Here's the thing people don't get. There is a lot that goes into daily d-management, especially if you're trying really hard to reach or maintain a specific a1c.
This morning I woke up at 7.8. Awesome. I am happy with that number, given last night (late-night snack, so I was worried about staying stable overnight and was conservative with my insulin dosing for that snack. Went from 5.6 before bed to 7.8 in the morning? I'm ok with that. Better than going low).
Took 3 units of Humalog at 6:30am: 2 for the 2 coffees that I planned to drink, and 1 more because while 7.8 is an ok # to have greeting me in the morning, I would like to be lower than that during the day.
Fast-forward to work. In by 7:30, start snacking on breakfast while I work at 7:40. 198 g of strawberries have about 11g of carbs. Breakfast oatmeal is 42g carbs, and the soy milk I added to the oatmeal would be about 8 (I didn't really measure), bringing me up to a total of around 61. Breakfast ratio is 1:12, which gives me 5 more units of Humalog. I also take my Levemir now, so by 7:40am we're at 3 injections and one finger-stick. oy.
I'm pretty thrilled with my 2-hour post-meal # of 5.8, and later (around 11:15) I start thinking about lunch. I brought a delicious-looking salad of kale, cabbage-y bits, pumpkin seeds, and dried cranberries. I checked the bag (it's a pre-mixed salad... I'm not creative enough to mix something like this on my own) before I left for work, but a) the nutritional info included the dressing, which I had to swap out for a different one from my fridge (which might make the carb info no longer accurate) and b) I forgot what the # was anyways. On to the internet I go!
I use an app that I've found to be pretty good in situations like this: it's called FatSecret, and it's meant as a weight-loss tool and activity tracker. I've found that its database includes nutritional info for a lot of foods, and I really like being able to pull up a specific brand of product that I'm eating. If I type "sweet Kale salad" into the Search bar, it pulls up the same salad brand as the one I bought, and allows me to customize the amount and re-calculates revised nutritional info for me based on the amount that I specify. With this, I learn that my salad is about 22g of carbs (probably mostly from the dried cranberries!).
I've also got some carrots and dip here in the fridge at work, and I plan to snack on some of those at lunchtime too. I use the same app to figure out carbs(ish) for approx how many carrots / how much dip I'm going to eat. This part of my meal calculation is probably not all that accurate, but I take a guess and hope that my bg will be ok in the afternoon.
At this point I'm torn. My carb count puts me at needing 3.5 units, so I wait til my pre-meal check to decide whether to round up or down.
Noon rolls around and I'm 5.6. Blast! I was hoping I'd be a little too high (or a little too low) to make the rounding decision easier. I decide to round down to 3, and figure that if I'm higher than I'd like by 2pm I'll fix it then. Going slightly high beats being low at work. 3 units of Humalog at noon, then I sit patiently and wait about 15 minutes before chowing down.
As I wait for those 15 minutes to pass, I decide to head over to the bathroom. To get there I have to leave my office, exit my side of the floor through the pass-protected doors, and walk across the bridge that connects the east and west sides of the building. I spend this walk alternating between scratching and putting pressure on the place on my stomach where I gave my Humalog. It was a bit closer to my bellybutton than I normally inject, and it's starting to feel like it's going to bruise. I pause to wonder whether other people working on my floor find it odd that I sometimes wander around with one hand putting pressure on a spot on my stomach (or my side, or my arm... not my butt, though. Not at work, anyways).
I was right, by the way. Tiny bruise from that injection site :(.
After 15 minutes, it's time for lunch! When it comes time for my 2-hour post-lunch check, I'm almost excited. Not only have sugars been great all day, but I also have been taking notes all day so I can accurately post it here. I don't usually keep track of all of my d-stuff in such a detailed way.... My excitement is pretty short-lived though. I check, I mark in my meter that this is a post-meal check, and...3.3.
What the...? That is unexpected. I really wasn't expecting that. For starters, I haven't noticed any symptoms, and also...I rounded down! As usual, I start running through the possible explanations in my head:
- Maybe the "22g carbs" in my salad were mostly from the dressing, which I swapped out for a different one, so the new one might have had fewer carbs?
- Maybe this is one of those prolonged-low things that can happen the day after exercise
- Maybe this is my interrupted sleep last night (it was painful..I slept for maybe 3.5 hours total last night) coming back to mess with me
Whatever it is, it needs to be fixed. The two apples on my desk are sitting there next to the jar of watermelon-flavoured Dex tabs, and honestly apples seem like the better option (plus the dex tabs are a new jar! I don't want to open a new jar...). I head to the kitchenette area at work with my apple, wash, slice, and return to my desk. Munch munch munch. My apple has about 16g of carbs that are far, far tastier than any glucose tabs could ever be.
I start to wonder if I should have dipped some of my apple slices in the peanut butter I have here. I know protein needs to accompany a treatment for lows, as it helps to prevent the low from returning. I'm already done my apple though - could I get away with eating peanut butter on a spoon at work? How awkward would it be if someone came to my desk in the middle of that? On the other hand, it's almost time to go home, and I get incredibly carsick when I'm low. That settles it. I hate feeling like I'm one speedbump away from hurling all over a public bus, sooo... check around, see no one approaching, and BAM! Super sneaky...eating spoon-peanut-butter.
Sometimes I wonder if other diabetics go through similar thought processes when put in similar situations. I surely can't be the only person who's ever sat at a desk in an office wondering if they can (super stealthily) get away with eating some protein in a way that would look super weird if someone walked in.
15-minute check says that I'm 5.4, so I'm in the clear for now.
All of these thoughts that have been
going running bulldozing through my head today are pretty standard - and today has been a pretty good day! The days where I wake up high or low and can't seem to get things under control, no matter how hard I try? Or the days where the persistent highs kill my appetite and leave me feeling nauseous all day? Or the days where lows give me a brain fog that lasts all frigging day? Diabetes is much more prominent in my thoughts and actions on days like that. Some days it's almost all I think about, because the way my body feels won't let me think about anything else.
A few months ago my brother came over to my place. This was not too long after my November issue with the super-crazy-won't-go-away high sugar that had me visiting the ER. I also had made a poster back in September when I got my Best a1c Ever (so far) back from my endo's office. The poster was just a sheet of flipchart paper that said YOUR A1C IS ___%, in really big colourful letters. I stuck it up on the wall in the staircase so I'd see it every morning and remember that trying hard does result in better numbers, even if trying really hard is, itself, really hard sometimes. When my brother was over, he sort of gestured at my poster and asked, in a trying-to-be-casual sort of tone, what had happened earlier in the month. He said he had seen my facebook pic (I was pretty excited about that a1c. Had to share it...) and said "I thought you said things were going really well. I was surprised when Mom told me what happened...", with his voice sort of trailing off towards the end.
The thing is that trying really hard, and having a 3-month average that meets your expectations doesn't necessarily mean that everything is ok. There are still high and low points; that can be (at best) annoying or (at worst) terrifying, exhausting, or life-threatening.
This has been a long post. I guess there's a lot that I wish the people around me understood about life with diabetes...like how diabetes is really, really, really all the time. I don't just mean that it's present 100% of the time, but that it's also something that takes up a lot of energy and thought every single day. I wish that was easier to explain to people.