When I first got my Animas 2020 Insulin Pump, I religiously uploaded the data via Parallels Desktop and the Animas program for Windows. Sadly, the Mac version of the upload program that is available in the USA for the Animas Ping isn’t available in Australia for the 2020. No matter, I had a way to upload with Windows.

Eventually it became a chore and I ended up not doing it for the past year or so. I think I did it once in 2011, and no one looked at it anyway.

There’s a website: www.diasend.com, which I heard about ages ago that also takes uploads from my pump, but for some reason I didn’t pursue it. I can’t remember if it wasn’t available back then for Mac or for Australia or for what reason I didn’t do it.

Today I received a letter from AMSL, the Animas people in Australia. The letter said that it was introducing the Diasend website and upload program for Australia and that I could make use of it,  on a PC or Mac. I wondered how easy it would be…

Went to the www.diasend.com website. Registered. The system didn’t however have my blood glucose meter, so I just chose the closest one, and that seemed ok.

I then downloaded and installed the Diasend Uploader App for Mac. That was very easy, and requires a restart.

After installing the app, I grabbed my IR dongle – the one that usually connects my pump to the Windows program to upload the data. I wondered if I would have to go get an extra program for the dongle, which had to be installed on the Windows side. Nope!

Plugged it into the Mac, put my pump on suspend and positioned it over the dongle. Then I clicked ‘Confirm” on the Diasend Uploader App and away it went.

It was THAT easy!

Then I logged into my account at www.diasend.com and saw everything it had uploaded. Amazing! Really good reports, trends and more!

I can download reports in PDF and take them to my Endo, or the clinic can register and can see my data anytime I update it.

The list of compatible devices is here. Currently it includes the Animas 2020, Animas Ping and Omnipod insulin pumps in the clinic uploader and the Animas pumps for the personal uploader.

I’m SERIOUSLY impressed!

Now is just such a time.

I had what could be loosely called dinner around 9pm. It was a bit of mince, maybe less than a cupful, with some spices and less than half a Lebanese pita – probably 1/3rd. One pita (the large, flat kind, not the Israeli pocket kind) is about 39 grams of carb. So I bolused for 25 grams, plus another 5gr for the mince which had some tomato paste in it. I’ve eaten nothing since.

At 11pm I tested and was 12.5 mmol/L (225 mg/dl). Shocking, right? So I did a correction bolus. It’s 1:45am and I’m now still 12.4 (223)!!! The insulin has had no effect. I’m not entirely sure what my basal is doing either. Probably nothing much, but clearly some insulin is getting where it should be or my blood glucose would probably be much higher.

If it was my pump site, which was a new site yesterday, you’d think I’d have been high all day. I wasn’t.

This is just one of the mysteries of insulin, diabetes, food, insulin pumps. I’m fairly poor at the moment, struggling to get new clients in an area where no on knows me, so to waste a site by changing it so soon, has to be done with much thought and consideration, but really, I have no choice. If bolus and a correction has done nothing in 5 hours, it’s a foregone conclusion. Change the darn site.

I have to ask myself – what on earth could have gone wrong with the site 24 hours later? I have no idea! I haven’t yanked it. The line hasn’t got caught on anything. The site change went normally. I give up! I have no idea what the problem could be!

Right now, there’s nothing I want to do less than changing a site. I don’t want to change it because it’s too close to bedtime and I will now need to stay up to  make sure the site is working. I’ll also need to give myself a shot because my blood glucose has been high a bit too long, so I won’t know if the site is working or if it’s the shot. And I’ll have to use one of my last few Inset IIs, so I’ll have to order more earlier than I anticipated, which I can’t do right now.

Doesn’t matter how much you know, you never know what’s going to go right and what’s going to go wrong, or when! Isn’t it one of Murphy’s Laws? Things always go wrong at the worst possible moment.

In case you are, it’s the act of giving insulin, often much more than you need, when you’re really angry at a high glucose reading that you can’t immediately explain, or one that refuses to come down.

If you read any diabetes blog or forum enough, or have it yourself, you’ll know that for many people with diabetes, in all its incarnations, it’s a 24 hour job to look after it. Yes, even when you’re sleeping you have to make sure before you rest your weary head, that you have calculated and mashed together, to the best of your ability, food, insulin, activity, stress and more, so that your blood glucose won’t go low or high overnight.

There are very few things in life that you can’t take a break from – even for one day, let alone a week or two of blissful holiday. Diabetes is with you 24 hours a day and it has to be managed 24 hours a day.

So now and then I get cranky with it. Even though I know a lot of the science, on occasion, diabetes doesn’t behave as expected.

I probably under report every last bit of the bad stuff here on this blog, but tonight I’m sorely tempted to put some very raw feelings on the screen.

It’s more than annoyance and less than outright anger – somewhere in between. Let’s see if I can contain myself.

Here’s the scenario:

Dinner: BBQ
Food: Hungarian cabbage salad (oil, vinegar and a tiny bit of Splenda – a scant teaspoon for a whole cabbage), steak, tomato, cucumber, avocado – just with salt, half a corn cob (as a treat) with some butter.
Drink: Water and some diet mineral water.

Easy to bolus for? Supposedly! On paper, other than the corn, it’s lowish carb. I’ve bolused for this kind of dinner a gazillion times and been fine. Hadn’t eaten for many hours before.

I calculated about 30gr carbs, figuring that I would probably have maybe 1.5 loosely packed cups of cabbage salad (I could eat that stuff all day long!), half a tomato, the half cob of corn (definitely not low-carb), 3 slices cucumber, plus I also bolus for protein and fat and a few extra carbs for the diet soda (the one I drink has 3g carbs per glass). It would easily be way less “carbs” if I didn’t add in 50% of the protein and 10% of the fat (TAG bolusing).

My BG was were I expect it to be when I’m not eating – perfect. Total already bolused for today 20gr carbs. Am happy with that.

I entered the carbs into my pump, went for a combo bolus of 2 hours (very thick steak with fat) and thoroughly enjoyed my dinner, with the steak rested well before I started eating.

I really thought I did everything right. Apparently not…

At 2 hours I checked my BG and it was fine – just inside normal and the combo bolus was just ending so the insulin should still be working and keep working for another 2-3 hours as the rest of my dinner hit my bloodstream.

At 4 hours I should have stayed within normal range yet I was way higher, totally on the wrong side of normal. Not too much but enough to make me cranky. Diabetes you are not behaving tonight!

Did I underestimate the carbs? I didn’t think so but I probably did – it was probably the steak that I didn’t calculate properly. I thought I did a small overestimate on the total I should bolus for, but thinking about it and checking some nutrition info, I’ve probably under-bolused for the steak.

Insert expletives, because I don’t want more fat-promoting insulin. More expletives because I must have screwed up. More expletives because I don’t want to be dealing with this right now. Rage bolus coming up!

At midnight, my angry fingers dialled up more than what my pump suggested.

Two hours later (2am) and I was back inside normal but not where I usually am. Technically I should have gone low.

Hmmm… more expletives. Another rage bolus, but this time more rage than bolus. It’s now 3am and I’ve stayed exactly what I was at 2am! What the bleep?

So what is it? Insulin not working? Pump site not behaving (it’s behaved fine the last 48 hours)? Total screw up on the carbs and how long they would take to hit my bloodstream?

It’s easily 7 hours since I’ve eaten. Seven hours for a steak to keep working? I’m not so sure about that but in case it is… holy cow (pun intended)!

So now I’m faced with changing out my pump site and going to bed. Never a good idea! It’s much better if you hang around awake to make sure the site is working and that you have a stable blood glucose before you hit the pillow. Or do I have another rage bolus? Maybe it was all that swearing that caused the stress that caused the BG to stay up. We all know how the just the tiniest amount of stress sets me off.

Don’t know what I’m going to do yet. I still have hope that all the insulin I’ve taken will do its job or the dinner I had won’t keep repeating the BGs I don’t want!

Now that I’ve moved to a more populated area, I’m hoping I’ll meet more pump users. While the Diabetes online community (DOC) is teaming with pump users, and I’ve come to know many of them over the past couple of years, talking face-to-face with others seems to be quite a different experience.

I was a bit worried about getting a new Diabetes Educator up here. I’ve known about one DE who is in private practice in this area. I wasn’t sure I could afford appointments with her, but since I’ve made further enquiries, it seems I can. I’m really excited to be seeing Deb Foskett from Insulin Pump Angels. She not only comes highly recommended but has won awards as a DE. I’m not sure when I’ll be seeing her yet, because I need to get some referrals from my family dcotor, but I’m hoping it will be soon.

So that’s one worry about being in a new area, organised and solved!

I’ve also had an endo recommended to me, so I’ll give him a go too. Apparently appointments take a while. No problem – I’m not so eager to see an endo right now.

Being up here has played some havoc with my diabetes. I have no idea why. I’ve had to increase my basal by a quarter of a unit for about three quarters of the day! Yet, I seem to be more active here! I’m still going to have to tweak the basal a tad. It’s not quite right yet.

I’ve been in the pool nearly every day, and I’m still working out how to avoid higher BGs when I get out, despite exercising in the pool. I must say that with all my aches and pains, I’m feeling ever so comfortable swimming and floating around weightless and cool. It’s hot here – so far, not as hot as it can get, but hot enough. (Read: too hot for me.) The pool is a godsend!

The winters here, like Byron Bay, will be glorious! Few more months before that though.

Annoyingly, I’m getting raised BGs after some very low-to-moderate exercise in the pool. Really, there’s hardly any effort at all in 30 minutes of swimming, floating and walking in the pool.

What usually happens to me is that the first lot of increased activity for the day raises my BG and the second lot (if there is one) lowers it.

I’ve not yet experienced this amount of swimming on a pump, so it’s an experiment in itself to see how I’m going to manage it. So far, I’ve only been in the pool once per day. It’s such a hassle to peel off that miracle suit (which doesn’t work because I still look like a beached whale), shower the salt water off (yes, it’s a salt water pool) and then wait for the swimsuit to dry again before wriggling and struggling my way back into it. A second swim will have to wait for a second swimsuit! Those suits are hard enough to get on when they’re the right size. I think mine is one size too small! Maybe time for two new ones?

I’ve tried eating a small amount of carb before I get in the pool, taking a bolus and then taking my pump off for the 30 minutes. It didn’t work so well. I’ve tried doing nothing. That didn’t work well either. Next experiment is just a small bolus without any carb. Two hours after swimming, I’m still not going any lower and I always have to bolus.

I’ve only just ordered replacement parts for my Animas that will ensure it is waterproof. They should arrive in the next couple of days, so I’m not worried about managing all this without the pump on for the swim-time. I will pay closer attention when I get the parts and I can wear the pump while swimming. That will mean no break in basal insulin and I’ll get a better idea of what my BGs are doing both in the pool and a couple of hours later.

I haven’t gone anywhere near the gym yet (which is right next to the pool). I’m hot and sweaty enough and that gym looks like pure torture! I’ll leave the gym to the cooler days/months.

A change in lifestyle often means a change in insulin regimes and a learning curve to figure out what’s right. That’s on top of seasonal changes in insulin needs. I’m hoping that Deb (the new DE) can give me some help as well.

Many of the female patients seemed to have wings on their sides where the pump tubing was inserted and they got lipohypertrophy. But that was the least of it. None of them had normal blood sugars. Of the new patients who came in using pumps, there was only one whom I was able to get near normal blood sugars. It was because he was still in his honeymoon period. After a year on the pump, his blood sugar started getting unpredictable. And why is that? I believe it is because of the scar tissue that forms where you have a foreign body inserted for days at a time.

First, from Wikipedia:

Lipohypertrophy^[1] is a medical term that refers to a lump under the skin caused by accumulation of extra fat at the site of many subcutaneous injections of insulin. It may be unsightly, mildly painful, and may change the timing or completeness of insulin action. It is a common, minor, chronic complication of diabetes mellitus.

Here’s my response, directly to Dr Bernstein:

Much as I’m a low and lower-carb fan and I respect the logic behind your low-carb theories, I’m very pro-pump.

That stated, I read many blogs and forums and I don’t know anyone whose A1C hasn’t improved, or their diabetes has become more unstable on a pump – provided they’ve had the right education and continue to tweak their insulin until it’s right for them. Lack of proper pump education can be the cause, as can many other factors (eg insulin allergy) that can be investigated and dealt with. True, I don’t know everyone in the diabetes world, but the majority of what I read and hear doesn’t bear out your statement.

Scar tissue? Sure if you keep putting the inset in the same place and leaving it there longer than is recommended.

On the other hand, I can show you the huge, deep, very-slowly-fading bruise I still have 18 MONTHS after stopping Levemir! I was told to inject NovoRapid on one side and Levemir on the other. For now I’ve lost that area on my belly for my pump cannula because it’s as unreliable as I could ever imagine! All my pump occlusions have occurred in that area. I dare say there’s also some lipohypertrophy in that area.

One can get lipohypertrophy on injections too!

The body has plenty of areas to insert a pump cannula before there’s no place left because of hard, fatty deposits, if indeed you get them at all. If you really run out, you’ve been pumping for an awfully long time. In addition, the possibility of  lipohypertrophy is reduced if you change your site within the recommended time. Some seem more prone to these fatty deposits than others.

And really, do you think, Dr Bernstein, that in 10 or 15 years time, we will still be using the same insulin pump technology?  Surely not with current advances! But maybe we will. Who knows?

I don’t see a whole lot of people scrambling to get off insulin pumps because their blood sugars haven’t improved and stay improved. Sure, people do go back to MDI or take a break, but mostly for other reasons, as far as I can tell.

My own experience of moving from MDI to an insulin pump saw a 3 % point decrease in A1C by the first test after! It was the very best thing I’ve ever done for my health. My A1c is still improving as I tweak what I do with my pump ! How does that in anyway reflect unstable blood sugars or ones that don’t approach normal?

Actually, your idea of normal seems a tad narrow. Research shows when the damage from diabetes happens, and it’s certainly still within the higher range of blood sugar recommendations for people with diabetes, but above what you recommend. So, neither recommendation is necessarily right.

In this age of people being interested and involved with food, cooking, lifestyle programs, good restaurants, farmers markets, recipes, entertaining and so on, some of us simply can’t always do the 30 grams of carbs a day you recommend. Some of us also don’t want to. Some of us do mostly low-carb and everything in between. But we’re still achieving good A1Cs and we’re avoiding those damaging blood glucose spikes.

I’m not saying low-carb and injections don’t work, but for me, some days I do want to have an occasional piece of cake or pizza, or a slice of that new sourdough bread that everyone’s raving about, and my pump allows me to do that with extended boluses and calculations that I was so sick of doing in my head when on MDI and often getting nowhere even on low-carb.

Pumps are also great for people with gastroparesis, particularly with the ability to do extended boluses. Yes, I know you can achieve similar with longer acting insulin injections. Why bother?

I don’t want to continually draw attention to myself in restaurants with friends by having a 15 minute conversation with a server about what he or she can and can’t bring me to eat. I don’t want to live my life like that and I don’t want my friends to be subjected to that conversation ad nauseum. I just want to order the lowest carb thing I can find on the menu and if that ends up being way over a particular carb allowance, so be it. I yank out my pump, enter an extended bolus and I’m done. No bringing out shots or insulin pens and being looked at like I’m a drug addict. Not that I ever much cared about that, but it’s an issue for many from what I hear.

Sometimes my friends want to dine where almost everything on the menu is carb-laiden, or I’m invited someplace where there’s little that is low-carb. Do I have to stay home? How would I manage that with injections? Pull out a syringe every half an hour? Or maybe I just shouldn’t eat? Yes, people do manage on injections, but I say I have better and far easier control with a pump AND I have the quality of life I want. I can and do participate in social meals as a nearly normal person. That’s priceless!

I have another autoimmune disease that sometimes plays havoc with my blood sugars. Do I really have to manage that with injection boluses or an increase of a 12-24 hour  basal when I can’t predict when it will stop? With a pump, I have minute-by-minute control of basals. I increase for a couple of hours at a time, test every hour or two, to see what’s happening and I’m done.

In conclusion, I would much rather have 10 years of far better A1Cs than I had on shots, and be more easily able to sometimes live outside the low-carb regime than not. And I would much rather and more easily achieve that with an insulin pump than with injections. If someday I have to go back to injections, because of lipohypertrophy or because my BGs have become unstable because of a pump, then I’ve still had 10 or 15 years of doing much less collateral damage from diabetes in a far more convenient way.

Again, I’m not saying your “normal” blood sugars can’t be achieved with diet and insulin injections, but why bother when most insulin pump users will probably tell you it’s so much easier with a pump?

If you think that all pump users have unstable blood sugars or that their A1Cs are not more normal than they were on MDI, you’ve been hanging around in the wrong places!

With the greatest of respect for what you’ve done to help people better control their blood sugars (me included), I’ll wear my pump and have better A1cs until the last place I can wear it is on my big toe! I dare say that most people using a pump would agree.

Leaving me on a gurney for 2 hours waiting to see if anything was going to have any effect, was horrible! I react badly to midazolam, so I refuse to have it. Instead, I go into my hand ops with some Xanax (that I take about twice a year, if that) plus regional anaesthesia. I’ve had regionals not fully work before but never as “not fully” as this time. It was more like, “hardly worked”.

Footling about with anaesthetic injections into my upper-chest/shoulder, and using a nerve probe “thingy” as well, just wasn’t something I want to go through again anytime soon. No thanks! Then having a go at the tender, inside part of my wrist with that monstrous needle… well, it was all I could do not to punch him. I did swear though… several times… in no uncertain terms, despite being rather off my tree on the Xanax.

So after the surgeon ended up injecting local into a very partially anaesthetised hand (another huge ouch), things started looking up. The two tendon-releases could begin. His jokes helped too. I was quite awake through the whole thing (half hour surgery) because by that time most of the Xanax I’d taken at 2pm, had mostly worn off by 5:45pm when the surgery finally started. The pressure cuff on my supposedly anaesthetised arm never has never bothered me, and it didn’t this time either.

My blood sugars were taken about every hour. They looked good! More about that further on.

The op went well and I went home with a numb hand, a partially numb arm and bandaged hand in a sling that was threatening to slice my neck open! What are those flimsy paper slings anyway? Can’t hospitals afford proper slings?

Soon as I got home, I reefed out the sling I’ve used for the last 3 ops – a lovely padded strap sling, complete with purple ribbons I’d attached to hide the two ugly joins. Ahhhh… comfort!

It took until the wee hours of the next morning for my arm to get any feeling back and well into the following day (Saturday) before I got some feeling back in the middle finger.

Oh boy, that first day… after a couple of restless hours of sleep… out came the pain meds they gave me at the hospital. I’d forgotten I don’t react well to codeine, so the next doses were just over the counter pain meds, which sort of did the job. By the following day, I took nothing. Didn’t need to.

Today, 5 days later, despite stitches in both incisions on my palm, I’m typing with just a little discomfort! I’ve almost got the middle finger straightened, although it is still quite swollen. The little finger is fine. The palm is still painful, but better every day. Plus I’m itching a bit, but not as much as usual. The surgeon changed the stitches after eliminating everything else over the last few ops.

Apparently there was tons of fluid in the middle finger, which probably accounts for inflammation pain, which I already had, on top of post-op pain, so that’s understandable.

Stitches come out on the 7th and despite pain if I move my hand where it shouldn’t be at this stage, and eye-watering pain if my fingers get caught on something, I can say that in a day or two, the pain before the op was much worse.

I’m also really happy to report that thanks to my insulin pump, through 6 hours of fasting beforehand, and the 4.5 hours I was at the day surgery unti until I got a post-op snack, my blood glucose stayed between 5.2 mmol/L and 6.2 mmol/L (93 mg/dl and 111 mg/dl) for the whole time! I made no adjustments to my pump during that time. Great basal test!

I’m somewhat surprised that my BG didn’t surge during the stressful anaesthetic antics. Just the smallest bit of stress usually has an effect.

Despite my initial misadventures, the outcome is as expected. In a week or two, I will have zero pain and the problem will have been fixed yet again, by the very skilled surgeon I go to. Thanks Dr M!

Morning basal tests are never a problem. In reality most mornings are basal tests for me. And I know for sure that my basal is exactly right.

Note: Basal is the insulin I get 24 hours a day – the background insulin that is needed all the time, without food. If you do not have diabetes, specifically Type 1, your pancreas does this for you automagically. The most important reason is that your brain needs glucose to function. If your blood glucose is low this is one of the reasons you end up in a kind of brain-fog, unable to function.

Back to breakfast. Often, however, I don’t eat anything at all for many hours after I wake up. Yeah, that’s supposed to be bad for you. Breakfast is the most important meal of the day, they say.

If I end up having a reasonable breakfast within a few hours of waking, then I can forget about lunch. I’m just not hungry.

So why am I carrying around all this extra weight? No idea! Most of the time I do reasonably low-carb. All that falls over in the evening. Doesn’t matter what I do during the day – eat, not eat, snack, have big meals, the evening is the deal-breaker.

If I ever had to do lots of little meals a day (they say that’s better for metabolism), I know I couldn’t cope.

Unlike breakfast, in the evenings, I can eat when I’m not even remotely hungry. It’s a real struggle to tell myself I don’t need that snack and I’m not hungry. My brain tells me I am. Maybe it’s something to do with leptin not functioning at that time of night? I don’t know. Sometimes I’m successful at resistance and sometimes I’m not. (Yes, resistance is futile!) Even so, everything’s easier with an insulin pump. I can bolus in the middle of an extended bolus with anything I add to dinner, like desserts or snacks, or even more dinner. It’s so easy!

I think it’s the evening snacking that is playing havoc with my weight, but even if I don’t have them, I’m not losing a single ounce. It’s sooooo annoying! I think having a desk job doesn’t help either. And truly, I hate planned exercise, but I know I have to do it. I just keep putting it off. Lupus and arthritic pain doesn’t help. Any exercise I could actually do, probably wouldn’t make any difference. It never has before.

Exercise doesn’t really burn off calories… well I guess it does when you do enough of it. Figure out how much exercise you’d have to do to burn off a Big Mac! I don’t think anyone has THAT much time on their hands, let alone the effort-value. Exercise helps your cortisol levels, which in turn helps a whole bunch of things in your body. That should be the primary reason to do exercise, not the calorie-burning part of it but the cortisol part.

One time I always lose weight. When I have to move house! Something to do with skipping tons of meals, not snacking and moving bits of me a great deal (like 12 hours at a time) while packing boxes. If only I could do that every day! Moving house is coming up for me in the next few months. Something to look forward to in terms of weight loss!

These cases are not only cute, but protect the pump, which has to last at least 4 years! As a Type 1 with an Animas 2020 insulin pump, I know how important that is! They come with a matching belt and can also be worn with the clip that comes with the pump. I’m hoping that kids will love these and be proud to wear their pumps and show off the cases.

The cases are available at www.estore.zansuri.com. They are designed mostly for kids, but teens and adults can wear them too! Please don’t hesitate to contact me if you have any questions.

Today (actually it’s 3:00am the next day) I was out at a venue, cooking for Rosh Hashanah (Jewish New Year).. and eating. What’s that Jewish credo? We fought, we won, we ate. But on Rosh Hashanah, we pass commiserating over 1 & 2 in our history, and go straight to eating.

Managing diabetes can be a minefield at the best of times.

Today, I had activity on top of yesterday’s activity (cooking and prepping), and (between serving & clearing) eating an evening meal of several courses that promised to be a carb-fest of the worst kind! I blogged yesterday about how much restraint I might show. All that went to hell in a hand-basket!

Despite all that, I seem to have managed ok-ish, but could have done a whole lot better.

I got to the warehouse around 3pm and we started work in earnest around 4pm. I couldn’t have anticipated that timing as I left home and thought to increase my basal. Glad I didn’t because we sat around for more than an hour shooting the breeze before we headed for the kitchen. I would have headed low before we started.

I had some highs during the afternoon and evening (under 9mmol/L (160mg/dl), though), but fought the urge to treat them fully. Every time I BGL-tested, I got freaked out by the higher numbers, but I knew if I treated more than I did (1 small correction at 5pm), I’d get into trouble later.

At 7:15pm I bolused for food at 1/3 of pump-suggested dose for the big fat carb-lie I told it (brave, eh?).

On a combo over 2 hours, I’d told the pump only about 1/3 the carbs I really had!!! Tell it 1/3 and bolus 1/3 – interesting formula? And then had square of banana cake and pretended I didn’t have diabetes at all!

I had apple dipped in honey, at least 4 half-slices of semi-sweet bread (Challah), sweet fish (Gefilte Fish), a stew that was loaded with rice and potatoes, salad with a dressing I made (that had tons of honey-mustard in it)… and some other salads. All that, along with tasting from 4pm, and boy did I taste a lot of dishes,.. adjusting seasoning and tasting again. Yummmm!

Seriously, I can’t tell you all the stuff I ate that was loaded with carbs! While I didn’t have huge portions, it all added up, and kept on adding up.

Only the coleslaw (S&W Mayo) and beetroot salad (lemon/oil) were without added sugar or honey. It was like one big hypo-food fest! I think I told the pump 30grams of carbs and I’m sure I had at least 100+grams and more!

On the other hand, I had been standing and walking around the kitchen so long, I was in pain, which usually raises my BGL (I have lupus arthritis in all the wong places for being on my feet). A few hastily-bought (today) supermarket painkillers at various times really helped. After that I could hardly feel my aching feet, legs and back.

Right now, I can barely move! All pain meds have definitely worn off!!

Last thing I ate was around 8:30pm – 6 hours ago.

Highest BGL was a 9.9 mmol/L (178mg/dl) at 8:41pm, just after we’d finished eating, and while that number is high, I kept fighting the urge to treat.

I’ve been on a 40% reduced basal for about 4.5 hours, and at midnight started to head down… 9 (162) then 8 (144) and I’m now 7 mmol/L (126mg/dl).

Talk about exhausted! I fell asleep (sitting on the sofa) around 9:30 when we got home and woke around midnight. My BGL could have gone higher during that time, but I’ll never know. I doubt it though. Without treatment before or during those 2.5 hours I slept, it would probably have stayed high for when I woke.

The last insulin I bolused was that combo at 7:15pm with 4.30 units. Before that was 0.7u around 5pm.

I’ve dropped 2mmol/L (32mg/dl) in just over 2 hours since midnight with 40% less basal started at 9:15pm and no bolus.

It’s only 3am now (yes, this night owl should be sleeping) and I assume I’ll come down further by 4am. Who knows where I’d be if I fully treated every time I tested? Probably in the hospital by now!

How could I have avoided those early highs and not had hypos later? Maybe I should have corrected more early on, or increased the basal for 4pm, but I also didn’t know how much I had to do and when I could rest.

Not so easy.

Difficult to know what to do when you don’t know what you’re going to be doing 1-2 hours later, when the insulin has its peak effect!

Early in the evening, every time I thought to do an increased basal, or a correction, I simply couldn’t estimate at what time my body would start doing its usual post-activity BGL drop, or indeed when that activity would end – and that was on top of yesterday’s activity and hypo some 6 hours after.

So, I just didn’t do much correction all day or evening, and the one time I did, it was at half the pump-suggested dose.

Most of the time, I totally ignored the pump-suggested corrections when I entered my BGLs.

You’d think I’d run a marathon the way I’m carrying on, when in reality what I did was a little like working in a slow-paced restauant kitchen for one 5 hour shift! Nothing like my usual chained-to-the-desk work though.

I know I’m steady at 7 mmol/L (126mg/dl) now, a little higher than usual for this time of night, but I suspect a small, long-acting carb might still be necessary. Will assess in an hour, if I can stay awake.

I don’t want to reduce the -40% basal any further at this point, but I’d set it to 9 hours and I have 4.5 hours to go. Will see how I am before sleep, and readjust then, at least to beyond when I’ll wake up, just to be safe. I’ll deal with whatever in the morning.

And I get to repeat all this for lunch tomorrow? Maybe not! No idea how I’ll drag myself out there again by 10am!

I definitely have a much better picture of what happens with increased activity over several hours, over two days… FOR ME – and I can’t emphasise this enough. Someone else’s blood glucose reaction to the same experience, might be vastly different. So many people go low during increased activity or exercise.

Having only been on an insulin pump since June 1st, relatively speaking, I’m still pretty much a novice. Maybe it gets easier as time goes by and experience grows.

The management of diabetes during (for me) unusual and rare prolonged activity is certainly a minefield. I learned lessons tonight and for me, that was as important as not getting enormous and immediately dangerous spikes during the process, or having equally worrying hypos afterwards. The middle-ground, erring on the side of caution, is surely better than possible extremes.

Entering your BGL during the day, and then entering BGL with the grams of carbs you’re about to eat, will allow the pump to accurately suggest how much insulin it should give. It’s done on an incredibly complicated algorithm and it also knows how much bolus insulin you still have active at the time. This is called Insulin on Board (IOB). It figures this amount into the insulin-suggestion calculation.

On some pumps, you can just accept the suggested amount. On the Animas 2020, you have to enter the amount yourself. I rather like this idea because the pump has no idea what I’m going to do next – exercise, sleep, eat more, suspend the pump after the bolus and many more possibilities. I can then give less or more according to my needs over the next 3 hours.

The pump can be set to remind you to test your BGL. I have mine set to remind me every two hours after entering my BGL, which I test several times a day. After any entry, the reminder comes on screen for you to confirm it or change the reminder time – 1 hour, 2 hours and so on. When I sleep, I set the reminder to zero hours, so it doesn’t do the reminder alarm and wake me.

Because of what the pump records and the reports it produces, I have not yet needed to record anything manually.

Once a week, I upload the data from the pump to my computer via an infra-red cable. I produce the reports as PDF documents that I email to my medical team. They can then see trends, averages, total insulin and more, and perhaps suggest  adjustments.

The sample report below is just one of a number of reports available. It’s the one most people with diabetes will recognise – it’s very similar to a handwritten log. Yes, it’s my log for last week, with reasonably OK numbers (only reason I’m sharing).

Looking at the report, I see if any adjustments need to be made to any of the pump settings. Of course I’d probably look at a week or more of data, not just a couple of days.

Last week, I made a huge effort to keep my carbs fairly low, lower than my usual under 120 grams per day. It certainly paid off for me.

You’ll see the following:

The time of day across the top. Each day has 3 lots of data: BGL, Grams of Carbohydrates Eaten, Insulin Bolus.

At the far right, you’ll see the average BGL for the day, the total carbs for the day and the total insulin bolus for the day.

At the bottom of the report, the last 3 rows are the averages for the time of day, and the averages for the week on the right.

Note that the BGL measurements are in mmol/L, the standard in Australia. To convert to the USA standard, multiply by 18, or see the chart at the end.

There’s another report hat shows all the BGL testing data. You might test more than once an hour, eg if you’re low, or after a site change. The log book only has BGL value in any given hour – the average of all tests done in that hour. You can’t see in the chart below how many times I might have tested for any one BGL shown.

I’d love it if my HbA1C would be done on just the four days showing! Now, wouldn’t that be nice! Almost everyone I know in the diabetes world, has highs and lows. The days shown aren’t typical for me. I’m still having a problem going high between 11pm and 1am. I’m slowly tweaking the pump to take care of this. It’s not easy because I tend to go low in the early hours of the morning. I don’t want that to happen while I’m sleeping, so any insulin I have between 11pm and 1am will still be active 2-3 hours later.

I wanted to share because it was something I wanted to know and see before I decided which insulin pump to get. As you may have already read, I totally love my pump and I’m extremely happy with the choice I made.

This chart shows HbA1c and what your average BGL would be in both mmol/L and mg/dl. It’s such a handy chart, I use it all the time!