Making spontaneous basal changes - Like I'm low, I'll just shut it off for a bit.

8.  Ignoring alarms - both mechanical and internal, pump, CGM, and our own lows.

9.  Eye Balling Gargantuan Amounts of Carbs, even though we know how to use the scale.

10.  My favorite, licking the blood drop off the finger post prick!  Makes me feel really rebellious.

What are some of your "Things You've Been Advised Not to Do"

Have an Awesome Day!

Trev

Wednesday, April 27, 2011

My Mind is a Garden

I used to say this to myself on occasion when I was younger, like 20's younger. I can't say I came up with the concept, because I picked it up from a book I read back then called, The Monk Who Sold His Ferrari by R.S. Sharma.

It was one of the concepts he presented in his book. I honestly can't find the book.  But to this day it proves to be a good mantra.

Think about it.  We need to protect our mind from the constant bombardment thrown at it daily from the outside world.  Media, movies, and negative people we may encounter in our daily travels.  My post called Help or Hinder I wrote a while back about those who can be called hinderers and those people who we call helpers is an example of the filter we need to use to protect our "Garden" of a brain.

Where am I going with this? 

I think we all have a tendency to go on "Auto Pilot" the daily grind so to speak but a meeting I had today made me ponder life.

 This post was prompted by an elderly gentlemen I met in my daily travels. He is 94, almost 95. Sharp as a nail, an absolutely amazing person.  He has been on this planet since 1916.  I listened to him tell me about his life and I was in total awe for well over an hour.  Now that's a feat for a guy who's nickname used to be the road runner.

He said to me life is a blessing.  It is a gift. To be able to experience the joys of love, laughter, children, and of course golf.  Now I am not a golfer, but this fellow still hits the course once or twice a year. Amazing or what!!!  He stretches every day. He has lived all over the world and as he says "My wife and I were to busy having fun to argue, she was an amazing woman!"  What an amazing outlook on life.

Needless to say I left this interaction pondering the journey of life. People we love, people who love us. Places we live, the magnificent world we live in. Life truly is an amazing journey. Often over shadowed by our daily routine.

I just wanted to share this interaction. It inspired me to look at all aspects of my life. Where I've come from, where I am, and where I am going. Most importantly to appreciate all of it.

In the grand scheme of things Diabetes was only a small part of the over all picture.

Oh, back to the "Garden".... Basically;  I need to focus on the positive things that nurture my mind, let it grow, and keep it healthy.

I am off to go water my brain---kidding.

Trev


Tuesday, April 26, 2011

FIRE The Easter Bunny!

"My 3 Middle Children
Rowan, Grace & Abby"
WARNING:  Parental Advisory.  Do Not Let Your Child Read the Content.

YES, I said it.  I have been pissed at the Easter bunny since I was nine years old, the year I was told I had to "cut" out the candy. "D" Day, the year of Diagnosis.  That's what they did 28 years ago. They weren' t into letting patients control their diabetes. Carb counting wasn't promoted, it was basically, here is your exchange meal plan diet, good luck.

So when we got home(28 yrs ago), and these notorious holidays swung by, my parents took the meal plan to heart.  HAPPY freakin EASTER!  Instead of the basket with the huge chocolate bunny, I got a toy, and a bag of peanuts. If I was exceptionally lucky I also got a can of Diet Tab.  What's Up with that!!!

I asked my parents "Why did the Easter bunny not bring me chocolates this time?"  They told me he knows I have diabetes.  I thought, crap, even he knows.  That means, Santa will definitely know. This really sucks! 

Now fast forward 28 years to the land of Intensive Insulin Therapy and Carb Counting.

These holidays are still happening, as you all are well aware. Now I have learned to just take huge amounts of rapid insulin to "Have my Huge Chunk of Chocolate"  and so can my 2 type 1 kids.

Needless to say, I still to this day, have this secret grudge against the Easter Bunny. I almost feel bad about it, but it exists.

"Enjoying the Good Stuff"
These Holiday Occasions all involve the over consummation of "High Fructose-Glucose, anything Sugar-ose containing food in large quantities. Now for us living with a pancreas on permanent hiatus we are kind of screwed!  Y'all know what I am talking about.  No matter how hard I try even with intensive therapy and the use of rapid acting insulin, my blood glucose level for the 24 hrs during the "Holiday Occasion" is a jagged looking mountain of a graph. Naturally my children share this same graph. 

I still leave the key in the mail box for the Easter Bunny, but I really wish he'd bring us a new pancreas or at least call Santa and maybe they can both get together, swap magic and make it happen.

Even though Easter is easier then 28 years ago, I still wish these holidays were a little easier on the blood sugar control.

Trev






Friday, April 22, 2011

Cool Gizmo Machine AKA CGM

"Meet Mr. CGM Man!"
I am really wanting to initiate some serious CGM (Continuous Glucose Sensor) sensing in da house full of Diabetics.  My drawbacks were financial, basically couldn't afford the 200 for 4 sensor equation. But we now have a "Flex Account" meaning, I could, if I wanted to, get them covered. Hence my new dilemma.

The new barrier is not the cost, but the size of the Medtronic Sensors.  They could be used to hang up the cork board in my kitchen. Seriously, that BIG!  So I did some research to try to sway me into making a decision. Just Skim it. Thought since I read it I might as well share it!


My Take: 

Battelino and crew took 120 people with type 1 DM. (Randomly - which makes the study better) split them in half, one control group, one treatment group. They followed the groups for six months and concluded the following:

“In conclusion, the results of the current study demonstrated significantly shorter time spent in hypoglycemia in children and adults with type 1 diabetes who used continuous glucose monitoring compared with standard SMBG, with a concomitant significant decrease of HbA1c.”

In a nutshell:

CGM is a good way to stay out of the hypo zone.   It also has an effect on over all control shown by a lower A1C.

 Here is very informative article discussing some “don’ts” with RT-CGM(Real Time CGM) use and insulin pumping, written by Howard A. Wolpret, MD.

Here is the Link to the Article Titled; The Nuts and Bolt of Achieving End Points with Real Time Continuous Glucose Monitoring.  Here is the Article Link  Lots of cool graphs, talks about things like not shutting the basal off to treat lows, and not pre-maturely bolusing for highs. Good stuff!

Another Study published by the Juvenile Diabetes Research Foundation Continuous Glucose Monitoring Study Group.  The authors randomly assigned 272 PWD to use CGM over a period of six months.  This is what they found:

“After 6 months, near-daily CGM use is more frequent in intensively treated adults with type 1 diabetes than in children and adolescents, although in all age-groups near daily CGM use is associated with a similar reduction in A1C."

Once again the results show that there is a benefit from frequent use of CGM for PWD of all ages.

"MedTronic"
I think there’s a trend here.  Well on a personal note;  in our house full of diabetics  we are the proud owners of  two insulin Pumps with CGM capabilities.  We own one sensor (2800 bucks) and we don’t currently use it. For the aforementioned reasons.

"The Dex"
Unfortunately the Dexcom CGM isn’t available in Canada(I hear from the DOC that it's mucho better) and I have yet to hear anything back from my numerous emails writtem to the company.  I love my Medtronic Pump, and the built in Sensor thingy, but the needle is ginormous! Like Hammer and Nail large.  I can barely stomach it let alone my wee one.


If anyone reads this and knows anything about the Dex and when it is going to immigrate to Canada, please keep my clan posted. 

Trev



Sources: 
Another Study published by the Juvenile Diabetes Research Foundation Continuous Glucose Monitoring Study Group.  Factors Predicative of Use and of Benefit from Continuous Blood Glucose Monitoring in Type 1 Diabetes. Diabetes Care 32:1947–1953, 2009.
http://care.diabetesjournals.org/content/32/11/1947.full.pdf+html?sid=4c7cc395-3b1b-48c1-b381-6a43aa732cd5

Tadez Battelino, MD, PHD, Moshe Phillip, MD, Natasa Bratina, MD, PHD, Revital Nimiri MD, Per Oskarsson, MD, PHD, Jan  Bolinder, MD, PHD. The Effect of Continuous Blood Glucose Monitoring on Hypoglycemia in Type 1 Diabetes.
Diabetes Care 34:795–800, 2011

Howard A. Wolfert MD.  The Nuts and Bolt of Achieving End Points with Real Time Continuous Glucose Monitoring.  http://care.diabetesjournals.org/content/31/Supplement_2/S146.full.pdf+html?sid=21e0bbe2-9439-45b6-825b-69b69aca3cc3


Thursday, April 21, 2011

Pickled Diabetic Melon - Proof

Good Day!  I am so happy to hear from Y'all! 

As promised I did a review of some literature to check into the "Pickled Brain Syndrome" I blamed my recent act of stupidity on.  Here are a few I found to chew on.

Malone and colleagues did  a study  using rats that showed the following in support of  the “Pickled Brain” theory.
Hyperglycemia, but not hypoglycemia, was associated with adverse effects on the brain polyol pathway activity, neuronal structural changes, and impaired long-term spatial memory. This finding suggests that the hyperglycemic component of diabetes mellitus has a greater adverse effect on brain functioning than does intermittent hypoglycemia.

In other words the brains pathways involved in memory access is hampered when PWD experience high blood glucose. Gee I could have used this information years ago for all sorts of evil means.

 

Perantie and company performed a study that set out to determine whether hypoglycemia or hyperglycemia resulted in cognitive impairment in Type 1 children.

What they found was the following:
 The group with T1DM had lower estimated verbal intelligence than sibling controls. Within the T1DM group, verbal intelligence was reduced with increased exposure to Hyper, not to Hypo. In contrast, spatial intelligence and delayed recall were reduced only with repeated Hypo, particularly when Hypo episodes occurred before the age of 5 yr.

What the hell. Like we Parents want to read this.  I think I turned out okay, I managed to complete post secondary education, but I remember having “good” exams days, and “bad” exam days, and in retrospect the bad ones were the “My Sugars Out of Whack Days”

As my wife constantly says in our house, “Protect her little brain”

Sommerfield and colleagues examined a group of adult type 2 diabetics and found strikingly similar findings as the above two studies. 
Speed of information processing, working memory, and some aspects of attention were impaired during acute hyperglycemia. Subjects were significantly more dysphoric during hyperglycemia, with reduced energetic arousal and increased sadness and anxiety.
The findings above support the pickled brain syndrome. Not only memory but mood as well, which for children who are already emotionally challenged makes for a challenging scenario.   Damn high blood sugars!

Kubiak and his folks reviewed some research and discussed this the effect of post meal glucose spikes on memory.
 If you link to the publication near the end there is discussion about post meal blood sugar highs impairing memory in Type 2 Diabetes. Interesting, and something else to consider when dealing with our own management.

Article Link  - To Discussion.  

This information certainly reminds me of  the importance of maintaining tight glycemic control. Not only to prevent the typical, frequently spoken about complications we constantly hear about; blindness, vascular disease, kidney failure, feet issues, penis issues, heart disease, etc. But the "Pickled Brain" issue.


Well I wish you all a fab Easter weekend!!!

Trev

Sources:

Malone, John; Hanna, Suzan; Saporta, Samuel; Mervis, Ronald F; Park, Collin R; Chong, Ling; Diamond, David M. Hyperglycmia not hypoglycemia altners neuronal dentrites and impairs spatial memory.  Pediatric Diabetes. 9(6):531-539, December 2008.

Perantie, Dana C; Lim, Audrey; Wu, Jenny; Weaver, Patrick; Warren, Stacie L; Sadler, Michelle; White, Neil H; Hershey.   Effects of prior hypoglycemia and hyperglycemia on cognition in children with type 1 diabetes mellitus.Tamara.Pediatric Diabetes. 9(2):87-95, April 2008.
Sommerfield, Andrew J. MRCP; Deary, Ian J. PHD; Frier, Brian M. MD. Acute Hyperglycemia Alters Mood State and Impairs Cognitive Performance in People With Type 2 Diabetes. Diabetes Care. 27(10):2335-2340, October 2004.

Kubiak, Thomas; Hermanns, Norbert; Preier, Michael; Kulzer, Bernhard; Haak, Thomas MD.
Memory Impairments Associated With Postprandial Hyperglycemia and Glycemic Control.
Diabetes Care. 27(2):634-635, February 2004.






Wednesday, April 20, 2011

My Pickled Diabetic Brain - Seriously!

"My brain on sugar"
First off;  Thank-you dear online friend who tipped me off to re-enable my post option to include comments.

Yes,  I feel like a big idiot.

I thought I was loosing my mind! Like maybe the stuff I've read related to having cognitive defects (brain issues) after having my melon (brain) pickled in sugar for 28 + years was finally becoming my reality.

You may,  or may not, have noticed my post earlier today, yes that one, the one about a diary, and publicly sharing thoughts, and experiences related to diabetes.

Well that my friends was a figment of your imagination. As I pull out my magic wand and erase your memories.  Just like in the movie Men in Black

If you didn't catch my earlier post today then no worries, you didn't miss a thing. Let's say it was a pickled brain thing.  

Let's just say between a higher A1C and a long SAD winter, there is still snow outside, not kidding I some how, not sure how, disabled my comments on my posts.  

Well it is now re-enabled, and I look forward to hearing from you guys, if I have any scant amount of credibility left in the DOC.

Oh, since I mentioned it; the pickled brain thing that is.  There is some research indicating us PWD do experience slower memory recall, and cognitive function when our sugars are screwed up beyond recognition.  I promise to do a legit lit review tomorrow, and write a quick post on Diabetes and Cognition.

Well, I wish you the very best!

Trev






Tuesday, April 19, 2011

Top 10 List: Sugar Spikers (Non Food Related)

Here is our list of things that take our flat lined blood glucose reading and shoot it up into the crazy zone:

1.  The Dawn Phenomenon - That damn hormonal surge!

2. The Re bounder - The rebound high after an extreme low or rebound from an over night low called the Somogyi effect

3.  Post Exercise Spike -  Increased levels post intense exercise.

4. The High Blood Sugar made Worse by Exercise Spike - Different then the above.

5.  The I'm Stressed Out Post Argument High -  Also called the Post Terrible Meeting, Post Anyone who Stresses you out High.

6.  The Dehydrated High -  The  I haven't had anything but coffee today spike.

7. The Site Change Spike - Good before the pump site change terrible after.

8. The Forgot to Bolus for my Meal High - Opps

9 The  Fasting High - AKA I  Forgot to Take my Bedtime Longacting.

10 The "where the hell did that one come from?" Spike - Which there is know rational explanation at all. AKA the Diabetic Curveball High

Feel free to add your own.

Cheers!

Trev

Monday, April 18, 2011

Don't Mess with My Coffee!

"A thing of beauty!"
Living with Diabetes is one of those diseases(All though I hate calling it that) that requires us to make many lifestyle tweaks in order to be successful in achieving optimal blood glucose control

Some things that I have had recommended to me over the years include:
-Test and record
-Eat this way not that
-Exercise more, but do it this way
-Take this insulin at this time
Etc....etc....

But do they have to mess with coffee?  I mean really, come on, Dr Oz says its good for you.

Most PWD likely note a subtle spike or even pronounced increase in blood glucose post Java. I know I do.


Well unfortunately there is evidence that is backing this up.  Note this article I found in my email this morning from Diabetes In Control:

Glucose levels can double when having coffee and combining with carbohydrates.
James Lane of Duke University says studies have shown the increase in blood glucose levels that occurs after adults with Type 2 diabetes eat carbohydrates is exaggerated if they also drink a caffeinated beverage such as coffee.
The inaugural issue of Journal of Caffeine Research: The International Multidisciplinary Journal of Caffeine Science reports a growing body of research suggests caffeine disrupts glucose metabolism and may contribute to the development and poor control of Type 2 diabetes.
This caffeine effect could contribute to higher glucose levels in those with diabetes and could compromise treatment aimed at controlling their blood glucose, Lane says.  The links that have been revealed between diabetes and the consumption of caffeine beverages -- especially coffee -- are of monumental importance when it is acknowledged that more than 80 percent of the world's population consumes caffeine daily.
Lane reported that several recent studies have looked at the connection between high levels of caffeine consumption and impaired metabolic function. After examining these investigations, he said that most have confirmed that caffeine can increase insulin resistance, one of the first steps toward developing Type 2 diabetes.

Furthermore, in adults who already have Type 2 diabetes, consuming caffeine can make their condition worse. Lane described one recent study, which showed that the increase in blood sugar levels that occurs following a meal rich in carbohydrates is nearly doubled when a caffeinated drink is included as part of the meal. This could make treating diabetes more difficult.

Journal of Caffeine Research Vol. 1
Please note that as I am typing this post I am enjoying the biggest cup of coffee I could find on my way to the office this morning.  I simply take more rapid.

Trev

Friday, April 15, 2011

Robin in The Snow? - That's Just Not Right!

"Taken Today, Seriously"
Isn't it suppose to be "Robin in the Rain"

The robin just doesn't fit. Speaking of not fitting, or being incongruent......

My blog writing attitude hasn't been fitting lately.

First of all I owe you all a huge apology. Well at the bare minimum and explanation.

My Posts have been rather erratic in "Attitude" as of late, I am sure you have noticed.

So, I reflected on why I started blogging and the title of my Blog, and the phrase, "Stories about Navigating  Diabetes Myself and Parenting 2 Type 1 Children" and ask;  am I still reflecting this in my writings?


I went back to review my first post titled  "It Started with Me, Now There's Three" and read the first paragraph:
Three to Treat is my attempt to reach out and share some experiences of dealing day-in day-out with this challenging thing they call Type 1 Diabetes. 

Pretty simple. Very clear sentence. My attempt to reach out, through the fabulous online world and share my day-to-day experiences  about Type 1 diabetes.

Which begs the question;  have I been doing this lately?

I must admit I lost focus over the past two months, more like lost my mind(attitude)  I need to get back to those initial reasons.  The fundamentals reasons, like the ones quoted from my original post.

I merely want to "reach out" to others.  I want to "share" my experiences. 

So I ask myself why?

My free thought answer was this:  The fundamental human need to belong, and a drive to relate to others who experience what I do.  I hope others feel a sense of identification with some of my posts.  I hope those who live with Diabetes or care for someone with diabetes, reads a topic and think, "Oh, I totally hate when that happens" or "Hey, I should try that next time"  I hope to connect on some level through my writing and sharing. 

In order to do this I need a congruent attitude, a consistent approach, hopefully something you look forward to.  Trust me I can barely handle my own indecisiveness and fluctuating attitude. 

Not like the Robin in the Snow, which is confusing to the mind. It is not what we'd expect. So it messes with and confuses our brain. I don't want my blog to resemble or compare to a Robin in the Snow.

Sincerely,

Trev





Thursday, April 14, 2011

Up-chuck-it-up-ticus & Diabetes - Bad Combo

"Flickr Pic"
Day 1: Friday

I answer my cell "Hello, Trevor Speaking"

"Hi Mr H,  this is Mrs Blank from the Day Care calling, I am so sorry to bother you at work but Cadee just soiled her third pair of pants, and she vomited"

I reply, "Okay, I will come get her"

We spend the evening, cleaning up vomit, and the other.

Day 2: Saturday/Sunday

My Wife says, "I have a tummy ache, and feel like I am getting sick"

I think, oh oh, it's contagious...

She goes to bed, and follows the same course for 24 hours of vomiting, and the other.

Day 3:  Monday

My wife stays home ill. But the kids appear to be okay.

I pack em all into the enormous van, and head out to drop them off and go to work.

Day 4: Tuesday

The kids appear okay. My wife is better but tells me she feels beaten up and very weak.


I pack em all into the enormous van, and head out to drop them off and go to work. 

I get a call from my second oldest. "Dad, I am not feeling well can you pick me up from school?" I reply, "Okay, I will be there shortly" 

We go home and she suffers the same fate as the first two victims.

I think; who is going to be next?

Day 5: Wednesday

Abby tells me she is okay, so I pack em all into the enormous van, and head out to drop them off and go to work.  This time hoping to make it the full day. No such luck.

My cell rings, "Hello Mr H, Rowan really isn't feeling well and feels like she is going to throw up"

I give the customary response.  "I will be right there to pick her up" 

I pick her up, and sure enough she looks pale, and we go home. 

Now it gets tricky.  We now have a sick kid with diabetes, and we know they do not mix well.

That evening, Rowan had a terrible, relentless low blood sugar, that dug it's heels in and WOULD NOT come back up.  

There we were, shoving glucose into her poor little body as she was throwing it back up. It wouldn't budge. We were seconds away from taking her to the emergency department for some IV glucose. We waited, checked her sugar again for the 5th time in 45 minutes, and it seemed to be trending up into the normal range.  Thank goodness, we went to bed, well sort of.

If you are wondering about Glucagon, I had it ready, but one of the side effects is vomiting, so I was hoping it would not be needed. 

Finally she was able to keep the last juice down. 

Once again diabetes added that element of danger, that; let's take something that's already difficult and make it more so element. Enough already, we are trying to protect my kids grey matter. Back the $%^$ off Mr D. 

Day 6: Thursday

Well I made it through most of the work day. Thought I was in the clear, and then the cell rang. 

Now I am typing about it.  

We had 4 out of 6 family members contract the "Bug" responsible for the syndrome, "Up-chuck-it-up-ticus"

A whole lot of hand-washing, surface wiping, sheet washing, work missing, smelly time I must say. 

One for all and all for one, it kinda applies, maybe?

Man, I hope I beat the bug. 

Trev






Monday, April 11, 2011

Would You Like to Buy Some Cookies?

Sure! I say enthusiastically to the 2 Girls standing on the porch holding a box of "Girl Guide" cookies.

As all five of my girls huddle behind ready to pounce me if I say no.

I say "Just one sec while I go get the money"  I return with the 2 toonies (2 two dollar coins in Canada) hand them the money and retrieve the goods

I close the door and my offspring follow us (the goods and I) into the kitchen.  Eagerly waiting for their delicious cream filled cookie to be rationed out.

Then reality sets in. Crap, Rowan was high 15 minutes before the goods arrived. 

I take the cookies and put them up in the cupboard risking a full on assault from all five of my children.

But I only say one thing, "Rowan's high right now"

They all (with the exception of the toddler) understand. 

I distract the wee one with a toy, and a drink.

The rest sit down at the table, and say " Come on Dad let's finish our game of cards" I smile and sit.

On the inside I think.  What a great bunch of kids, Rowan didn't complain at all, and the others put their own desires (trust me for an 8 and 10 year old to deny themselves a cream filled cookie is a major feat) aside for the consideration of their little Type 1 sister really touched my heart. I was a very proud dad at that moment.

This is one of many examples of the things parents with children of type 1 diabetes have to experience more often then they should.

Trev

Saturday, April 9, 2011

Self Experiment - Does Diet Effect Your Mood?


"Me Fired Up!!!"
 This was also Posted On My Sister Blog Diabetes Mind Game yesterday, but is relevant to all.

Good Day All! Boy do I have something I want to share!!!  I have not been this fired up in a long time. No I am not manic. This is some really revolutionary stuff. I didn't invent but check it out!!!

Not sure if I mentioned this,  but my last A1C was 8.4 % which, in my opinion for myself, pretty much sucks!!!

So I took a hard look at my current diabetes regime and self management.  By hard I mean honest, like; can I do more, am I measuring, trending, tracking, counting, am I consistent. To answer myself; as to whether I've been a well behaved PWD. I'd have to say, NO. I haven't been consistent in doing any of the above.

The result,  a shitty A1C.  Time to do something radical. Time to make a plan, and stick with it. Time to smarten up, and as you all know, I have 90 days.  At which time I will repeat my A1C and have a check-up with my physician.

Over the past four days, I know, not long, but I have to share this, I have been doing the following:

-Off my Pump, back on the Multiple Daily Doses.

-Re-Read Dr Bernstein's Diabetes Solution , for the second time in 4 months(This time I took notes)

-I have been eating the following portions daily:
Breakfast:  6 grams Carb and 3 oz Protein(Measured using a scale)
Lunch: 12 grams Carb and 4 oz Protein(Pre-made the evening before)
Dinner: 12 grams Carb and 6 oz Protein

-I have been taking the following insulin:
AM: Levemir 15 Units (split into 3 separate injections as per Dr B's Suggestion)
AM: Apidra 5.5 Units
Lunch: 4.5 Units
Dinner: 6 Units
Bedtime: Levemir 5 Units

Broken Down:

Correction Factor = 1 Unit will drop my BG by 2 mmol
1 gram of Carb increases my BG by approximately .3 mmol
1 unit of insulin for 1.5 oz of protein
1 unit of insulin for 6 grams of Carb
2 units to cover the Dawn Phenomenon (2 hrs after waking)

-I write everything down
-I tested every 2-3 hours for the first 3 days
-I discovered Sugar Stats a website that allows you to log your numbers, graph them, and so much more. Get this! If I am out, away from my computer I email my blood glucose reading using my phone to the site and review the numbers later. It really is awesome!(No I am not an affiliate, so I don't get anything if you visit the site)

Okay, so what?! 

I am going to tell you, the first day sucked!  I felt low(hypoglycemic) because I wasn't used to having sugars in the normal range. I felt hungry, I had a massive headache. Day two, still feeling headachy, but slightly better. Day three, better. 

Today, I feel fantastic!!!  I have no headache. I have no post meal spikes, my range yesterday and today has been close to that of a non-diabetic.  I never in my 28 years of being a Type 1 have seen numbers, I mean stable, steady. 

My mood and my mind is clearer then I ever thought possible. I am not exaggerating. I post my numbers publicly on Sugar Stats if you want to check them.  It's really encouraging to eat a meal or take a shot and knowing exactly what the outcome will be.  I admit I was really hesitant to take 1 unit for 1.5 oz of protein. But seriouly, it's totally possible!

The only downfall is it is a rigid regime,  but I feel great and that is motivation. I don't feel edgy, like I am on an emotional roller coaster that I would get with spikes and drops in my blood sugar.

Stable numbers (Stable Carb and Protein + Stable Insulin = Stable mood ) 

That is my conclusion thus far.  I know it is only day four but I am onto something life changing. I just feel it!

Trev


PS:  Yes this is my official plan, I am not Flip-Flopping as stated two posts ago.


Friday, April 8, 2011

Dear Government Person - Not Your Secretary!

As most of you know I have Two Type 1 children (out of five) who have had their pancreas hijacked by little evil invaders destroying their beta cells leaving them without insulin.
The little one, diagnosed at 18 months, who is now 6, is using an Insulin Pump to deliver her insulin. The oldest one, is simply too vain at the moment to consider pump therapy.

This post was inspired by a post I read today by Jamie Naessens on Diabetes Mine discussing the Canadian Health Care System. Great post, I recommend you check it out.

It got me thinking about the provincial difference. I was born and raised in Ontario, Canada. We moved out here to Alberta 7 years ago. Little did we no that while living out here we would be  challenged with the onset of Type 1 Diabetes for 2 of our children. 

To get to the point, the contrasts between provinces became really apparent when I heard Ontario providing all Children under 18 years of age being subsidized for pumps and supplies. Meanwhile, I am making car pump payments on 2 new Insulin Pumps in the same Country.  I immediately dug my heels in, and wrote a letter to the Provincial Minister of Health.  I honestly doubt he read it. As I received a response from an unknown individual, assigned to respond diplomatically to such emails and letter inquiring about the discrepancies from province to province.

Here is a paragraph from the email response I received:

The Government of Alberta is committed to providing Albertans with access to quality health services. Decisions to publicly fund health services must be supported by evidence regarding their potential health benefits. Alberta Health and Wellness is currently undertaking an assessment of insulin pump therapy. This assessment will provide evidence on safety, efficacy/effectiveness, cost effectiveness and other relevant information of insulin pump therapy compared to multiple daily injections. This assessment will guide our overall approach to insulin pump coverage.

It was a very pleasant letter, it did say that they have a number of income based programs; of course I work and don't qualify for these. I know stop your whining (In case you were thinking that) 

Okay, so they are evaluating the evidence, okay......so now what?  The cynical side of me thinks; to look for cheaper methods, so they can not provide pumps in Alberta, which is a huge up-front cost but the best therapy for children in terms of hypoglycemic management, blood glucose control, and oh yes, quality of life. Phew, that was a thought-full!  But seriously hurry it up a little, because having three car payments is killing me. Not to mention not being able to utilize life saving technology for our Type 1 Child who has no hypo awareness.

I have yet to write back.  I am new at this advocacy thing, which is surprising since I have been Type 1 for almost 30's. 

I would like to investigate ways to be heard, political avenues to pursue, how in the heck do I make change in a sparsely populated country for Type 1's?  Basically how do I cut through the "red tape"

But, I am a little busy;  working full time, raising five children, and managing three Type 1's.

Trev

PS:  If you are curious, this is the main portion of my letter to the Minister below:

It is perplexing that the richest province in the country has its
citizens paying for essential supplies, new insulin, insulin pumps and
supplies (out of pocket) to prevent complications down the road that
will inevitably save the government money.

The diabetes coverage has improved in other provinces dramatically, what
is the delay in this province?

In any event, I am aware this letter will likely be screened, it is
however my hope to have it forwarded to the Minister of Health.

My main purpose is to advocate for better coverage for type one
diabetes, and those parents and individuals who choose the best
treatment available based on the most current clinical research.

I firmly believe this will save the health system millions of dollars in
the long term.

Kindest regards

Trevor ---------

Thursday, April 7, 2011

Ever Heard of a Flip-Flopper?

I am sure y'all have figured out by now that I am a bit of a flip-flopper. No it's not a type of fish, or a sandal,  it is this undesirable character trait to try something, decide it ain't working(too quickly), and changing it....again, kinda deal.

I am now back to re-analyzing my numbers again. I am stable one day, high the next, like a flippin roller coaster!  Hence me pulling out the Dr Berntstein's Diabetes Solution  and reading it with a magnifying glass this time.

I flip-flop with my diet. I flip-flop with my insulin. I flip-flop with the way I deliver my insulin. What the hell!  Stop it already-I am yelling at my self.  Don't worry not aloud. 

I flip-flop with blog writing, and ultimately do it anyways.  I am sorry if I am confusing to follow, trust me I am torturing not only to you,  but also to the people that surround me on a daily basis.

Okay, I have stuck to some major decisions in my life; my commitment to my wife, my commitment to my career, although I have had many different type of jobs in the same field, but I am still in the field.

I have always enjoyed Muay Thai, never flip-flopped on that.  Too much fun!

But when it comes to diabetes, I need to pick a plan and trial stick with it. Enough with the rapid cyclical trialing of insulin, pump, MDI, back and forth, variable carbohydrate intake, etc. 

I have written about Pro Carb or Low Carb? in a past post, and I have trialed the low carb approach with amazing results. It is obvious to me what needs to be done, I just need to do it.

Well at least for more then a week.

Please tell me I am not completely mad; are there any other PWD that flip-flop???

Trev

Wednesday, April 6, 2011

Don't Compare me to Peanut Brittle!

"Try Counting This"
I am Reading Dr Berntein's Diabetes Solution for the Second time in the last 4 months. I read the term "Brittle Diabetes" and thought, interesting, I don't hear that very often anymore.

Now in the book he was just discussing the terminology used in the last few decades to classify the different types of diabetes, Type 1, Type 2, then IDDM(Insulin Dependent Diabetes Mullitis) NIDDM (Non-Insulin Dependent Diabetes Mullitis) LADA, and he briefly mentions the old "brittle diabetes"

It got me thinking, I used to hear this term all the time.  "Oh you are taking multiple shots per day and have to test often, you must be a brittle diabetic"  Must say I haven't heard it in a while.

Which is good, since it used to leave me feeling, well, for lack of a better word, "Emotionally Brittle"

I'd think to myself, Brittle, I am no such thing, but I'd also question and overly reflect on the "Brittle" statement, and as a result, it'd make me feel a little sad. 

The actual definition of "Brittle" according to http://www.thefreedictionary.com/brittle is the following:

1.
a. Likely to break, snap, or crack, as when subjected to pressure: brittle bones.
b. Easily damaged or disrupted; fragile; a brittle friendship. See Synonyms at fragile
2.
a. Difficult to deal with; snappish: a brittle disposition.
b. Lacking warmth of feeling; cold: a reputation for being brittle and aloof.
3. Brilliantly sharp, as in percussive sound.
4.
a. Perishable.
b. Fleeting; transitory.
I have never viewed myself or any other PWD in any way as the above definition would depict.

I think if one chooses not to accept the disease, emotionally, that person is slightly more likely to damage themselves, but to loosely throw the term "Brittle" around (which isn't done anymore) is a poor depiction of an insulin dependent type 1 diabetic.

I am glad times have changed, but perceptions still exist.

I have often felt more health conscious as a result of my diabetes. More in tune with the signals our gift(body) sends us. As a result, I felt stronger and in better physical shape then a lot of my friends, and relatives. I have never once considered my self breakable, perhaps a little "Snappish" on occasion.

I know the term was meant to describe the persistent fleeting fluctuations and difficulties presented in treating labile or hard to manage blood glucose levels.

But this is the problem with judgement terminology, like "Brittle" it conjures up a mental picture and thus leaves an impression.

Things are not that simple, and the more we learn the better we understand diabetes, and not just view it as a type, or poorly controlled, brittle, or any other injurious term that limits understanding.  

Trev

Tuesday, April 5, 2011

Pump Adjustments - Part 3 (Correction Factors)

I am writing this a few days late.  I have taken the pump off today but here is what I did over the week-end.

Now it is time to fine tune my correction bolus. So to refer back to Dr Conway and Colleagues,  The Professionals Guide to Insulin Pump Therapy  as quoted below:        


          Adjusting the Correction Bolus:

The goal is for the blood glucose to return to within 1.7 mmol/L of the target blood glucose within 4 hours of giving the correction blous.The correction bolus is based on the insulin sensitivity factor: the mmol/L one unit of insulin will lower the blood glucose.

Raise or lower the mmol/L on unit of insulin should drop the blood glucose.  Make small adjustements: .3 - .6 mmol/L for each adjustment. 

For example, if the insulin sensitivity factor is 1 unit for every 2.8 mmol/L above the target and the blood glucose 4 hours later after giving the correction blous is ?? mmol/L lower than target, adjust the insulin sensitivity factor to 1 unit for every 3.1 - 3.4 mmol/L.

If you recall I have set my pump correction factors according to the chart. So for 1 unit of insulin it is theoretically suppose to drop me by 1.5 mmol/L. 

This seemed a little high, or low depending on which way you look at it. I know I normally need 1 unit for 3 mmol/L.  Sure enough, I have changed my pump settings since I was reunited 5 days ago. I have set my Correction Factors as follows.

0000 = 1 unit for 6 mmol
0400 = 1 unit for 1.5 mmol
2300 = 1 unit for 6 mmol

I have used the correction for breakfast --- it worked
I have used the correction factor for lunch --- Needed to change it to 1 unit for 2 mmol
I have also change my dinner CF as I was dropping way to low.  Trial and error.

Now they are:

0000 = 1 for 5
0400 = 1 for 1.5
1100 = 1 for 2
1600 = 1 for 3
2200 = 1 for  5


Now you are probably asking yourself why I took the pump off? 

One - I am impatient and my fasting is really sucking lately. I tweak, I test, I trend and change.  But I, at this point in my life, have limited time and energy to do what`s needed to fix my basals.  I don`t want to wake up every three hours to test right now. 

Two - Money, thats right, we have coverage, but we need to purchase up front, and once again, Rowan is priority.

Three - MDI works for me when I let it, meaning, when I behave in the food department.

She is the priority
My plan:

 Wait until I can take a vacation to focus, trend correctly, and have the resources to buy some glucose sensors to really get the settings correct.

So, back to MDI, Levemir, and Apidra.

Trev

 (I had a comment to take into consideration, that is when adjusting basals make the change 2 hrs before hand, which makes a lot of sense)

Monday, April 4, 2011

Mouthy Monday?!

"Ahhhh, Blue Skies"
Okay the last two posts have been a little on the dry side.

So as I peer out my office window and the sky is blue, like sunshine blue,  it motivates me to write about fun stuff.  Don't worry it is my lunch break so I can spend a little time blogging, surfing, etc.

Why the title?  I don't know really. I was going to post about sugar levels, and pumping, but kind of sick of it, since all three of us Type 1's in our crazy house are on this super strict recording kick. 

Basically a whole week-end of asking:

"Did you write it down"
          "What did you eat for carb?"
                   "Dareian go test Rowan, please"
                             "When did you take your insulin last"
                                        "How much carb did you eat?"
                                              "While write it down then so
                                                          I know what to change"

The dialogue goes on and on.........not to mention my own recording. I decided to wait to buy the CGM sensors, and bought food instead.

Monday 's my day to yack!  No,  not throw up....but just talk, or type.  No agenda, what ever comes to mind. I am sure diabetes will creep up in the post at some point, as it has above. Oh well.

So if you notice my pic, taken today; the sky is blue, but we still have the white stuff, which is melting, thank goodness.

I did something crazy this week-end, are you ready for this, I took five kids to a community swimming pool.
Normally I would pre-medicate to stay calm (kidding) We arrive, on Saturday and the place is packed.

The pool, I swear has hired 2 life guards for every swimmer, and if you let your child go outside the meter radius they scold you, seriously.  So you can well imagine the scenario(I get scolded every time) It is better now because I only have 2 kids under 8 to keep in reach.  The others are independent enough to go off on their own.

So Rowan and I disconnect our wizards, and lock up over 10000 dollars worth of pumps into our 50 cent locker. I always hesitate ever so slightly before I walk away, but they are always awaiting our return.

Then we swim, risking our infusion sets, as they may and almost always do peel off, but this time they stay intact, another plus because this also means we save about 50 bucks.

"Don't let the Cuteness Decieve you"
My three year old non-d has turned into an alien like Stitch from the Disney Movie.  Crazy, non stop, fearless, non-listening, testy, lil, monster, but cute. Cute for her safety.

My only diabetes message in case any reader is looking for one is.......life goes on regardless of having the D, in between testing, recording, treating, thinking,  enjoy those fun moments like swimming, sunshine, non-D stuff!

Did I also mention I am the champ at crazy 8's, oh ya baby!!!!

Happy Monday! 

Trev

Sunday, April 3, 2011

Pump Adjustments - Part 2 (Carb Ratios)

"Carb to Insulin Ratios"
First a quick update on the basals.  So I've decided to stay Pump Bound, with Mr Wizard Senior.  All is well thus far.  I set my basals as listed in the last post.

 Day one, my AM reading sucked, so it was a bust, day 2 much better.

Lots of testing, and documenting. Every little detail, Carbohydrate, fat, protein, activity, glucose levels.....I knew it would be a lot of work, but today I 'm already seeing stable before meal numbers.

Tonight I will have an early dinner (easy on the fat and protein) and fast until tomorrow to test my night-time rates which means a 0300 AM check. 

Next on my list to tweak are the carb ratios.

So to refer back to Dr Conway and Colleagues,  The Professionals Guide to Insulin Pump Therapy  as quoted below:

Adjusting The Meal Time Bolus:
The goal is for the blood glucose to rise not more then 2.8mmol/L 2 hours after a meal.  The meal bolus is based on the insulin to carbohydrate ratio: one unit of insulin to a determined number of grams of carbohydrate.
Raise or lower the number of grams of carbohydrate covered by 1 unit of insulin.  Make small adjustments: 1 to 2 grams of carbohydrate for each adjustment.
For example, if the insulin to carbohydrate ratio is 1:15 and the blood glucose two hours after is only 1 mmol/L above the pre-meal blood glucose, adjust the insulin to carbohydrate to 1:16 or 1:17.

Okay, so I have programed the 1:10 ratio into my pump for all meals. We shall await the outcome. As I have pumped for many years I know my variables roughly, but I am pretending to be a newbie.

I know that breakfast requires more then lunch and bedtime snack much less then supper, if you follow me. But I will do the trial and error thing and hopefully refine the regime. 

Better test since it's 2 hours post lunch as I type this.  One second.........

Okay, now. I am surprised it is high (Well technically in target, but I personally shoot for single digits) Based on the recommendation I was 7.4 mmol before lunch  and 10.4 (3 mmol raise) so I guess I am being too hard on my self.

I still ask myself;   Did I count properly? (Carbs that is) I did eat 2 strawberries on steroids, well, I am not changing the rate yet and  I plan to leave it for a couple of days.

If I get the same reading tomorrow post lunch then I will heed the advice above and change the ratio accordingly.  Work, work, work, think, think, think, tis diabetes!

I think I may hit Cosco tonight and get some CGM sensors, but man they are 210 dollars. Ouch.

Once again I know a lot of my readers are well versed in pump management. Hopefully someone finds this review useful, I know I am.

Cheers!

Trev






Saturday, April 2, 2011

Pump Adjustments - Part 1 (Basals)

So I have decided to give the pump a serious trial despite the multiple variables listed in my last post.

Question is: Where do I start? 

I have decided to start from scratch, from the beginning, like a Newbie.

Why you ask;  well I've been off my pump more then on it in the last 12 months and I have gained a few pounds.  I think starting with the fundamentals(clean slate), will be good for re-training, sharing, and it will force me to look at all variables effecting my current glucose control. If you want to perfect something, go back to the basics. Otherwise old habits will ensue.

My Last A1C was 8 % so clearly I am not controlling my blood glucose levels adequately.

So I figured I would share my plan and experience with adjusting my basals.

First thing I did was review the recommended ways to adjust basals by reviewing a document written by Dr Robin Conway and Colleagues  based out of Smith Falls, Ontario, Canada. The Professionals Guide to Insulin Pump Therapy

I have used this resource in the past and consider it compulsory reading for any pumper.  This clinic's website The Diabetes Clinic is very patient centred, and easy to navigate. It has everything, and I have found it to be the most useful in managing my pump therapy and others I deal with.  I have no affiliation with them other then finding them on the web.

So I flipped through the first 6 pages and came to page 7.  Titled: "Estimates for Starting Insulin Pump Parameters"  It is a chart giving you an estimation on where to start your basal levels at based on your TDD(Total daily dose of Insulin)  Cool. I scroll down, my TDD using MDI was around 44 units per day.
Based on the chart I should do the following:

Basal: 0.7 units per hour
Meal Bolus 1 unit for 11 grams of CHO(Carbohydrate)
Correction Factor 1 unit for 1.8 mmol(multiply by 18 for US)

Neat, very easy to follow. As I remembered.  I have another hand-out from an Endo that adds another factor to consider. If your A1C is above target, Multiply the TDD by 1.1-1.3 and go from there. I will do that since I am not at target. So 44 times 1.2 =  52.8. SO back to the chart and this is what I get.

Basal: 0.8 units per hour
Meal Bolus 1 unit for 10 grams of CHO(Carbohydrate)
Correction Factor 1 unit for 1.5  mmol(multiply by 18 for US)

Okay. I am now programming my pump based on these new settings. However, I would be unwise, since I know my rhythms. I know I need less insulin from bedtime until 0300 AM. I also know I need more insulin after waking. So what to do?

Keep reading.

On page 8, they list 4 Basal rates, but recommend most people begin with one. I am not most people, I know I said I am going to start from scratch but what I will do is this:

I know from the past I need more in the AM, less in the post sleeping so my plan is this:

Basal Plan # 1:

0000 = 0.04 (1/2 the recommended) 
0300 = 0.8
0800 = 1.6
1000 = 0.8
2300 = 0.4


Trust me this is an increase from my current programing. So we shall see how it goes. I suspect some lows.

How do I test the above:  To quote Dr Conway's recommendation below:

 Adjusting the Basal Rate:
The goal is for the blood glucose to remain within 1.7 mmol/L of the target blood glucose value in the fasting state.
Change the basal rate by .1 to .2  units per hour over the period of time the blood glucose is too high or too low
For example, if the blood glucose rises after 3 AM and drops after 9 AM, raise the basal rate by .1 unit per hour from 3 - 9 AM and evaluate the effect each night.

All right then, this is the plan. The document also has good work-sheets to use for recording and analysing numbers starting on page 13, adjusting the overnight basal. Which is the most important one to start with.

As all PWD and those who care for PWD it is much easier when you start the day out with a good number.

Stay tuned, and I hope these new settings, bring the fasting down a little.

Cheers.

Trev


PS: I know a lot of my readers are well versed in pumping, and I want you to know I am open to new ideas and/or alternate resources.

Friday, April 1, 2011

Pumping vs MDI - A Case for Both

VS
I have just recently reintroduced my "External Pancreas" back into my life. Well,  at least on a more permanent basis then before. We now have 100 coverage for pump supplies. Need I say more.

So, as you all know, my last A1C was, not desirable, at 8% which means my numbers were running in the double digits over the last 3 months(Canadian values eh) 

I really have been a bad diabetic, well, lets just say I needed to improve my record keeping and do some serious analysis. I need to measure more frequently and stop eating crap when ever I feel like it, I feel like a big hypocrite some days when I am telling people to do the opposite of what I am doing or "Do as I say not what I do"

In any event, here I am analyzing my numbers, and now I understand why my A1C sucked!!  Okay, too dramatic, but let's just say I did not meet the recommended target of 7%.

My fastings are above 8 mmol(multiply by 18 for US)---Not good.

So I analyse:  Why are they high? (Glimpse into my mind)

-Too much fatty food for evening snack or meal?
-Not enough insulin to cover the food?
-Inadequate Ratios?
-Inadequate Basal?
-Am I sick? Nope.
-Am I stressed? No more then usual
-Am I exercising? Yup, didn't last night.
-Dawn effect, rebound from a low?  Don't know. 
-Am I due for a site change?  Is the site a good one?

Man, these are a lot of variables to consider. "Pumping is sometimes more work then it's worth" --- to quote my direct thought.

Options:
-Switch back to the MDI(Levemir/Apidra) or Stay on the Pump? This is a Rhetorical question, just typing out loud so to speak?

My argument for the Pump:
-Once I do the work, skip breakfast, test the basals, analyse ratios, eat properly, tweak, test, etc....it works, less lows, more of a match to my physiologic profile.
-On the negative it is a whole lot of work, I am not sure if I am up for it.
-Obtain some CGM sensor sets for my pump and really figure out my basals.
-Freedom from Multiple daily injections, once it's(pumps) settings are accurate it is a major time saver in calculating corrections and ratio's, which is a major plus.

My argument for MDI:
-Don't mind injecting, and you know the amount you inject is the amount you will get, as with the pump you have to consider age of the site, site integrity, is the pump flowing like it should etc.
-Less variables to consider. For example, if my before lunch is high, then I need more Apidra, if my fasting is high, is it food, dawn, rebound, or my bedtime Levemir dose.
-Carrying around my Apidra Pen is a pain, but not really, since I would not have my pancreas clipped to my belt.

Other things to consider:
Daily routine:  My routine is stable, Monday to Friday job, predictable exercise patterns, week-ends are a little unpredictable.  Pumping is good for fluctuating schedules and eating patterns, I am a predictable fellow.

As you can see I can justify both methods to control my blood glucose level.  Which will I choose?

Still thinking about it.

Trev