I thought I have been doing quite well.
Sure, I've had a few more lows than usual. Sure, stress can do that. And sure, I keep having to remind myself after treating these lows that maybe it's time to slash away at my basal rates so these lows happen less often, but then I forget right up until the next 2.7 is staring me in the face.
Then this happened, and I found myself sitting in my office 2 days ago with an empty pump and a 6-day-old infusion set. That may be the norm for some, but I usually try to keep to a 3- or 4-day site rotation, so 6 is a bit much. Limiting sets to 3 or 4 days usually easy for me, since I've never made it past day 4 with any insulin left in my reservoir.
I think at this point it's safe to say that despite my best (okay, my medium-est) efforts, wedding planning has bested me. Diabetes care has fallen by the wayside. I'm still here, still bolusing for food and chowing back on glucose tablets when I'm low, but being proactive about my self-care is taking a backseat to all of the wedding stuff.
So, step 1 has been Recognizing The Need For Change. I guess step 2 is actually doing it. On that note, I will upload my cgm data to Carelink when I get home tonight. I will. Tonight.
I mean, not right away tonight. We have a meeting with the wedding DJ after work. But after that. Definitely.
I thought I have been doing quite well.
Treating lows with ginger snaps this morning, because today is a day with an I-can't-handle-anotherfuckingglucosetablet kind of mood.
& no, I was not actually 2.7. My cgm was off by a bit; my BG was 3.0. Still low, but not in the 2's.
BGs in the 2-somethings usually result in the mad rush to stave off death with ALL OF THE CARBS RIGHT NOW OMG. My 3.0, today, was treated with cookies, coffee, and that difficult bitch, patience.
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?
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.
I made it! After two false starts last week (having some issues with my bike chain), I successfully made it home from work today. I set a 60% temp basal starting 4 hours before I left and continuing 30 minutes into my ride. It's a bit excessive, true, but I wanted to be extra-cautious since lately I've been tending to run low in the afternoons.
Both times last week when my chain got jammed and I couldn't get it un-stuck, the resulting high blood sugars were pretty miserable. I used the same temp basal (60% for 4.5hrs) in anticipation of a 60-minute cycling commute, so after getting home by car I would inevitably be stuck with a stubborn high BG for most of the night. The frustration from a failed ride is one thing, but dealing with the highs afterward made a missed bike ride into a whole different experience*.
I have to say I'm pretty thrilled that I finally made it home by bike. I'm also pretty pleased that I managed it with no lows.
Next task: see if I can manage a stable 7, WITHOUT lows, throughout my ride, instead of the 10 shown above. Unlikely, but hey! A girl can dream, no?
A crappy one. Briefly; only for a night, but still. Feels pretty crappy.
A couple of weeks ago I had an appointment with Patricia, the dietician in my endo's office. The GI Dr recommended that I meet with the Rd to get strategies for converting to a gluten-free diet. He asked if I would be willing to meet with either the dietician in his office or the one in my endo's office. Sure? Why not. I called that day to book an appointment with Patricia, and later that month we sat down together to talk about my celiac diagnosis, what I'm eating, how the new diet is affecting BGs, etc.
I started the conversation by pointing out that since the celiac dx, my consumption of wine and cider has pretty much skyrocketed, while preparation of healthy home-cooked meals has dropped to an all-time low. She gave me some strategies for making small changes towards a better/more balanced gluten-free diet, then asked if she could download my pump to review my data while I was in the clinic.
Sure? Why not.
I hand over my pump. She links it up to her Carelink Pro, generates a few reports, and leaves briefly to pick them up from the printer. When she returns, she sits at her desk with a highlighter and attacks the reports in front of her. A few moments later she pushes a paper showing sensor data towards me.
"Do you see what I've highlighted here?"
"I --" ..... "Lows."
"These are severe lows. 1's and 2's. This is a week's worth of data."
I review the paper again. It is speckled with yellow dots. A LOT of yellow dots.
Waking up in the morning? Yellow dot. Breakfast - spike city. Post breakfast? Yellow dot. Lunch time? Moderate hill. Post-lunch? Yellow dot. Pre-dinner? Yellow dot. Post-dinner? Spike, plateau, moderate descent. Bedtime? BG within range.
Overnight? Yellow Dot City.
Patricia looks at me with kindness in her eyes and says she would like to call Brenda, my RN, in to help troubleshoot some of these stubborn lows. I shrug. Why not?
Enter Brenda. Brenda reviews Yellow Dot City. Brenda does not look happy about Yellow Dot City.
Brenda shuffles through the papers to find the one that lists my pump settings. She turns to me and her gaze sort of softens. She tells me that we need to do something about these lows. She explains that if I'm comfortable with her approach, she wants to slash my basal rates quite significantly. She suggests modifying one of my meal carb ratios as well, explaining that these things should leave me a little bit higher than I usually aim to be. She backs this up by showing me studies and research documenting how above-average-glucose levels over time can help to restore low glucose sensitivity. I take her word for it -- usually I'm interested in things like this, but I just can't bring myself to want to read the paper this time.
Brenda tells me it looks like I'm burnt out. She says she knows that I know that something isn't working, but analyzing the data in order to fix it is a daunting task, and she says she understands that I'm not feeling up to it.
She asks me to download my data in a few weeks and provide that to her. She's not asking me to do anything differently - not wanting extra monitoring or checking BGs. She wants me to carry on as usual, but with higher BGs. Her goal is to have me running between 8 and 10 for a few weeks, which will hopefully bring back some of my low glucose symptoms and allow me to feel lows coming on.
She doesn't ask me to do anything new. Nothing extra. Just a one-off data download in a few weeks so she can review the progress.
I know I'm lucky to see my doctor in a clinic where my team (RN, RD, MD) can call on one another to support my care -- but never have I been more appreciative of having a team who recognizes what I'm capable of and works with me to try to fix things.
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.
- Very cool: I entered a giveaway, and won a meter supply case from courtesy of Stacey, at The Girl with the Portable Pancreas! I'm exciteddd!
Pump says low.
Melody says shhhh pump, I sleep.
Boyfriend is not home.
Pooch says NO HUMAN WAKE UP YOU ARE BEEPING WAKE UP EMERGENCY OMG OMG OMG.
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.