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Thursday, January 17, 2013

(Over)-Avoiding Lows & the CGM

I avoid lows like the plague. The lowest number I have seen in the last year or so was 77. And while I'm happy about that, I am not so happy about oftentimes running in the 160-220 range, with my A1Cs over the last few years firmly planted around 7.5-7.8%. I know that's not horrible, but I also know I can do better. The truth is I read so many posts about devastating lows other T1s have (sometimes frequently it seems) and it makes me feel super guilty that I am able to avoid that. But then I also hear about all the A1Cs in the 6s (and lower!) and I feel even more guilty for running high a lot of the time (even if it's not super-high)...

The truth is my A1Cs were better when I didn't stalk my BGs like I do today. I started stalking a few years ago with the main goal being not going low, and while I have successfully achieved this, I have also raised my A1C and I see the 200s way more often than I should. My endo is happy that I have (almost) no lows and he is also happy that I don't swing wildly up and down all the time. But I know that (on average) my numbers should be about 50 points lower.

For some time, I avoided the idea of a CGM because I didn't like the idea of something being attached to me. But I must say, testing 15-20 times per day (sometimes more) took it's toll on me emotionally (and financially). Furthermore, running high during times when I can't test all the time (like when I am teaching) due to fear of lows is bad and I know this. So finally, a few months ago, I got setup with the Dexcom Seven+ and I absolutely love it. Finally, I have some peace of mind when I am lecturing or hiking or chasing my dogs. Finally, I can give my fingertips somewhat of a break. And most importantly, I look at the graph and there is no denying what needs to change.

In the last few months, I have been able to push my numbers lower than I have felt comfortable before - i.e. I used to correct 90s and aim closer to the 150s before the CGM. Today, I feel much more comfortable with the 90-120 range. That is not to say I come close to staying there the whole time, but I have re-evaluated by goals from just keeping my BGs under 200 overall, to aiming for pre-meal values under 130 and minimizing post meal peaks to 180. Of course, I am not always successful, but the CGM has really made me reconsider some of the misconceptions I had about my BG trends. I have yet to have my A1C checked after starting on the Dexcom system (that's coming up next month) but I am (cautiously) optimistic. Also, I have to admit that the Holidays still kicked my ass this year (Dexcom notwithstanding) and I was totally guilty of rescheduling my appointment from 1/7 to 2/18 in an effort of avoiding disappointing myself and my doc... =)

Monday, January 14, 2013

T1D: Lows, Highs, Laughter

Type I Diabetes is not easy to live with. I usually do not let on about this fact when I tell others about my diagnosis. However, it became easier to be honest with others after accepting the diabetic me. Coming to terms with T1D for me was much more that just seeking treatment and sticking with it. It involved accepting diabetes as a part of myself and loving myself (and my diabetes) with all I had.

For almost four years, I did not carry around Glucagon or snacks. For almost four years I assured myself and everyone close to me that diabetes was "not a big deal". At first, I just tested four times a day, counted/estimated carbs, took the amount of insulin they said to take (nothing less and nothing more). My A1Cs were good, I felt good. I had my first "real" low when I was 20 years old. I was high (on weed), and I was confused and terrified. I was shaking. "I feel like I'm going to pass out." - I said to my boyfriend (now husband). "It's not the weed" (I'm an experienced smoker). Next thought: "I should test my blood sugar" (God bless me). "It's 42, I need juice, please get me juice, now, NOW." I chugged the tall glass of orange juice. "It's getting worse, please don't let me die." Within 5 minutes, I could feel the calmness creeping back in. "I'm starting to feel better", I said finally, drinking more juice. I didn't even test again after that (just once later, before bed). This happened a couple of months after I started insulin therapy. I was a brave soul back then... That is not to say this experience didn't shake me. I realized then that this was serious. However, I still didn't always carry snacks or Glucagon. But I started paying much more close attention to how I feel, having then realized that this could actually make me pass out (or worse). 

Flash forward two years: I'm living abroad, I'm broke and I can't afford to test often. I'm high on Moroccan (or Pakistani) hashish, I'm writing a research paper, I'm feeling quite stressed, and I'm feeling "tingly"? Something's off.... I must be really low, I think, quickly reaching for crust-less white bread (yep, in Spain, they sell crust-less bread slices!), Nutella, juice, whatever... 20 or 30 minutes pass. It gets worse, I feel shaky, terrified, awful... I test, finally: 340... WTF... It takes me another 30 minutes or so to figure out that what I am actually feeling is panic: what a way to learn that anxiety attacks and low blood glucose feel damn about the same. stupid paper, stupid money, stupid diabetes.

Which of course brings me to laughter - when tripping on mescaline a few years ago, I finally accepted myself as a diabetic. 

[If you're unfamiliar, Google the use of psychedelics in therapy and the use of MDMA in the treatment of PTSD (check out maps.org for recent studies). I may "defend" (explain in depth along with what Walking the Dragon means to me) all this is another post, but for now suffice it to say that classic psychedelics like mescaline or psilocybin have extremely low toxicity, and under the right set and setting can be powerful tools for self-exploration, extremely honest conversation, and self-acceptance. I am not saying this cannot be achieved without drugs or suggesting that anyone should use any drugs by the way. Also, I should mention that they are extremely powerful, mind-altering substances, and one should be well-prepared (in all the D-ways and the non-D-ways), well-researched, and have a sitter if they do ever engage.]

In any case - back to the story. I was tripping (mildly but effectively), and I went to check my blood sugar. My meter, instead of looking annoying to me as it usually does looked shiny and animated, welcoming and inviting. My shiny bottles of insulin looked even more friendly. "All this stuff - I'm so lucky to have it" I thought, reflecting on people 100 years ago, for whom T1D was a not-so-quick and awful death-sentence. Seemed so funny to put in a test strip, wait for the screen to turn on, prick my finger, squeeze out blood, apply it to the test strip and wait for a number - in fact I'm pretty sure I burst out laughing. This is who I am - I thought - Diabetic. And I am so lucky to be alive, to be healthy (T1D notwithstanding), to be able to enjoy life, to be able to know within such a small range of error what my blood glucose level is, and to be loved. And to love myself - with Diabetes - to LOVE my diabetic self... 

Today, I test frequently (understatement?), use a CGM, and hoard numerous snacks, glucose tablets (and even Glucagon!) with me at all times. And I tell many more people about my diabetes, along with the challenges that come with it. It upsets me much less than it used to when I encounter uneducated (even prejudiced) people, and it doesn't bother me that much anymore if people act like they feel sorry for me. Because I know myself and my disease, and try to be open and honest about it (instead of ashamed and ignorant) I can live better with it. And for that, I'm truly grateful. 

Con mucho amor ~M

Thursday, January 3, 2013

T1D: Things They Never Told Me

When I first started insulin treatment some 6 years ago, I naively thought it really was as simple as a carb-to-insulin ratio that when followed and timed properly would magically result in close-to-normal, steady blood sugars. I thought this, because that was basically what my healthcare providers told me - the only thing I was fore-warned about were the symptoms of low BG...

Looking back, I shouldn't have been surprised that after getting off a trans-atlantic flight to Spain, my numbers were consistently and annoyingly high for a few days... Or that after walking around and sweating in the Costa-Rican heat for hours, my seemingly non-symptomatic low of "37" (the lowest number I've ever sighted) was probably to be expected... Or that dehydration will mess with insulin activity... Or that I need about 40% more Humulin R to cover my meals while driving cross-country... Or that drinking alcohol can/will (depending on the amount of OH & carbs consumed of course) make your BG plummet, sometimes like 4-8 hours later (something college students should probably be aware of)!

This (I hope!) is not be the case for everyone, but I never received information when I was in the hospital learning to treat for the first time to what degree activity and stress levels (as well as simply the TYPES of food we eat, not just the CARBS) impact BG levels. Most of these things, I figured out as I went, and still learning everyday.

I'm not so much complaining about my healthcare providers - they suggested meeting with a nutritionist, and I got the initial free visit, but not having regular meetings as part of my insurance coverage, I obviously opted out. Once I realized that low BG (and BG levels in general) are a "serious matter" (understatement?), I was ever-so-grateful to have the internet to be able to look up all this info as well as compare notes with and meet fellow PWDs... Also, grateful to have the Dexcom technology - I know it's not perfect, but it makes my life A LOT easier.

Having said that, I extend my utmost respect to parents of children with Type 1 Diabetes... At least when I fuck up in my own D-care, I laugh it off (most of the time) and move on (always)... I can't imagine what it would be like if it was someone else in my care: I was too old for parental D-care (being 18 y.o. @ dx), but I think all the T1D parents (many of whose blogs I've been reading) are amazing!

Con mucho amor - and remember: do you own research, pay attention, and don't forget to walk that Dragon!