Tuesday, January 25, 2011

Over-testing....

Seriously, gotta say this before I start on tonight's post....you ladies are so incredibly amazing and wonderful!  I was so nervous about posting about my problems with depression and PPD and all of the emotional baggage that I've been left with, even after accepting help and medication for it.  You have no idea how much it means to mean to read the supportive words, the admissions of dealing with PPD as well and experiencing similar things.  Meri, you're so right about it being more common than we seem to think it is.  It's a sad thing that so many people go through it and believe themselves to be alone!  I have to tell all of you, the post was inspired by something that our marriage counselor and I talked about....the difference between shame and guilt.  Shame is a destructive emotion.  It convinces us that we have to hide whatever it is that we're ashamed of and leaves no room for correction or acceptance.  Guilt, on the other hand, inspires us to be better, to make more of an effort, to change so that we won't be stuck hiding anymore.  By posting about my depression and PPD, I'm trying to get rid of the shame so I can work on making myself a better mom, a better wife, and a better person.  Thank you so much to all of you for allowing me to do that and for being here to support!  I only hope I can do the same for all of you!

Exercise update....I'm still going strong!  I've fallen into a pattern of going to the gym for 3 days in a row and then taking one day off.  I tend to start feeling a bit run-down and tired by the time that day off comes around.  My husband calls it a feeling of being "over-trained".  For him, I think it is.  He lifts weights in the hard-core, testosterone-zone of the gym (not the machine weights, but the ones with barbells and big round disks).  For me, I think it's more a lack of sleep than being over-trained.  Whatever it is, I'm starting to listen more to my body and what it's telling me to do.  I haven't dropped any clothing sizes yet, but my clothes are fitting me better now.  I came to a very important realization today: I don't want to be skinny!  Really, I'm serious on this one!  I have no desire to be "skinny".  I've discovered that what I truly want is to be "athletic".  I want that sleek look that athletes who run get.  The strong, muscled legs with sleek muscles, not the ones with veins popping out because they're JUST THAT MUSCULAR.  Think "panther" instead of "housecat".  Oh...and the pregnant boob lady?  You know how some women look like they've swallowed a basketball when they're pregnant because they don't put on weight anywhere but their belly?  Well, Boob Lady looks like she swallowed a torpedo!  Seriously!  No fluff anywhere on that woman, but her belly has this pointed look to it.  So funny to see!

Over-testing?  Bet some of you think there's no such thing.  But there is!  Please understand that I'm only talking about my experiences with Lily's and my diabetes.  Maybe this doesn't apply to others.  But, in my mind and experience, over-testing is a serious hazard and something we should all be aware of.  I'm going to explain what I mean and why it's a hazard.  Last night, Lily had swimming lessons.  Before her lesson, she was comfortably in the low 200s (217).  I don't see this as a problem since she's going into the pool and I don't want to risk her going low while she's swimming.  So, no correction.  When she got out of the pool, I tested her right away.  472.  What the heck and where did that come from?  I wondered if maybe her infusion site had crapped out on us, so I waited to give her the correction until we could get home and get a new site in.  Got home, tested her again...508.  Yuck!  Gave her the full correction and tried to get her to eat some protein for dinner.  My husband tested her 30 minutes later, as he was getting her ready for bed.  492.  Pump said to give her another 0.675.  I backed it off to 0.4, thinking that I didn't want her to stay high, but didn't want her to drop low either.  Tested an hour later....349.  The pump said to give her more of a correction.  I didn't.  An hour later, she was 82.  She tends to trend upwards at night, so I decided to give her a few more minutes and check again.  Fifteen minutes later...65!  Oh my!  I hate waking her up to get her to drink enough juice, but it's what we have to do.  So, half a cup of orange juice and back to sleep she goes.  I, on the other hand, stayed up an extra hour longer, just to keep testing her and making sure she was stable and steady for the rest of the night.

So, here's the thing...the pump is not infallible!  I know, horrifying fact, isn't it?  Seriously though, here's the thing with the Insulin On Board (IOB) feature....everyone's body is different, everyone's metabolism is different.  I know you can adjust on the pump how long insulin stays in your system.  It's a great feature.  But, that doesn't mean that we all metabolize insulin at a set, same rate.  Lily and I both burn through our insulin in 3 hours.  But, I know with my body, my insulin peaks at an hour and a half after bolusing.  That means that the majority of my insulin has already done it's work if I test an hour and a half after a meal.  Lily's body, on the other hand, seems to hit peak-point for her insulin closer to two-hours post-basal.  But her pump doesn't know that!  So it tells me to give her more insulin.  On a normal day, I try to make sure I'm not testing her within that two-hours-post time.  Unless she seems like she might be going low, I try really hard to not test.  I do get caught by this mistake a lot though.  Because it's very rare that we have a "normal" day.  If she's running high and I want to make sure she's coming down, I tend to over-test.  My husband over-tests all the time.  We just want to try to make things perfect for our children, right?  Can't help but over-test sometimes.  But, we've had quite a few instances lately where we've over-tested.  And then she drops low.  And still has IOB.  And we have to try to get sugar into her to absorb that extra insulin so she won't keep going low.  It's so frustrating!

Anyway, I just wanted to share our experience with over-testing with all of you.  I know how incredibly driven we all are to make things as good as we possibly can for our kids, to keep them within that magical "NORMAL" range so that they can feel their best and go about living active, happy lives.  It's such a hard balancing act to keep!

8 comments:

  1. Oy... how do we do it? The part on over-testing made my eyeballs roll back in my head a little bit. I know that I know intuitively all about when the insulin peaks in Elise, and when it's all gone... but I've never actually sat down and thought about it, you know what I mean? I guess I have my own IOB feature in my brain! IT makes me so very tired just thinking about it.

    Sorry I've been bad about commenting lately. Just so many blogs, so much going on, and not enough time! I have been reading, just no time to leave any comment love.

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  2. For some reason none of your posts have shown up on my dashboard :{ sorry im so behind. Glad youre feeling better and things are coming together. Xo

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  3. Hmm...I agree, and more so I think that things are more severe with CWD. It seems like a half an hour without insulin CAN cause major problems with Isaac one day, but then not another day. And things like increased basal over two hours help more to combat a high than major doses of insulin to bring it down. And, and, and...once I see a pattern it all changes! Right?!
    I wanted to comment about depression and PPD, but I can't find the words. It's a tough one for me as I know it's something I dealt with both times. Especially with Isaac and the sudden unexpected c-section after trying natural birth and him getting stuck only to find out that he was over 10lbs and had a HUGE head...anyhow...you're not alone. It's cruddy and for me ALWAYS partially there and has to be taken care of daily.
    I hope you're having a great week and have gotten in an awesome workout groove :)

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  4. Hey girl! Keep up the great work on "YOU" on so many levels. I am with you on the "panther" vs. the "cat" AND you made me LOL with those metaphors.

    On the over testing - WOOT! I totally agree, especially on highs coming down. I do test every 30 minutes during hockey but that is to boost Joe up...never to correct or monitor highs. You are such a great mama and pancreas...not just in all you do, but in the work and the insight you are putting into and applying to you.

    LOVE YOU.

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  5. I'm with you on over testing. We are not meant to be CGM's! Keep to a schedule, and test more if your gut tells you to. That is my motto!

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  6. I think my biggest pet peeve about D is how long it takes to bring down a high. Treating a low is quick...really 10-15 mins in most cases. But those dang highs take HOURS! So frustrating. I do notice that insulin in Bryce seems to peak MUCH later too...so if we test/correct each time, he is bound to go low. Could also be the ISF is off. But anyhow, it sucks and the pump isn't always right....go figure.

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  7. For highs test every 1.5 hours after correction (Apidra should start moving her downwards by then). But if I got a number in the 400s and then 500s would check as you did because it could be a failed site, etc. Then with the lows, you would have to check. Unless wearing cgms, no crystal ball, so would have done what you did. I don't guilt myself about "over testing" because no one checks just for the heck of it; you check because you need to.

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  8. Something else the CDE said to me is that she wonders if sometimes the cannulas are getting backed up (and we don't get alarms because it's not great enough of an amount to cause back pressure to set the alarm off!)...so say you give .125 insulin for a snack and her basal rate is .05 it might just be sitting there surrounded by tissue build up, you check BG and give a large correction dose that pushes the correction plus all that insulin you gave for food and basal out past the built up tissue. Then they received the right amount of insulin to start, but it wasn't able to get utilized until the larger amounts pushed it through. The CDE said she sees this more with smaller kiddos whom are on tiny amounts of insulin with pumps than she does with MDI and also that once basal needs increase she doesn't see it as often. Then in her lovely teachy voice she says "That is why site rotation is key!" And I responded with a lovely, "but he only has his tushy and legs right now to rotate with. We do our best."
    Just another point of view that I remembered in my not sleepy haze this AM :)

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