Thursday, April 30, 2009

Thursdays Thought

   OK, here's a thought. I'm thinking that maybe there could be an association between using Apidra and my having so many "No Delivery" alarms of late. I've used Novolog in the pump for many years and NEVER had a "No Delivery" alarm from it. It could be coincidence to have been having the alarms of late and to be using Apidra at the same time. That's easily possible. This is my last cartidge of Apidra I'll use for the summer as I just emptied the latest bottle.

   I'm just trying to brainstorm the possibilities here and see what others are experiencing. So, any others having "No Delivery" alarms...fairly often?


Tuesday, April 28, 2009

Tuesday - Trainer Ride

Ride: 18.5 Miles
Terrain: Trainer
Time: 0:01:00

Pre-Ride Glucose: 278 mg/dl ( too far north )
Post-Ride Glucose: 120 mg/dl ( headed south )
Intake: NADA
Ride Pump Status: Normal

   OK, so you squeeze in the miles anyway you can sometimes. Today's schedule dictated a quick trainer ride at home. Normally, I'm at work by 7 AM, but today was a cool weird day. I was asked to do a quick local news interview (for Tour De Cure) for a Saturday morning community segment. I hadn't ever done that before...so ther's a first. The ride this morning, while looking out the back porch at perfect morning riding weather, was well less then great, but ok.

   Back to the Apidra issue again. Yesterday afternoon my glucose jumped through the roof for a few hours, after a typical meal I would normally eat, and then finally came back from the north pole. This AM it did the same thing again and then with both bolus on board and exercise, it came back home and then headed south quickly. Time for breakfast. Now, it should be noted I'll change sites again tonight, but Sunday I mowed the lawn with a new cartidge of insulin. Got the problems after that. I've also had multiple "No Delivery" alarms, on two seperate cartridges, the past few days also. We'll see how this next change-out goes. I will say that this is going to be the last bottle of Apidra I use until colder weather starts up in the fall. My health is worth too much to me to have to continually battle with this.





Monday, April 27, 2009

Global Heroes 2009 Selection

Global Heroes

   Well, I put my application in again this year.....that's all that this is worth again the answer is no. I think we've come to the day when it's easier to qualify with hard work for something like Boston, then it is to be chosen for entry into something like Global. That's alright though. I've got plenty else to keep me busy as most of us do. Maybe another year. Cheers.






Thursday, April 23, 2009

Wednesday - Work Run

Run: 3.0 Miles
Terrain: Flat Track
Time: 0:30:01

Pre-Run Glucose: 78 mg/dl
Post-Run Glucose: 121 mg/dl
Intake: 6 PB&Honey crackers
Pump Run Status: 30%


   I just needed to get out and stretch the legs. There is a track at work, right behind the hospital, that surrounds the parking lot. Perfect for burning off the days woes while waiting for the wife bec. we car pool. I had just enough time to do a slow warm-up (I'm not in as great shape as I was in Feb.) and run three miles. Even though my sugar was a little low, I decided to leave a small % basal on. I want to keep this up and see how it effects my feel and condition during various runs. Better to practice when no competition is happening. My glucose bumped up a little bit, to like 131, and then dropped back down to around 120 just after the run. I wasn't pushing hard, so I knew I'd be OK here. So it was. Next time I want to start within my ideal range 130-180 and keep the basal and see what happens.

THOUGHTS:
   As far as my Apidra change-outs is going, I'm still changing every 1.5 days and not having problems with almost uncontrollable high glucose levels. This is looking good.

   As for another issue, that would be my CGMS. It's not very cold here in the winter, but cold enough since we also keep out thermostat set at like 67-68 through the winter, that sleeping with a down comforter is heavenly. Here's the problem I have though. I can't hear the alarms going off from the CG when the pump is under the comforter. I kept the vol. on high, but regardless, I just don't hear it but like 5% of the time. That is really bad. I need that trending data to help me be aware of what's going on while I'm sleeping. It's not a problem in the spring and summer, only late fall and winter. I've placed the pump on Vibe, just to see if that help. It did a little. So, for most of this winter I've kept it there during the night, but that's only allowing me to know if I'm trending up or down maybe 15% of the time. I just sleep like a bear and don't pick-up on the feedback from the pump very easily while sleeping. What I'm thinking would really help, is to have an external speaker linked to the pump. Like an added feature for specific uses. Set it on the nightstand and hear the alarms going off. Plug it in and it could receive via RF the trending data from the pump. I think this could really be great for a lot of heavy sleepers or those who require thick blankets to sleep comfortably.

What's your take?
Got any cool ideas?
Have some of the same problems?

Monday, April 20, 2009

Apidra 1/2 Fill #1

   As of today, no problems splitting my cartridge fillings. I filled it up to 110 units on the 16th at the last fresh change out. Then, Saturday before the ride I refilled the cartridge with another 110 units. So far, "no problemo". I rode for 2.5 hours Saturday with the pump next to me under the jersey. No problems so far on that same insulin. What I'd like to do this Saturday is to ride with a temperature gauge of some sort next to the cartridge on the pump. Then I'd like to measure the same location temperatures on the pump for one night under the down comforter.

Saturday, April 18, 2009

Saturday - Baby Brick

Ride: 38 Miles Run: 1 mile (I know, I know)
Terrain: Rollers and Flats Terrain: Flat Track
Time: 02:31:19 Time: 0:08:41

Pre-Brick Glucose: 75 mg/dl (Rats...not the place to start at!)
Post-Brick Glucose: 234 mg/dl (Over-did it a little...)
Intake: 1 pkg fruit gummies, 1 granola bar, 10 oz Heed, 1 protein bar
Brick Pump Status: Suspend (First 60 mins only)

CORRECTED (Thanks JN)
    Saturday was a beautiful day. Went on a 40 miler with friends. It was a little windy, but I was feeling good and it wasn't really noticed by my brain or legs. I started out with sugar that was too low for the normal start feeling. 15 miles in I thought it was still dropping, should have waited and done a finger stick, but indeed it was going up....too high and too late to finish or be near the finish feeling good. I put took the pump off of suspend at the half-way mark realizing I had overcompensated (Dummy!). It's that same old lactic acid feeling/burning in the muscles I get when this happens. I'll chalk it up and try to play it safer. It's like there is only this window from 90-180 mg/dl where if I'm in it I'm cranking and feeling good. When I'm outside of that window is when I tend to have issues. So, I'm gonna have to baton down and get this correct. I didn't feel like doing much of a run to end the day, so 1 mile was all I could pull in. Oh well, next time.








Thursday, April 16, 2009

Wednesday's Apidra Statement

For those who were paying attention, yesterday I INCORRECTLY stated the threshold temperature of Apidra to be 98.6 degrees. I was thinking about Novolog when I wrote that and I have corrected this. Apridra's threshold temerature is in fact 77 degrees. Which is why I've put this on the blog. THIS IS POTENTIALLY A BIG DEAL FOLKS.


Wednesday, April 15, 2009

APIDRA - What's the BIG DEAL

Some Details: This spot concerns those who use Apidra in an insulin pump and exercise fairly often. Realise that most of this data is from personal experience, that linked and quoted data is tested and factual according to each of the respective companies.

   I saw my endo this last week and my wife got to meet her for the first time also. It was a good sit down. We were looking at my bg's and trending along with correlative food intake. What the endo wanted to know was if I was having high, almost uncontrollable glucose levels at certain times of usage from the pump. When I say "certain times" I'm referring to how many days worth of insulin I put in the cartridge and when those problems highs were starting in...I fill it for a 3 day usage. So, it turns out it was almost always like day 2 or 3 of a cartridge when I started having uncontrolled high Glucose. I could take two times the normal amount of insulin and the glucose would barely budge. So, here's the issue. Apridra, made by Sanofi Aventis, has a 77 degree threshold, after which the effectiveness of the insulin degrades. They also state, "Infusion sets (reservoirs, tubing, and catheters) and the Apidra in the reservoir should be discarded after 48 hours of use or after exposures to temperatures that exceed 98.6 degrees F (37 degrees C)".

   So, "control we have a problem". We're talking about users of a product ranging from the not so energetic to the very energetic. Those very energetic are going to get their outside body tempts above 98.6. Let's face it normal body temp is 98.1 degrees and add a good run to that on a sunny June afternoon......forget using that cartridge of Apidra attached to you hip, according to Aventis. I sleep very comfortably during the winter under a wonderful down comforter also. The temps under that thing are great for the body, but horrible according to Aventis for your Apidra. NO WONDER I 'VE HAD PROBLEMS GETTING THOSE SUGARS DOWN SOMETIMES.

Let's do a little comparison here with Apidra, Novolog, and Lantus.

Production: Apidra and Lantus are manufactured by Sanofi Aventis. Novolog is manufactured by Novo Nordisk.

Insulin Recommended Storage (Pump/Tubing/Etc)

Apidra Infusion sets (reservoirs, tubing, and catheters) and the Apidra in the reservoir should be discarded after 48 hours of use or after exposures to temperatures that exceed 77 degrees F (37 degrees C)".

Lantus The opened (in-use) cartridge system in OptiClik® should NOT be refrigerated but should be kept at room temperature (below 86°F [30°C]) away from direct heat and light.

Novolog NovoLog® in the pump reservoir should be discarded after at least every 48 hours of use or after exposure to temperatures that exceed 37°C (98.6°F).


   So, here we have a confused intersection of details. Pump companies, let's just use Minimed, say to change your infusion sets and cartridges every 2-3 days. Insulin pharmecos say to change insulin every 48 hours regardless and sooner if the insulin is exposed to temps greater than a range of 77 to 98.6 degrees.

   I will state the following from self-observance. I've never had uncontrollable upswings from Novolog during high intensity exercise, summer months, sleeping under a very warm comforter, or even going 4 days (I know, I know) on the same cartridge of insulin. I can only state that I have done most of these things with Apidra and am having issues with uncontrollable high glucose about every 2-3 cartridge changeovers. I think if I were more closely analysed this, it would be revealed that the insulin is going bad from temps exceeding 77 degrees.

Test Solution:
I've started to fill the cartridge for 1.5 days worth of insulin. Let's see how this goes, until July when temps will force me to use Novolog for safety again.


Food For Thought:
It's summed up in three alphanumerics "TT1". They use Apidra and they use the Omnipod, which is attached to your body, not clipped to your hip. How long do they use their insulin pods for? Even more importantly, what does the sustained external body temperature get to for one of their cyclist users?


What Say you?








Tuesday, April 14, 2009

Tuesday - Dog Run

Run: 3.3 Miles
Terrain: Very Hilly
Time: 0:29:43

Pre-Run Glucose: 201 mg/dl
Post-Run Glucose: 103 mg/dl
Intake: Nada
Run Pump Status: Suspend


   I had to get my lazy butt back into running so this is a start. No problems on this run, except that I could feel myself about three of four good runs out of shape. So, I'll work on that. I plan on doing the M3 (Mystery Mountain Marathon this fall, so I' had better keep putting miles in the bank. I really wore out my dog Riley also. So, maybe I can use his need of exercise as an excuse to get out and keep getting the miles in. This Friday I'll attempt to get a brick or double brick in again. I've had no luck between very bad weather and or just too much on the honey-due list for the last few weeks.





Sunday, April 12, 2009

Sunday - Shake Things Up Ride

Ride: 36 Miles
Terrain: Lots of hills, including an unexpected multi-level 1000 footer
Time: 3:03:43

Pre-Ride Glucose: 149 mg/dL
Post-Ride Glucose: 201 mg/dL
Intake: 28 oz gatorade, 1 granola bar, 6 PB crackers
Ride Pump Status: Suspend


   This was a Red Riders ride to kind of see how everyone would do on a far more varied route. Variety is what we got too. It was good, but folks just couldn't stick together as a group very much. Thinking they had to turn here or there....not really knowing though, and worse yet, not really waiting. Next time I'll just give them all turn-by-turn and let them go at it. I guess I'm not use to leading out on rides enough yet to have expected this.

   The ride was good for me. Having pushed myself on Saturday not all too much, it felt good to get out and stretch the legs again. I hope for more of this in the future too. No diabetes issue for this ride either. I had enough supplies, even for two other folks who thought they had tire changing tools but hadn't realized that they really didn't have them. All is cool. That's why it was a "Black Hawk" ride. I don't like leaving anyone behind. I don't think it's nice or smart.






Saturday, April 11, 2009

Saturday - Speed Ride

Ride: 18.1 Miles
Terrain: Mild Rollers and Flats
Time: 0:57:13

Pre-Ride Glucose: 98 mg/dL
Post-Ride Glucose: 156 mg/dL
Intake: 6 PB Crackers, 8 oz. Heed
Ride Pump Status: Suspend


   OK, first I need to get my butt out there and run more. I'm getting ready for my century, but I've still got to run man. OK, with that out of the way, Saturdays' ride was with winds of like 25-30 mph in 3 directions on the loop I do. Man, that will give you a workout. Thank goodness for aerobars. I feel like I actually rode pretty well though. I'm thinking that when the perfect day comes and I happen to find myself out ther eon my fav route, I ought to be able to push 50-55 mins on the 18 miler. This was a typical ride though, I just pushed a little harder than normal. I didn't like starting low, but it hiked up soon enough and stayed there to the end. Then I just do a temp basal for like 1-1.5 hours of like 140-150% of normal to compensate for the liver still thinking it needs to convert fat to glucose.




Sunday, April 5, 2009

Sunday - Hammer Duathlon

Race: Run 3, Ride 17.4, Run 3
Terrain: Run - pretty flat, Ride - Very Hilly
Time: Race total 01:49 and some change

Pre-Race Glucose: 184 mg/dl (Ahhh perfect!)
Post-Race Glucose: 143 mg/dl (even better)
Intake: 12 oz Heed
Race Pump Status: Suspend

   Race #1 for the year. You know today was different. I met friends at the race. Picked my packet up and headed for the restroom. Typical affair of everybody waiting in line stretching while they wait. I was running about 15 mins late, so I didn't really get a good warm-up. My wife, the blessing she is, chose a spot in transition and dropped my bag and racked my bike. I got over to transitions with 20 mins to spare and got ready. It was a sunny yet brisk morning. Really just a typical spring morning. So, I wore tri shorts and jersey with arm warmers. Those turned out ot be a better choice than the long sleeve base layer most folks went with. The Anthem is heard over the PA so it's start time after that. The crowd gathers for the start and whithin the minute we're all off running.

   During the first run, I notice a young lady (she's like 9) kicking it up and keeping a pretty good pace. I caught and passed her, but only for now. It was cool every once in a while someone she passed would yell out "good job Gram, Keep it up". My tran times felt pretty good. I'll estimate them to be from 20-25 seconds each.

   The bike section had changed this year. I hadn't known about this until race morning. This also meant the ride would be longer this year. Last year it was out and back on a busy Hwy 444 with a 360 at the turn, in the middle of the highway. Not too cool. This year someone firgured it out and looped us on a couple of back roads bringing us back out to 444 again. I'll take those three 45 degree turns compared to a 360 anyday. Those turns brought a substantial amount of climbing though. After the 2nd turn you crested and could see your rolling down-hill for like 2 miles spread out in front of you, and I'm one the only one who put it in the big gear and hammered it out for a nice down hill. My wife hates to hear about those downhill speeds..todays was about 40 mile per hour.

   I got back to the last run and of course the legs felt a little stiff for the first mile. I paced myself and started to open it up a bit after I got a bit more in the groove. That same young lady appeared out of nowhere and I asked her how she was feeling. "OK. I didn't know I was going to have to run again though", she says....as she ticks it off right by me.

   I settled my mind on the fact that I would not look at time, EVER, thoughout the race. So I didn't. And to be honest I soon didn't care about it either. I was just out there enjoying and pushing myself. It was a good day to race.

   The funny thing is I podiumed. I nevre thought for a second I would, so my wife and I left early. My buddy calls me up and tells me I had second place for beginner. Not bad I think to myself. I will say that by midsummer at the earliest, I don't think I'll be feeling like a beginner anymore. For now, I'm definately still a beginner though.





Thursday, April 2, 2009

Thursdays - Thought

   This is the second race of the year and the first Duathlon of the year for me this Sunday. It's looking to also be a wet one. I look forward to it. I've never had to race in the liquid sunshine yet. Another day, another experience. An average run tomorrow with a friend ought to get me feeling good about Sunday. The run is flat and the ride is going to have rollers and a few larger hills. I know of a few experienced guys in my age group already signed up. I'm there for the fun and a little personal pushing of myself also. As long as I at least match last years time (01:18:31) or hopefully do better then that, I'm a happy camper.




Wednesday - Speed Work Run

Run: 2.25 Miles
Terrain: Track Run @ work
Time: 0:16:01

Pre-Run Glucose 233 mg/dl
Post-Run Glucose: 106 mg/dl
Intake: Nada
Run Pump Status: Normal


   Remind me that when I realize I haven't been running enough, and might be turning into a "Weekend Warrior", that throwing the shoes on to get some miles in doesn't mean go out and do something hard right off. No, get your body back into the rythm again with 1 or 2 average runs, then hit it.

   So, I don't think I screwed anything up too badly, but it made me think better of it for next time. The body was telling me an average 5-8 miler would have beeter to get back on track with. My starting glucose was a bit high than I would have liked also. Add to it I was doing higher intensity and the sugar was trending downward quickly. So, it's a good thing I quite when I did.