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!

Revisiting my new year’s resolution

I’m using the bonus hour that I acquired this morning when a low blood sugar woke me up to write this post. Last night I couldn’t fall asleep. I was pleased that my blood sugar was in the 80’s, having come up from a slight post-dinner low and stabilized at this most ‘normal’ of levels, but I had the nagging feeling that it wouldn’t last through the night.

See here is my big blood sugar-sleep dilemma: earlier in the week I’d had a bedtime snack close to bed and woken up with high blood sugar the next day. I was frustrated by this, but I had slept wonderfully. I find that the snack helps me fall asleep, but presents the challenge of usually requiring a little bit of insulin. Just the right amount though – too much and I’ll wake up low in the middle of the night (which is kind of dangerous you know), too little and I’ll wake up parched and drowsy the next morning (high bg).

So last night, I managed to avoid the bedtime snack. I’d brought up my low with a little bit of fruit right after dinner and then coasted. But being so close to 80 mg/dl made it hard to fall asleep and then I dropped over night.

Instead of sleeping this morning I’m doing research. I want to experiment with some of the food recommendations made by Adam Brown in this month’s issue of Diatribe. I think if I can find more foods that fill me up at dinner time without spiking my blood sugar, I’ll have less of a desire to snack later on.

There is always something great in Diatribe! I am amazed at how much I enjoy it and find useful diabetes wisdom every time I drop in. Check out the links above to see for yourself.

Finally, just in case you aren’t already in awe of sleep, I’ll leave you with this Radiolab podcast about its powers.

Choices

On my first day of grad school, my pod alarmed in the middle of an orientation session and I had to rush home, still unsure if the bus I’d chosen was the right one to get me to my apartment. On the way, my iPhone 4 and I struggled with the spotty internet to email my advisor and let her know I wouldn’t be able to meet her – technical difficulties. That’s not really what I told her of course. I explained it all – because you can’t just explain a little bit of diabetes once you get going. It’s hard to just say “My blood sugar was low” or “My insulin pump malfunctioned.” I always feel like I sort of have to justify that statement with, “Oh and I have Type 1 diabetes. And I’m ok – I’ve just got to handle this.” The good-hearted people of the world want to know that you’re ok, which is touching. It can be really hard to give people who want to help and be there for you some reliable protocol to follow, because so much of diabetes is adapting to the moment. So much of it is being in-tune with your own body and responding in what might seem, to an outside audience, like a contradictory way from how you responded before. Sometimes I eat cake, sometimes I don’t. That doesn’t mean that in one situation I’m thinking about diabetes and in the other I’m not. It’s always there, presenting choices or at least weighing in on them.

This post is meandering because my thoughts are meandering right now. If there could be a central theme here, it’s choices and how they fit into our otherwise unpredictable lives. Diabetes reminds me that I make many choices in the day, from how I treat my body to how I communicate my identity, positionality and needs to others. It also reminds me that no matter how fixated we become on one choice or path or reality, our pod could always alarm right in the middle of it and we’d have to respond. This is another diabetes metaphor, but please don’t let that prohibit you from translating it to your own life if you are a person without diabetes (or not, maybe you don’t like metaphors). I’m just grappling with this – the contradiction between writing and reading our lives, both of which (I’m gently arguing), are quite necessary.

Everything in life I ever needed to know…

“I decided many years ago that a high blood sugar does not define me any more than a great blood sugar defines me. For 42 years I have been chasing the perfect blood sugar. It has never happened for more than a minute just the same as the really high ones do not last any longer.”

– Rick Phillips

I want to give a shout out to change. Year after year, change has stood by me. More than that, change even visits me day to day and moment to moment. So here’s to change: a truly dedicated friend.

Obviously, I also want to give a shout out to Rick Phillips, whose response to last week’s question is today’s featured quote. A big thanks to everyone who responded and added to our conversation around high-blood sugar blues and how to pick yourself up from them. Rick’s quote jumped out at me because of its utility for maintaining perspective as we manage (versus ‘control’) blood sugar and also as we manage (versus ‘control’) life. Last week I was talking to a fellow graduate student, job seeker and swimmer in the sea of uncertainty at a social for public healthers in my program. She mentioned that it’s taken her a year and a half to feel like she’s truly gotten her footing here and now it may be time to shift everything once again, perhaps even in a totally new place. I thought of Rick’s quote – how many ladders of learning and accomplishments and life experiences do we climb up, only to reach the end and realize we’ve moved not to a new plateau of constancy, but simply on to the next challenge? That sounds a little pessimistic I think, but it’s not intended to. Blood sugar management from the accept and let go perspective can sound a little pessimistic to – like, no matter how hard I try, even if I check my blood sugar and get that magic 90 mg/dl, it’s already changing, I can’t hold on to it. But! BUT! In truth, this is a comfort too. This wisdom of letting go is so helpful in diabetes and in life, because it directs us back to the process, not the product.

I think I’d like to make one of those posters like you see on the wall of dentist’s offices: ‘Everything in life I need to know I learned in kindergarten,’ except it would say: ‘Everything in life I need to know I learned from diabetes.’ That’s a little over-simplified though. In truth, not knowing has led me towards these conversations with friends and others that help me to break free from dichotomous thinking and see that there are ways of seeing and thinking about challenges that I have not even considered yet, which is itself a comforting thought.

So change, you may be a wildcard, the guest who comes to the party in sequins, carrying a jello-cake and two days early – but, you might as well come in.

¿Por qué bailar solo?

Hay mucho sobre que pudiera escribir, pero quiero empezar con una discusión sobre la palabra ‘prójimo.’ Esta palabra ha entrado mi mente y mi mundo mucho recientemente, y estoy pensando en lo que significa ser una buena prójima. Otra palabra que ha entrado es comunidad. Fui a una comunidad ayer adonde es evidente que hay esta idea de vivir, en las palabras de una residente, “de una manera interdependiente.” Es, dice ella, una alternativa de vivir tan independiente, sin reconocer que somos dependientes el uno del otro. Por qué es tan dificil en nuestra cultura (en todas las culturas?? Algunas más que otras??) a aceptar que no podemos hacer todo por nuestra cuenta. Por qué se da tan mucho miedo ser vulnerable y aceptar ayuda? Pienso que es una funciona de nuestras percepciones sobre la relaciona entre nosotros y los demás, o sea, entre nuestro mundo interior y mundo exterior. Es aquí adonde traeré diabetes entra la conversación. Está semana me caí por las escaleras. Le di un asusto a la mujer que estaba subiendo desde la otra dirección. Fue interesante que mis movimientos y la acción a mi cuerpo podría moverla también – que estábamos conectadas en esta manera. Luego, en mi clase de bailar con mi pierna doliendo mal, me di cuenta que mi azúcar fue muy bajo y que posiblemente era por eso que caí. El nivel de azúcar dentro de mi cuerpo influye mis movimientos en el mundo. Esta es una metáfora perfecta para la influencia que tenemos en nuestros aldrededores. Nuestros pensamientos, creencias, prejuicios, y historias personales tienen un impacto en el exterior sin nos guste o no. Somos conectados. Solo podemos operar en el mundo sin reconocer que dependemos de otros mientras tenemos poder, o sea, hasta que perdemos el control. Para mi, cuando me caí, perdí control. Fue una experiencia humillando, que me transformó en otro cuerpo temporalmente. Este viaje, pienso que es valioso, porque permite empatía. Esto, empatía, pienso que es el ingrediente clave (para mi) de ser una buena prójima. Obviamente, hay otra moral aquí también para mis amigos que tienen diabetes tipo 1 (o 2 realmente), que es, por favor, mide tus niveles de azúcar frequentemente y cuídate cuando tienen bajos. Ahora mi pierna se siente mucho mejor y estoy otra vez pensando en como podemos usar la palabra gratitud como un verbo. Tal vez, si estamos luchando por encontrar empatía, podemos pensar en todas las cosas en nuestras vidas por lo que deberíamos tener gratitud.