#Dblogweek Catching Up: Days 1 & 2

Message Monday - Monday 5/16

Lets kick off the week by talking about why we are here, in the diabetes blog space. What is the most important diabetes awareness message to you? Why is that message important for you, and what are you trying to accomplish by sharing it on your blog?

I started my blog in December 2012, about a week after binge-reading Kerri Sparling’s blog (sixuntilme.com). In short, reading about the life of others living with type 1 diabetes made me feel like I wasn’t alone in this relatively rare condition, and helped me feel more optimistic about my future, as well as more committed to caring about my diabetes instead of having it always be on the back-burner. Starting the blog in many ways was and continues to be my therapy, but over the years I also came to realize that my voice is important, because like everyone else’s, it’s unique, and has the potential to possibly help someone else. I don’t have a particular message to give, besides perhaps – you are not alone, and that the diabetes online community (#doc) is vast and helpful. And that’s why I am here!

The Other Half of Diabetes - Tuesday 5/17
We think a lot about the physical component of diabetes, but the mental component is just as significant. How does diabetes affect you or your loved one mentally or emotionally? How have you learned to deal with the mental aspect of the condition? Any tips, positive phrases, mantras, or ideas to share on getting out of a diabetes funk? (If you are a caregiver to a person with diabetes, write about yourself or your loved one or both!)

Most of the time I am pretty upbeat in general, and that includes my feelings about diabetes. I am constantly saying how lucky I am to be alive today, and not 100 years ago, and to have always-improving technology to help me achieve the best control possible – in particular a meter and a continuous glucose monitor that provide quick data. I do my best not to dwell on transient highs and lows, as that is part of life with diabetes, and part of life in general. When I feel down however, is when I feel that diabetes has just made some kind of major interruption or caused a shift in my life. When I see in writing that people with diabetes will not be allowed to participate in the scuba diving, when I feel fearful that I may need medical attention when I have a stomach bug and no matter what I do I can’t seem to bring my blood sugar up, when I have to stop what I am doing and sit and eat. In the long run, these moments are greatly outnumbered by the better moments of “I can do this, I am doing this, watch me.” I would be lying however if I said that the low moments don’t take their toll – they do. Sometimes, I feel jealous of people who can eat and exercise without considering... anything. Sometimes, it feels unfair. I try to remind myself that I have not walked in their shoes so to speak, and that everyone has their challenges, but I cannot help but feel like living with diabetes is a pretty massive challenge, simply because it’s all the time, never-ending, life-threatening, and can be very scary to deal with. Again, most days, it’s just like brushing my teeth, a minor annoyance, and not very time-consuming. But not all days are like that. “This too shall pass” is a phrase I know applies to everything, diabetes included. But perhaps the very best way I deal with emotions surrounding diabetes (and life in general) revolves around my mother’s favorite phrase: “Life is like a sine graph.” A few months ago, I wrote a guest-post on diabetesdailygrind.com about this and I invite you to visit it here: http://www.diabetesdailygrind.com/finding-my-flow-through-one-trigonometry-function/’

A1C swings

It was a long time ago now (2012) that I found the #doc and started my blog here. Back then, I felt alone in my diabetes journey, and I am so happy that I have met so many wonderful people as a result of this condition, and learned so much about life with diabetes on a variety of topics – management, mental health, pregnancy – you name it. 

When it comes to diabetes management, it is a very individual thing. People have different targets and goals, but if there is one thing we can probably all agree on is that celebrating our improvements no matter how large or small is a good thing. So that is what I am doing today!

A little over a year ago, I learned that my A1C was at my personal highest since diagnosis – 8.6%. Yesterday, I learned that I had achieved my personal lowest – 5.7%! And that is a huge accomplishment for me!

To be honest, I never thought it was possible for me to achieve an A1C under 6%. I had a few A1Cs in the 6s throughout my 9-or-so years with diabetes, but I often had lows in the 40s when I achieved those (e.g. 6.2%). Alternately, I have had A1Cs in the high 6s as well, but to be quite honest, I was still globally high (mid-high 100s) a lot of the time, even if I managed to avoid more extreme highs.

What changed between today and 15 months ago for me? Lots of things. I will attempt to summarize as I hope maybe this can help others trying to lower their A1C. 

1.       I stopped drinking alcohol. Well, it’s not like I will never have a drink, but I am no longer choosing to consume 2 or more beers or vodkas on semi-regular (ok, regular) occasions, such as when out with friends or on Friday or Saturday nights. Why does this matter for me? Well, with alcohol’s known bg-lowering effects, I always tend to over-compensate with un-bolused food later in the evening, staying high over-night (in efforts of avoiding lows), and as a result, greatly affecting my overall time in range. 

2.       I reduced the amount of carbs that I eat. I talked about the benefits this provided me in a very long post a few months back. I still am able to indulge, but having more refined carb choices in my diet (such as bagels or ice-cream) for me requires portion control as well as being very patient with pre-bolusing. As an example, I buy those almost child-size ice-cream cups (about 12g of carbs). I add nuts and berries and it’s an awesome treat. Bagels have always been my weakness but are merciless to my blood sugar. I have found that bagel thins (about 20-25g carbs) provide a nice bg-friendly alternative and satisfy about 80% of my bagel cravings.

3.       I do not eat when I am high – I pre-bolus with whatever correction and watch the CGM to see myself at or under 120 before eating. 

4.       ^The CGM = lifesaver. It is quite an investment, but reasonable with my current health insurance, and has allowed me to feel safe in the double digits overnight, be more comfortable with dosing more accurately and pre-bolusing when necessary, and has also allowed me to catch and correct rises very quickly.

5.       Being more consistent with exercise. My exercise really just consists of walking, hiking, and cleaning. I find that if I am doing about an hour (but at least 40 minutes) 4-5 days a week, I get much more consistent results. 

That’s really most of it. Pretty simple, but as we all know consistency can be difficult when it comes to diabetes management. So I am pretty proud of myself for sticking with it! A short three months ago my A1C was 7.3%. That’s just to say that drastic changes can take place very quickly in the same individual – I am so happy that I was able to achieve such as drastic improvement in such a short time on multiple daily injections, and while not feeling like diabetes completely took over my life. I really never thought I would be able to join the 5s club – but here I am! What is most important to me, is the stability. I have not had lows under 55, and I can count on 1 hand my highs over 200 – and that’s the biggest achievement of all.

Diabetes goes haywire

I have been gone for a month? It’s been quite a month!

I was pretty busy with work, preparing for a conference presentation, and just generally catching up of stuff I have been slacking on… helping husband with job searches and apps, picking up this season’s gardening, and a long commute has not left much time for writing, but I will fill you in.

The most eventful and horribly annoying week is now behind me. I have recently started to almost feel smug about my diabetes management – and deservingly so in my opinion, as achieving consistent averages over months in a row that translate into an A1C in the mid 5s is certainly reason to pat myself on the back and feel like a total diabadass. Of course, when you least expect it, it comes to kick you in the face (or wherever else it sucks to be kicked). 

Two days before my departure to Seattle I noticed that I wasn’t feeling well. Over the course of the following night, I experienced what I can only describe as the worst-ever case of food poisoning or GI bug that I have ever encountered. I didn’t sleep all night, with projectile vomiting and diarrhea, couldn’t keep down fluids, and could barely keep my blood sugar at 70 all night, despite consuming (and then erhh un-consuming)  about 80g of carbohydrate. Around 4 am, a Capri Sun and a whole Vitamin water later, I crawled up to 150 mg/dL and stayed there for half of the next day in fear of plaguing lows. It is times like this that I wish I was on pump therapy. What I would have given in those moments to be able to “untake” (suspend) insulin…

The story does not end there, however. Still feeling like total crap, now with what felt like excessive dehydration and pronounced body aches, I was questioning my abilities to travel the following morning. Of course these things always happen on the weekends, so I found myself in the emergency room in order to be assessed/ possibly treated for dehydration. In the end, I had some ketones (nothing horrible, just consistent with excessive vomiting, etc.) and low sodium. After an afternoon of drinking nothing but chicken noodle soup, chicken broth, chamomile tea, and eating some saltines and pretzels (which is about all I could eat), I pulled it together just in time to make my early morning flight on Sunday. 

The story does not end there, however. My GI system still did not feel back to normal, and as I attempted to resume “normal” eating habits and insulin dosing, I failed miserably. It seemed that although I was keeping food down now, it just wasn’t absorbing the way it was supposed to, and I found myself having to chase the impending lows yet again. Seriously, I can’t even look at Starburst and Smarties without gagging right now. The issues were compounded by weird travel food, carb over-estimation, presentation stress, and a ton of walking around the Seattle hills. Monday night was scary. I should have in retrospect just reduced my basal doses. But I didn’t. And after hours of walking around the city, together with the aforementioned resolving GI issues, I had to stay up alone in my hotel room for hours, afraid to go to sleep, because no matter what I ate (without taking any fast-acting insulin whatsoever) I could not get up to 100 mg/dL. Luckily I found a dollar, the only one I had, and purchased a Sprite from the hotel vending machine. Otherwise, I was running out of food, and was so close to giving up, putting on my shoes, and walking a block up the street to the hospital to ask for a dextrose drip. After half the Sprite, on top of all the other food I consumed (totaling maybe 50g of carbs, and that was on top of my dinner of salmon, rice, and asparagus that I didn’t even bolus for!) my BG was finally crawling up slightly enough for me to go to sleep. I woke up in the 140s, afraid to correct. That morning, I finally reduced my basal dose. I was still afraid to bolus for breakfast, and it wasn’t until I was in the 170s that I started nudging it down. 

The story does not end there, however. That same day, I spiked to 200 mg/dL about three times. I blame it fully on overly-conservative bolusing coupled with presentation stress. By Tuesday night, the day before my return flight home, I was staying up to wait for my BG to come down reasonably so I could have decent numbers over-night. The next day was travel day, and I had one more scare, where I once again over-estimated my breakfast carbs, and ended up chugging about 30g of juice right before boarding my airplane (because really, the last thing I wanted to do was pass out boarding a plane.)

Through all this, I have to say I feel that Dexcom was my saving grace, even though I still went through about 100 test strips. And to think I almost didn’t bring it on this trip because I didn’t really want to deal with the TSA. I opt for a pat-down as I do not want to take Dex through the scanner, nor    do I myself want additional radiation exposure, and I wasn’t sure how they would handle the Dex. But I am happy to report that both screenings went smoothly (well with the exception of the guy rolling his eyes at me and saying that he hoped I wasn’t planning on flying or using my cell phone, because don’t I know that those produce radiation, queuing my rant about the additive effects of radiation and people having their rights and reasons based on cumulative radiation exposures, such as from frequent flying or employment exposure, health conditions, or any other number of reasons).

Ugh, what a week. I am still on pacific time and dragging myself out of bed at 5 am this morning was not pleasant, but I have to say, I was happy that my stomach was feeling more normal, and that I woke up with a blood sugar of 82 (although I did require about 6g of carbs overnight not to go low). Amazingly, I lost like 5 lbs this week, and have kept my basal doses reduced, and decreased my I:C from 1:8 to 1:10. We shall see what happens next! I am trying to take my own advice from my last post and shake this off, I am. I am just so ready for predictable, please.