Diabetes vs. Car Crashes (aka Once Upon a Time)

Once upon a time (in the Fall of 2008), a young (20-yr. old) woman (OK, Me) who was treating her T1D diligently (although with minimal testing, aka a little nonchalantly)  was moving with her boyfriend in the Boston area. On the third or fourth trip, going back for more furniture, the couple got a little lost in the new neighborhood, and while looking for the right turn, in combination with awkward ramps and blinding sunlight (not to mention the hunger), hit a metal ramp head on in their little Honda going no more than 35 MPH...

The Driver's (male) airbag goes off, the passenger (ME, MM!) is left stunned. The hood of the car is smoking and leaking fluids, what's worse it the Driver's head, which is leaking blood. The passenger calls 911.

What may be more distressing than a (Thank God, [seriously]) more superficial than at first thought wound to the Driver's head was the fact that I (the Passenger) pre-dosed (oh-so-diligently) 2U of Humulin R in anticipation of a some sort of fast-food cheeseburger on the way to pick up the furniture...

I remember pleading (in shock) with the Ambulance guy to "give me glucose tablets" (they only had gel, which was super-gross). They lead me (calmly) onto the back of the ambulance to test my BG. Once he got out the thing (meter), he was like " I'm not sure how to use it [what??!!] ". At that point, I snapped out of my shocked state and remembered that I (in fact) had a BG meter in my bag. My blood glucose level was 110. (Insert shock and feeling like the Ambulance guy thinks you were kidding about the Diabetes) LOL.

Fast forward 1 hr. and I'm having Coke (non-diet, unknown amount) in the ER because I "feel like it". I alternate between bitching about Diabetes (aka confessing my Dx) to my [back-then future] mother-in-law (whom I called on the ambulance ride to MGH)... and also this is my first time BITCHING about DIABETES to anyone ever... Fast forward 4 hours, as we're finishing moving (while my then-boyfriend, now husband, is still at MGH). I'm exhasuted as I sneak out for a cig [Parliament] , and I feel shaky (still haven't had dinner). I go upstairs and (discreetly) test my BG (it's 40-something). I drink some juice and throw away the rest, I help clean up, move furniture into car, deliver it to E. Boston, pick up boyfriend from hospital, thank God I'm still alive.

Such as life, funny to have remembered this so vividly almost 5 years after...

Accountability in T1D Management

Honestly, when I write down what I eat and how much insulin I take and when, and what my blood glucose is at all times, it's a lot easier to be happy with myself regardless of the actual numbers (I think they call that logging, but I like to call it being accountable). If I'm having highs, I correct, make note of it, and also list some possible explanations. I feel more confident making small changes to my treatment plan when I see all the data in front of me on paper, in fact I become more comfortable with a lower BG range. I am my own little science experiment. When I'm having a bad time, careful logging tends to bring me out of it, as I tend to be extremely more honest with myself on paper about the carbs I eat (as opposed to handfuls of blueberries unaccounted for, guilty ;). I hate being high, I am sick of it. Not that I'm always high. But a lot of the time I'm higher than I should be. And while I can avoid looking at my meter averages or tell myself that I don't have to correct the 180 because I "might" exercise later, it all becomes so much more difficult to ignore when you have all these numbers in front of you six or seven times a day... Accountability... Furthermore, the logs provide invaluable information over the course of long-term events, like finding out I ALWAYS seem to need extra insulin on Monday mornings, that Tuesday and Sunday mornings are the most carb-friendly, that my insulin resistance increases after ovulation (due to progesterone increase I think)... It's time to break out the log again I think.

In Progress...

Today is my 4-year wedding anniversary. I was 21 when I got married, following a 3-week engagement, and preceding a 10-month stay in Madrid, Spain. While I must say that at the time of our big announcement, a shock and awe reaction arose (amid perhaps some doubt about our young age and long-term intentions), to us it was more like "well, it's going to happen anyway, and what a way to honeymoon for almost a year" :) I'm happy to say that looking back, I would not change a thing <3

The picture below depicts us just after saying "I do", walking away to "All You Need is Love" (by The Beatles).

The title of this post,"In Progress" is because that is just the way things are - all of our lives in many if not every way. As I think about how my husband and I grow together, I can't help but also think about my Diabetes, and how we grow together as well. It's not always unicorns and rainbows, but in the end, a combination of compassion, dedication, and hard work, and most importantly, LOVE will get you where you need to be (meaning you're kind of there already) - that is while ever-changing, and always being "In Progress". 

P.S. I Love You

-MM

This Morning's Blood Glucose BullSh*t

When I woke up at 3 am and tested my BG, my meter said "176". I took 1/2 U of Novolog and went back to bed. Given that 1/2 U "should" lower me by 50 points (although it varies a bit depending on time of day, not even considering activity levels), I was not surprised to see the "131" at 6:30 am, in fact I was rather pleased. I dosed 4 U of Levemir and went on to take a shower, feed and take out the dogs, prepare lunches, etc...

Upon opening the refrigerator, I felt a strange chill. Not surprising - the fridge is a cold place. OK. I feel strange. Am I anxious? I can't be low, I just tested 30 mins ago and I was 130, I thought looking at the clock. There is NO WAY I'm low. Why do I feel like I'm having heart palpitations. And why am I sweating, I so much?? (A second ago I felt cold). Another minute and two fingers on my (carotid? :x) artery, and I was like - OK clearly your body is trying to tell you something. I tested and the "60" came back, glaring.

What came next was quite surprising (to me). I measured out the appropriate amount of juice, treated. 5 minutes passed and I was "64" (I DID NOT DRINK ANY MORE JUICE!), waited 10 mins and I was "92". OK. 30 minutes later I was about "140". I'm proud of myself for remaining calm and not ridiculously over-treating. It gives me confidence and hope that I can do that in the future more consistently.

Sadly, it seems that natural Glucagon reeaaally kicked in later, kind of spoiling everything, and raising me into the 200s without any food. (At least I assume that I'm in rebound mode now).

So it's been an interesting day so far. I'm really still confused about how I could've gone down 70 points in 30 minutes (from 130 to 60) without any Novolog or exercise. My best guess is that something was messed up with that first test, although I have no idea what it could've been... I'm certain nothing is wrong with the meter because the #s correlate to how I feel (although guilty of losing control solution). Also, ovulation is around here, so it could be that. I've never heard of any kind of Levemir mishaps in term of absorption - it has fatty acid chain on it, which binds to a protein called albumin, so as the albumin "falls off", it is slowly used in the bloodstream. I've heard with Lantus that you can get immediate absorption is the injection is not SC, because of the pH solubility, so with Lantus a butchered injection may cause a sudden drop but not with Levemir (please please correct me if I'm wrong)... The reason I'm even entertaining this is because I would expect such a drop if the Levemir did somehow act "all at once"...


(and yes, I'm certain I took 4 U Levemir and NOT Novolog lol)...

The Struggle

Currently my 7-day blood glucose average is 199 and my 14-day blood glucose average is 194.

It's not that I'm not trying - in  fact I KNOW I am because in the last 30 days I have tested my blood sugar level 460 times. 460 TIMES. My 30-day average? (you guessed it!) 199.

It's not that I'm not trying - it's that I'm terrified of lows. But in moments when I allow myself to think about that scary word ("complications") my struggle with my inability to maintain steady numbers in the low 100's (instead of steady numbers in the high 100s) stings a lot more than the ever-powerful fear of the low that will  may leave me incapacitated or worse...

I know that I (almost always) have strongly felt the lows (pretty much as soon as I hit 80 I feel like I'm ready to pass out), so realistically, knowing that information (along with the fact that I test so much and am anal about triple checking for safe [read: slightly and sometimes not-so-slightly high] night-time levels) I should feel empowered and confident in trying to aim as close to normal at all times as (super)-humanly possible... nevertheless - all I feel is a dread when I'm 90 that it will drop at the slightest thought of any physical or mental effort and leave me feeling like total shit. sigh.

Nevertheless, I am committed to (any kind of) improvement. I will start by patting myself on the back for like zero lows this month (lowest was 82 I believe) and for firmly staying out of the high 200s and above. At least my high (199) average represents something that is not 30-500 in range, but likely something that's typically between 170-220... also, almost of my tests are post-prandial so I'd like to think that fasting levels aren't as bad as it seems, but the truth is I'm probably in denial and it is in fact as bad as it seems, because even though numbers may be "just numbers" I think they can speak volumes... especially given the sample size of 460...

What does not help the issue is that I tend to be a kind of all-or-nothing person. I set goals that are difficult to reach and I go for them, but in fact if things don't seem to be going my way 100% I tend to feel discouraged and unaccomplished. If I set a goal of a 30-day average of 120, I'm sure I may even come close to that (armed with Dexcom and extra strips of course), but I'd probably feel worn out the next month and rebound to 250...

I don't know how to work day by day and see a slow shift in my average and feel accomplished. I do hope that I can learn to do that, because it seems that it may be the only way to fight this battle. I need to feel somewhat normal throughout the course of the day and extreme highs and lows prevent that greatly, and I know that hour-by-hour efforts (even if more time-consuming) will reflect positively on my feelings in the moment and in the future.... We'll see what happens, I'll keep trying, I'll try harder, Try not to let fear get in my way so much, although it's easier said than done...

Catching up...

During my 8-day vacation in Mexico, I struggled with Type 1 Diabetes. My BGs were (largely) running in the 200s.  I had 2 or 3 300+s. ... I had a GREAT vacation. [I had no lows.] I feel well-rested and yet still hung-over, and I've already jumped into work head-first, organizing a conference, starting to work on my dissertation, my gardening, and my research...

My Diabetes accomplishment came today, when I decided to use a old note-card to start logging in order to improve my numbers while retaining a very low record of lows. So far, I've logged 1 in the 200s, and 6 in the 100s. So that's an improvement - and that's all that matters.

All you need is love

It is my wish that everyone learn to believe in themselves, trust themselves, and remember that it doesn't matter what anyone else thinks of you - it's what you think of yourself that will make or break you.

Also, it is my wish for everyone to feel very very much (doesn't matter for whom/ what/ why/ how) LOVE

Con mucho amor, como siempre
-Maria