Blood Sugars

Forever Learning

2 Comments

“I never get it wrong. I just learn for next time.”

If there’s one quote that truly resonates with me in the way I manage my diabetes, Grumpy Pumper summed it up for me perfectly in a tweet that surfaced this weekend from the Sports and Exercise Weekend he was attending in the UK.

The biggest piece of diabetes wisdom that I often impart is that time and experience is my biggest asset in living with diabetes. Because each and every one of those valuable hours spent managing my diabetes have taught me something. Like only bolusing for 60% of the carb count on my banana. Or living to regret every hypo that I’ve treated with something nicer than skittles or glucose tabs. Or remembering to bring a spare of everything with me.

I am a bit of a perfectionist in the way I manage my diabetes. I meticulously monitor my basal rates, count my carbohydrates, time my insulin to the kind of food I’m eating and give deep thought to the physical activity I undertake each day. It’s no simple equation, by any means.

My biggest downfall is that I don’t handle it very well when things don’t go to plan. I can often be found swearing out loud in front of my meter, verbally expressing my frustrations.

Yesterday was one of those days, as I found myself low twice after my breakfast and wondering how today had been any different to my other mornings of late.

As I sat in my desk chair at work, recalling the actions I’d taken that morning, two particular things came to mind. The first being correcting a blood sugar of 7.1 upon waking up, ignoring the insulin I already had on board from an earlier correction (and perhaps if I’d washed my sweaty bed hands prior to checking, the number may have been different). The second being the ginormous orange I added to this morning’s brekky. As I searched through my Calorie King app, I learned that oranges had 5.5% carb content, rather than the 8% I had in my head.

Living with diabetes is a constant learning process. I still surprise myself at how much I continue to learn after a good two and a half years of more diligently managing blood sugars. I wonder if I will ever live to see the day where I’ve learned everything that there is to learn.

What I do know, however, is that I don’t feel so guilty for my blunders when I can identify reasons for them.

Replicating the Good Days

2 Comments

At the moment, I’m trying to replicate days like these.

Rather than these.

I have whole weeks where my carb counting is spot on, insulin just ‘works’ and blood sugars are simply effortless to manage. There are less highs, and less lows. The stream of good blood sugars seem to have somewhat of a flow on effect, so long as I can keep the train on course.

Then there are the weeks where blood sugars simply do not want to co-operate with the maths. Blood sugars feel like a lot of effort to manage, because naturally the insulin doesn’t work as well when levels are out of range. The urge to rage bolus is real, ultimately leading to more lows, and more rebound highs. It feels much more difficult to get the train back onto the course, rather than simply keeping it on the course.

In the midst of trying to pinpoint things, this was yesterday’s discovery.

11.1 was the greeting that I received from my FreeStyle Libre sensor after breakfast yesterday. It’s not what I was expecting, given that I had woken up to a blood sugar of 6.2 and carb counted my eggs on toast and milky coffee.

I gave an additional unit of insulin, and decided against reducing my basal rate for a day on my feet at work until that stubborn high started to come down.

Normally, a one unit correction while ripping open pallets of bulky furniture would send me plummeting. Yesterday, I was lucky to nudge the top edge of my target range.

As I recalled the day prior, my blood sugar had also remained stubbornly in the 8s despite repeated corrections. After increasing my basal rate in the evening and avoiding every urge in my body to rage bolus, I slowly but surely landed back into range by bedtime. Only to find that the ascent had begun once again when I checked at 1am.

By this point, I knew what had happened. In fact, I was feeling like an idiot that I had not picked up on this sooner.

Perhaps not as terrible as the banana bread highs that spoiled insulin had given me last time, but spoiled enough to make my blood sugars noticeably more stubborn to manage than usual.

Tools and technologies are only as smart as the people using them.

By sharing some more bits of the daily grind here, I’m hoping to make myself a bit more accountable to replicate more of those good days.

One Messy Night.

1 Comment

I was ready to go to bed.

As I watched my blood sugar slowly climb into the 10s, I gave a unit of insulin to correct. Thinking about the after effects of stacking my dinnertime insulin on top of a late afternoon coffee and one of Nonna’s biscotti, I set a temporary basal rate of 150% for 2 hours to help that insulin better do its job.

I set the alarm on my iPhone for 1am and switched off the lamp on my bedside. With a nagging feeling of doubt as I turned on my side, I fumbled for my pump in the dark and gave another unit.

DURN! DURN! DURN! DURN! 

I hastily fumbled for my phone to silence the shrieking alarm, before switching on my bedside lamp again. As I swiped my Libre reader, I was half expecting see blood sugars heading into low territory.

Instead, I was actually a pleasant 13.8.

I was in disbelief. However, I thought it could be plausible after having pasta for dinner. I reached for my insulin pump, and gave a rage bolus of 3 units.

ZZZZ! ZZZZ! ZZZZ! ZZZZ!

My rage clearly wasn’t enough to fuel the delivery of this bolus, which was stopped in its tracks by a very irritating occlusion alarm that was hissing and vibrating at me for attention.

I ripped the cap off my infusion site, which revealed a perfectly clear looking site. A poke and prod around the area showed no signs of any discomfort. I primed several units of insulin out of my pump line, watching it spill over the cannula and pool around the cap to satisfy my paranoia. I held my pump line up in the air and ran it through my fingers, watching it like a hawk for signs of air bubbles.

With my paranoia satisfied, I reattached the cap to my infusion site and delivered the remainder of the bolus that my pump had cut off. I set another temporary basal rate of 150% for the next two hours, setting my alarm for 3am.

When I stirred at 2.17am, feeling rather uncomfortable, my Libre reader revealed a reading of 17.7 and rising. I hastily grabbed my pump and went to deliver another rage bolus of 5 units.

ZZZZ! ZZZZ! ZZZZ! ZZZZ!

That hissing, vibrating occlusion alarm sounded once again, stopping my rage bolus in it’s tracks.

By this point, I was furious as I flung my bed covers away from me and was forced out of bed.

Finally, I ripped the infusion site away from my stomach. There was no kink in the cannula. There were no signs of blood, bruising or bleeding on my stomach where I’d placed the site. Everything looked fine, and I was convinced I had just wasted a perfectly good site.

After inserting a fresh infusion site, setting a temporary basal rate and delivering my third rage bolus of the night, I was finally able to close my eyes.

I wasn’t surprised to learn that I’d slept over my 6.25am alarm. I gulped down my coffee, showered, and hastily threw two pieces of frozen Pane Di Casa into my bag to toast at work.

I soldiered on, reminded of just how much responsibility rests on my shoulders every day.

Four Foods I Cannot Bolus For To Save My Life

4 Comments

I remember starting off on vague insulin doses of 5 to 10 units at every meal instructed to me by the hospital. Then I saw a diabetes educator, and learned to carb count. Adding up every gram of carb on worksheets supplied by my dietician only led to frustration over why logic was not translating into steady blood sugars. (Of course, little did I know about the gazillion other factors that could affect my blood sugar back then…)

For a few years in the middle, I just swaggered by and thankfully lived to tell the tale.

Fast forward to today where I’m using an insulin pump, carb count nearly everything I eat at home and have a pretty good idea of what most foods that I eat will do to my blood sugars. I know exactly why my blood sugar is high as I’m typing this right now (hello, potato bake with no pre-bolus). Overall, I feel pretty comfortable with being able to eat, give insulin and manage my blood sugar levels today.

That being said, there are still a few select foods that I cannot bolus insulin for if my life depended on it.

Pasta.

If there’s one food that confuses the life out of me, it’s Pasta. You can’t go by what’s on the packet, because most packets only refer to the uncooked weight. Seriously – who in the world eats dry pasta? If you were to make that mistake, I‘d be surprised if you weren’t chugging down litres of coke or making a dash to the emergency room.

Logic tells me that Pasta has around 28% carbs in it. The carb counts in our plates of pasta at home would be huge, because who on earth can only eat 1 cup of pasta? But if I were to give a massive insulin dose for all that carby goodness, I’d be eating glucose tabs for dessert.

All the extended boluses in the world can’t keep me from the Pasta lows, which can only mean that Pasta must be a really really really slowly digested food. These days I tend to settle for bolusing for 50 to 60% of the carbs at the time of the meal, accepting that the remaining 40% of the carbs that have absolutely no effect on my blood sugar whatsoever must be magic.

Soup

If there’s one meal that I despise purely for diabetes reasons, it’s soup. Who on earth can count the carbs in all those lentils, veggies and pastina that have been sitting there in the pot stewing all afternoon?

Then there’s the hassle of attempting to drain all of the liquidy goodness from the soup ladle for the purposes of weighing my plate, and then scooping up only liquid from the pot to add to my dry plate.

Add to this the same principles as pasta – all of those lentils and pastina are really slowly digested and would send me low quite easily. With carb free veggies and meat in the mix, I’ve sort of settled on bolusing for about half the number of carbs I would with Pasta.

Bananas.

Fun fact: I cannot eat a Banana without going low. Which is shit, because I actually happen to like them a lot. I very much look forward to my mid morning coffee and banana, while other times I slice it up to mix in with my Overnight Oats.

Logic tells me that a Banana with skin intact has around 13% carbs in it. But if I were to weigh my banana and bolus that much, I would be low within the hour. I’ve sort of settled on bolusing for around 50 to 60% of the carbs in my bananas, and some days this does the trick while other days it does not.

Steak and chips. Or Pizza. Or any kind of restaurant meal, really…

I have a love hate relationship with pub meals. I love how delicious and mouth watering and salty a steak and chips are, but I absolutely hate the night sweats and resilient high blood sugars that follow in the aftermath.

After learning that restaurant meals tend to be higher in fat to make them more delicious, I tend to set a temporary basal rate increase of 50% on my pump for 8 hours to combat the insulin resistance. I don’t prebolus for anything, given that fat slows down the digestion. I might also bolus for 40 to 50% of the protein in my steak after the meal is over, using a extended bolus over 2 to 3 hours.

Get the insulin in too early, and you go low. Get it in too late, and my blood sugars go up, up, up. It’s definitely a case of hitting the sweet spot.

***

Ahh, food and insulin…if only it were as easy as counting the carbs, giving an insulin dose and catching a unicorn 2 hours later.

Access to Supplies Isn’t a Question, It’s a Right

6 Comments

My Blood Glucose Meter is one of the most important things in my life. Its one of the first things that I see on my bedside table when I wake up in the morning. I’ll zip it up securely in its little black case and tuck it safely in my satchel, where it will accompany me on my daily commute. I’ll open my satchel again before I start the car, just to make sure that its there. When I get to work, I’ll place it carefully on the shelf in my locker. It patiently sits there for much of the day, ready to be at my service as much or as little as I need it. Before morning tea. Before lunch. As a post-lunchtime reassurance. If I start to sweat or shake uncontrollably. At the end of the day, I’ll tuck it safely back into my satchel, before it finds its familiar place back on my bedside table at home.

When I’m dealing with a disease that is unpredictable and ever-changing, numbers are always on my mind. They plague me throughout the day. They plague me when eat. They even plague me when I stir in the middle of the night. I’m constantly questioning myself. Thinking to myself. Doubting myself. ‘I wonder what my blood sugar level is right now? Did I give myself enough insulin at lunchtime? How much will I drop in the next hour? Am I feeling hypo? No, it must just be this afternoon’s task that’s exhausting me. Wait, maybe I am hypo? No, no way. Well, maybe…’

Last week alone I had 58 moments of uncertainty. Last fortnight there were 125. And in the last month there were 257 of them. And I have this one little device that has the power to sweep my mind clean of all the thought processes scattered there. To dismiss all of my concerns and rid me of my fears. To keep me grounded. To keep me sane. One little prick produces a number and I’m empowered again. I feel secure. I’m back in control. I know how to react.

I consider myself pretty lucky here in Oz to have unlimited access to blood glucose meter test strips, needles and other non-medication products that I use on a daily basis to manage my diabetes. Since registering with the National Diabetes Services Scheme (NDSS) upon diagnosis, I have been able to get my diabetes stuff at a heavily subsidised cost, without a doctor’s prescription, whenever I like. As little or as much as I feel I need it in order to manage my condition.

So, I’m pretty devastated to hear that some Aussies with type 2 diabetes are about to have that freedom taken away from them. If their diabetes is not treated with insulin, it will be up to their doctor to decide whether they will benefit from blood glucose monitoring after an initial 6 month supply of test strips.

Yes, a type 2 would not use blood glucose monitoring as much as a type 1. But I’ve no doubt that they would go through those exact same feelings and thought processes. I’ve no doubt that at some point during the day, the week or the month, a type 2 would need to rely on the security of a blood glucose test. If they’ve eaten something different at dinner. If they’ve done more exercise than normal. If they’re not feeling well. Diabetes causes A LOT of uncertainty.

Its like being handed a box of test strips and being told “you have 6 months to get your diabetes under control.” And then in 6 months your blood glucose meter is taken away and you’re told “you now have to keep your blood sugar levels between 4 and 8 all the time.”

Diabetes is not something that we can always “get” under control in 6 months, let alone maintain all the time. Our lifestyles are ever changing – work, travel, diet, families, physical activity – all of which have significant impacts on our diabetes. Doctors aren’t by our side 24 hours a day to see, let alone understand, what we’re going through. The only person who knows you best, is you.

We are blessed to have all of these fantastic tools available today to help us manage our diabetes. For many, a blood glucose meter gives us a sense of security and control. It should never be a question of who gets them. I only wish the people making these decisions would understand.

Source: The inspiration for this story came from Renza at the Diabetogenic blog. There are more details about this decision process over on her blog.