196 mg/dl

On the seventh day of blood sugar…

I slept in an hour past my alarm (it’s ok, it’s Saturday) and my meter gave to me

a 196 mg/dl.

Yesterday I went to the gym in the middle of the day and a yoga class after work. I ate well enough and went to bed at 137 mg/dl, still with a little insulin working in my body (did not finish eating by 8 pm).

It’s hard to exercise after work and still get in a reasonably early dinner. It’s a strange trap to have to choose between the two.

But really, I think my bg crept up in the morning hours, as it does if I fail to take my 24 hr insulin around the same time every day. I had taken a little booster shot of it the night before, as is my habit on weekends. Typically I take my 24 hr insulin at 6:45 AM or so. I take a pretty small dose and it seems to wear off at almost exactly 24 hrs for me; meaning that if more is not injected to replace it, I will begin the slow rise. I meant to wake up at 8:30 AM, but my body knew better and kept on sleeping.

Health trade-offs. Not pleased about this. Blogging a number that is ‘too high’, gives me a new understanding of how kids must feel when they have to report their blood sugars to doctors or parents. Intuitively, we know that the number is not a grade or score, but it can sure feel like it. I wasn’t a kid when I was diagnosed, so I’ve always been a self-grader, but I bet it’s scary when you feel like your actions are going to be judged by others because of a blood sugar reading. I bet it feels like that sometimes even when others aren’t actually judging you.

Oooone Fiiifteeeeeen!

On the fifth day of blood sugar my meter gave to me: 115 mg/dl!!!

Obviously this is to be sung to the cadence and tune of FIVE GOLDEN RIIIINGS!!!!

Sorry that my picture makes my reading look like an Olympic track star.

But actually, this is a star reading. Not that I’m judging my readings or assigning value (I’ve had to combat this instinct during my T1D journey) – I think I’m doing better (but clearly still like to assess progress).

Anyway, last night we didn’t even walk into the restaurant until 8 pm. At that point though, we were all starving, so we ordered and got our food quickly.

I’d gone to see a jazz band with a couple of friends; we were headed to Thai food after. These two friends and I, plus usually another, meet up regularly to discuss life and share challenges and successes. Time with them is therapeutic and restorative; as key to my health as eating vegetables or checking my blood sugar.

I had a cup of coconut soup and a chicken and green bean red curry paste stir-fry entree (lots of descriptors!). Typically at Thai, Chinese, or Japanese restaurants I invert what you might think of as the traditional rice to food ratio. I use rice as a garnish, sprinkling a bit of it on top like snow. In fact, you can think of the dots in today’s picture as either snow or rice falling onto the 115 (these are all original digital drawings by the way and totally available for purchase 😉 ).

Going out to eat is great – you try spices and flavors you wouldn’t at home and someone else cooks and cleans. But for me, the hardest thing about eating out is having to drive home afterwards. The time right after meals is some of the most difficult: biggest fluctuations in blood sugar, greatest potential for a low or high blood sugar that is going to mess with my awareness. Because I don’t drive if my blood sugar is low and I don’t love sitting alone in my car on cold winter nights waiting for my bg to rise, I took a more conservative meal time dose of insulin than I otherwise might have for the food I was eating.  When I got home, my bg was 186 mg/dl. Based on the blood sugar scrutiny of the last few days, I took what I felt like was an accurate correction dose, and hooray! it was.

There are 7 more days of blood sugar left, so if you’re enjoying these posts, feel free to share with someone else who you think might as well. Thank you for being on the journey!

Katie

On the fourth day of blood sugar…

my meter gave to me, a 146 mg/dl.

Well, we all know that this is the most wonderful time of the year. There are gatherings and celebrations almost every night – and for a person with T1D, this can be a little exhausting. Last night, I was really excited to have no plans other than eating my leftovers from fancy Monday night dinner the day before.

I finished dinner at 7. At 9:30, my bg was 176 mg/dl or so. The past couple nights I’ve corrected and gone a bit low, so I decided to be more conservative and take just 1 unit of insulin, even though what I probably needed was something like 1.3, as my correction is 1 unit for 60 mg/dl, roughly. What’s a correction dose? you ask – it’s a ratio to understand how much 1 unit of insulin will bring your blood sugar down from a static level. So for example, 1 unit should have brought me down to about 116 mg/dl if my correction factor was correct. But it’s never that simple. This is like the correction factor in a controlled weather chamber. So if we could separate everything else that has happened in the day out from this individual measurement of blood sugar, then we might be able to make a precise estimate such as this. But here’s the thing, so many factors affect blood sugar.

Let’s play a game. Guess which of the following do not affect blood sugar:

  1. stress
  2. fat content in a meal
  3. protein content in a meal
  4. baths
  5. exercise 2 hours ago

 

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If you guessed baths, you fell for the trick! All of those things can affect blood sugar. In fact, I’ve been in a bath habit of late, because it’s relaxing, but it’s also caused me a few false lows. The heat of a bath or a shower can activate insulin such that you’ll have a blood sugar dip unexpectedly if you’ve injected insulin recently. For me, I tend to go low and then bounce back up. It seems like it is speeding up the insulin action, rather than magnifying its impact overall. For other people though, it might be a magnifying effect.

Anyway, I went to bed in the 140’s, I woke up at 2:30 AM in the 140’s, took roughly half a unit of insulin (which is a little tricky using insulin pens that only measure in 1 unit doses) and woke up at 6:40 at 146 mg/dl. Can I explain this? No. But my guess is that the fair amount of fat in my meal was slowly digesting and keeping my bg slightly elevated, despite the correction doses I took.

Moral of the story – in diabetes, nothing exists in a vacuum. No two days are the same. Rules make a complicated mess of factors sound simple when they are really not.

Happy Wednesday!

Katie

*https://pixabay.com/en/photos/question%20mark/?

86 mg/dl

Aren’t you excited for another morning of blood sugar analysis!?

No, of course you aren’t.

But we’re on this journey together, so hold on.

FIRST OF ALL, A BIG, GIANT DISCLAIMER: this is not meant to be medical advice and I do not have medical expertise. In fact, these posts are really more aimed towards those who don’t have diabetes. More on this later, but the hidden agenda is just to expose all of the different factors and decisions that go into blood sugar management. So once again, I’m not saying that the way I manage is the right/safe way, or that my goals and targets are right/safe for anyone else, but rather I am simply recounting my experiences. 

On the third day of blood sugar my meter gave to me – an 86 mg/dl!

Last night I didn’t even start supper until 8 pm, which by the way, was the infamous cauliflower steaks of which I have expounded previously. This time we topped off the cauliflower puree with a fried sage leaf and served with local chicken sausage. Very upscale Monday night.

Anyway, I checked after my guests left and was high, took a correction dose, cleaned up the kitchen (time passed) – and by the time I was ready to close my eyes for sleep, was 80 mg/dl again. I knew insulin was still working in my body, so I ate a tablespoon of honey and went off to slumber.

This morning was pure luck. I have to assume, since once again I’m confronted by the continual curiosity that is not having a CGM, that I was just coasting on a flat line of blood sugar all night (not necessarily true, FYI).

By the way, ideal range for me to wake up in is 80 – 120 mg/dl. Again, that’s just me. Some people prefer/feel safer to wake up 90 – 150 mg/dl, for example. And, as a reader pointed out in yesterday’s comments, meters and CGMs are often off by 15 mg/dl or so in either direction, making it really difficult to know exactly where you are anyway.

Until tomorrow!

Katie

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

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.

The Best Thing About Backpacking: Part 2

A light breeze was rustling the rainfly when we awoke the next morning, but the downpour was over and waves of sunlight rolled past, lighting up our little orange home. I flipped from side to side a couple of times on the hard ground, trying to keep myself from tumbling down the slope. More sleep being evasive, I was eager to start the water heating for the first cup of coffee in the woods – a unique pleasure that combines two of my favorite things into one. I sat up and put on my old pair of backpacking glasses, found my meter case safely stashed in a plastic bag, and checked my blood sugar. 160 mg/dl – a little high. This was, I thought, to be expected, since I was 137 when I went to bed and I’d cut my Lantus dose by half in preparation for the day of hiking. Better than fighting lows all day, I thought. I unzipped the soaked rainfly which now clung to the tent after its stick stake had crumbled and given way overnight. I managed to haul myself and my pack out from under it and stumble into the bramble patch that we’d appropriated in the night. Ahead of me, a few short oak trees canopied blueberry bushes and huge ferns. Further, at the border where the land turned steeper, big Balsam fir trees spread their evergreen branches into regal teepees. To the right, mountain after soft mountain, rolling in the Virginia way. Behind me, a taller peak with a bright green bald was dotted with what could have been nothing else but a herd of wild ponies.

Unbeknownst to us, we had set up our camp in paradise. I ran back to the tent and crawled into the deflated vestibule. “It’s so beautiful out here!” I shouted to my slowly stirring companions. “Really?” “Oh yeah?” I had already run back outside. The Navigator unzipped the trail side door of the tent, just in time to say hello to a pair of early morning hikers. Also unbeknownst, we had set up our camp at most 10 feet from the Appalachian Trail. In the night, in the rain, it had felt like we were far from the pedestrian thoroughfare. This was an accident of minor importance though. We set up our first breakfast on a small rock to enjoy the views of ponies and passersby. I took about half my normal dose of Novolog to go with a higher carb breakfast than usual and halved my morning Lantus dose (I’m on a split Lantus regimen right now) once again, to set myself up for a day with less lows.

From there the skies just got bluer, in every way. After we’d retrieved our wet clothes from the branches we’d decorated with them, we set off again, this time North on the AT, to begin our ‘loop.’ Within moments we stumbled upon this scene:

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Unlike my last eager venture to Grayson Highlands, I decided that this time I would allow the ponies to come to me if they wanted, but I would not approach them first. Luckily this worked out just fine. They were very friendly. They also seemed intrigued by my hiking poles (just another reason among the many to carry hiking poles).

Sometime later, we said goodbye to the ponies and continued on our way. Light clouds dappled the sky and the colors around us shone in response – bright greens, sunset oranges from the just-past blossoms of the wild, fire azalea bushes. It was slow going because we had to keep stopping to greet and photograph every pony in the area. We could probably provide a pony census to Virginia if it was ever needed. And just when we thought ponies had come to rule the Highlands’ ecosystem, we happened upon…

 

these lovely (and somewhat intimidating) ladies. They were lunching on a high mountain pasture, so we decided to as well. For the first few minutes of lunch I fed the low blood sugar that had crept over me as I gazed out over the 360 degree views in a partial daze. It seems like for those first few hours of backpacking I can’t ever eat enough to keep my blood sugar up. I slowly came back to our beautiful reality while Raindancer, who had quickly become comfortable with the herd, fell asleep for a 15-minute nap.

Somewhere before or after lunch the trail took us over a little stream and we stopped to refill our Nalgenes. Hiking/life in general with diabetes requires a lot of water. I recently learned (remember this for your next trivia night) that diabetes comes from the Latin for: “It has to flow” (I know that clinically this is not a good thing, but philosophically I really dig that slogan). So anyway we got out our Aquamira and engaged in the process of readying our water. In life, I’m not always patient with the process, but there’s something about the process of purifying water with Aquamira that I love. Maybe this is part of ‘the best thing’ about backpacking – engaging deeply with the process of getting where you want to go.

Sometime around 7 pm we made it to a crossroads, literally and figuratively. We needed more water, we had reached a large boulder that supposedly offered good views, and we were tired. We decided to set up camp and go in search of water, rumored to be just around the bend, after eating dinner. Prior to eating dinner though, we ascended the curved face of the boulder and were met with a literally breathtaking view. You hear people say things like, “she looked breathtaking,” or “wow, this sunset is breathtaking,” but if something is really breathtaking you can’t speak because you are gasping. And that’s how this view was – like, “Ahh!” So beautiful, so unexpected. The sea of clouds had parted and the mountains were everywhere. Although I’ve grown to love the Piedmont of NC, views like this remind me that there’s just nothing like having your breath seized by the mountains. Could this be the best thing about backpacking?

Minutes later, I had wondered if perhaps tearing into a tortilla bowl of beans, tofu, cheese, and avocado as you stretch your tired legs out on the bare ground was perhaps the best thing. There’s nothing like eating dinner in the woods when you’re really tired after a day of hiking. Also, here’s where I’ll make my plug for never going backpacking without hot sauce – it’s worth the weight. I carry mine in a small Tupperware given to me by none other than the Navigator, who understands my love of sauces. It’s very lightweight and a huge improvement over the whole glass bottle of Cholula I carried last time I was in Grayson Highlands.

The day was perfect – magical in every way, and so it shouldn’t have been a surprise to us that the night sky would have been perfectly clear, illuminated only by the pinpricks of a million tiny blazes of light. Why should we have been shocked that the ground flickered with the slow awakening of mountain fireflies, who move with more direction and purpose than the rapidly flitting lowlanders? And yet still, with stars above and around us, we stood mesmerized. I’m all about favorites, ultimates, zeniths, etc., and so I could say that if there was a thing that was best about backpacking, it had to be this mountain field under the cover of darkness – air the definition of fresh, a comforting silence filling the space in between the calls of katydids and click-click of bat wings.

But, I just can’t say that. In fact, no one of the miracles of the day could take the title of ‘best thing.’ To categorize our time would have been to leave out the process, the parts of sum; to forget that each moment was a combination of feeling connected to the Earth and to each other. Perhaps, if I want to answer my friend’s question, I’ll land on connection as the best thing about backpacking. It’s different every time, but it happens, somewhere in between bailing water out of the tent with your bandana, spotting a speckled salamander under an old log, and helping each other find the trail.

A quick acknowledgement and plug for the amazing blog of Hiking Bill. He provides in-depth descriptions of many hikes in the Southern Appalachians and includes helpful ‘hike planners’ at the end. 

You can find his description of the Pine Mtn/AT Loop that we used to plan our route here.