Merry [Pump] Christmas!

merry christmas batman

After eleven stinking months of bitching at strangers on the phone, switching over to Oregon Health Plan (due to losing my job at the shitty, shitty restaurant), and fulfilling all of the compliance requirements in order to be approved for a pump by Kaiser’s weirdo DME committee….

I FINALLY HAVE A NEW PUMP!!!

Allow me to introduce you to Mister Plum, my brand-spanking new Medtronic Revel 523:

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What a handsome little fellow!  

This little monster is CGM-compatible and comes loaded with new, handy features (and complimentary gadgets) that will improve my diabetes management, including:

  • Post-meal BG reminder:  My A1c was recently rose back up to a dreadful 9.0, and my endocrinologist determined that a large part of the problem is my failure to test after meals. I simply forget. This function allows me to set my pump to squawk at me two hours after I eat, so forgetting is out of the question. The sooner I catch highs post-meal, the better I can control my overall sugars until I can determine what I’m doing wrong to get high post-meals in the first place. So stoked.
  • Capture Event function:  This function lets you capture certain moments in time that can be incorporated into your overall trends, such as BGs, exercise, insulin intake, and meals.
  • Missed Meal reminder:  If you have a problem forgetting to bolus with dinner, you can set a span of time to remind yourself to do so.  This is not as helpful for me at the moment because I do not eat at the same time every day.  Also, I generally do not forget to bolus with meals.
  • Bayer Contour Next Link blood glucose meter:  I *love* this thing:
    • The lancet device is less painful and the strips require much less blood than One Touch Ultras.
    • This meter is programmed to automatically ask you to categorize your reading as “Before Meal” and “After Meal” before you even see the reading itself.  This makes it easier to analyze whether you are off on your basal, carb-to-unit ratio, or are possibly in need of a carb-counting refresher.
    • Additionally, this meter has a built-in USB port, and communicates with your pump when plugged into the computer.  And now that CareLink has been upgraded to be more Mac-compatible, I will be able to get a better sense of my overall trends and behaviors.

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BG Reminder!

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The fancy Bayer Contour Next Link BG meter.  My new love. 

Lessons Learned

If you are in pump purgatory as I was, hang in there.  Be patient with the health administrators on the ground who are trying to get this done for you.  I promise you that they want to accommodate you, but because of the administrative hurdles instituted by top-down execs who mercilessly seek to cut costs, it will take time.  Try to humanize yourself to administrators to gain their sympathy (read: cooperation) and remind them why you are an excellent candidate for insulin pump therapy.  As an athlete, I argued that my dynamic and active lifestyle would be jeopardized by the constant eating you have to do while taking long-acting insulin* injections.  You can’t ramp down your insulin intake after you’ve taken a shot, so if you decide on an impromptu bike ride or random mountain climb, you have to eat beforehand or you’ll go low.  This makes weight management difficult, which in turn can affect how much insulin you require in the first place.  It’s a cycle, and remind them of that.  Keep your head up! 

Here’s to great control in the future with my new gadget!

Photo Credit: memecenter.com/keptinkurk

*Nota bene:  I am not full-scale attacking syringe-based insulin therapy.  Many respectable athletes use long-acting insulin.  I just believe that you have to be extremely regimented to make it work.  I am not.

Sunday Stats: Week of March 16, 2014

Sunday, Bloody Sunday…. self-disclosure time!
Loudspeaker

There is a lot of anecdotal evidence showing that people who track their fitness see more progress, likely because they know how they measure up against their goals. Now that I am starting to develop a fairly regular health and fitness routine, I’ll be publishing my stats every Sunday to track my progress. They’ll be pretty basic to start – weight and BG stats for now. Next week, I’ll start tracking the inches ((shudder)) and RHR. Also, I’ll be posting about my goals in the near future…

I have a quarterly appointment with my endocrinologist in April, after which I’ll publish many of the same stats I posted in my Baseline Assessment. I would loooovvveee to see my a1c below 7. Fingers crossed.

WEIGHT: 152 ((sigh))

DIABETIC STATS:
     7-day BG average: 181
     14-day BG average: 190
     30-day BG average: 216

     Before Meal 7-day average: 131
     Before Meal 14-day average: 146
     Before Meal 30-day average: 178

     After Meal 7-day average: 241
     After Meal 14-day average: 254
     After Meal 30-day average: 282

     Lowest BG of the week: 40
     Highest BG of the week: 344

THOUGHTS
I’m liking the overall downward trend of my diabetic stats, particularly my pre-meal BGs. I’m down 15 points for my baseline 7-day average of 196. Unfortunately, this was the only stat I took down from my meter to establish my baseline – I’m excited to see what my 14-day and 30-day averages are going to look like next week!

I clearly need some improvement in the After Meal category, as this seems to be the major source of my high BGs. This could be an issue with carb-counting, my carb-to-unit ratio (currently 1 unit of insulin for every 12 grams of carbohydrates), or a little of both. I suspect the most likely culprit is carb counting. It is not even remotely an exact science, and I am in need of a major refresher. Luckily, my endocrinologist referred me to Kaiser Permanente’s nutrition department, and I will be setting up an appointment soon.

Nota bene: A lot of my lows are going unreported. When I was without health care, I had to severely cut back on my blood sugar testing to conserve test strips, so I was taught not to test for lows because I don’t need a meter to know when I’m low (hot neck, cranky, sweaty, disoriented, HANGRY).

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I will be getting in the habit of testing for lows to show that trend to both my readers and my endocrinologist. While we’re on the topic of evil, evil lows, I’ve been having at least one hypo a day for the past four or five days, and I am not a fan of this trend. Lows feel like shit on a stick.

Anything else you guys think I should be tracking on a weekly basis? Chime in and leave a comment!

Photo Credits: ideasmile and http://efficientawesomeness.com/

Switching Gyms and Leaving my Comfort Zone

“The reason for our suffering is our resistance to the changes in life.”
~ Leo Babauta, Zen Habits

For those of you who know me in real life, you probably know that I don’t necessarily respond well to change – particularly when it comes to routines upon which I have come to rely. However, I am quite aware of how certain types of conflict can be extremely healthy, as conflict has the potential to spur progress. I consider conflict to be a wide range of things, including a disconnect with what you may find comfortable. Change is conflict.

This week, my small mom-and-pop gym closed down. Now, there were a lot of things I did not like about this gym. The staff basically gave up on the place – floors remained unswept and essential items not stocked. Also, this gym had an iterative identity problem, demonstrated by the owner’s constant moving of things around, which was a major source of aggravation for me. On the rare occasion when I did need something, staff members were hard to find because the owner removed the front desk/station. Oh, and the owner kept the kettle bells locked up for the paid group exercise sessions. God, that pissed me off something fierce.

All this being said, I had one area where I worked out, it was low-priced, and I was for the most part content. But I was not seeing results.

When I was told the gym was closing, I felt that same internal panic mode activate – now what?!? Not having a gym was certainly not an option, as I had recently (and publicly) committed to returning to peak fitness and health. But I definitely did not want to get stuck going to a big-box, warehouse-style gym, surely packed with judgmental, hard-bodied gym-rats. With those obsessive-compulsive personality traits. Those Type A’s. The last time I did a trial membership at a large gym, I hated it – I felt like a jelly-legged slob being silently assessed by these people with superior physiques. And it shut me down. Needless to say, I wasn’t looking forward to gym-shopping.

Irony: I am now a member of a big-box, warehouse gym, 24-Hour Fitness, a national fitness chain. It’s a “Super Sport” facility, which translates into bigger.than.shit. It’s massive, and is apparently one of the busiest gyms company-wide.

Picture of Gym

My visit to this monolith of a gym taught me something crucial: There wasn’t a problem with that large gym long ago, the problem was me. The problem was my projection of self-doubt and insecurity onto others – strangers that I didn’t know and whose minds I certainly couldn’t read (I’m not Sookie Stackhouse). I also learned something awesome about myself: I’m not that insecure person anymore. Throughout this complicated journey of having a chronic illness, I have developed my own sense of self and a unique sense of self-protection that comes with having to prioritize your health over pretty much everything else. No matter what someone has to say or think about me, at the end of the day, I have to take care of myself in a very tangible way. And somehow that crossed over to my perception of self.

Change = Progression

This change, this conflict, is just what I needed. I look forward to discovering what my new gym has to offer me on my journey back to peak fitness. I now see my new community of hard-bodies and I am inspired. I admire the hard work they’ve put into optimizing their health and wellness. And I am prepared to follow suit.

Photo credit: Urban Spoon

Assessment: The Body Mass Index Revisited

In my inaugural post detailing my general health statistics, I made a short mention that the Body Mass Index is widely criticized as a flawed measurement and that it should not be the sole determinant of whether you are overweight.  For my own education and others, I’ve decided the explore the issue a little further. 

What is BMI?

The National Institute of Health (NIH) defines the Body Mass Index, or BMI, as a “measure of body fat based on height and weight that applies to adult men and women.”  The Index was derived in the 1830’s from a math formula conceived by Lambert Adolphe Jacques Quetelet, a Belgian astronomer, statistician, and sociologist.  Not a physiologist, nor kinesthetics guru… nope, a stars and numbers guy.

The formula is:  BMI = mass(lbs)/height(inches)2 x 703.  This formula yields a number that corresponds to the following categories: Underweight (Below 18.5), Normal (18.5 – 24.9), Overweight (25.0 – 29.9), and Obesity (30+).

Limitations of BMI

Nick Trefethen of Oxford University states that because the human body doesn’t scale equally as it grows, the current BMI formula only leads to confusion and misinformation. The height of short people is divided by the weight too much, and is divided by too little for tall people.  The result is that short people are being told they are thinner than they actually are, and tall people are fatter than they actually are.  Is this a boon for us miniature folks?  I don’t think so, there’s more…

NIH identifies two further limitations of the BMI:  First, it overestimates body fat in athletes and others who have a muscular build, and second, it underestimates body fat in older persons and others who have lost muscle. In other words, it does not consider the dimension and tissue composition of the individual.  Furthermore, many critics point out that BMI does not differentiate between gender, which is of note because women generally carry more body fat.

One size fits all. 

Based on the conventional BMI formula, two individuals of the same height, but with different dimensions and body density, could have comparable BMIs.  This sends the message that if you are X feet tall, you must be Y weight, no exceptions.  Yet, muscle weighs more than fatty tissue, and studies have shown that a greater proportion of muscle tissue to fat tissue improves your quality of life.

At-Home Alternatives to the BMI

Body Adiposity Index (BAI).  
This measure, created by Richard Bergman of the University of Southern California, calculates body fat using hip circumference and height, without the disadvantage of requiring a scale.  However, studies have concluded that this measurement no more accurate than the BMI, particularly among clinically severe obese women.

Waist Circumference Measurement.
NIH regards waist circumference as a particularly useful measurement for individuals who are categorized as normal or overweight on the BMI scale.  Furthermore, it is an independent prediction of health risks, such as type 2 diabetes, dyslipidemia, hypertension, and cardiovascular disease.  It should be noted that while waist circumference is optimal for predicting risk with the elderly, there are variations in predictability between ethnic and age groups. Generally, you are at high risk if your true waist is measured over 40 inches for men, and 35 inches for women.

Waist-to-Hip Ratio.
Similar to Waist Circumference, this measure is also great for predicting health risks, in addition to body fat. To calculate your ratio, use a tape measure to take a reading from both your natural waist line and the widest part of your hips, then divide the diameter of your waist by your hip measurement. If you measure below 0.95 for men, and 0.80 for women, you are considered low risk.

Body Fat Measuring.
If you have access to calipers, this measure is calculated by taking measurements from the waist, shoulder blade, biceps, and triceps.  Those measurements are added up to a single figure, plotted against a chart that takes your sex, age, and measurement into consideration to calculate a percentage.

The New BMI.
To account for the three-dimensional aspects of humans (errr, everything…), Trefethen came up with a “New BMI.”  A colleague came up with a simple New BMI Calculator here.

Et tu, Little Furr? 

As previously mentioned, I am almost 5 feet 4 inches tall, weigh approximately 150 lbs, with a waist and hips of 32 inches and 42 inches, respectively. So am I actually overweight as my BMI suggests, or a victim of bad math?

BAI:  33.3% – slightly overweight, similar to my BMI.
Waist Circumference:  32 inches > 35 inches – not overweight and not at risk.
Waist-to-Hip:  0.76 – regarded to be within a healthy range.
Body Fat %:  No calipers yet. Will update when they are in my possession and I’ve pinched myself.
New BMI:  This calculator compares my traditional BMI of 25.75 with a New BMI of 26.25.  Slightly more fat (harrumph).  It then states that my appropriate weight range is between 105.7 and 142.8 lbs.

My Take-away:  As you can see, my respective measurements plot me as normal to slightly overweight, but with low health risk.  While these calculators are good for getting a rough idea of where I stand, I recognize their limitations, particularly as I am on the cusp of many of the categories.  My goal moving forward will be to re-measure in three months, with a desire to get off the cusp.  I believe I sit squarely in the weight-loss goal category of most Americans – trying to lose that last chunk of weight.  As I previously stated, my specific goal is peak performance, even as a type-1 diabetic.   

And to try not to “lose that butt”: 

Sir Mix Alot

Assessment: Establishing My Baseline

“You can’t know where you’re going until you know where you’ve been….”  ~ Someone Marginally Intelligent 

Thus, I commence my journey back into being an athlete.

But, before I set my fitness and health goals, I think it’s important to establish a baseline for both health and fitness. This is the health portion of that assessment.  As I learn more about what it means to truly self-assess (read: not beat up on myself), I will incorporate more information (for example, a postural assessment).

Without further ado and in my science-y style, I give you my deplorable health stats:

General Physical Stats:
Overall Weight: ~150 lbs. ((sigh))
Height: 5 feet 3.75 inches
Body Mass Index: 25.7*

*Thoughts: Many people believe that BMI is a flawed measurement.  For example it does not account for the relative density of individuals with differing percentages of fat and lean tissue. I tend to agree. According to the BMI, I am technically overweight. I am not – I am a short woman with dense, muscular legs (for the record, I am a size 6, considered to be pretty average).  That being said, Furr.is.out.of.shape.  But Furr will win. 

Measurements:
Bust:  35.5 inches
Waist:  32 inches
Hips:  42 inches
Thighs:  25 inches ((thunder clap))
Arms:  12 inches

Thoughts: Nothing to see here, folks, move along ((thunder clap)).  I will be taking a “before” picture of myself – this is essentially that “before” on paper, so that I may track my progress in terms of shrinkage, of which I don’t plan on doing much of.  However, I will not be posting such a picture until I have made some visible progress, for insecurity’s sake. 

Aerobic Stats:
Resting Heart Rate (RHR):  84 bpm (beats per minute)
Maximum Heart Rate (MHR):  (220-age) 190 bpm
Lower Range of HR (50%):  0.50(MHR – RHR) + RHR = 137 bpm
Upper Range of HR (85%):  0.85(MHR – RHR) + RHR = 174.1 bpm

Thoughts: I don’t know much about the meaning of these numbers quite yet.  It does appear that my RHR is higher than most.  I’m not sure if this is a good or a bad thing. 

Diabetic, Metabolic, and other Medical Stats:
Hemoglobin a1c:  9.3
Average Blood Glucose (BG) This Week:  196 
Highest BG:  432
Lowest Recorded BG:  68

Thoughts:  Plain and simple, these numbers SUCK.  

Thyroid:  3.12
Cholesterol:  207
HDL Cholesterol:  65
LDL Cholesterol:  144
Triglycerides:  85

Thoughts:  One of the few happy revelations that came out of my [first] endocrinologist appointment [in four years] is that it appears I do not need to be on thyroid medication.  Good times!  Otherwise, all of these levels are normal, but on the higher end of the range.  My goal will be to reduce them generally.  Interestingly enough, my triglycerides are closely connected with BG levels, so I hope to see a quick reduction there. 

There you have it.  My health on paper.  These should be updated quarterly, and I’m excited to see what my new lifestyle will do change these numbers for the positive.

Namaste, suckas.