Night Time

Diabetes Game Plan: 2016 Edition

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New year, new me.

Kidding! Don’t even get me started on those Facebook statuses…

Ever since I’ve had diabetes, my New Year’s resolution has obviously centred around (wait for it) diabetes. Eat well, get my blood sugar levels down, maintain a good hba1c result without too many hypos and exercise. Scrap that last one, who the hell am I kidding here!

If I’m being honest here, I feel that for the better part of the last five years, my diabetes management has sort of stayed the same. I’ve chalked up good hba1c results, but they’re extremely difficult to sustain inbetween endo visits. Making a dedicated effort that delivers those sustained results is also hard, especially when there are a million other things going on in life.

But I want to do better than okay with my diabetes. I’ve already been at it for five, going on six years. That fraction of my life with diabetes is slowly, but surely growing. I want to look after myself. I want to minimise my risk of future complications. I want to remain hypo aware. I want to remain independent, and in control of my diabetes. I want to live a long, and healthy life.

So instead of that overall improvement this year, I’m going to strive for stable overnight glucose levels.

Night times over the past few months have never been such hard work. I can’t remember the last night where I didn’t have to wake up at 1am, test and give a correction shot. My last full night’s sleep seems like a lifetime ago. And mornings where I have woken up in range without minimal effort overnight have been rare occurrences.

I also know that it’s been a long time since I’ve had a full, uninterrupted night’s sleep. It’s been a long time since I’ve woken up feeling refreshed. It’s been a long time since I’ve woken up feeling pleased with my morning number, and have that sentiment echo positively throughout my day.

So, perhaps this is an argument in favour of switching to the pump. However, until that decision is made next month, I still need to manage with Multiple Daily Injections.

So, in 2016, I’m making a resolution to focus on the back end of the day. Say, from 4pm to 10pm – the 6 hour window before I go to sleep for the night. In these 6 hours, I will focus on doing as much as I can to not spoil my overnight glucose levels. Staying away from high fat foods. Satisfying my desire to graze on junk food with something healthy. Being patient when testing and correcting after dinner.

I know that I can do this.

I hope that I will eventually return to a point where I have some confidence that my overnight glucose levels will remain stable.

I hope that I will be able to return to a point of getting a full, uninterrupted night’s sleep more often.

I hope that if I can get those overnight levels within range, I will have one third of a stellar a1c result up my sleeve and a lot more enthusiasm in my mornings.

Defeated In The Darkness

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I could feel the sweat dripping from my forehead. My favourite red checkered cotton pyjama pants were stuck to my thighs, drenched in sweat. My entire upper body was trembling. I felt like I’d woken up from a bad dream that still felt very real in the dark of my bedroom. I pulled off my blankets, which I usually hid underneath to stop myself from freezing in the air conditioning.

The red numbers 12.40 were glowing back at me in the dark of my bedroom early on this Thursday morning. I reached over to flick on the lamp beside my bed. I pulled back the cap on my tube of test strips, grabbed one and feverishly stuck it into my meter. I pricked my finger and navigated it over to the test strip. 2.1 mmol/L. Just the number I wanted to see at 12.40am on a Thursday morning.

I heaved myself up to reach for the bag of marshmallows on the bed head behind me. Too weak to support this upright state, I leant over to one side. My elbow rested on my pillow, supporting my upper body weight. Marshmallows were in hand.

I opened the zip lock bag and pulled the marshmallows, stuck together from the heat, apart. One, two, three, four, five. I mentally counted to myself as I placed them into my hand, knowing my hypo-muddled brain would lose count of how many I’d eaten midway through.

By the time I was down to that last one, I couldn’t even remember eating the other four. I collapsed back onto the bed, relieved as my head sank back onto the pillow. I felt absolutely exhausted, and too weak to move. I reached over for the remote to the air-con, dialling the temperature down a few degrees. I so badly wanted to close my eyes, but knew I had to stay awake and see this hypo through. I turned and faced my bedside lamp, hoping the bright light would keep my weary eyes distracted.

I’ve always felt very in control of my diabetes. Throughout the day, I’ll test as often as I want. Those tests produce numbers. Numbers that give me a sense of security. Numbers that keep me in the know while I’m riding the wave of an unpredictable disease.

But when night comes and my body switches off, I’m forced to give up all control.

Laying there in that moment, paralysed in front of the lamp, I couldn’t help but feel a little defeated by my diabetes.

I roused again at 2.24am, having dozed off in front of the lamp. I switched it off, rolled over and closed my eyes with a sigh of relief.

(And I’m only now realising why my shoulders were aching the following day!)

Nightly 1am Blood Glucose Checks

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I’ve always based my decision to check my glucose levels overnight on how confident I am that they will remain stable. There have been good stretches where I have enjoyed several weeks of stable numbers through the night. And some wonderfully uninterrupted nights of sleep. Then there have also been some terrible stretches, where I have had absolutely no confidence in my glucose levels whatsoever. Which pretty much sums up the past couple of weeks for me.

I’ve been stuck in a bit of a rut these past couple of weeks. It probably started with a few days of less than perfect food choices. It would have been followed by a couple of days of less than ideal, and even harder to control, numbers. It has resulted in a lack of energy, and some unhealthy habits on my part. Like some late nights, and some extremely long weekend sleep ins. And the longer I’ve let this go on, the harder it has been for me to pick myself up and begin to climb out of this rut.

There is one thing I have done differently during this rut, however. I have taken ownership for the consequences of my unhealthy behaviour these past couple of weeks. That consequence is getting up at 1am every night to test my glucose levels. I’ve dialled up my Lantus dose to cover the added stress, fat and carbs consumed. But I’ve never really felt certain whether my glucose levels will settle, or spike again after I go to bed (mostly the latter).

There’s no worse feeling than waking up to something like 15. Or even worse, 20. It puts a huge damper on the quality of my day, and the people I interact with. I hate thinking about the fact that my glucose levels have been sitting at those crazy high levels for the better part of 8 hours. I am ridden with guilt when I think about how irresponsible I’ve been, and of all the damage that I’ve done to my body.

During this rut, I’ve managed to catch a lot of those highs at 1am and bring them back down within range by morning. I’m quite proud of that. Having control over those night time numbers has slowly restored some of my diabetes motivation. Gradually I’m getting back into my healthier habits, and my insulin requirements seem to be getting back to normal once again.

By the time I went to bed on Sunday night, I finally felt confident that my glucose levels would not rise through the night. What I did not anticipate, however, was going hypo at 1.30am. But I will still take it as a win. I just need to drop my Lantus dose a tad more, and I should be good to go once again.

Hopefully ready for the start of another good stretch.

The Diabetes Translation of “Good Thanks.”

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“Hi, how are you today?” Is what I’ll be asked the minute I walk into work this morning.

And “Haha, no too bad thanks.” Is my boring, stock standard reply that I seem to give every other day.

However, the diabetes translation of these words actually goes something like this:

Well, I wanted to have an early night yesterday. My blood sugar level was a perfect 5.3 at 9.42pm. I so badly wanted to go to bed and not think about numbers for 8 whole hours. But I couldn’t. That’s just one of the realities of having diabetes. I can do so, sometimes. But at the moment, I just can’t. I have absolutely no confidence in my night time glucose levels at the moment, which means that I can’t treat myself to a whole uninterrupted night’s sleep. I had to set my alarm last night, so that I could test my blood sugar levels during the night just to make sure.

I was startled awake at 12.30am by my favourite blaring noise that came from the alarm clock on my iPhone. My blood sugar level was another perfect 4.7, and I was able to quickly go back to sleep.

I woke up again at 2.11am, feeling a little shaky. I wanted so badly to ignore it, and drift back off to sleep. I could not be bothered opening my eyes and turning on the bright light of my bedside lamp in order to test. But I had to. I activated one of my diabetes superpowers and forced myself awake. Another perfect 4.5. I was convinced I was hypo, and had to test again just to be sure. Nope, it was 4.7. And with that, I was able to drift back off to sleep again.

I woke up next at 3.54am, feeling shaky once again. This time I was 3.1. I had to work out how many marshmallows I would treat my hypo with, and carefully measure them out onto the palm of my hand. If I don’t do this, my hypo-hangry brain will completely forget how many I’ve eaten once I start.

For the fourth time that night, I had to drift back off to sleep. And for the fourth time that night I was woken up, this time by my 5.50am morning alarm.

So, all in all, I had a crap night.

That’s what “not too bad thanks” really means, if I were to answer your question truthfully today.

Night Time Blood Glucose Monitoring Mishaps

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It was 10pm on Tuesday night, and I was getting ready to go to bed. We had Pasta for dinner, a family favourite in our house. Pasta usually produces really good blood sugar levels by bedtime. However, being a low glycemic index food, Pasta also tends to have somewhat of a delayed effect on my glucose levels. Once I fall asleep and the majority of my rapid acting insulin wears off, my blood sugar levels tend to creep up. And I’ll wake up the next morning with something crazy like 15.

I was a perfect 7.3 at bedtime that night, but I wasn’t confident that my blood sugar levels would settle there. So I decided to set the alarm on my phone for 12.50am, so that I could test and correct later on. I turned out the light, and went to sleep.

The next thing I knew, I began to stir as my Dad came and opened the door to my room. I could see light streaming in from behind the closed vertical blinds, and the clock on the side of my bed read 6.38am. I was convinced it was Saturday. I was still lying in bed at 6.38 in the morning because it was Saturday. Until Dad asked me if I was going to work that morning. And I realised that it was, in fact, Wednesday.

What the hell had happened? My mind was foggy, and for the life of me I couldn’t even remember hearing the alarm go off. Which was unusual. I hate my alarm. It’s one of those awful buzzer-like sounds that startles me awake in the morning. It’s so startling on a sleepy brain that I usually scramble to silence it each morning. But I also love it for the fact that it has never failed me. Until now.

I didn’t even hear that alarm go off at 12.50am. Well, at least I couldn’t remember hearing that alarm go off at 12.50am. As I tried to put the pieces together, the only reasonable explanation that I could come up with was that I had hit snooze at 12.50am. And in doing so, I hadn’t been able to re-set the alarm for the morning.

I angrily got up out of bed to test my blood sugar. I knew it would be high, but I was hoping for a miracle. The last thing I wanted to deal with that morning was a high blood sugar and the shitty mood that would inevitably go with it. But, as expected, diabetes gave me a lovely 15.6.

I furiously threw the covers on top of the bed and got dressed. I began swearing, and throwing every curse word I could think of at diabetes. I jabbed in 8 units of insulin. A couple of units to cover my usual morning requirements, and a couple to combat that stubborn 15 that I’d been sitting at for the past 8 hours.

I was so furious with myself that I decided I would go straight to work. I didn’t deserve breakfast with such a high blood sugar level. I didn’t deserve that coffee that I so enjoy relishing in the morning either. And the last thing I wanted was to go into work later and let diabetes take my afternoon away from me.

I clocked on at work at 6.58am, just in the nick of time.

And I added a second alarm to my iPhone, to ensure that this would never happen again.