Epic Lows

Have you ever wondered what it was like to have a low blood sugar last two hours?

Well, let me tell you. It sucks. And it’s happened to me three times this week.

It’s not a question of why I went low. I’m pretty sure I know why I went low. The first (and probably second time) it was likely from stacking insulin during a rage bolus. And the third time it was from taking my normal bolus right before going to working at a retail store that involves a lot of walking.

All three times the lows weren’t exactly unexpected. But what happened after I went low was surprising.

I couldn’t come up.

My first epic low happened in the wee hours of Saturday morning, and it took 3 juice boxes — with my blood sugar tanking to 35 mg/dl! — before I started to sputter northward. I ended up flying into the stratosphere during the day only to crash land after dinner that night, complete with a LOW on the Dexcom. Yikes. A couple days passed before an epic low at work, which took two cans of Dr. Pepper  — that’s more than 120 grams of carbs! — before I resurfaced, and even then, I only topped out around 200 mg/dl.


photo 1-7Saturday morning’s epic low (there are actually 2 lows in that second dip — I didn’t come up until the third juice box)

photo 2-7Saturday night’s epic low

I have never needed more than a juice box to correct a low blood sugar, and certainly not two cans of regular soda (the equivalent to about 4 juice boxes). I mean, really?! I know I probably had a little too much insulin on board, but it’s not like the contents of my pod emptied into me!

I can’t quite figure it out. I’m now completely paranoid about going low because it’s not just a momentary hiccup. These lows are lasting hours. They are quite unpleasant. I can’t figure out what’s going on. If this is a complication of diabetes, it seems like the oddest sort. I thought for a moment it might indicate gastroparesis, but this would literally be the only time my blood sugar didn’t respond to glucose. My body responds to food at every other occasion! It’s just when I’m super low, my body is suddenly like, you know, we’ll get around to it when we feel like it. 

Ugh.

I know epic lows can happen to the best of us. But three times in a week? That just seems… weird. I know I still have diabetes because I’ve had plenty of high blood sugars when I’m not low! Has anyone gone through a string of epic lows? Did you ever figure out what the problem was?

Happy World Diabetes Day!

photo-1_thumbWell, I almost missed it, but I’m here! Hoping everyone had a productive World Diabetes Day. I spent part of the day participating on the 24-hour long Twitter chat for World Diabetes, which was definitely enjoyable. I don’t participate in Twitter chats nearly enough, mostly because on Wednesday nights I work until 8pm and so I don’t get home until the chat is more than halfway through.

My bit of diabetes advocacy for the day came in the form of a guest post for Anne of Fannetastic Food, a big healthy living blogger. Last month Anne posted about some recent blood work, and she talked a little bit about diabetes. I suggested to her that I could write a guest post about diabetes for World Diabetes Day and National Diabetes Awareness Month, and she agreed! I was so excited! But I was very anxious writing this guest post. Eventually I decided to write 14 things that people might not understand about diabetes, but in reality, I probably could have written about a hundred! It was very stressful trying to decide what to write and how to condense it so that it wouldn’t become a book. So far the comments have been amazing, so I’m really happy about that.

I’ve been kind of quiet around these parts mainly because school and work have taken up so much of my brain power that I haven’t been able to put together any thoughtful posts recently. But I’m going to try to get a few lingering posts up in the next couple of weeks, before the holidays roll in. Can you believe 2014 is almost over?!

How did you mark World Diabetes Day? Do anything special?

Walking A Mile

Easy-3They say that you really don’t know someone until you’ve walked a mile in their shoes. Well, I’ve never walked a mile in the shoes of someone who has type 2 diabetes or gestational diabetes or someone who was diagnosed with diabetes as an adult or any other variation of this dreadful disease. And there are a lot of variations.

When I saw the prompt for this month’s DSMA Blog Carnival (which I’m horribly remiss in responding to regularly), I was stumped:

Anything easy about living with your type of diabetes that isn’t easy for another type?

There are a few things about this that made me question whether or not I could even answer a question like this. First and foremost, I speak for my diabetes. Not yours. Or hers. Or that guy over there. Just me. And my perception of what is “easy” may not be so easy for someone else.

The second thing that got me thinking was that I don’t really know what is easy or hard for another type of diabetes because I don’t live with that disease. For example, I have a horrible gag reflex. I choke on aspirin. I had a hell of a time taking metformin a few years ago when I decided to see if I could help my insulin resistance. So to me, taking injections is easier than swallowing a pill.  Does that mean taking injections is easy? Not by a long shot (ha! pun!). But other people might think, Allison, it’s a freaking pill once a day. Get over yourself.

A few years ago, I had dinner with a friend of mine who has type 2 diabetes and she mentioned how her blood sugars affected not just what but when she could eat. She said if her blood sugar was high, she would have to delay a meal and often would go on a walk to bring it down. She couldn’t just pop a pill to lower her blood sugar. It took a lot more effort. I remember thinking that sounded terrible, because I just pressed a few buttons on my pump and that took care of business.

I suppose the flexibility to take insulin whenever I want is a perk of type 1 diabetes… or at least, a perk of someone who uses insulin. (And if there’s even such a thing as a perk with diabetes.) But using insulin comes with a whole host of things that are not easy. Pump failures. Bad insulin. Poor absorption. Miscalculating carbs and crashing or soaring. It’s really not that easy.

I can’t even talk about stigma, because the stigma against type 2 diabetes often trickles down to the rest of us who bear the title “diabetic.” I suppose there is less outright discrimination against me, because most people have a general concept that type 1 diabetes is not lifestyle related.

“That’s the one you’re born with, right?”

“That’s the really bad kind, right?”

“Should you really be eating that?”

I might not be discriminated against, but my ears are still bleeding.

On the surface you might think, “Well, type 1 PWDs can eat whatever they want,” but that mentality can end up being a lot more dangerous and counterproductive than you’d think. I don’t even want to think how many high blood sugars I’ve suffered because I thought “Well, I can just bolus for it” and then completely underestimated what I was eating. I might not have to suffer with people telling me that I “did it to myself” but I still have to listen to stupid, ignorant remarks and misguided advice from the Diabetes Police. And while I didn’t have to integrated diabetes into the already chaotic world of college, I still had diabetes in college and it still sucked, regardless of how long I’d had it.

But I will tell you what I do think is easy. I think it’s easy to think that you have it worse than someone else. We live in our own skin with our own experiences coloring our perceptions. We struggle to overcome the obstacles that diabetes puts in our way and because we are so intimately familiar with our own journey, we can feel each painful rock we have to step on in order to get where we want to go.

We are so focused on our own arduous path that we rarely look over to see if someone else needs help. We judge people based solely on a few sideways glances, never really looking to see what they’re working against.

I think it’s easy to think we have it worse than someone else. It’s much harder to swallow that belief, make ourselves vulnerable and ask if there is something we can do to serve other people.

That Time I Ran A Half Marathon

B0z0cM_IgAAaVbBSo, I ran a half marathon on Saturday.

I know, I know. I didn’t really tell anyone about it. I had a couple false starts this summer with other half marathons and I got a little gun-shy talking about it. I didn’t even really talk about it on my other blog. But I did it! Want to hear how it went? Good, because I’m telling you anyway!

Friday evening a couple of my local D-friends and their respective husbands came over for dinner. Even though it was right before a race I felt comfortable because they are both healthy eaters so I knew I wouldn’t have an issue. Well, turns out I did! Not with high blood sugars, but with lows. I crashed pretty bad after dinner (I think I overestimated the carbs) and ended up having to drink and eat more than I expected.

At about 4 am I woke up to a blood sugar of 187 mg/dl on the Dexcom, and took a baby correction. No, I didn’t test. Yes, I know better. I’m sorry…

I woke up at 7:00 am with a blood sugar of 90 mg/dl. Not terrible. But context is king in diabetes and I was not so happy with that number at that time. I had a gluten-free piece of toast (more on that another day) with some chocolate peanut butter and coffee then we were out the door!

When we arrived at the start, I took a quick test. I was only going to carry my Dexcom with me, and Erik was going to meet me at the halfway point for a quick test to see how on track the Dexcom was. At that point, I was 89 mg/dl. Ugh. So I gulped one of two juice boxes I had (the other would be staying with Erik if I needed it at the halfway point) and prayed that would be enough. I was carrying five HoneyStinger gels which have 25g each. I only planned on using 3, maybe 4, so I anticipated it being enough but I was starting to get nervous!

I felt really good for the first couple of miles, but at mile 2.5, I heard a familiar buzzing sound. It was my pod. My pod had failed. As predicted.

You see, as much as I love the Omnipod (and I really, really do like it a lot), it has this really unfortunate tendency to fail on my runs. It doesn’t happen all the time and it doesn’t happen with any particular mileage or any particular pod placement. But if it’s going to fail, it will be while I’m running. I had actually prefilled a pod earlier that morning in anticipation of this but, as luck would have it, that doesn’t work.

Pods apparently start a timer when you put insulin in it, and by the time my pod failed, the backup pod had already timed out. The PDM couldn’t recognize it as being a new pod. I quickly called Erik and told him he need to go home, get a new pod and bottle of insulin, and meet me at the halfway spot, which was 4 miles away.

Just a little while later, the Dexcom started buzzing that I was below 75 mg/dl. Ugh. I was at Mile 3, and had planned to fuel at Mile 4 so it wasn’t too far off from my plan. I took a little extra walking break but continued my run / walk pace because I felt just fine. In fact, I’ve noticed that the lower my blood sugar is, the better I run, so long as I don’t actually have hypoglycemia symptoms.

After mile 6, the Dexcom alarms again that I’m 58 mg/dl. I’m not sure I believe it but I take another HoneyStinger just in case. I wasn’t far from where I was planning on fueling again anyway. Erik calls me just before I reach our meeting place, and he’s actually behind me, so he sprints to catch up! We pull over and I do a pod change and BG check. I’m actually 108 mg/dl, and I’m glad I checked. Dexcom can be such a little liar sometimes.

I take off again and manage to keep a pretty good pace for the next few miles. The Dexcom doesn’t alarm at all the rest of the race, but I take a HoneyStinger at Mile 10, and a little bit of Powerade at mile 12.

I finish the half marathon with a time of 3:05:34 and a BG of 187 mg/dl.

The first half of the race projected me at a sub-3 hour, and I know that stopping for a pod change really slowed me down. I’m pretty pissed about it, because I don’t know what to do to stop it from happening. I’ve been on the pod for over a year, and did tons of runs without any issue until it started this past August. Part of me wonders if there’s something funky with the last shipment of pods. There just isn’t any rhyme or reason to it. I wish I’d known not to prefill a pod, because it was such a waste of time. If I’d had a pod and bottle, I could have easily changed my pod while at least walking.

I’m also pissed off at Dexcom. It told me I was 106 mg/dl at the finish, a whole 80 points off from what I was. It just isn’t reliable when I exercise. I never wear it while running or working out anymore. I find it totally useless. I don’t know why I thought I could get away with only testing once.

I definitely should have brought strips and a poker with me. My FlipBelt that I was wearing could have easily held everything I needed: a PDM (which I was already carrying), test strips, poker, pod and insulin. None of those things even weigh that much, so it’s not like that would be a big issue. I could have done what I needed to do during the walk breaks I was already taking. Sigh. Lessons learned, right?

Of course, I’m happy to just have finished. I keep telling myself that the time doesn’t really matter, at least not for the first one. No matter what, I set a personal record because I’d never done a half marathon before. Overall, it was a pretty good first race.

Yep. First race. Not last race. There will definitely be more.

 

Wanna Talk To The FDA?

SurveyOn November 3, there will be an unprescendented conversation between the diabetes community and the FDA taking place and YOU can get involved! DiaTribe wants to collect as much feedback from the diabetes community (type 1, type 2, caregiver, whoever) so that they can really know where we stand and what we need from the FDA. This is our chance!

There will be a live webcast from 1-3pm EST so you can listen to the conversation happening between patients, the FDA, and experts from ADA and JDRF. Registration and a finalized agenda for the meeting will be available soon, but save the date!

Head on over to the survey now and answer the questions. They need the answers within the next five days in order to have time to analyze the results before the meeting. I took it and it takes about 5-10 minutes to do. Very easy! No trick questions!

The After

This is the part where I usually start fucking things up.

I’ve lowered my A1C before. A quarter, a half, even a full percent. Now I’ve jumped one and a half percent and all I can think is: “How long will it last?” Because I’ve seen my A1C go down. And I’ve also seen it go up. And down. And then up. And then down.

My A1C rarely stays put and it rarely stays moving in one direction.

I get my A1C done. It’s above where I want it to be. I spend the next three months diligently counting carbs (possibly even lowering my carb count), testing more often, correcting more aggressively, exercising more often, and in general just being a totally bad-ass diabetic. Okay, well I am always a bad-ass diabetic, but this time I’m extra bad-ass. And then I get my A1C. And it’s awesome (eh, awesome-ish). So I think, great, I have it figured out. We’re all good here. Then the days, and the weeks, and the months go on and I start maybe being a little more careless with the carb counting or bolusing early, but I think, well, my A1C was such-and-such, so this one little (::cough::) indiscretion isn’t going to be the end of the world, right? Until I finally make my way back to my endo, get my A1C done, discover it’s crawled back up to where it was six months ago.

And so it goes.

It just pisses me off because I feel like good control is a recipe for diabetes burnout, but if I relax for even a millisecond everything goes to hell anyway.

I need to find a happy medium between being completely obsessive and completely lackadaisical.

My next endo appointment is on December 29th (Merry Christmas to me!), and my main goal for my next A1C is to keep it exactly the same. Well, within reason. Mid-sixes. To do that, I’m trying to focus on a few things:

1) Download my Dexcom receiver and review my graphs every time I change my sensor. I don’t do this enough. I need to do this more, and if I do it every time I change my sensor, that should be somewhere between every 7 to 14 days.

2) Change my goal BG to 90 mg/dl instead of 100 mg/dl. I saw someone recommend this a few months ago and from what I’ve seen in the last two weeks since I did it, it’s pretty helpful. By having just a tiny bit more insulin going in, I think it helps account for any discrepancies in carb counting or in absorption.

3) Not be afraid to make tweaks to my pump settings. I have a bad habit of thinking things will just “fix itself.” Sometimes it does, sometimes it doesn’t. If a pattern emerges, I should fix it, even if I might need to change it back later. It takes less than a minute to change a pump setting. I should be more proactive.

4) Have regular appointments with my CDE. Sometimes patterns don’t always make themselves known to me, or sometimes I don’t realize that by fixing something, I’ve caused another problem somewhere else. After all, our days are cyclical. What you do at one time of day can impact another part of the day. I have an appointment with Jenny for Monday, and I’m hopeful to keep up monthly appointments with her.

 

Do you have any tips for making sure you don’t start slipping back into old habits? 

 

Diabetic Living + TCOYD Recap

This weekend I drove down to Des Moines, Iowa for the TCOYD conference and for a meeting at the offices of Diabetic Living, one of the magazines I write for (I’m in their current Fall 2014 issue!).

When I arrived at the Meredith Corporation (which publishes DL), my editor, Martha, greeted me and showed me some of the behind-the-scenes of how the magazine is put together. We went down to the test kitchens, which is an enormous room that looked like an IKEA showroom. There were about six or eight fully functioning kitchens all in a row. There was a lot going on, including one cook that was making some chicken marsala that will be in next summer’s issue. It smelled so good! I love Indian food.

photo 1-3

Then we went to the Photo department. I saw the Prop room, which has just about every kind of dish, glass and servingware you could imagine! The room was huge. Then we went over and saw some of the photo shoots going on, including a feature on some healthy desserts. We taste tested a brownie with mint creme filling and it was pretty good! Martha says that they taste test every recipe that goes into each issue, which not every magazine does. She also explained that when they do the photo shoot, they photograph the precise serving amount you should have. It’s very technical!

photo 2-3

On Saturday, I went to the TCOYD conference at the Iowa Events Center. A few DOC favorites were there, but there were also a couple missing faces because of the fires in Chicago that delayed flights. So sad. But it was still a good conference!

Here are some key take-aways:

“There’s never been a better time to have diabetes” – Dr. Steve Edelman 

There was a heavier emphasis on type 2 diabetes than at some other D conferences I go to. Dr. Edelman shared that:

- Any drop in your A1C will reduce the risk of complications. It’s not a sprint, it’s a marathon.

- It’s never too late to take control of your diabetes by putting diabetes high on your priority list.

- The gene for obesity may be linked to the gene for type 2 diabetes.

- Your therapy may change over time. Even if you do everything right, your therapy may change. It’s not that you’re failing, that’s the progression of type 2.

- It’s important to get regular eye screenings and kidney labs done, because symptoms of those complications aren’t felt until it’s severe.

Change Your Mind, Change Your Diabetes – Dr. Bill Polonsky 

  • No shame, no blame. Some people believe the reason they have diabetes or not good diabetes, is because they are bad. That is scientifically not true. genetic link and often invisible environmental factors. even when we look at numbers attached to weight or when we check BGs. we must remember it’s just a number. no good or bad numbers, just information. we give too much power to these numbers, to give self-worth as human beings. “it’s just a number.”
  • Remember the good news. With good care, the odds are good that you can live a long and healthy life with diabetes.
    • 1978: more than 30% with severe vision loss, 38% with nephropathy, 10% amputations
    • 2009 – 1% severe vision loss, 1% amputation, 6% nephropathy.
    • There is a normal life expectancy for type 2 PWDs compared with the general population when you have good care.

Sir William Osler says, “To live a long and healthy life, develop a chronic disease and take care of it.”

  • Make sure that you have concrete and reasonable diabetes care goals.
    • Focus on the important stuff. Not everything is equally important. “bang for your buck list.” Being on the right medication and taking it is the biggest bang.
    • Give yourself a break. You can’t be perfect and you don’t need to be.
      • Take a diabetes vacation, just plan it ahead. how can you give yourself a little break in a way that is restorative. it’s people who take unsafe vacations like ignoring the disease for 20 years. Talk about it with HCP to get a little break and get what you need.
  • You don’t have to do diabetes alone.
    • Find people who will root for you and help your loved ones help you. Have conversations with loved ones who are supporting your efforts, but sometimes you might have people who are giving you too much support. They all mean well but you end up working against each other. They are always coming from a place of love and caring but they may not know what to do. Because they love you, they are never going to stop. You have to distract them, give them something clear of how they can help.
  • Develop a sense of humor.

CGM: Revolutionizing Diabetes Care – Dr. Jeremy Pettus and Kelly Rawlings

- According to new studies, the Dexcom really is more accurate than Medtronic

- However, Medtronic is an integrated system and the 530G has the Low Glucose Suspend, both of which could be very useful for some people.

- Dr. Pettus suggests that in the future, rate of change arrows will play a bigger role. If your blood sugar is 200 mg/dl and rising, you might need more insulin than if you were 200 mg/dl and dropping. He said that at first we’ll learn to do it manually, and then later it will be automatic.

- Dr. Pettus, who has type 1, boluses off his CGM almost all the time. (Not sure I could be that brave!)

- One patient of his uses the Earthquake app on his iPhone to make the alarms louder!

Diabetes Criminals and Diabetes Police – Bill Polonsky and Steve Edelman

photo 5

This was a session where patients and healthcare providers had a chance to air their grievances.

- Patients shared that providers are often: not interested, don’t listen, give bad advice, and aren’t empathic.

- Providers shared that patients often: don’t come prepared, stop taking medications without consulting with their doctor, won’t spend the time to get educated, feel like they are working harder on their diabetes than the patient.

- Edelman and Polonsky shared that: patients should come prepared with a short agenda to maximize efficiency with time, show appreciation for what their doctors do, and understand that providers went into the field to help people but they are under a lot of stress.

- They told providers that no one asks to have diabetes, so we need to be careful not to blame patients. Guilt does not create motivation.

Keynote speaker – Joe Piscatella (a motivational speaker and author on living healthy)

- Stress is a major reason why people don’t take care of their health, because they are stressed out and don’t feel they have the time.

- Major causes of stress:

  • Multitasking
  • Anger and hostility
  • Depression
  • Constant connection

- No such thing as stress reduction, but you can learn to manage stress. You learn to manage diet and exercise better.

  • Deep breathing (in through the nose, stomach out, hold it, out through the mouth for 5 beats)
  • Dxercise – the most important element: regularity by getting a partner
  • Perspective — it’s the way we view an event that makes it stressful or not stressful.

Joe shared that he had coronary bypass surgery at age 32 and was diagnosed with an aggressive cardiac heart disease. His doctor told him that he should continue on living the way he was, because there was no hope! He would likely not see his children, then 4 and 6, graduated high school. But his wife believed that he should do whatever he could to live a healthier, longer life.

She said, “You can’t change the cards you’re dealt, but you can change the way you play them.” 

Now Joe is in his seventies, and has seen his children graduate high school, college, grad school and law school and has four grandchildren! Now that’s the power of positive thinking and healthy living!