I have all these tools at my disposal to help me manage my diabetes: my glucose meter, my test strips, my insulin, my pump. The majority of the time all of these things work great, but they aren't indestructible and we have to be careful with them to ensure they keep on working like they are supposed to. The recent summer heat wave got me thinking that if I could change or improve something about current diabetes technology I'd like our tools to be more durable and reliable when mother nature isn't a dry, mild 70F day in and day out.
Insulin: The little handy information insert that comes with our insulin warns us that it shouldn't be exposed to temperatures above 86F otherwise it will degrade and lose potency. What this means for me is that the insulin in my pump won't work as good at higher temperatures which means my BGs will go up. There has been a string of days with temperatures in the 90s and 100s which isn't good for keeping the insulin we carry aorund with us 24/7 stable and potent. How about broader temperature ranges to keep our BGs from spiking on summer afternoons?
Glucose meters and test strips: Like insulin these also have preferred temperature ranges (40-86F). I've had instances where I've tested my blood sugar in the winter when I've been outdoors--hiking, walking, jogging, football games--and my meter delayed in returning a BG reading. If its 28F and my meter usually returns a reading in 5 second, and now its spinning away and taking 10 seconds can I trust the number its giving me? I had a scary low BG episode while camping and my meter kept taking a long time to return a result and giving me test strips errors - I assumed it was because it was cold out since it had worked perfectly all day.
Moisture: Not only are extreme temperatures a problem for our tools but moisture can be one too. I'm not just talking about jumping in pool with your meter, but even light rain, humidity, or sweat can cause our tools to not function properly. An accidental dip in water can ruin a glucose meter and test strips cannot get wet. Some times we get caught in the rain when walking the dog, or its starts to rain while we are out jogging or biking, sometimes we get sweaty after exercising and a bead of sweat drips and falls into the test strip vial. Are we to never go out in the rain or sweat? How about tools that are a little more forgiving when it comes to exposure to moisture? They don't have to be waterproof to 300m, but a little more moisture resistance would be nice.
These aren't whiz bang ideas but I think they would give us peace of mind that our tools are functioning properly at times when we most need them too. It can also save us money by not having to throw away supplies and save us from wasting insulin that gets skunked in the summer.
I tend to have vivid, intense, frantic dreams when my blood sugar crashes while I'm sleeping.
During the day when my BG crashes it brings intense feelings of instinct and survival - I must eat NOW. I'm not familiar with everything that happens inside the body to evoke this kind of response. I wonder if these physiological responses somehow trigger my vivid low blood sugar dreams.
These are the low blood sugar dreams I had last week:
For whatever reason, somehow a polar bear was in my house. I wanted to help it get out but at the same time I was scared to get too close to it. I could tell it was confused and frightened and I knew that it wouldn't understand that I was trying to help and might try to attack me. Then some people came and they wanted to kill the bear to get it out of the house, but I didn't want the bear dead. I was torn because I wanted to help the bear but was too scared to and I'm trying to get these other people to not shoot at the bear and I wake up and my BG is 48.
There was big hairy brown spider hanging from the ceiling light that is right in front of our front door. I am freaking out because I HATE spiders and its just dangling there by its web. My dog is jumping around and barking cause I'm freaking. My husband grabs a pair of scissors to cut it down from the web but the scissors can't cut through it and this big spider is hanging there with all its legs moving and I wake up and my BG is 46
I'm making dinner and like a good diabetic I weigh and measure everything so I know what the carb count is and how much insulin to take. But all of my measuring cups are rusty and gross inside. I don't want to use them because the rust will get on the food. I'm panicking because if I don't measure my food I won't know how many carbs are in it and how much insulin to take. I wake up and my BG is 56.
Do you remember what you are dreaming about when you have an overnight low blood sugar?
Months of diligence. Consistent food choices, consistent exercise, logging blood sugars, adjusting insulin doses. An all around feeling of well being. It all collapsed following last week's endo appoitnment. That day my hard work and diligence meant nothing.
So I took a break. I didn't exercise, I gave in to my munchies, drank wine, and sipped lattes. I watched my BGs creep up and up.
Not the best way to react to adversity.
I thought this week would be different. I was trying different meals, lowering my carbs, and exercising. I was rewarded with the same high BGs.
Can one week off really derail my progress that much? Seems so.
Are there other explanations for the crappy BG week? Maybe the stifling heat playing tricks with my body or dimisihing the potecny of the insulin in my pump. Maybe it is the infusion sights on my upper thigh - each one has been painful - is my skin not conducive to ideal insulin absorption?
It feels like there is no progress with this disease. I feel like I've been down this road before. It feels like I'm starting from square one again.
We hear this all the time. "Insurance only allows 4 test strips a day." "Why do you need to test more than four times a day." "If you want more test strips its alot of paper work."
I test a minimum of 6 times a day. Before and after each meal. Most days I test 8 - 10 times. Some days more depending on my activities and my BG trends - exercising needs added testing, treating lows also needs added testing. If I eat more than three times a day - added testing.
Our medial professionals advise us to do all these tests to best manage this disease. Before and after each meal. They advise us to exercise - this means testing before, during, and after, exercise. Before you get in a car to drive. Anytime you just don't feel right. If we follow thier advice it adds up to needing more than 4 test strips a day.
How are we to keep our BGs as close to normal as possible if we can't get all the information we need to make adjustments to insulin dosing, nutrition, and activity levels? The info we need is provided by these rationed tests strips.
Where does this magic number 4 come from?
My BGs aren't always perfect. Maybe I test too much. I guess I could make 4 test strips work. I guess if my post meal BGs are in range, I wouldn't need to test before meals. But what abut exercise or physical activities? What about the times you just don't feel right. I'd be going into situations blind, risking hypoglycemia.
I'm fortunate that I have not had these limits placed on my test strips. But it really upsets me when the default reaction is to write a script for 4 test strips or when my diabetes supply company screws up my order, making the assumption that I only need to test four times a day. It costs me time, stress, and energy to get this straightened out.
Why does every doctor appointment and trip to the pharmacy feel like a fight against number 4? Why do the best things for managing this disease need to be justified, over and over again?
I have a pretty big adventure ahead of me. Three days/two nights in the wilderness. Everything I need will be in a pack carried on my back.
I have 8 weeks to get ready. I don't want diabetes to screw this up.
I want to get my diabetes fine-tuned for this trip. A simple 30 minute walk around my neighborhood always tends to lower my blood sugar. Walking for miles, over varied terrain, carrying 25+ pounds will definitely have a BG lowering effect.
I'll need to figure out the best adjustments for my diabetes. I don't want to have to treat lows every mile. I'll need to figure out how much to lower my basal. I'll need to figure out my nutrition - the best things to eat, that are portable and non-perishable, give me energy to traverse up and down mountains, and keep my BGs steady. I need to figure out if I should bolus for snacks that I eat while hiking. I'll need to figure out basal adjustments for overnight so that I do not have another episode like this one.
(Me at the pinnacle of last month's hike)
Last month I set out on an 8 mile hike to start getting ready for this trip. (It ended up being 9.4 miles due to a slight navigational error - oops!) It was a pretty strenuous hike - all uphill for the first half, downhill for the second, rocky terrain, a gain of 2400 ft in elevation. I lowered my basal rate to 50% for the duration. Checked my BG every two miles. I found that on the uphill I needed to eat a few snacks (glucose gels and lara bars) to keep my BG from going low. On the downhill, my BG spiked to 200, maybe because it wasn't as strenuous, maybe because I ingested 30 grams of un-bolused carbs when I started going down hill. I battled a series of lows from about 8PM - 10PM that night. Woke up at 220 the next morning.
I'll need to do more of these "experiments" in the coming weeks. I want to go into this trip confident in my diabetes.
I've finally had it. I'm breaking up with my endo.
I'm sick of being talked at instead of talked with. I'm sick of the commands instead of discussions. I'm sick of how long I wait for the 7 minutes I get with him. I'm sick of not having a voice during our appointments - because there is no room for my voice, only his. I'm sick of the same pamphlets and booklets he shoves at me as I leave - some kind of consolation prize for his lack of compassion. I'm tired of leaving his office feeling upset, angry, and frustrated - every time I leave.
I've said it before, but this time I mean it.
Monday morning I arrive for my appointment with him 5 minutes early. Medication list and dosages neatly typed and glucose logs completed.
Forty-five minutes later I'm called back. Fifteen minutes later he finally comes in.
He looks at my labs and my glucose logs. "Your A1C is 6.1, but you've had a lot of lows so this false." Thanks doc, could you be more blunt.
"What meter are you using?" Freestyle Lite. "That one is not accurate I want you start using this one." But, you gave me the Feestyle last year because you said it was better. "Other meters can be 15-20% wrong." (I'm thinking aren't all meters 15-20% wrong because that is the FDA standard?) "Use this one instead. Your insurance probably won't cover the test strips but there is a coupon you can use." Gee thanks for giving me something that is not covered by insurance.
As I'm checking out with the receptionist to get copies of my lab work and set my next appointment I notice that my new test strip prescription is only for four a day. I tell the receptionist this needs to be changed, I need ten a day. "But your insurance will only approve four. Anymore than that and its a lot of paper work and time for us." Really?
I leave the office pissed off, with a prescription that is useless, a carb counting booklet, and a handy wall chart on hypoglycemic symptoms. (In all fairness, I did get a free vial of inuslin.)
Gee thanks doc and unhelpful staff. Let the search begin...
I spend weeks and months honing my diabetes. Exercising, mindful of what I eat, logging my BGs, counting carbs. My BG averages steadily decline, hovering around 110. Things are going good, my diabetes almost feels predictable.
But then the 200s re-appear. Precision measurements, carb counting and calculator-assited mathematics mean nothing.
220, 240, 223, 247, 201.
The correction boluses are modest at first. After all, its only been two hours since I ate and last bolused. Do I really need another 6 units of insulin floating around risking a low BG that leaves me a sweaty, shaking puddle, unable to formulate complete sentences that don't include profanity?
Could it be the hot weather disintegrating the insulin in my pump? Nope fresh insulin today.
Maybe its the site change, going from my stomach to my leg. My leg has been a steady site in the past. Why should it matter - its all skin?
I go through phases with my diabetes and my approach to food. I'm mostly very careful about what I eat. But there are times when I don't give a damn what I eat or what it will do to my blood sugar. And then there are times when I get really focused on my nutrition.
I am in a phase right now where I'm really careful with what I'm eating. These phases usually coincide with my endo appointments and me wanting to see good numbers across the board on my lab results. This focused phase unfortunately coincided with the 4th of July. A holiday to celebrate the founding of our nation. And also a time of cook-outs, fireworks, and summer fun.
Its a holiday that often finds me back in my hometown, celebrating with my family at our riverfront cottage. Lots of cooking-out - a smorgasbord of grilled food, homemade side dishes, divine desserts, and plenty of beer.
In years past I would throw caution to the wind during this celebration - eating what I wanted, indulging in desserts, drinking beers. I end up bolusing like mad, with BGs in the 200s and 300s and crashing to the debilitating 30s later that night. Between the swinging BGs, gorging on food I don't normally eat, and beer I end up feeling pretty crappy.
This year was different. I have been feeling so good lately with the way that I've been eating that I didn't want to screw it up. I didn't eat a slice of dessert, I didn't drink any alcohol - actions unheard of in most circles on the 4th of July.
I felt great all weekend. I "partied" with friends and family and watched fireworks explode over the water in front of me. I had a great time. I wasn't dehydrated, I wasn't hung over. I didn't have a headache. My average BG for the holiday weekend was 100mg/dl. I ran 4 miles.
Did I miss out on anything? Nope. Wild BGs and feeling like crap just aren't worth the dessert.
I spend a lot of time reading about diabetes. Some things are funny, some are inspirational, some are informative, some make me cry, and many describe life with diabetes better than I ever could. I'd like to share some of the things that I come across that shape my feelings about diabetes, my health, and life.
Here are your savory breakfast links:
2011 ADA Conference Wrap-up from Diabetes Mine: Lots of promising news from this year's American Diabetes Association scientific sessions. My faves are the improvements in life expectancy for folks with Type 1 diabetes and the artificial pancreas may be getting closer to reality.
An article on a person with Type 1 completing an Ironman Triathlon in St. George, Utah: An inspiring accomplishment and proof that this disease can't stop us.
Dear Diabetes from Six Until Me: I think the most frustrating thing about diabetes is that no matter how much you try to control it and do all the right things it doesn't play fair. And that is why diabetes sucks!