Insulin

Dear Pancreas

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Dear Pancreas,

Congratulations. You’ve officially been in retirement for eight years today. I hope you’ve enjoyed the seemingly endless stretch of long sleep ins and lazy, effortless days.

If there’s one organ in the human body that I’ve truly come to appreciate since you clocked off for the last time eight years ago, it would have to be you.

You were able to produce just the right amount of insulin for the carbohydrates that I sent your way, and convert those carbs into energy for me to use through the day.

You were able to respond to all of the crazy factors that affected my blood sugars. Things like pizza nights, illness, stress, physical activity and even how well I slept last night!

You were able to produce just the right amount of insulin so that my blood sugar didn’t peak too high, but also didn’t drop dangerously low. You never had to chase the unicorns.

I honestly don’t know how you did that gig all by yourself for 17 years. You didn’t have any resources at your disposal. You didn’t have any healthcare professionals to guide you. You didn’t even have any friends to support you. Yet you never once complained.

Being a pancreas is in no way normal. There’s no one else quite like you. The nature of your job can feel rather isolating. Yet you held your head up high. You stood tall. You never once showed a single shred of emotion. You never burned out.

You’ve definitely pushed me far from my comfort zone. I’ve met new people, I’ve visited new places. Your retirement has definitely instilled a great deal more confidence in me than I’d ever once imagined.

Dare I say I’ve taken quite an interest in you. I read about you. I talk about you. I write about you, frequently. I’ve even dedicated a whole blog to your demise. Some might say I’m obsessed with you.

You’ve left me with tonnes of additional duties since you departed the office eight years ago. I’m ashamed to admit that I don’t do the job half as well as you once did. I have to do the job of a human being as well, you know. I do try my best, you know, but somehow I don’t think I’ll ever be able to fill your shoes.

So, in case you had forgotten, today also happens to be my eighth diaversary. I’m not sure if you’ve been out shopping yet, but if you wanted to get me something really nice to mark the occasion, you could simply get up off the couch and come out of retirement.

I know I can’t offer you much, but I promise to feed you, take care of you and provide a roof over your head. I’ll never for a second take your job for granted again.

So, what do you say?

With all my love,

Frank

Insulin Gone Bad.

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I couldn’t help but notice the reading of 14.1. Is that high? My friend asked me from across the table as I was demonstrating my FreeStyle Libre.

Yeah, I obviously haven’t given enough insulin for the banana bread, I replied, pulling my pump out of my pocket and bolusing for another 30 grams of carbs ever so casually.

I had already bolused a very generous 60 grams of carbs for the slice of banana bread and iced coffee I had ordered at the local cafe, but I wasn’t overly surprised to see the upward trend arrow on my Libre.

My blood sugar was still skyrocketing by the time I arrived home an hour later, with my Libre clocking in at a lovely 17.4. I bolused for another 10g of carbs, bringing the total for my mid morning coffee catch up to an overly generous 100g of carbs. I was certain that all of this insulin was bound to kick in any minute now.

After another hour had passed and my Libre clocked in at 25, I had figured that banana bread was the devil. After a prick of the finger came in at 20.4, I ignored all insulin I had on board and gave a full 4 unit correction. I also set a temporary basal rate of 100% to help get things moving in the right direction.

After a bucketful of insulin, my blood sugars slowly but surely began moving in the right direction over the course of the afternoon.

When dinner time rolled around and I was back in range, I bolused for the 50 grams of carbs on my plate. I drank a glass of water. I stepped outside and turned the sprinklers on. I washed some strawberries that I planned on having post dinner. I drank yet another glass of water. I stepped outside again, and switched the reticulation off. After distracting myself for a good 20 minutes or so for the bolus to kick in, I finally tucked into my dinner with the hope of avoiding another blood sugar rollercoaster.

Fast forward to me in front of the television 2 hours later, and my blood sugar clocked in at 16.1 with an upward trend arrow on my Libre.

I scrolled back through my pump history, noting that my last prime was four and a half days ago. As I swapped out the infusion site, my brain began to cotton on to other moments of particularly difficult-to-manage post meal blood sugars in recent days.

The lone milky coffee that sent my blood sugar upwards of 10. The hot cross bun that I’d carefully pre bolused for, but landed me close to 20. Rising blood sugars, despite a long walk fuelled by 10g of chocolate beforehand. Even a pasta meal had been extremely difficult to manage.

As I connected all of these recent occurrences together, I eventually recalled another occurrence of skyrocketing levels when my insulin had spoiled 2 years ago.

My insulin had spoiled! There was my answer! 

So, maybe Banana bread wasn’t the devil after all.

Learning to Fuel My Body with Type 1 Diabetes.

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Trying to stick to a diet of 8,000 kilojoules a day is hard work.

I know that when I do eat enough to sufficiently fuel my very active body, I don’t feel lousy, exhale air or yawn half as often as I’m used to. I have more energy, focus and enthusiasm to pour into my day. In fact, I’m so focussed on getting those kilojoules into my body that I don’t think think about chocolate or even coffee half as often (no, I am not kidding).

I also know that this 8,000 kilojoules a day business is hard work (have I said that already?). Organising meals and snacks takes time out of my day, even though I am more than capable in the kitchen. It’s been very easy for me to slip back into my old habits of existing on rabbit food until dinner time when I haven’t organised myself in the mornings.

I embarked on this new eating-to-fuel-my-body kick at the end of February, rebounded for some part of March after I got sick and the Cadbury Choc Chip Hot Cross Buns kicked in, and am only just getting back on track in the past week or so.

I first learned about eating to meet my daily energy needs after reading The CSIRO Total Wellbeing Diet and The CSIRO Low Carb Diet last year. Despite it all making perfect sense, putting kilojoule counting into practice on top of carb counting, checking blood sugars and all of those other diabetes tasks felt extremely overwhelming. Thankfully, the smartphone app My Fitness Pal made tracking my kilojoule intake really easy.

The biggest change since I’ve began eating more is increased insulin sensitivity. Which I guess is a good thing, right? It started with unusually easy to manage blood sugars in the evenings after dinner. I would then wake up low during the night, have a glucose tab or two, only to wake up low again a few hours later. Fun times, right?

I’ve dropped my basal rates by about 10% overall, and so far, so good. My biggest challenge is continuing to eat this way so that I can maintain the same sensitivity to insulin.

I’m not really focussed on skewing a particular way with protein, fat or carbohydrate, but do find myself eating more protein than I was before. At the moment I’m honestly just focussing on eating enough, eating well and getting a balance of everything in there.

I find myself eating more significant meals for breakfast and lunch, rather than a slice of toast or a toasted ham and cheese sandwich. Like this amazing Sunday roast of pistachio stuffed chicken breast wrapped in prosciutto that has doubled as Monday lunch.

I embarked on this way of eating for more physical reasons, but the benefits seem to have extended into my diabetes as well.

I have more energy and focus in the short term, and I’m hoping that this will only replicate further in the long run (if I can keep it up!). The increased insulin sensitivity is making blood sugar levels much easier to manage. In the past I’d correct stubborn highs with little or no effect, and override the suggested correction on my pump with a larger bolus. Now, a correction seems far more effective than before.

I get that balancing food and blood sugar levels is no easy feat, but I don’t think I ever truly appreciated just why it is so important to eat.

Four Foods I Cannot Bolus For To Save My Life

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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.

Diabetes at 3.14am

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I stirred in my sleep, registering the blaring red 3.14 on the clock radio beside my bed. Pulling my left arm out from under the covers, I fumbled around for the switch at the base of my bedside lamp. When my desk was finally illuminated in cosy warm white light, I heaved the remainder of my body up from the bed, reaching for my meter and test strips.

This certainly wasn’t the number that I was expecting to see, considering the full 2 unit correction that I had given prior to bedtime for a 10.7. (And in case you’re wondering, I’m only using the OneTouch Verio to deplete my final box of strips…)

I immediately ripped my pump away from it’s resting place inside my inner left pocket, and gave another full correction of 3.3 units for that very uncomfortable number. My frustration was only further fuelling my actions, as I set a 50% basal rate increase for the next two hours on my pump to ensure that this correction insulin did its job.

As I flicked off the lamp and rested my body back onto my bed, I couldn’t get back to sleep. I could feel the heat emulating from my pillow, and flipped it over to the cool side. My whole body felt stuffy, presumably a consequence of the higher blood sugar.

As I lay there, tossing and turning, my mind was quickly consumed with guilt.

I wasn’t happy that it had taken me this long into the night to finally stir in my sleep and check my damn blood sugar. I felt terrible for the fact that I had been sitting there, at that very uncomfortable level, for the better part of five hours. I felt frustration, because a mere two weeks ago I was super insulin sensitive and today I feel like I’m not getting enough.

Second guessing my prior decision in the darkness, I reached for my pump and lowered that 50% temporary basal rate to 30% before clipping it back inside my pants pocket.

Trying to purge those thoughts from my mind, I began thinking about all of the positive things that I am doing in managing my diabetes, reminding myself that numbers like those are isolated occurences nowadays.

If this had happened in the middle of the day, I’d have corrected the high without giving it a second thought. But laying there in the middle of the night with nothing else on my mind to worry about, was a completely different story.

By the time I woke up on a grey Sunday morning, last night’s occurrences felt like nothing more than a dream.