Wednesday, March 31, 2010

2 + 2 = 5

As a teenager, I sat in the cold unpersonalized classroom listening to the obese man in the front of the room. He sat at a raised podium-like desk, spouting strange phrases focused on numbers and angles and how they all connect. A blackboard in the background was littered with figures and symbols, but none of it made any sense to me. Mr. High School Math Teacher broke from his monologue and pointed a question at me, grimacing as I shot back an answer that indicated I was clueless and didn't much care about what he was talking about. His face contorted as if in pain, and he held up and shook a large textbook as if to say, "This is important to your life and you should care, Mr. Hoskins."

In response, I gave an answer that hadn't been said aloud to a teacher before: "No, it's not important to me. I'm never going to use this in real life. If you can tell me how that's going to be important to my writing career, then maybe I'll take more of an interest."

That was in 10th grade, my final year of the two required for high school math. That led me to college, where I went into journalism and sidestepped math for philosophy. What I'd give to go back in time, kick that kid in the head, and pay more attention in math class. That sophomore year's classroom math denial was years before I'd find it necessary to become a Human Calculator, responsible for Diabetes Math on a daily basis. Math has come back to haunt me so often, but even moreso since I recently began a Pump Hiatus for the first time in nine years.

On my trusty insulin pump, routine scenarios such as Carb Counting, Correction Calculations, and Insulin On Board Adjustments were simple. Punched a few buttons and the math was done. Without taxing my mind or having to tap into my sub-par mathematical abilities. But now, without that pump, I'm on my own. Going online or looking at nutrition books or sheets is easy enough, and occasionally I can muster the skill to add up the items on the list and draw up a needle for that amount. Occasionally is a key, here.

But food labels confuse me. And EVERY bite of food carbs means you face a Stowaway Math Problem (see George and Scott's awesome YouTube video on this!). For example: measuring out 1/3 cup that costs 13g for each serving, and I'm eating 3.5 servings. Plug that into the equation with an insulin-to-carb ratio of 10g (which I refuse to change because that's a simple number that offers HOPE for easier calculations.) Then factor in a correction bolus for a 202 mg/dL, and adjust for the snack or correction bolus taken a couple hours ago that hasn't yet worn off completely...

Ugh. Seriously. Even though I typed that above graf, my mind tuned out right after the spot about measuring a 1/3 cup portion. Had you been here watching me type, you likely would have observed my eyes glazing over. There's numbers, symbols, lines, graphs, angles, and weird herioglyphics floating across my sightline... Ugh. But this is such a regular part of life, and food-makers don't ease the difficulties, either. Like when you order a pizza, and the pizza-makers own website says one slice out of 8 costs so many carbs... Yet the pizza you've received is cut into 10 slices! WTF?! C'mon! It's like they're trying to make my D-Math more difficult!

Luckily, I'm not totally lost to the Dark Mysteries of the Math World. Thanks to my wife Suzi, who's a banker and math guru. She's got the skill.

This means that while Suz is the calculator, I'm left to say what I want to eat, possibly help in cooking and preparing it, and letting her fill me in on what it all costs (in the Hoskins Household, that's our lingo for carb counting: How much does this "cost?"). It's a great partnership. Admittedly, though, I'm the weaker link as I'm just lost without her.

Anyhow. In the first days off the pump, I kept Bacon Gibbs handy simply for the math. But then he refused to solve any math problems without having a filled, ready-to-go reservoir. So reluctantly, knowing the implications of my actions, I took out the battery and resolved to tackle the Dark Arts of Mathematics. Thanks to my phone that has a built in calculator, my work and personal computers that have desktop calculators, and any other number of calculators spread out in my world. the daunting task is at least manageable. Suzi is a lifesaver, too.

But I'll admit that even outside the addition and subtraction, the D-Math is more difficult without a pump. No constant basal stream to help guide down BGs at any given time. No extended boluses, especially for food items like pizza and chinese. The Lantus Pen injections I'm taking each night at bedtime appear to wear off in final stages of the 24 hour period. And the peaks and leveling off periods are different.

I'm just a little "off." This could just be the first week, in that my body's just getting used to the differences. Hope so. Because math is tough enough, without having to factor in these other nuances. Fellow D-Blogger Jim Huck, a math teacher by day, recently delved into this topic with a bit of humor that struck a cord and had me laughing out loud - a common happening when reading his great writing. He presented a D-Story Problem:

Johnny is a type 1 diabetic who tests his blood sugar at 6pm and discovers that he is 240. He had eaten 3 slices of Round Table Pizza at 5PM (when his BG was 118), which had 72 grams of carbohydrates and 30 grams of protein. He had already taken 4 units of Humalog at 4:45 PM, and his normal insulin to carb ratio is 1/13. Since the pizza has a lot of fat, Johnny expects that it will take about 3 hours for the pizza to finish digesting. Taking into account that his meter has a 20 percent margin of error, the food label has a 20 percent margin or error, his insulin dose at 5PM could have been off by as much as 39 percent, and now that his blood glucose level is up at240 mg/dl, his correction ratio could be off by as much as 30 percent. The question: How much beer will Johnny need to drink to forget that he has diabetes? Round your answer to the nearest six pack.

That's it exactly, Jim! At least some of us PWD are math teachers, have math-inclined spouses and family members, or simply can rely on insulin pumps for some math help. It does us well, even if we didn't capture the pride of our High School Math Teachers. We should form a D-Math Club, with Mr. Huck leading the way!

As far as the math goes, I'll look forward to returning to my pump in a month or two. Then I won't need to be a Human Calculator as much. Maybe then, 2+2 won't equal 5. Well, maybe it won't. I'll never be the person who could have answered that question posed so many years ago by Mr. High School Math Teacher, but at least I can look back and know that he had a point. Consider this my semi-public apology: Mr. H.S. Math Teacher. you were right. I should have paid more attention to you, because math is important to my life. Especially my D-Life. Wish I would have known it then.


Shannon said...

With each post about your pump hiatus, you're reminding me why I love my pump so much! I will not take it for granted!!!

I hate math. That is all.

Anonymous said...

I too am on a pump hiatus and the math is my biggest obstacle! I'm going on week three and my numbers are better than they've been on the pump for a LONG TIME. I wish you the best of luck and it's nice to know, even though we're strangers, there's someone else out there who feels exactly like I do

Anonymous said...

Trudy from TuDiabetes writes: Hi Michael. I took a full year off from my MMT522 for my pump sites to recover, to regain the ability to absorb. When I started using my pump again a few months ago, I decided to use it on weekends and use MDI mid-week. My goal is to get as close to the same feelings, same results off the pump as I have while on it. During the year I was just MDI my A1c was 6.3; with my dual treatment it is 5.9. O.K. Once I was on Lantus and took both a morning and nightly shot; now I'm on Levemir, also with two shots. I got an accumulation of Lantus over time; Levemir is gone in eight hours, which works well for switching back and forth with the pump. So, on MDI: (1) first thing in the morning, I take one unit of Apidra for the inevitable need for extra morning basal, (2)take my morning Levemir, (3)Apidra for boluses and corrections, (4)one-third the amount needed for a bolus with Regular and two-thirds with Apidra for those times when I would have taken an extended bolus, such as all dinners, certainly Chinese food, pizza, etc., (5)bedtime Levemir. I keep sites separate for MDI and the pump; and then rotate within those separate areas. I don't know if any of that is helpful to you, but good luck!

Judi said...

For people that want to take a pump vacation and don't have math skills or a person with math skills close by, there might be a way to use your pump as a calculator.

I haven't had a pump yet that couldn't run with an "air cartridge/reservoir". Fill up an old pump cartridge with air, load it into the pump, and go thru the load process, just using old tubing. If you want, you can set the basal rate in the pump to its very lowest setting.

This will allow you to use all the math functions of the pump, including, if you desire, the ability to plug in the amount of your food doses you give yourself by shot. Just put in that amount, dose that amount of air into space, and now the pump will calculate the IOB for that dose.

This is a real lazy way to do it, and kind of avoids forcing you to do the calculations yourself, but it is a way. I’ve done it while waiting for a new pump to arrive.

Michael Hoskins said...

Judi: Thanks for that tip! I did do this temporarily, but eventually gave in to the need to do the Math myself. Laziness only gets me so far.

babscampbell said...

I received the same comment from my math teacher, "Ms. Ayers, you are going to need this information in your future." To which I replied, uh, no, I don't think so. So, Mr. Talbert, I'd like to publically apologize and say yes, I do need this in my future life and I STILL hate it.

Besides recalculating recipes to figure out the content in a 1/16th slice when the label is for 1/6th serving, or what is the carb value if I use an artificial sweeterner vs. sugar or honey. . .we've just changed to a different carb:insulin ratio for EACH meal.

By the time I calculate my meal, everyone else is finished eating and ready for dessert, which, of course, is another math problem.

Thanks for this post! It made me feel like I'm not alone and gave me a much needed afternoon giggle! I'm RTing it now!

Anonymous said...

From a CWD Forum D-Mom, whose 11-year-old daughter was diagnosed in early 2007.

Enjoyable blog post.

I remember going into my daughter's 5th grade class and giving a brief lesson on Type 1 Diabetes. I drew a line graph (with a shaded range) and explained where her BG numbers should be and then noted highs and lows and talked about how she would feel with them. We discussed serving sizes, carb counts, carb ratios and correction factors.

What made it wonderful was that they were actually studying line graphs and ratios at the time. I was able to say, "You don't know now what you will use math for in life, but your life may depend on it!"

My daughter always took a buddy with her to the clinic after lunch. She had them look up the carbs in a master book, figure the right count based on "I ate 1/3 of this, all of that, and 1/2 of the other." Then she let them figure the insulin dose. Of course, she and the nurse confirmed it. It was fun for her and at least she got a bit of fun out of diabetes management each day.

She has been pumping for 1 1/2 years. I still have her "guessimate" what the dose will be before the pump shows her the result. She is amazing accurate. At night, I also have her figure out if the IOB is going to be a problem at bedtime based on her current BG.

This has empowered her to be able to go to sleepovers and overnight camps with the ability to manage her diabetes well.

Anonymous said...

I can TOTALLY relate to this post!!!

I've NEVER been good at math...why have to learn it when we have calculators?? If you were to form a D-math club, there would have to be tutors!

This made me realize how much I take my pump for granted!! I never have to put too much thought into the calculations...maybe I should brush up and study or something.

Colleen said...

Definitely my favorite part of pumping (all of 4 months so far). I've always been terrible at math and when I started insulin I about had heart failure when calculating. Even bought a cheapo calculator to keep in the kitchen drawer!

Anonymous said...

This gave me a chuckle and it's all so true.

In a recent interaction with Caleb's school nurse about a couple of unusual bg readings, I explained why I thought things were off referring to basals, insulin duration, tails, extended bolus' etc. This woman is very bright and well versed in Caleb's care. However her response to what I thought was a rather straight forward message was, "worse than level 10 sodoku."

This is all such a puzzle that we try to solve repeatedly every day.
I'm enjoying following you on this hiatus. :)