I love treating my hypos with Skittles. They’re small, portable and the carb count is easy to remember. But I hate how expensive they are.
Yesterday, I thought outside the box and went for a party bucket instead of a bag.
Who says diabetes can’t be done on a budget?
I feel well and truly hungover after a day of dealing with rollercoaster blood sugar levels.
It started with the slice of thick cut raisin toast I had for breakfast. Probably not the most sensible choice of breakfast, but I felt like it. My blood sugar was a lovely 6.8. I’ve been working diligently at producing straight lines overnight and into the morning, and I felt ready for a challenge. So I pre bolused my insulin, drank my coffee, dressed, prepared my toast and ate it.
My FreeStyle Libre showed a perfect 6.9 and steady when I arrived at work, and I was able to put my fears of the toast spiking me to the back of my mind as I started work.
About an hour later I checked again, only to find a 13.1 and an upward trend arrow on my Libre. Nowhere near the 20s territory that raisin toast could potentially send my blood sugars, but still a surprise considering the increased intensity of my physical activity at work yesterday morning. I’ve been producing some spectacularly stable lines through the mornings, so seeing that 13 was rather irritating.
I watched that 13 slowly go down to 12.2 and then settle at 11.0. I should have just left it. I still had close to 2 units of active insulin on board. I was working intensely and I knew the insulin would be extremely sensitive. But the frustration of that 11 got the better of me, and I gave a correction bolus of half a unit, as suggested by my pump.
No more than ten minutes later, before the insulin bolus would have even had time to kick in, my levels were already showing signs of descending. I felt so frustrated. I knew that I should have just left all and good.
As I watched the downward trend arrows on my Libre, I decided to have my morning tea of coffee and a small banana. As I watched my levels enter hypo territory, I added another 15 skittles into the mix and went back out to work.
I refused to check my levels for another hour to avoid any more impulsive actions, until I saw that I had rebounded to 13.3 with an upward trend arrow. I had very little insulin left on board from breakfast, so I entered my reading into my pump and gave half of the suggested correction dose.
I thought I had been extremely cautious, yet within half an hour I was plummeting once again. Not wanting to over-treat this one, I cautiously ate 12 skittles. I ended up needing another 8. My levels bounced back into range, before eventually falling back to hypo territory again by lunchtime.
I felt doubly exhausted from a morning of intense work, combined with rollercoaster glucose levels. By this point it was lunchtime, and all I really craved was sugar. A jam donut and a chunky Kit Kat joined my toasted sandwich for lunch. It was a crazy, crazy ridiculous carb count, but I knew that I would be able to get away with not spiking too high while I was working.
If I had just accepted that raisin toast will naturally send me higher than oats, I might not have had the rollercoaster day that I’ve just had.
Although surprisingly, my glucose levels didn’t go any higher than 14.3mmol all day. Silver linings, right?
“Doesn’t your sugar levels go high if you eat too many sweets?”
This was a question that was posed to me over the weekend, as I reached over and grabbed a sweet from the table.
“I’m low at the moment” were the first words I could get out of my mouth, resisting the urge to add more words until the sugar was sitting safely in my belly.
“I have type 1 diabetes. My body doesn’t produce any insulin.”
I pulled my pump out of my pocket, thankful for my newfound prop that keeps my flailing hand gestures at bay.
“This delivers all of my insulin for me. Technically speaking I can eat anything I want, so long as I give insulin to cover it. Obviously it is better for my blood sugar levels if I eat healthier foods, though.”
This person then went on to tell me that she had been recently diagnosed with early signs of type 2 diabetes, and that the lifestyle changes suggested by her doctor were easier said than done. That she wasn’t sure how changes to her diet would fit in with the rest of her family at home. As she questioned her need for the medication prescribed to her, I could see just how hard it was for her to accept her condition. It brought back my own memories of hiding my diabetes, unable to accept my new ordinary.
I curiously asked if she was testing her blood sugars at home, or whether she had seen a diabetes educator yet. As she told me ‘no,’ I nodded my head. The last thing I wanted to do was to try to give advice. The last thing I wanted to do was to act like I knew what she was going through, or what was best for her. Type 2 diabetes is completely different to type 1. Heck, one person’s diabetes is completely different to another’s.
Yet at the same time, I felt like I should have done more to help her out. I felt sorry for her, because her doctor didn’t seem very helpful or supportive. I hope I said the right things.
“I know it’s hard. It’s taken me ages to make changes that have lasted. I’ve had diabetes for six years, and I still have days where I don’t feel like I’ve got it right.”
All I really wanted to do was to give her a big hug and tell her everything was going to be okay.
Hopefully she sees in me that it will be.
“Are you alright?”
“What’s wrong?”
“You seem quiet today.”
I knew why my work mates were asking. Diabetes has been affecting me so much at work lately, to the extent that my feelings could be read off my face with ease.
“I’m fine. It’s nothing.”
It wasn’t nothing. But the last thing I felt like doing was talking about it.
Going to work with the insulin pump has really tested my patience. I’m on my feet and moving around for much of the day, which makes insulin a lot more sensitive than normal. My work day is a prolonged period of physical activity, and not simply an hour of exercise. I guess what makes the insulin sensitivity more of a big deal with the pump, is that my basal insulin is being delivered to me live and continuously as I’m working, unlike Lantus.
For a few days last week, the hypos were relentless. I recall having at least three on one day, in particular, last week. Three. Every time I crack open a fresh canister of skittles, I hear my diabetes educator’s voice ringing loud and clear in my head.
Minimise the lows. The first thing we need to do is to minimise the lows.
Hypo unawareness is my biggest fear. With every passing hypo, all I think about is was whether I can feel it or not. I think about how much longer I will be able to feel them. At the end of it, all I really want to do is succumb to the defeating exhaustion that follows.
I had talked over my work day with my diabetes educator in the beginning. On a scale of 1 to 5, I’d rated my level of physical activity at around a 3. We’d anticipated a reduction in basal insulin requirements while I was working. I just never anticipated that the taps would take so long to turn down. I’ve now reduced my basal rates to about one seventh of my normal rate, and it finally seems to be holding me steady through the mornings.
The other factor that I am also starting to consider is the insulin I take to cover my meals at work. I’ve been plummeting quite quickly after my lunchtime insulin dose, and I’m starting to think that I might need to reduce my bolus by a certain percentage.
I’m hardly a role model for physical activity. I’d never have guessed that it would be such a significant issue for me on the pump. Not in a million years did I expect to be here, writing about physical activity and diabetes!
But I’m close. I’m really close to nailing this.
I felt a lot more comfortable adjusting to the insulin pump at home, despite the enormous patience and mental strength it required. I didn’t have the added stress or pressure of being at work, or anywhere, at a given time. By the end of week one, my overnight basal rates were holding me steady through the night, and my diabetes educator was confident in my ability to justify the decisions I’d made around my basal rates. I saw out the week with a greater level of confidence in the device that was attached to me.
Going back to work, however, threw a curveball into the mix. It was a great relief to be able to pull out the pump and show everyone that it wasn’t a surgery, or a great big computer strapped to my back. But suddenly, my pump workload had doubled. I had two very different days, with very different activity and insulin requirements to consider.
My job is quite a physical one. I am on my feet for much of the day. Some days I am simply standing around the table where my team breaks down deliveries. Other days I am climbing ladders, lifting things intensively, or furiously unblocking the cardboard chute. The intensity of my activity often varies throughout my work day.
My biggest setback in those first few days was hyper programming my pump settings, without being patient enough to see them through the day before making changes.
I had initially set my basal rate to drop back a notch at 7.30am, half an hour into my work day. In response to a 17.0 on my FreeStyle Libre on Thursday morning, I gave a 2.5 unit correction that my pump suggested.
The ease of access to glucose data through my FreeStyle Libre tested my patience that morning. I was compulsively scanning. Scanning, scanning, scanning, way too frequently. Upward trend arrows, hitting glucose levels of 18, 20 and 22 within minutes. I was impatient, and set a temporary basal insulin rate of +10%.
Within half an hour, my levels were starting to fall. Feeling satisfied, I cancelled the temporary basal rate.
Half an hour later, I was still falling. I kicked my basal rate down again.
Half an hour later, and I found myself hypo. I set a temporary basal rate of -50%, and treated it.
My biggest mistake in those first few days at work was trying to micro manage data after meals, before the insulin had finished doing its work. My diabetes educator had told me that the first thing we needed to do was to minimise the lows. Yet I couldn’t get that stupid high off my mind.
I know damn well that insulin takes time to kick in, but I ignored my better judgement. I probably upped my basal rates unnecessarily, which was essentially extra rapid acting insulin in my system in the hours that followed.
I paid for my compulsion throughout those first few days with some very exhausting lows.
This week, I am trying not to hyper program my pump. I am setting basal rates the night before, and sticking with them through the day before making changes.
I am trying to remember that what goes up, must eventually come down again.
