In Time

Time is a funny thing.

If there is something fun planned for later in the day, time seems to crawl, making the day seem extremely long. This also applies if there isn’t much to do. And when we have too much to do, there doesn’t seem to be enough hours in the day. We are simultaneously encouraged to “live in the moment,” “take time to smell the roses and enjoy,” and “get somewhere yesterday.” Our morning alarms keep us on track as well as provide a hindrance to something more important, like sleep. We are also reminded that we have a finite amount of time to make something great of ourselves, so don’t waste it by being anything less.

As a PWD, time is also of the essence! It’s recommended that we change our infusion sets every three days and our sensors every six. Our insulin, once opened, only lasts 30 days, but its effectiveness is dependent on the elements, and we discover this over time with high and other erratic blood sugar results.

We are advised to wait 15 minutes after treating a low with fast acting carbs, which can feel like an eternity. And we spend another two hours (or two days) reconciling the inevitable rebound from said low blood sugar. But we can’t over-correct that high blood sugar because our insulin has an active peak time of anywhere between 2 to 6 hours. So that 300 mg/dl is just going to have to wait, isn’t it? (It doesn’t – rage bolus away.)

Our blood glucose meters have gone from taking 2 and a half minutes for a result to 5 seconds or less. Yet we still wonder if the number it pops out is accurate enough to dose a meal we should have bolused for 20 minutes ago.

We have the technology to have our sugars tested every 5 to 15 minutes, but we need to calibrate the technology every 6 to 12 hours to maintain accuracy. Nevermind that we can only calibrate three hours after a meal, when a blood sugar is stable, and when there is little active insulin in the system. So we spend our time planning our calibrations and smack ourselves when we miss the perfect opportunity to do so by about 15 minutes. We also need time to change out sets, sensors, faulty insulin vials, lancets, test and re-test when we don’t like the result… all while being told that there is too much available out there to make diabetes more convenient and we have no excuse to not live our lives like a “normal person” would… except when we try and our A1Cs reflect that.

We spend hours, days, and months fighting with insurance companies to approve the care to give us more time on earth, yet they take their sweet time figuring out if they want to pay for it.

We take risks with time, guessing that 18 units left in the pump will get us through a 10 hour work day… until your co-worker brings in cupcakes. Damn. Let’s not forget about the time and effort required to have a “quick slice of pizza.” Spouse ordered Chinese food on a whim? You’ll pay for convenience later. Or explain, for the third time, why you just can’t partake in it.

We get told that our time will be shortened if we don’t take care of ourselves. That diabetes kills. Yet we see other T1Ds living well into their 90s, which means they began life as a PWD on some of the earliest technology and medical advances available. (Which wasn’t much – but they still survived.) Maybe time really was on their side. Then we laugh half-heartedly at how many times we’ve been told there will be a “cure” in 5 to 10 years, yet wonder if there will one day be any truth to that statement.

We try to manage our time to plan for possible spikes from high-fat meals, over-correction crashes, exercise fall-out, travel, stress, sickness, and well… breathing. But sometimes, even the most neurotic planner can’t expect to time doses exactly to accommodate whatever bricks are thrown at your ideal CGM flatline.

And if we spend too much time thinking about the time it takes to try and be healthy, we kind of go crazy. So we ask for the support of others who advise us to take just one day at a time.

 

 

[Alright, alright, fine… I’ll swim back to the shallow end of the pool next time… ha!]

Happy Black Friday

Here is a great example of what Black Friday looks like in the US.

No seriously… most stores and malls opened at midnight last night. But I thought it would be a good time to sleep instead. Or at least I tried. Since I was up around that time, I thought, well, why am I not shopping right now? Oh well, right, I want sleep.

Our Thanksgiving plans were altered slightly. Well, maybe more than slightly. The hubs woke up with an epic cold and we were slated to sit in a car for 2+ hours to visit my family. Since I have an ailing grandfather, we both figured it’d be a horrible idea to spread the cold to everyone in my family. Plus – the hubs just felt miserable. And I’d have to do all the driving. No thank you.

We had two options. Some of my good friends host an “orphan Thanksgiving” every year for those in the swing community that can’t afford to travel or don’t want to travel to their respective families. And then my brother-in-law and his wife were also hosting a mini Thanksgiving at their apartment. After some phone calls, it turns out I’m heading to two Thanksgiving dinners. One at 3 and one at sometime after 5 pm.

So here comes the ultimate game of pacing yourself so you don’t overeat and overdose on insulin. Since I was hungry at 3 and could stand to eat, I did. But chose my weapons wisely. And bless my friends for having a diabetic friendly meal prepped. I brought all my Splenda/Low Carb desserts to enjoy and carb count. They offered sweet potatoes that were boiled; not mashed, marshmallowed, and brown sugared, thank goodness. Plain steamed green beans with onions, rather than in a high carb/fat casserole. Dinner rolls with carb info. Just a couple things on the appetizer table. The biggest offender on my pump was a slice of jalapeño cheesy cornbread that everyone fought over. Yum!

Oh. And wine. Lots and lots of wine. I had to drive, so I mostly just watched everyone down glasses while I nursed my one and half. With some water.

On to the next party…

I started that part of the evening at 210 mg/dl. Which is crazy. That never happens. My average Thanksgiving blood sugar is 250 or higher. So for being 2 hours after I ate and that’s as high as I recorded, I was pretty stoked. (Though, I have no idea what my pre-dinner sugar was because… well… oops.)

I didn’t partake in second dinner, with the exception of dessert at the end. The hubs hadn’t eaten yet, so this was his meal after napping for most of the day. This dinner was quite different. Sweet potatoes with brown sugar and marshmallows. Green beans and bacon. Mashed potatoes. Mostly the stuff from my hubs and his brother’s childhood. And while delish… way hard to carb count. So I refrained, stating that I already had dinner, but would take some leftovers home. And then enjoyed a slice of homemade pumpkin pie.

Which I grossly overestimated.

I read somewhere that a good size piece of pumpkin pie is 37 grams of carbs. This was a good size piece, but maybe not a store bought size piece. I also over corrected to bring down my sugars floating at around 160 at this point and had been for the last couple hours.

By midnight, I’m 54 mg/dl. In an effort to not mess with my morning sugars too much, I only have juice and try to go to bed. 15 minutes pass and I still can’t shake the low feeling. Check again and I’m 46. Another round of OJ and some crackers and PB because obviously something isn’t sticking. I’m browsing Facebook to keep my mind occupied while my sugars hopefully come up. 15 minutes pass again and I’m at 96. Thank goodness. Bolus to cover the midnight snack. Briefly consider changing to go shop with the crazies. Decide against it and head to sleep.

Wake up at 9:00 am with a 101 blood sugar. How the hell did that happen? No idea. Let’s go shopping!

Ugh… Diabetes: 1 Me: 0

I had one of those days where I seemingly ate a steady diet… and my blood sugars just misbehaved.

I was also particularly upset that I scarfed down two (really gross) veggie protein sausages with my whole grain Eggos this morning in an effort diversify the meal and was high for most of the morning.

And an average lunch that I always have shot me up to 280 two hours post meal.

I think this was payback for going to sushi (again) last night.

Well played, diabetes. Well played.

 

ETA: Okay – this made me laugh. Download the PDF at the bottom.

An Anamoly

Well kids, I’ve stumped another diabetes professional. That increases my count to about 5 people that really have no idea what to suggest to help me counteract the extreme postprandial readings I experience, mostly after breakfast and lunch.

Backstory: I’m not a textbook diabetic. I’m sure many people can argue this, but really. I’m so not! It’s not that I’m insulin resistant – it’s just that the meds that are supposed to peak at 15-30 minutes usually peak at an hour instead. Thus resulting in an epic spike an hour to two hours post meal, and then an epic drop to normalcy around the three hour mark. This of course hurts my chances of ever maintaining a controlled rise. My doctors have tried cocktails of insulins to try and counter the spikes, which typically only left me crawling on the floor asking for juice to pick me up from hypoglycemia. But – perinatal docs all want me to have my postprandials at 120-140 during pregnancy… which is my struggle.

So today I saw a dietitian that specializes in mostly GD, but also works with T1s and T2s during pregnancy. I figured she’d have a better idea or different suggestions on how to get her patients to stop spiking.

Our conversation went like this:

Me: So I have been micromanaging my eating habits and blood sugars lately and I’m not seeing a difference. I’ve got dinner down, but breakfast is hell. I’ve tried just about everything humanly possible with the exception of starving myself.”

D: Well, maybe you shouldn’t have any milk or dairy at breakfast.

Me: I don’t.

D: Well, have you tried complex carbs and under 30 grams.

Me: I have. Sometimes I just have 15 grams.

D: Are you consuming about 8-10 grams of protein as well?

Me: Sometimes more. I was given a rule of thumb to try a 1:2 ratio between protein:carbs.

D: And you still spike?

Me: Every time.

D: …

Me: …

D: I have no idea. Maybe you should talk to your endocrinologist.

Me: <ragequit>

I’ll give it to her though. At least she’s being honest and was extremely happy that I’m trying to figure out what the hell is going on BEFORE we start trying to throw pregnancy into the loop. But as a dietitian  she couldn’t really advise me to increase my already, crazy high, insulin ratios. (1:4 most times of the day.) And bonus – apparently this clinic appointment was 100% covered by my insurance so I didn’t need a co-pay to get more non-answers.

However, I apparently gave my perinatal the impression that I had no idea what I was doing, carb wise. Though I’m pretty sure I told her that I’ve tried everything and that my docs at the previous hospital pretty much threw up their hands and said “no idea!”

Next week, I meet with the endocrinologist  who can probably hook me up with a dietitian that, you know, works with diabetics. (Concept!? Amazing!)