Read Me: SuiteD + Diabetes Forecast

acqbjeKKiAs most of you know, I don’t just write about diabetes here at The Blood Sugar Whisperer. I freelance for a number of diabetes publications, and right now I have a couple new things up at SuiteD, which is Insulet’s community of blogs, and at Diabetes Forecast, the publication of the American Diabetes Association.

I have wanted to write for Diabetes Forecast pretty much since I started writing about diabetes more than 10 years ago, but never had the opportunity until recently. You’ll be seeing a lot more of me in the pages of DF! But for right now now, you can read about finding the right lancing device in Diabetes Forecast and also on their website.

Over at SuiteD, I’m sharing my thoughts on the benefits of pumping while exercising

Exercising is not something that comes naturally to me. I’ve never been an athletic person! So it’s easy to want to give up when it’s both hard on the body and hard on the diabetes. Luckily I’ve found that using an insulin pump has helped in many different ways as I try to stay active.

The post says I’m training for my first half marathon, which isn’t true anymore because I already finished my first half marathon! Right now I’m starting to train for a couple of other races, which I will be sharing with you very, very soon!

Threshold

How long does it take you to change something?

I recently finished an article for Diabetes Forecast about using CGM data, and one thing that I learned was that patterns can be identified when they happen more days than not over at least two set changes (so that you’re not making changes based on bad absorption or insulin gone awry).

The other day I was dealing with a 300 mg/dl blood sugar with two up arrows and I was at my wits end. I had been dealing with crazier than usual blood sugars and I couldn’t identify the problem. The only time my blood sugar came anywhere close to normal was when I gave a huge injection via syringe, and that just ended up with me crashing to 55 mg/dl at 5 am. Not exactly a pattern I wanted to maintain.

Were all these highs because I wasn’t exercising quite as often? Maybe. Was it the Thin Mint Girl Scout cookies I was eating? Could be. Was it my menstrual cycle? Probably not, I wasn’t due for another two weeks. My pod rotation is pretty good, and I had problems over two pods, so I thought perhaps it was time to change my basal rate or bolus ratio.

After a pho lunch at a Vietnamese restaurant (which was the cause of this particular spike), I almost headed across the street to a coffeehouse with the best chai tea, thinking I should at least hold out until the evening before making any decisions about tossing the pod I was wearing. But I just couldn’t shake the feeling that there was something more to it than just needing some tweaking.

When I got home, I decided to use a fresh bottle of insulin. Within a few hours, my blood sugar was back down to normal.

So all of this made me think about thresholds. How long do you stay miserable before you do something different? On our CGMs, our thresholds warn us that we need to do something. They are super helpful when it comes to making in the moment decisions about whether to drink some juice or shoot up some insulin. But what about other kinds of thresholds? Like, the threshold for how many times you can go over your threshold before doing something to identify and remedy the problem. Whether that’s sticking with the same bolus ratios or basal rates despite knowing that it just isn’t quite cutting it, or maybe it’s a insulin set that’s past due, or an insulin bottle that just needs to be thrown out. Sometimes I find myself suffering with consequences without actually addressing what’s causing them. Why do I wait so long to do something? Why did I wait almost 3 days before deciding to change the bottle? I came precipitously close to living another few hours with dangerously high blood sugars. Why was my threshold so high when it came to making the changes I need?

I often see this when it comes to changing my basal rates. I will give correction bolus after correction bolus like insulin is water and sleep ain’t no thang, when really just a small tweak in the basal is all I need to flat line over night and I can wake up (more or less) completely refreshed. I can’t figure out why my tolerance for nausea,  unquenchable thirst and blaring alarms is so high.

What’s your threshold? How long do you wait before you do something? 

The Four Meme

4-2The Four meme is making the rounds and I thought it would be something fun to post. I don’t really post non-diabetes things here, so this will give ya’ll a chance to get to know another side of me!

1. Four names people call me other than my real name.

To be honest, no one really calls me anything besides Allison right now.

1. In high school, some people called me Ally if there was another Allison in my class.
2. At diabetes camp, my camp name was Angel.
3. My husband calls me babe and other assorted nicknames.
4. Very few people call me Mrs. Nimlos, but I suppose it has happened.

2. Four jobs I’ve had.
1. Assorted food service jobs in high school and college
2. PR professional
3. Assistant editor at DiabetesMine
4. Retail associate

3. Four movies I’ve watched more than once
1. Star Trek: First Contact (I am a HUGE Trekkie, and so sad about Leonard Nimoy).
2. Ever After (a Drew Barrymore Cinderella adaptation movie)
3. You’ve Got Mail
4. Clueless

4. Four books I would recommend
1. Life of Pi by Yann Martel
2. The Diary of Anne Frank by Anne Frank
3. Man’s Search for Meaning by Viktor Frankl
4. The Immortal Life of Henrietta Lacks by Rebecca Skloot

5. Four places I’ve lived
1. Eugene, Oregon
2. Hoboken, NJ
3. New York City
4. Minneapolis, MN

(among other places — I’ve lived in 8 cities in the last 10 years)

6. Four places I’ve visited
1. England
2. France
3. Canada
4. Mexico

7. Four things I prefer not to eat
1. Tomatoes
2. Brussels sprouts
3. Peas
4. Cooked spinach

8. Four of my favorite foods
1. Popcorn
2. Indian
3. Thai
4. Ethiopian

And cupcakes, of course.

9. Four TV shows I watch
1. The Walking Dead and The Talking Dead
2. Downton Abbey
3. The Originals
4. The Vampire Diaries

Four things I’m looking forward to this year
1. Visiting Oregon for one of my best friend’s wedding
2. Going to Hawaii for Christmas
3. Running a Ragnar, benefitting JDRF
4. I’m not sure I’m looking forward to turning 30, but I’m certainly anticipating it…

Four things I’m always saying
1. “What are you shopping for?” (at Pier 1)
2. “Have you ever had a gait analysis?” (at the running store)
3. “How many carbs is this?” (at home, to my husband)
4. “Can you hand me my diabetes kit?” (also at home, also to my husband)

So there you go! A little bit more about moi.

Resilience

Forgiveness of self and forgiveness of others leads to resilience. This is something that my professor said the other night in my Foundations of Family Therapy class. It stuck in my head and I have been thinking about it ever since.

The thing that stood out to me the most about this sentence was the idea of forgiveness of self. When I was in college, I was meeting regularly with a therapist. One of the things that I learned from talking to him was that whenever something would go wrong in my life — and at the time, it was, of course, a relationship with a boy — I immediately thought that it had to be my fault. I often thought to myself, “What did I do? What did I do wrong?” I had placed this undue responsibility for things on myself and I couldn’t figure out why that was.

Eventually I figured out that it was a thought pattern that had been ingrained in me since I was diagnosed with diabetes. Every time I had a high or low blood sugar, I would analyze what went wrong and what I could have done to prevent it.

It took me a long time after coming to that revelation to break the habit of so much self-blame when it came to managing my diabetes. I slowly worked my way out of the pattern of thinking that I was always responsible when something didn’t go the way I wanted. Of course, I don’t completely let myself off the hook when I do something that doesn’t work out but it’s not my automatic assumption. So part of it is recognizing the areas where I need to take responsibility and forgive myself for making unwise choices because, hey, I’m human, and then recognizing the areas where I don’t need to take responsibility because, hey, I have diabetes. Shit happens and not all the shitty stuff is my fault.

This is something that I still see so often in social media. There is so much self-blame that goes on in diabetes management. Our medical community doesn’t help the situation. The entire way that diabetes management is set up is very focused on what the patient does (or did), versus what the diabetes is doing. But once I learned to quit blaming myself when something went wrong, I think that it made the mental aspect of managing my diabetes a little bit easier because I didn’t take things personally. I think it’s helped make me more resilient in the area of diabetes burnout because I don’t view a high blood sugar as a personal attack on my character. I don’t like having a high blood sugar, and of course I don’t like having diabetes and I don’t like the way that diabetes makes me physically feel.

I’m not perfect in doing this all the time. And sometimes when I do know that I did something wrong, I either get overly aggressive in how I feel about it (i.e. “How stupid can I be?!”) or I completely dismiss anything and I don’t learn from what happened. That’s why the idea of self-forgiveness really resonated with me. There is still so much responsibility in diabetes, despite the fact that we live with an unpredictable disease. I think remembering that I’m only human and sometimes I’m going to choose to make choices that didn’t work out. And although diabetes is not a person and not really something I need to forgive, I think it’s important to be forgiving and understanding of the situation. It doesn’t necessarily making life with diabetes easier, but I do think that working on this has made it a little easier to be resilient in the face of all the challenges.