Burnout

Feeling Tired With Type 1 Diabetes

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The final stretch of last year was a pretty challenging time for me, physically.

I felt tired. All. The. Damn. Time.

I would often find myself crawling into bed at the end of the day, feeling utterly exhausted. I was no longer waking up to my 1am alarms, and my blood sugars definitely suffered for it. I would wake up after a solid eight hours of sleep feeling bleary eyed, wanting nothing more than to close my eyes and go back to sleep again.

I honestly could not find an explanation for the way that I was feeling. Although the management of my blood sugar levels had slipped a little since achieving a personal best hba1c in July, my ability to manage them was still far better than they had ever been in my pre-pumping era. My bloodwork from July was also really good, and I had seen my endo in August.

I probably should have made an appointment with my GP, but I honestly didn’t feel that he would have been very helpful to me.

I felt more burdened than I had felt in a long time. in fact, I’d go as far as to say I felt equally or more burdened than I did during my start on insulin pump therapy. These feelings affected my work, my attitude around others and my overall quality of life. Part of me was ready to accept that these symptoms were simply a tradeoff of living with a demanding chronic condition like diabetes.

Living with type 1 diabetes creates somewhat of a complex relationship with food. We need food to fuel our bodies, but at the same time food spikes our blood sugar levels – and we want to avoid out of range glucose levels at all costs.

What’s the best nutrition advice for a person with diabetes? From my experience, It depends on what you’re reading and who you’re talking to. While I absolutely love my diabetes community, the overwhelming messages that seep into my brain is to avoid this food group or cut back on that one that and stop the spikes from happening.

I don’t want to single out any particular way of eating, but diabetes has distorted my relationship with food without me even realising.

The average male needs to consume about 8,000 kilojoules of energy per day to fuel his body so that it can function properly and match energy expended through activity. I don’t think I was even coming close to that. Not to mention having an active job where I’m on my feet all day expending even more energy by the minute.

I honestly cannot ever recall being taught to eat to fuel my body and meet my daily energy needs – from healthcare professionals and diabetes websites alike. Or perhaps I wasn’t listening carefully enough.

The past month or so has been a bit of a learning curve for me. Let me just say that it is pretty challenging to eat 8,000 kilojoules of quality food every day, and I have slacked a little at keeping tabs on this at times.

Of course, as with anything you make a major change to in life, diabetes management also demands attention and there have been a few tweaks to basal rates. I’ll share more specifics in time. 

But I’m sitting here in the sunshine typing this today, feeling far better than I have in quite some time.

Just Like Federer

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Earlier this month, I watched Roger Federer make his return to tennis after six months off at the Hopman Cup in Perth. At the time, I hardly would have expected him to make it to the Men’s Final of the Australian Open.

His last grand slam title was back in 2012, and he’s now well into his 30s. He was also matched against one of his greatest rivals, Rafael Nadal, against whom he did not have the odds of beating.

Yet last night, I was glued to the edge of my seat as I watched Federer break back his serve in the fifth set, and then earn a break of his own that saw him serve for the match.

It’s pretty remarkable to think that Roger Federer has been playing tennis for as long as I can remember. Although he hasn’t won a grand slam title since Wimbledon 2012, it hasn’t stopped him from continuing to play tennis.

I suppose the same can be said of Venus Williams, who scored runner up in the Women’s Final on Saturday night after a few quiet years. Mirjana Lucic Baroni, who made the Women’s Semi Finals for the first time since 1999! And Rafael Nadal, who is constantly prone to injury, but continues to persevere.

My diabetes management is feeling like a very endless task at the moment. In January, the victories feel like they have been outweighed by frustration. The motivation to diligently attend to self management tasks subsequently disappeared. The care factor has just not been there.

Yet watching some of these seasoned tennis players over the past two weeks has been so inspiring. For many of them, the victories have been far and few. Yet they continue to persevere. Their endurance never wavers. They are passionate, and enjoy what they do.

Unlike these guys, I can’t say that I am passionate about, or enjoy tending to a broken pancreas.

However just like Federer, I am confident that I will persevere to see the victories once again.

Burnout Is In The Air

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Don’t even get me started on those Spring has Sprung statuses…

I’ve been very much burned out these past couple of days. Surprisingly, nothing insulin pump related, either.

The truth is, I’ve had diabetes on the brain these past couple of weeks. I am striving to bring my A1C down by the end of the year. I’ve been stalking my glucose levels around the clock, demanding perfection. Carb counting. Weighing portions. Pre bolusing mealtime insulin. I’ve even heard the words remember to pre bolus escape from under my breath occasionally when I’ve been in the shower. I’m not kidding, either.

Last week, this constant diligence finally caught up with me.

I had two identical mornings, where I woke up slightly out of range on each. On Tuesday morning, my breakfast bolus failed to do it’s job of bringing me back into range. When I woke up slightly out of range again on Wednesday morning, I added another 10g worth of insulin to my identical breakfast, only to end up with an even higher blood sugar level than the day prior.

It got to me. It really got to me. Despite my best efforts, despite the constant monitoring and adjustments, I had still failed myself. Two identical days should be easier to manage, and yet they still produced completely different results. Diabetes is so damn unpredictable.

So I dropped the diligence. I didn’t feel like carb counting. I didn’t feel like weighing portions. I couldn’t be bothered pre bolusing insulin. I ate Croissants and chunky Kit Kats for lunch, because that’s what I felt like. Upward trend arrows on my Libre were compensated for with wild insulin boluses and temporary basal rates. Having access to unlimited glucose monitoring through my FreeStyle Libre sensor definitely made me feel I could get away with this downright shameful behaviour.

What scared me the most, however, was that this behaviour often mirrored my attitude towards diabetes prior to getting the pump. Lazy eating. Guesstimates. Rollercoaster swings in glucose levels. I lacked that sustained motivation. I didn’t really feel very much in control of my diabetes at all.

If this old reality has become “burnout” behaviour today, then I feel I’ve made a great deal of progress in the past couple of months.

A Basket Case?

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I’m sitting here, typing this, with a blood sugar level of 18.8. My FreeStyle Libre graph for the past 8 hours looks absolutely dreadful. I had to override the maximum insulin delivery limits on my pump so that I could give higher insulin boluses, and run higher basal rates to bring my blood sugar levels down.

I feel like crap. I feel ridden with guilt. I feel sick and tired of all the discipline that diabetes involves. I feel like I really don’t give a shit about diabetes today.

Rewind back to yesterday morning, when I woke up to a 9.1. Nothing too terrible, but far enough out of range to make my breakfast bolus less sensitive. Which, despite an added bolus for 10 grams worth of insulin with breakfast, still led to a reading of 15.0 afterwards. Which led to an I-don’t-give-a-shit slice of black forrest cake with lunch. Which led to an I-couldn’t-give-a-flying-f*** about being diligent attitude for the remainder of the day.

Diabetes demands so much discipline. Checking my blood sugar. Counting my carbs. Weighing my portions. Delivering my insulin. Pre bolusing that insulin 30 minutes prior for a optimal post-prandial result. Setting the alarm to check my blood sugar at 2am to ensure that I won’t wake up high the next morning. Foregoing so much temptation, for the sake of better blood sugar levels.

Diabetes already demands so much of me, and yet it never seems to be enough. It never seems to be enough, and that’s where the cracks begin to show. 

Yesterday afternoon, I was curled up in front of the couch with a coffee and an almost-finished (not by me) packet of melting moments biscuits. I had eaten one, and was sitting there staring at the last one in the packet for what must have been 10 or 15 minutes. Should I eat it? Or I should put the packet away?

I eventually ate the second one, and of course watched my blood sugar rise in the aftermath. As I gave corrections that couldn’t quite catch up to my rising blood sugar, I began to murmur to myself “you’ve got problem, mate.” “You need help.”

The funny thing being that if I didn’t have diabetes, this would hardly have been a problem. I would have eaten the second biscuit and enjoyed the hell out of it, instead of feeling guilty. I might have bragged to the next person I saw about eating those two whole biscuits, instead of feeling ashamed. I might have complained about feeling ready for bed after satisfying my stomach, instead of cursing my rising blood sugar levels.

If I didn’t have diabetes, this would hardly have been a problem.

If I didn’t have diabetes, I wouldn’t be talking to myself like I were a basket case because I ate two damn biscuits.

Removed From My Diabetes

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I’m heading back to reality today after a relaxing, yet eventful Easter break, a few too many Lindt bunnies and hot cross buns.

I haven’t easily forgotten the exhaustion I felt towards the end of last year. I’d pushed myself too hard at the time. My mind was in overdrive thinking about all of the things I wanted to get done at once, even though I knew it wasn’t realistic. It also wasn’t realistic to be able to keep going to work day in, day out for months and months on end with no break in sight.

I’m trying to map out my breaks throughout 2016, so that I’ll have something to look forward to. I’m also trying to give myself a bit more time to breathe at the end of the day, reminding myself that all of the things on my list will still be there to do tomorrow.

Hence, a break over Easter, and a break from my blog.

I will also confess to feeling a little ‘removed’ from my diabetes for a few days over the Easter weekend. Diabetes took a bit of a backseat while I was worried about a family member who wasn’t well.

The routine things like testing my blood sugar level after lunch, or getting up to test during the night seemed pointless in comparison to what was going on. There were occasions where I would fail to give my insulin dose straight away. Seeing morning numbers like 10, 12, or even 14 on the meter are usually enough to make me either angry or emotional (or both). Yet they didn’t even upset me in the slightest at the time. In comparison to what was going on, a few high numbers felt like the least of my worries.

For almost six years, I’ve managed diabetes through uni assignments, through working, through celebrations, through burnouts, through birthdays, Christmases and Easters. Yet there’s only ever been one thing that has actually made me abandon my post as the operator of my broken pancreas.

Distress.

I felt removed from my diabetes that weekend. I felt as though my diabetes was miles and miles away from my body. I didn’t want anything to do with it. Rather, I didn’t feel compelled to do the things that I should have been doing. Those things didn’t even seem remotely important at the time.

It was bitter to see someone I loved unwell. But it was sweet to have a break, to get used to the whole not-going-to-work thing, watch movies at lunchtime and watch Autumn set in.

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Bitter-Sweet. Just like diabetes, right?