The Rule of Half

This past Saturday, I ran my second Get in Gear 10K (that’s 6.2 miles) in Minneapolis. Unlike last year, my blood sugars at the beginning of the race were much better, but I’ve had a recurring problem over the past few weeks where my blood sugar plummets about three or four miles into my run. In the past, I’ve gone for my runs after a meal, using a half bolus to keep my blood sugar afloat. But not even that has been working lately! It’s been very frustrating as I’m trying to train for a number of races this summer.

I had an endo appointment last week, although this time I met with the physician’s assistant because I had to reschedule my appointment and my endo wasn’t available for a number of weeks. Anyway, the PA was nice enough (although I prefer my endo) but I did talk to her about my consistent lows, just to see if she had any ideas. I’d thought about emailing my CDE (Jenny Smith at Integrated Diabetes Services) but since I already had this appointment I figured I’d see what she had to say. This PA suggested that I also cut my basal which I have always, always been super nervous about because 1) I never really believed that cutting basal started up quickly enough for a run and 2) I don’t like dealing with high blood sugars from cutting insulin hours down the road.

But I decided that it couldn’t hurt to try since my usual course of action wasn’t really panning out.

When I woke up on Saturday morning at 7:30, I was 223 mg/dl. I decided to take half a correction, because I didn’t want my blood sugar to continue to rise. Good performance in athletics requires the same balance as everyday life — you don’t want to be too high or too low. For breakfast, I had a simple piece of toast with jam (needs to digest quickly) and some coffee, and I took half a bolus. Now typically this is where it would all stop for me, but this time I decided to cut my basal in half for 2 hours — from 8am (one hour before the race started) to 10am, which is about 20-30 minutes before I expected to finish running.

Erik dropped me off at the starting line and I did another BG check — 221 mg/dl. I was stable and steady. Awesome! Now you might be wondering about the Dexcom. I’m sort of taking a Dexcom break right now, but more importantly, I have never really found the Dexcom to be terribly useful for exercise. I know, it sucks, and I’ve complained to everyone and anyone at Dexcom who will listen to me. I’ve had it tell me I was dropping when I wasn’t, and I’ve had it tell me I was staying steady when I was rising dramatically. It’s irritating as hell, so I tend to just run based on feeling and fueling at appropriate intervals. So far, it seems to work pretty well for me.

During the run, I took one GU at the water stop, which was located at the halfway mark. I was struggling physically because I started out too fast, but I was confident that my fatigue was from over exerting myself and not because I had a low blood sugar.

When I finished the 10K, I headed over to the car and tested my blood sugar — 180 mg/dl. Perfect! Not too high, not too low. Well, I suppose it would have been better to be just a bit lower than that, but I thought that was a pretty decent number to finish at.

Overall, I think the rule of half (half correction, half bolus, half basal) worked out pretty well for me and I think I’m going to continue a similar routine moving forward. Of course, it may not always end up with the same results, but it’s a place to start!

#IWishPeopleKnewThatDiabetes

(This is cross-posted on my non-diabetes blog, With Faith & Grace, but I know not everyone here reads that blog, hence the double post.) 

There is a Twitter hashtag going around called #IWishPeopleKnewThatDiabetes and I encourage you to check out the stream to see what others are saying. This is a reflection on that hashtag and also a conversation I had a with a non-PWD (person with diabetes) friend last week. 

Last week, I was driving home from a Junior League event with a new friend when the topic of my diabetes came up (in the context of blogging and what I write about).

My new friend asked me if my diet was very restrictive and I sort of snorted and said, “I ate a cupcake tonight, didn’t I?” Clearly, I’m not a very restrictive diet. Some people with diabetes choose to be, of course, and that’s because that’s what makes them feel healthier. Depriving myself does not make me feel healthier and so that’s not what I do.

And so my friend asked if my diabetes was a pretty easy to control. I paused.

I told her, “Sometimes diabetes is barely noticeable. And sometimes it’s a living nightmare.”

I think that it would be easy to think that diabetes was pretty easy to manage just from watching what I do. A lot of diabetes is mental — the carb counts, the adjustments for exercise. If you’re eating dinner with me, you might see me test my blood sugar and bolus, which takes all of 30 seconds. But there’s a lot of mental gymnastics that takes place while I’m thinking about what to order, while I’m waiting for the food to arrive, and even after I finish eating.

  • Choosing what to eat doesn’t just involve what I’m in the mood for, it also depends on what my blood sugar is and whether or not I need to stick to something more low-carb and protein-heavy, or if my blood sugar is on the lower side, maybe I want to take advantage of that and order pasta.
  • While I’m waiting for food to arrive, I’ll think about how I want to bolus — should I take some insulin now and some over a longer period of time to account for the fat that slows down digestion? And what percentage do I take now? Over how many hours do I think it will take my stomach to digest and absorb this food?
  • When I’ve finished eating, I’ll keep tabs on my continuous glucose monitor to see if I was right or I’ll pay attention to my physical symptoms if I’m not wearing it (the CGM is a flawed machined that can get annoying with false alarms so I don’t wear it 24/7).

And this is just when I’m eating!

Of course, reading all of this — and also if you ever catch my diabetes rants on Twitter or Facebook — you might think diabetes is an all-consuming travesty on my life. And that’s not really the case either.

Sometimes, I don’t think about diabetes.

When I’m in class, diabetes rarely registers in my brain. When I’m watching television, having coffee with a friend, or reading, I can go long stretches of time without diabetes popping into my head. Unless diabetes rings the alarm with a low blood sugar, I usually don’t have a reason to think about it. If I feel fine, then I usually put diabetes off to the side and I try to stay focused in the present. Practicing mindfulness, I suppose, is one of my biggest coping mechanisms.

But there are a lot of times when I feel like I’m teetering right on the edge. When I’m running, for example. Or when I’m walking around the city, window-shopping. Or when I’m working. Or when I’m driving. Basically any time that I’m moving, because diabetes can have such disastrous physical effects when something goes wrong. I might not be actively thinking about diabetes in the same way I do when I’m eating, but I’m always aware. I’m constantly scanning my body, what I’m doing, what I’m going to be doing, what I just did. Making sure everything is flowing together. It’s like when you’re driving a car and you’re constantly scanning for other vehicles. You’re not actively using evasive maneuvers to avoid a head-on collision, but you’re ready. You’re on guard. You’re being safe by being prepared. All the time. Every day.

Diabetes is exhausting. It’s annoying. It’s frustrating. It’s unpredictable — you can do the same thing with the same meal and have two different results. It’s stupid crazy. It’s weird. It’s funny (sometimes). It’s painful. It’s loud. It’s buzzing and beeping. It’s not something I would wish on anyone, but it’s something that everyone can live a long, healthy and happy life with.

What I wish people knew about diabetes is that diabetes isn’t one thing. It’s not a piece of cake (pardon the pun) and it’s not the absolute worst thing that has ever happened to me. It encompasses a huge spectrum of feelings, both physical and emotional. It can run the entire gamut in a single day or it can stay pretty steady. Diabetes is not something I will ever be able to sum up in a 140 characters, or a blog post, or even an entire blog.

What I wish people knew about diabetes is that it is really hard to understand, even for those who have it. But we really appreciate it when you try.

Product Review: Abbott’s FreeStyle Precision Neo

A few weeks ago, Jessica Sachariason, Public Affairs Manager for Abbott, reached out to me about doing a product review of a new blood glucose meter called the Freestyle Precision Neo. Now, being an Omnipodder, I don’t really have much use for a glucose meter because the PDM that controls my pod is also my glucose meter. But Jessica mentioned that the Freestyle Neo was going to be a low-cost glucose meter and available without a prescription. Since so many of us know people who struggle to afford test strips, I thought this would be a great product to share.

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So here are my thoughts after using the meter for a few days —

Pros: 

  • The meter is very slim and lightweight.
  • Test strips are sold between $14-$17 USD for 25 strips and a one-time fee for the meter, which ranges from $22-$28 USD. That’s $0.68 or less for a single test strip. My Freestyle Lite test strips retail for $87.99 for a box of 50 at CVS, which is $1.73/each. HUGE savings.
  • The glucose reading is big and easy-to-read.
  • It has a touchscreen.

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Cons: 

  • The strips are foiled wrapped, not in a bottle. I find foil wrapped strips more difficult to open, especially when you’re low.
  • The screen is white font on a black background, which is my least favorite contrast.
  • The lancing device that comes with the meter is ridiculously hard to open. I actually couldn’t figure it out and just used my Delica (although to be fair, I don’t really like my Delica either).

Freestyle meters are known for having some of the best accuracy in the industry (albeit that’s not saying much considering how poor accuracy standards are for test strips, but that’s for another post, ay?!). The Freestyle Neo strips are made with the same quality standards as the other strips, Jessica reports, which is good to hear. I compared a couple readings between the Freestyle Neo and my PDM, which uses Freestyle Lite strips, and the results were within reason. But since I was comparing between two Freestyle products, other people using different brands may notice different results.

I think this is a great option for people who might not get sufficient quantities of test strips from their insurance companies. I know how annoying and detrimental those quantity caps are! I also think this is a great option if you’re traveling, have an issue with your glucose meter and need a back up. It won’t put a huge dent in your wallet!