31
Jan

I did this to myself

I know I have no right to complain.
My site was on day 4, and as an upper-butt-cheek-infusion-set, it has seen quite a bit of wear over the last 4 days.

My 6-day-lifespan sensor was restarted and was on day 8.
I postponed changing my site and sensor last night. "It's wasteful to change a site when I still have a half-day of insulin left."   "The infusion set doesn't even hurt that much. I'll just sleep on my other side again tonight."     "That sensor worked so well for its first round! It will be fine for a few more days."
The lies we tell ourselves to justify not having to change a site. Not having to feel that jab, twice, as two devices are inserted for 3- and 6- day spans (or 5 and 10, if you tend to stretch out your supplies like I do). All of this led to me sitting at work this morning with a splitting headache and a thirst like you wouldn't believe (I'm at almost 2L of water so far. Been at work for just over 2 hours). Cal reminder alarm prompted me to check my BG and to be quite honest, I probably wouldn't have bothered if not for that alarm. My cgm had me at 8.4 and dropping, so I wasn't worried.
Still, though. I should calibrate.

Fingerstick, 18.6 (335 mg/dL).
Well, then.
Working on a set change with this kind of headache is challenging. I rip open an alcohol swab, then stop. Squint. Rub my aching temples. What was I doing? Oh, right. Syringe, wipe top of insulin bottle. Use now-disconnected pump to calculate the correction dose. Deliver correction.
Another alcohol swab. What was this one for? Wipe top of insulin bottle, feeling vaguely like I've already done this. Think back, pushing through the throbbing haze of red that clouds my head and makes coherent thought a distant memory. Aha! Yes, I did do this.
Do it again. Change infusion set. Charge transmitter. Replace sensor. Look at the mess of medical waste and wonder why I didn't do this yesterday.

Looks like I have some tidying to do...

4
Nov

13? Balderdash, says I!

Welcome, ladies and gents. It is November 4th, meaning that we are 4 day in to Diabetes Month.
For today, I would like to give you a glimpse into the frustration that comes along with this big ball of autoimmune-related shit called Diabetes.
Ketones start spilling out into urine at a BG of 13 mmol/L. This is a well-documented fact, check the American Diabetes Association or similar sites to confirm. 
So why, then, does a BG like this:

CGM reading of 12.8

CGM this morning


Confirmed via fingerstick:

BG meter value of 12.3

BG via meter


Produce ketones that look like THIS:?!

Ketone stick measuring high ketones

PURPLE ketone stick


Please excuse me, I'll be spending the rest of the day suppressing the urge to scream while mindlessly beating my head against a wall out of frustration.

16
Oct

Fun math problem!

It's 2am. You have had 6 drinks over the past 6 hours. 

You have had a 70% temp basal set for the past 3 hours. It is scheduled to continue for 8 more hours.

Your current BG is 10.0. 

Your cgm says 9.6 with a straight-ish line, so it's not too far off. 


You have 0.3 units of active insulin on board. Your pump recommends an additional 0.9 units to treat the high bg.
You are a 40 minute drive away from the people who know how to help if things go south. The alcohol makes you much more sensitive to insulin than you usually are.

If you wake up with a BG above 12, your hangover will be magnified and you likely won't be able to make the drive home tomorrow.  If you go below 5, your cgm will wake up half the cabin.
What do you do?

7
Oct

Some things are best left unsaid

Dear Husband,
I know you are sick. You have been fighting game a sinus cold for days, and it seems truly miserable.  You're stuffed up, your head hurts, and when I turn on a light in the middle of the night, the brightness stuns you and makes your blinding headache that much worse.
I know all of this. I promise, I really do.

Thing is, with a blood sugar of above 33... at this moment in time, I am sick too.*
My head hurts. My stomach hurts. I am thirsty as fck but if I give in and chug back a ton of water, I know I will throw up from overdoing it on fluids. I can't have NO fluids though, since dehydration makes insulin work less efficiently, and I reeeeally want my insulin to work as well as possible right now.

I did a middle-of-the-night infusion set change, since the site I started before dinner seems like it's not working. My whole body feels puffy and swollen from drinking liters of water over the last few hours. I promise, you are not the only one who feels sick.
Yours is a special, acute kind of Sick though. You feel terrible now, whereas my type of sick is a chronic slow burn that spikes every so often, then goes back to lurking in the background.
I really am sorry for waking you up with my lights and beeping and swearing. I hope you feel better soon, love. And I really, truly do understand: it sucks to feel sick.

*The manufacturer for.my meter says that HI readings occur with a bg above 600mg/dl or 33.3 mmol/L. 

Glucometer manual here, if you feel like some light reading 

18
May

Telling an edited version of the story

I realized something slightly ridiculous today.

 

I told a lie about why I ended up waking up with a high BG this morning. I was out with a group of friends, but the migrane that's been edging in since I first woke up was getting louder and angrier by the minute. I spoke to the hostess to politely excuse myself so I could go home to sit in a very quiet room with the lights dimmed, and this kind, wonderful friend of mine asked what was up.

 

I told her, as well as her parents who had just arrived to the soiree, that I woke up with a high blood sugar and a splitting headache and it's been getting worse all day. I then shrugged. It must have been a kinked pump cannula or something, I explained. That's definitely why I woke up high.

 

It's not, though. I was 4.3 with 1.5 units of insulin on board when I checked before bed. I'd just started a new cgm and was still in the 2-hour warm-up period, so I had no cgm graph to indicate whether I was stable or dropping. I was uncomfortable going to bed at that number with insulin still on board, so I chugged back a juice box before brushing my teeth and going to bed.

 

I was, in case you can't tell where this is going, very mistaken about the effects of my on-board insulin. I woke up at 14 -- by far not the worst blood sugar I've ever seen upon waking up, but still high enough to give me the headachey, fuzzy-mouthed irritability that comes with a few solid hours of high BGs.

 

The part that's truly baffling though, is why did I lie? I'm positive my friend could not give less of a shit about the finer details. Why not just admit that I was scared of going low overnight, so I overreacted? There would be no judgement from this friend; no chastising me for not waiting it out or setting an alarm to check overnight. No finger-wagging or tsk-tsk-tsking at how I jumped the gun and treated a low that hadn't happened yet.

 

I know my actions weren't ideal. I think my reasons (fear of going low) are perfectly reasonable, but still I obviously overtreated. Why did I hide that information? Why treat it like I have something to hide?

6
May

Still figuring out the exercise thing

I think I found one of the most uncomfortable feelings basically ever - or in the top 10 at least. It starts with a high blood sugar, but not too high - something around 13 or just over.

13, by the way, is high enough for your body to start producing ketones. Did you know this? I did not remember this. Could happen though. Differs for everyone, but it's still possible.

So let me get back to the least comfortable feeling ever. That feeling when you exercise and in order to exercise you set a lower temp basal so you can exercise safely, but then following your exercise, you spike because your temp basal was probably a little overkill. That's okay though, right? Better safe than sorry. Having BG sitting a bit higher, maybe 12-13, post-exercise is certainly preferable to mid-exercise lows.  (For me, anyways. Lows while I'm fighting traffic on my bike would be mildly unpleasant, probably.)

That post-exercise spike leaves you sitting at 13. You wait to correct the 13 because you're grocery shopping and picking up things for dinner, only by the time you get home your blood sugar of 13 has turned into 13 with  large fucking ketones.

And dinner? Forget dinner. Instead of dinner, you get to be thirsty as fuck while simultaneously fighting the urge to hurl back up all of the water you just chugged.  Fighting rather unsuccessfully, I might add.

Add to all of this the incredibly defeating feeling of failing at exercise, failing at diabetes, and the infuriating helplessness of the fact that THIS. IS. NOT. FAIR.

THAT, ladies and gentleman, makes my top 10 for most uncomfortable way to spend my Friday night.

24
Nov

A quick update

November has been a busy month. Other than being Diabetes Month and having the online world be filled with World Diabetes Day-related posts and messages, that is!

In brief, a bit of what's going on:

  • How I spent about WDD: Driving! I travelled about 5hrs to visit family in a whirlwind trip that had me leave home Saturday morning and return Sunday night. I had never before taken a solo road trip that involved that many consecutive hours of driving, and on top of this I absolutely loathe long car trips, so I was more than a bit anxious to see how this would play out. Careful BG monitoring and CGM usage throughout helped to keep me in a safe range while driving, so that worked out nicely!

The only time over the entire weekend when I struggled with BGs was during my actual visit. I love my extended family dearly and was quite glad to see them (this was a last trip before they move farther than I'll be able to travel to see them), but the stress of family took all of my normal reactions to food/insulin and just about tripled them. I had multiple lows which, when treated appropriately (15-20g of carbs, wait 15 agonizingly slow and painful minutes), resulted in a super-spike. I chased the roller coaster for the entirety of my time spent with family (boo).

  • Also on WDD: I received a fun message from the company that hosts me here at deveryday. A whole mess that I couldn't deal with without my laptop resulted in deveryday being down for a couple of days, and now that we're back up and running, I need to work on restoring everything I've posted since September. It seems my fix has sucked the last 2 months' worth of posts into the void.
  • Some reading: Lately I've been finding myself flipping through Ginger Vieira's book. More on this later, but for now I'm finding it to be an enjoyable read.
2
Jun

When health stuff is all I've got going on

Sometimes I feel like diabetes doesn't leave me with very much left to work with. When I ask someone how their weekend went and in return they ask me the same, I sometimes struggle to come up with a description for my days that doesn't revolve around diabetes. I have entire days where all I can remember is the thirsty, bloaty, exhaustion-filled highs that wouldn't come down or the trembling, sweaty lows that shake me to my core.

 

I know that life isn't all about taking care of diabetes. Health and disease management should only be one part of a complete and balanced life. It makes me wonder, at times, what has to give in order to find that balance. Do you give up on tight BG control in order to gain back some flexibility in life? Or give up some of life in order to achieve a better A1C? The bums-me-out-that-it's-one-or-the-other thing aside, I feel right now as though I'm erring on the side of better BGs, and as a consequence I'm missing out on other things.

 

I need to figure out how to fix that. Until I get to that, you can find me working on some solid non-diabetes-related lies to tell people when they ask about my weekends.

 

7
Apr

Ketones and thoughts about lows

About two weeks ago I had an interesting experience with DKA.

 

I went to bed as usual, but woke up around 1:30 to go to the bathroom. I noticed my mough felt fuzzy, dry, and cracked, and (sorry: TMI moment coming up) peeing... hurt. This raised some alarm bells for me, since normally it isn't uncomfortable to pee.  I briefly panicked and wondered if this was the first symptom of a UTI. I've read several articles that discuss how UTIs are more likely to occur in people, specifically women, with diabetes, so given my symptoms, that was one of the first things I suspected.

 

I checked my bg and found that I was suuuuper high. The bathroom discomfort prompted me to check for ketones which, I discovered, were present in my  body in HUGE quantities.

 

I quietly wondered: Is it supposed to hurt to pee out ketones? <<file away under the "Google this later" category>>

 

 

I feel very lucky to have access to the healthcare team that I've got. When I realized I had ketones, I gave a correction bolus for how high I was and called my hospital. They directed me to the endocrinologist on call (since it was the middle of the friggin night), who called me a few minutes later to discuss what was going on. I explained the situation, and described how I don't usually have ketones, so I wasn't really sure what to do. Should I give extra insulin for the ketones? What if that extra insulin made me go low? Could I still go to bed with extra ketone-fighting insulin on board?

 

My worry was that if I gave the extra insulin that's normally required to treat high ketones, it would actually be too much, and in the morning I simply wouldn't wake up. I explained this to the doctor.

 

 

I don't think that anyone with diabetes has it easy, but I am pretty fortunate in that I am able to, with the usual loss of sleep and consultation with a medical team, tighten up my overnight insulin (basal rates) so that my blood sugars stay pretty stable overnight. This tends to change a few times a year, or when I experience extra stress, but for the most part I only tend to do a HUGE basal-rate-overhaul maybe 3 or 4 times per year. I only mention this to explain that when I go to bed, with basal rates that usually work for me and with the added benefit of my cgm, I don't always worry about whether I'll wake up in the morning. This night, I worried.

 

 

This story doesn't have a very interesting ending. I corresponded hourly with the on-call doctor, who gave me instructions for insulin and water consumption, and had me report on blood sugars and ketone levels until everything was back in range. I admit I did still wake up low, but it was a "mild" low ("mild" as opposed to "my glucose-starved brain is pretty sure I'm going to die, BUT maybe I can stave off death if I eat everything in the fridge"). I think I woke up at around 3.8, which for me is still a BG from which I can wake up. Low 3s or below means I won't wake up.

 

Looking back, it feels almost strange to think that at 3.8 I can accept that I woke up low but it was ok, whereas a 3.2 would probably have had me unconscious and missing my alarms, laying in bed until Boyfriend (or BFF) noticed something was wrong and gently nudged me, repeatedly, all the while shoving a ready-to-drink juicebox in my face and hoping I wouldn't throw it at him(/her) or drip the whole thing over a pillowcase (I've never done that while low... I swear.).

 

0.6 mmol/l (or around 10 mg/dl) can make the difference between waking up and not. I'm really not trying to be over-dramatic...just stating a fact.

 

It's weird to think of your own mortality. Some nights (some mornings...some days) I think I get closer to death than most. I guess one of the sad things is that you sort of get used to it over time.

 

 

4
Apr

When life gets in the way...

Lately things at home have been pretty hectic.

- We adopted two rabbits. They're adorable and precious, but litterbox-training baby rabbits is not an easy task. It involves a lot of urine-soaked newspaper...

- The dog got an eye infection. Then an ear infection. The the other ear...infected.

- He passed it on to the rabbit (so all 3 pets [2 rabbits; 1 dog] had to be separated, and one dog & one rabbit ended up on antibiotics)

- The dog then scratched his cornea and developed an ulcer in his eye. He's on meds every 3-4 hours over a two-week period, and for now he's stuck wearing his cone 🙁

- My lovely and wonderful best friend is getting married in a little over two months, and as her MOH I've been honoured and delighted to start planning a bridal shower and bachelorette. Also, wrangling friends and family members into planning sessions and coordinating details has, on occasion, left me just the teensiest bit frantic. Even more than that is the ridiculous idea that I need to pretend that I've got a solid handle on everything that's going on --  I'm not sure where this compulsive need to fake it is coming from, but the cool calm exterior that is presented (when in fact I'm tearing out my hair or panicking over details) to others involved in planning is proving a bit draining to maintain.

- Work has been insane. Like, insaaaane. I have, through the sheer luck of being the person who sits next to my group's manager, been tasked with updating some of our systems and processes on top of my regular work duties. It's been fun and challenging, and I've definitely been learning a lot as I go, but I admit it's been a uniquely challenging project.

- My elbow has been acting up. I'm on a waitlist for surgery on my ulnar nerve (that's the one that runs through two bones in your elbow), but I've got about another 6 months to wait, possibly longer. My symptoms have been ramping up over the last two weeks, leaving me trying to balance managing pain with my desire to actually use my hand. More on that later, but to sum it up, it's been making itself increasingly noticeable over the past little while, and nerve-blocking meds are no longer helping.

 

It feels very strange to look back over the last few weeks. Diabetes has actually taken a backseat to the drama of everyday life, and this feels very...strange. My Carelink reports show that I'm trending higher than I'd like, and to be completely honest I haven't done much about it. I know I have an upcoming endo appointment in about a week, and I know she'll make recommendations for changes in my basal and bolus ratios. Does that absolve me of any responsibility to review my data and make changes in response to what I see? Well....no. It does make it easier to just wait to let someone else make the changes, though. Lately it just feels like life has been too busy to let diabetes be as important as it should be, and my Carelink reports are proving that my diabetes care is suffering. I hope that this upcoming appointment can serve as the kick in the butt that I need in order to prioritize my health again, at least for a little bit.

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