65 mg/dl

On the second day of blood sugar my meter gave to me, a 65 mg/dl at 6:45 AM!

I would say last night I accomplished the no eating after 8 pm feat again (there were a few almonds, but who’s counting?)..

Let me explain a little more what the function of this goal might be in terms of nighttime blood sugar management. I want to be clear that it’s not just self-restraint for general health purposes.

‘Insulin on board’ is a term to describe the amount of insulin you have previously injected that is still working in your system. In general, insulin takes 20-30 minutes to become active in the body and has a duration of action of between 2 – 4 hours. That’s a big range, but I’ve noted that the max action of insulin is typically over for me after about 2 hours, and I don’t think much past 3 hours back when I’m considering insulin on board.

All this means that if I stop eating at 7 pm, like I did last night, then when I check right before bed, the number I’m dealing with will be more static, and thus easier to alter without as much unpredictability.

Last night I had a beef taco and a chicken tostada with a friend of mine at a taco stand, before going to a concert and puppet show in a shed. It was a little weird, but it fit just fine into my health resolution, so that must be a good sign.

I knew I’d be a bit high because I took a conservative insulin dose so I wouldn’t have to deal with low blood sugar while driving. When I got home later in the evening, my bg was 167. I took a unit of insulin but did not come down at all over the next hour. I took another half unit before bed.

65 is a little low. Below 70 is considered hypoglycemia. Times like these I wish I had a CGM so that I could see if I’ve been low for hours or if I had just gently arched down to this level right before bed (the latter being a preferable outcome).

I’ll explain more about ranges later. It’s important to remember as a reader, that management is highly individualized, and this is just my particular style.

Happy Monday.
Katie

119 mg/dl

On the first day of blood sugar my meter gave to me!

a 119 mg/dl at 9:20 AM.

9:20 AM?! – I know! Who gets to sleep that late in adulthood? The weekends are my sleeping time. I am like a bear, storing up for the next 5 days of waking up at 6:30 AM.

NOTICE: I am going to use “bg,” “blood sugar,” and “blood glucose,” interchangeably in these entries. They all mean blood glucose.

So how did this 119 mg/dl come to be? Well let me tell you, it was hard fought.

When I came up with this bg blog reporting idea, I didn’t consider the fact that it would expose my schedule and social activities, or lack thereof. Last night, Saturday night, I had no plans, which was exciting, so I cooked dinner, finished before 8 pm, and thought, “I’m well on my way to one of the four days!”

At 8:30 my bg was 96 mg/dl. Whew! I love a 96. Sometimes when I feel down about life, I check my blood sugar and it’s in the 90’s and I think, “Well, I’m sure doing something right!!!”

But I did not trust the stability of this reading. At 9:30 I checked again, just to see the trend. 149 mg/dl. Hmm, a slow rise that could very well have stabilized. “Great,” I thought, maybe I’ll even dip back down a little before bed.

At 11, I checked once more, just prior to laying down. 220 mg/dl. “Ugh”. Not good. So you know, my ideal range for prior to bed, if insulin action has ceased is 90 – 130 mg/dl. That’s just me. I was well above that.

I chose to take 2 units of fast-acting insulin. I also took 2 units of long-acting insulin, because on weekends when I sleep in past my morning dosing time, if I don’t take a little the night before, my bg will creep up in the AM hours.

At 2:30 AM I awoke, still caught up in my dreams, and feeling a little confused. 2:30 AM is sort of confusing time of day anyway, but I decided to check just in case. 101 mg/dl. Hmm. “Great!” Right where I wanted to be. I went back to sleep.

5:30 AM, I awoke again. Slippery mental state. Definitely low. 59 mg/dl (I hate to admit this, because night time lows scare people, but my body is great at waking me up…thanks body). So I ate 2 small spoonfuls of honey (about 1 tbsp in all), 2 cheddar crackers, and half a spoonful of peanut butter. Not scientific, just going on feeling.

Back to sleep!

I expected to wake up around 8 and be a little bit high. When I woke up at 9:30, I thought, “Ugh, I’m going to be really high.” But! But!? Somehow, 119 mg/dl.

So, there you go.

That was tedious huh?

Thanks for sticking it out.

Until tomorrow,

Katie

 

Diabetes Resolutions

I’m a person who loves resolutions. I love the celebration of shedding old parts of ourselves and adopting new habits built on all of the tremendous self-growth of the past year. That’s what the New Year symbolizes for me. Whereas other times of the year we resist change, both in the external world and the internal world, right around 12/31 we start to act like we think it’s the greatest thing ever.

So I was asking myself, in addition to my all of the resolutions I’d like to make in every other realm of my life, should I have a diabetes resolution? And then I decided, no. Basic diabetes management is a big enough resolution. It’s like asking your friend without diabetes what their health goal for the coming year would be and them saying, “Well, I’d like to start pricking my finger 8 times a day and counting all the carbs I eat and explaining very intimate details about my body to both my closest friends and to complete strangers multiple times a day. I’d also like to introduce a lot of self-shaming and restraint into my eating, exercise, and general lifestyle habits.”

I mean that’s big enough right?

But I was writing in my journal this morning and as I always do I made a note of my morning bg (this is not a ‘health journal’, just my journal journal), and I was moved to also note that the elevated number was likely due to late-night snacking. Now here, I want to make a critical explanation, because I hate overly simplified diabetes rhetoric. It makes it seem like, “Well, if those people with diabetes could just do what they were supposed to do, it’d all be fine!” No! my blood glucose could just as easily sneak high in the night without me having a late-night snack, if I didn’t have enough insulin in my system to cover the sugars my liver is naturally pumping out all the time (just like everybody’s is). And sometimes, not eating after dinner makes this more likely to happen – especially if I finished dinner early and had less insulin in my system overall, perhaps because it was a dinner particularly low in carbs.

The complexity of diabetes is what originally inspired me to write a blog. It’s like being part of a secret world – the ins and outs of blood sugar. I imagine myself like Mrs. Frizzle. taking her class to the pancreas for a day. So I thought, why not make a diabetes resolution and a.) use my blog for accountability, and b.) take you all along on the complicated journey that is every blood sugar reading.

I realize this plan has some flaws. People with T1D are gonna be like – “why would I want to read about her blood sugar when I have to manage my own?” And people without T1D are gonna be like – “why would I want to read about her blood sugar when I don’t have to manage my own?” But whatever, this is my resolution.

So here it is, stated clearly, my small diabetes resolution-experiment:

  • 4 out of seven days of the week, I will cease eating by 8 pm unless I have a low blood sugar and have to treat it (treating it means eating something, FYI).

What this really means for me is that I’ll be prompted to eat dinner earlier and eliminate post-dinner snacking on those days.

I’ll post my BG every morning along with a brief explanation of my theories behind the number. I could be right, I could be wrong, and we’ll literally never know!

Cauliflower is the new steak

Because steak will never be the new cauliflower, I’ve been making this recipe for cauliflower steaks out of Bon Appetit magazine, as often as possible lately.

Often I tell people that, while I can eat anything with diabetes that I want as long as I cover it with insulin and exercise, etc., I generally avoid white foods, as these tend to be laden with quick-burning, simple carbs.

Of course the cauliflower stands in stark defiance of this rule. For example, if you eat a whole head of cauliflower* you have consumed only 146 calories. That is crazy. Also only 29 grams of carbs and a whopping 12 grams of fiber. For reference, one Clif bar has roughly 250 calories, 42 grams of carbs, and 5 grams of fiber.* As you can see, raw cauliflower is clearly the better cross-country road trip snack.

That’s a joke, but the cauli steak recipe really has changed the way I think about this Brassica. It’s buttery, rich, and delicious, and goes great underneath sauteed ground pork with sage, and I imagine underneath many other meat and vegetarian-based proteins. Plus, diabetically* speaking, the steaks and the accompanying puree both have an almost potato-like heartiness that I often miss, without delivering a big punch of carbs. And also it’s totally beautiful to look at before you eat it or serve it to your loved ones. Let me know your thoughts and variations if you try it out!

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*https://www.nutritionix.com/i/clif-bar/cool-mint-chocolate/5b4f8589a9db904b1fcf24f1

*USDA, google sidebar

*As always, this is a made up word (but aren’t they all?) that you shouldn’t use in scientific papers or elsewhere.

Does diabetes limit your life?

My dad came to visit me for Father’s Day this past weekend. After dinner one night we got to talking about my work and about how the landscape of diabetes and its management has changed over the years. He asked about my experience of living with diabetes and how it had changed over the past 12 years or so. Dad, who I probably haven’t ever talked as openly about diabetes with, was more willing to be curious than I previously remembered. He asked me: “So – do you find that it (diabetes) limits your life?”

What an interesting question.

If you had asked me two days after diagnosis, I would have started bawling and talked about all of the dreams I had that I could never do now that I had to tote diabetes around with me. Dreams like: hiking the AT, kayaking in a remote jungle, abandoning society with no cellphone or attachment to the outside world…

If you had asked me two weeks after diagnosis I would have given some sort of manic response cloaked in coping positivity, like, “No! It has made me stronger, more organized, and more appreciative of life!”

If you had asked me two years after diagnosis I would have probably given you some more truthful examples, like how hard it was to be a summer camp counselor only 5 months after I’d been diagnosed; to be chipper and on full-time, while trying to give myself shots, check my blood sugar, eat someone else’s cooking, sleep in a cabin full of 8-year-olds, and otherwise make sure everyone was safe and entertained.

And then there have been other moments when the thought of doing it and doing diabetes, was just too much. I’ve said no to weekend plans and trips with friends, stayed in at night because I didn’t want to have to keep strategizing about my blood sugar so that I made sure to be at a good level to drive a car.

But – and I may be conveniently forgetting something – I’ve never not done anything I really wanted to do because of diabetes. Maybe I’ve been more exhausted before, during, and after it, maybe it’s made me ask myself how important something was to me before committing, but I’ve kayaked in a jungle, have gone on long trips, and have otherwise lived the life that I wanted to.

And – what’s interesting is how the “life that I wanted” has changed. My desires seem to be increasingly able to co-exist with a life that gives me space for diabetes management.

Natalie Goldberg says our obsessions can be our inspiration – and I’d be lying if I said I wasn’t obsessed with diabetes. But I’d also be lying if I pretended that obsessions wasn’t a prerequisite of diabetes; either you’re obsessed with it upfront in order to manage the moment to moment decisions and tasks, or you end up obsessed with the symptoms of high or low blood sugar, and other short and long-term complications. And to say I’m obsessed with diabetes is really barely scratching the surface – what I’m obsessed with is what diabetes represents – the interaction between our bodies and our environments. Between the internal and external world. Diabetes gives you a front row seat to watch the effects of every bite of food, every step you take, every bit of anxiety you hold on to, minute of sleep you get, sunburn, bug bite, cold, allergy, all of it – it’s all a weird dance. Or orchestra. Or rowdy old-time band (represented by featured image taken at Shakori Hills music festival, 2018).

So, after traveling a long and winding mental road to an answer, I replied to Dad that the question didn’t quite fit for me anymore. It was the first time I’d realized this, that the answer required a reimagining of the question. Deciphering whether diabetes limits my life, or impacts it in positive or negative ways doesn’t make sense anymore, because it’s an inseparable part of my life and experience. And letting go of that qualifying, deciphering, and even meaning making, feels like a relief.

Waffle Fries and Celery Root

February can be rough. The days are short, the weather is temperamental, winter closes us inside of its blue shutters…

But luckily, we have created several traditions to get us through, one of my favorite being, in atypical fashion, SUPERBOWL SUNDAY!

I, like many of you, went to a Superbowl party a couple weeks back and found myself so INSPIRED. Let me preface this by saying that in between the 2017 and 2018 Superbowls, I watched 0 minutes of football. So, it’s always a fresh experience for me. I couldn’t believe how physically strong the players were. I was also very captivated by how delicious the various party foods involving potatoes were. There were waffle fries (not from Chick-fil-A!), homemade potato chips (in three varieties!), and baked potatoes with gruyere. So, based on these two observations, I added two resolutions to my list for this year: 1) workout more; 2) eat more potatoes.

When I got home from the party, my blood sugar, despite a lot of extra insulin and monitoring, was above 200 mg/dl. I don’t like this – I don’t feel good when my bg is high and taking extra insulin before bed is a little frightening because of aforementioned nighttime lows. So I put the potatoes on the back burner, so to speak.

I did start moving more though. Yoga and walking have been good, along with a class or two at the student rec center. So with goal #1 underway, I got back to the potatoes.

Recently, I ordered a dish with shaved celery root when out at a restaurant. Between ordering and receiving my food, I forgot about this, and when it came I thought I was eating hashbrowns. Fancy hashbrowns, but still. So this weekend at the grocery store, remembering my positive celery root experience, I decided to branch out of my cooking rut.

If you’ve ever bought a celery root (also known as Celeriac), you know just how unappetizing it looks in its natural form. Celery root is, in fact, so ugly that I can’t believe we discovered it was edible. I can’t imagine being that first person to look at it and think, “I’m gonna eat that.”

But someone did and I’m glad.

It’s really a vegetable that you have to tackle – which goes well with the general metaphor of this post. I used this recipe from Bon Appetit for Celery Root Steaks with Tomatillo Salsa Verde as a basis.

Except I didn’t make the salsa because I planned to just pile my other food on top of the steaks.

Here’s a detailed play-by-play:

  1. Scrub that thing! – I took my veggie brush and I scrubbed the root thoroughly, rinsing under cool water.
  2. Peel it! – I took a carrot peeler and shaved off the rough skin (yes, even though I’d just scrubbed it), until it had a mostly smooth texture. Then I used the scooped end of the peeler to get out the fuzzy, radish like whiskers (ugh) near the end and smoothed once again over the top and bottom.
  3. Preheat it! – I was already baking brussels sprouts, so my oven was on 450 degrees.
  4. Slice it! – I sliced it into rounds, about a 1/2 inch in thickness, until I’d cut up about half of it. Then I cut it in half so I could lay it flat and cut half-moons of the same thickness.
  5. Sauté it! – I added quite a bit of olive oil to a big cast iron skillet, set this to heating on the stove, and laid the slices down into it, turning it down to about 6. I let them sizzle on each side for about 5 minutes total, flipping impatiently. I think the recipe is correct – 4 minutes each side with only one flip would have given a better, golden brown to each.
  6. Bake it! – About 10 minutes on high heat for a nice, tender texture (recipe says until it can be easily pierced with a fork or butter knife).

Pro tip: if the steaks are tender but you want more of a golden brown look, flip them over to serve; most likely they are browned on the pan side.

So, how do celery steaks stack up to potatoes, ounce for ounce?

1 cup celery root weighs in at 66 calories, 14 grams of carbs, and packs a powerful punch of 2.8 grams fiber, according to google.

Potato comes in at nearly double all of the above (except fiber): 116 calories, 26 grams carbs, 3.4 grams fiber, per cup.

So to me, diabetically speaking, Celeriac is the clear winner!

Oh and finally, Happy Valentine’s Day.

 

 

 

FreeStyle Libre

If you don’t have diabetes (and you speak a little Spanish), you might think I’ve come up with a new intention for how I want to live my life, sort of a ‘take it easy’ non-attachment type attitude. She’s living free style, libre man. But if you do have diabetes, you’ve probably checked your bg on a FreeStyle meter and at least heard of the new device that was just approved for sales in the U.S., the FreeStyle Libre.

I both like and hate the tendency of medical companies to give chronic illness management supplies names that inspire images of smiling people flying kites on the beach without a care. I dislike this tendency because it’s a false promise. These words couldn’t attract us to the product if it wasn’t true that diabetes, like many chronic conditions, imposes it’s own barriers. I won’t talk about those right now – maybe later. But what I like, is that these companies are recognizing what is truly hard about diabetes: not simply the pain of finger pricks or shots, but the hassle, the baggage, the constant back-of-the-mind thought (as covered previously) that it inspires.

For the past few weeks, I’ve really been wanting a break. There’s nothing to do with this desire, no accrued vacation time to take, no money to spend that can buy it. And yes, there are some strategies that one could employ to alleviate some of the pressure in these moments, but even thinking those up and navigating their implementation is the opposite of a break. It’s effort. A lot of effort.

And then, suddenly: FreeStyle Libre Now Available in US Pharmacies

In case you’re not familiar, the FreeStyle ‘reader’ looks like a normal blood sugar meter, but it is equipped to scan a little sensor, about the size of a large quarter, that you wear on the back of your upper arm, in order to measure blood sugar in interstitial fluid. I bought myself a reader and three sensors. For the past ten days, I could know my blood sugar anytime I wanted to, but not when I didn’t. Unlike a continuous glucose monitor (CGM), which I’ve always resisted, the Libre let me remain in control of the amount of information I receive. As someone prone to over-management, this is ideal.

A couple of specific examples:

  • Saturday night I was driving myself and a couple of friends to a concert. About 30 minutes before leaving I scanned the sensor on my arm. 90 mg/dl. 5 minutes later I scanned again 85 mg/dl. I was dropping a little. I ate half a tablespoon of honey. 10 minutes later I scanned: 95 mg/dl – stabilizing and good to drive, probably some fat and protein from my dinner hitting me now too. Because of the Libre, I was able to monitor while getting ready without poking my finger 3 or 4 times in 20 minutes and getting blood on my outfit. I could eat the right amount of carbs so as not to skyrocket into high bg, but also allow me to drive, and be ready on time without stress.
  • Another night, I was about to go into the movie theatre with a friend (a lot of recreation this past week) and wanted to have some popcorn, which is my fav. We’re in line, just a few minutes ahead of start time, I’m wearing gloves, a puffy coat, and holding my wallet. I scan, bg is a little low, and I know how much insulin to take once we find our seats. Again, no fumbling, no blood, no running out of time. I feel magical, like a superhuman.

So here it is, the day after my sensor ended and I haven’t put on a new one yet. I feel like I just got back from a diabetes vacation. I feel restored. I’ll put the new sensor on soon, but I’m rationing them, because my insurance plan still doesn’t cover them, and while they are relatively affordable out-of-pocket compared to a CGM, test strips, or an insulin pump, they still feel like an indulgence at this point.

Indulgence. It shouldn’t be an indulgence to know what your blood sugar is, right? I feel like it should be, how do I want to say this…a basic human right. But it does feel like an indulgence, because I know that my many of my friends in Bolivia and elsewhere who are living with diabetes, can’t afford to check their blood sugar more than twice a day, on a good day. Here I am, able to scan willy-nilly, a luxurious level of management that is not at all equitable across the globe. And it is an injustice.

Today is Martin Luther King, Jr. Day – a day to celebrate the undeterred pursuit of social justice. It’s not always clear what this means or what the clearest path to it might be, and I often find myself uncertain of how to nourish solutions rather than feeding problems. In this situation, there are big questions I have to ask myself when it comes to wearing this device while others can’t. I haven’t answered them yet, but I do know that this is a situation to at the very least, recognize my privilege and remain aware that the current state of inequity in access to medical care and technology is not OK. It’s also a time, I think, like many (most? all?), to be grateful. I’m grateful to the developers of this technology, to those who’ve funded the research behind it, those who’ve advocated for its coverage by Medicare, those who will tirelessly advocate for other insurance plans to cover it, and for the new found freedom it has afforded me. Finally, it’s a time for action, to ensure that all children and adults with diabetes can enjoy more freedom from disease and greater opportunity for wellness.