Tag: low blood sugar

Solo Road Tripping with T1D

Solo road tripping with type 1 diabetes is rough on blood sugar, and it’s not always the reasons you might think. Sure, the car ride is a long stretch of time when you can’t move around, which usually leads to high blood sugar. Then there is the fact that you can’t check your blood sugar like you ordinarily would, so you don’t know what it’s doing or if you need to adjust. But it’s also situations like I encountered tonight, shortly after arriving at my marvelous AirBnB for one in Greensboro, NC (message me if you this recommendation and I will provide!).

I had driven from Asheville to Greensboro earlier in the day ahead of a work-related training that started at 1 pm. Now it was 5 pm, and I had just arrived at my AirBnB. I was getting settled in and also noticing how hungry I was. Hungry and tired of driving. I went to grad school in Greensboro and I was happy to be back, even if only for a night. I arrived 25 min or so ahead of the training and ate cold soup in my hot car because I didn’t have anywhere to heat it, and it’s the only food I had in my house to pack. By the time the training started, my blood sugar was 185 mg/dl – not really that high, but I wanted it to be better while I was sitting there, so I took a correction bolus and it did come down…right in time for the cookie break. I was pretty hungry at this point because, while I had told at first told myself I was enjoying cold soup, halfway through the bowl I was no longer fooled. And then the woman sitting next to me came in with a container of steaming chicken! She had found a microwave. I was jealous and had reached that point in a training where it feels like eating is going to help you concentrate (not sure this works), so I picked out a cookie – and it really was a fabulous cookie. I think it was lemon blueberry, but not artificial at all. I ate the whole thing. My blood sugar shot up into the 200’s. I was now concentrating on this rather than the training, and ended up doing a correction bolus. I am using Fiasp now so the corrections work a lot faster, but sometimes this leads me to over-correct because I think it should be coming down faster than it is – and truth be told I just need to be more patient. By the time I left the training it was headed down but still pretty high. I got to my lodging and I thought about being brave and trying a new spot for dinner, but sometimes when you’re in an old place that you don’t get to spend time in very often, you just have to go to one of your favorites. So I put in an online order for Sticks and Stones, a brick oven pizza place in Sunset Hills that has a cauliflower crust pizza with a savory onion jam and fried eggplant called, “A Kiss Before I Go.” My dream pizza was to be ready in 30 minutes, which was more time than I needed, but Sticks and Stones is in my old neighborhood and I thought I might go the Bestway grocery store or stroll down my old street. I grabbed my phone, which as you know from my recent post is also my insulin pump and CGM. That was when I saw that I was headed straight down…and I felt it too. Yikes. Now my delicious pizza is probably on its way towards the oven, and I am not even able to drive! I need to go pick up my dinner and the only way I can get there is to eat first. It’s a real catch-22. So I grab the snack most efficient at shooting blood sugar through the roof in NO TIME FLAT: dried chili mango from Trader Joe’s. If I did not have diabetes, I would go through a bag a day just for its deliciousness. As it stands, if I eat more than two pieces at a time, all blood sugar hell breaks loose. It worked though, so well that by the time I got to the restaurant nine minutes away I was over 200 mg/dl and rising. I decided to bolus a wee bit to get my insulin going. By the time I got back to the house I was still in the 200’s, but I knew my first dose was active. I then counted my carbs, which is actually literally impossible with a homemade cauliflower crust pizza, because who knows what the ratio of cauliflower to other flour is. It could be straight cauliflower, but it’s probably not. This means it could be anywhere from basically 0 carbs, to nearly on par with regular wheat pizza. So I just guessed and reduced my pump’s suggested dose by 1 unit because I was very excited about walking around Fisher Park afterwards, which is a classic Greensboro charmer of a neighborhood.

Iconic stonework in Fisher Park by Andrew Leopold Schlosser (plaque rt.)

I had my dinner on the patio even though it was hot and humid for September and replayed some of my Greensboro memories. I loved my time in Greensboro, even though grad school was demanding and I was more than ready to leave my apartment by the time I finished moving out. There is something special about Greensboro. It’s got this oldness to it, a slow pace, and gardens and parks everywhere. By the time I finished my pizza, my blood sugar was…not high enough for a walk really. I put my pump in activity mode, grabbed some low treats for my fanny-pack, and headed out on my stroll. Groups of runners were hustling by, people with their dogs. I heard an owl although it was still quite light, and looked at the last of summer’s zinnias in the front yard gardens. I passed an old cemetery that I longed to stroll in, but at that point my blood sugar was dropping – two arrows straight down. I had made a loop in order to not be too far from my lodging at any moment. And so, I headed back. All in all, I think I got about a 30-minute walk in, but I wanted much more. That’s the trick of blood sugar. When you need it to be high, it’s often low. And at the other times, you don’t want it to be high but you can’t bring it down. The extra wrinkle of solo travel is that because you’re always the one in charge, you can’t just say, “Hey, can you drive,” I’m going a little low. If I’d had someone else to drive to the pizza, I probably wouldn’t have eaten anything at all and would have just been a little low at the start of my dinner.  This might have changed the after-dinner story. But, at the same time, solo travel is special in so many ways. On a solo trip, you make memories that only you have. It’s like having a beautiful stone in your pocket. Something that no one else understands the full significance of. I guess this could seem sad, but I love it. And you get to do just what you want and figure it all out and then tell the stories later. In this way, just like anything else, there are limitations and possibilities sitting side by side. The occasional blood sugar rollercoaster might take you for a ride, but it’s not the whole journey.

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

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.

Interdependence

This is the English version, slightly adapted to the current moment, of my last post from Sunday.

There’s a lot I could write about, but I’d like to start with a discussion about the word ‘neighbor.’ This word has entered my mind and my world a lot lately, and I’m thinking about what it means to be a good neighbor. Another word that has appeared again and again is ‘community.’ I went to a community this past weekend where it is evident that there is this idea of living, in the words of one resident, “in an interdependent way.” It is, she says, an alternative to living so independently, without recognizing that we do depend on each other. Why is it so hard in our culture (in all cultures?? in some more than others??) to accept help? I think that it’s a function of our perceptions about the relationship between ourselves and others, or saying it another way, between our inner world and our outer world.

It’s here that I’ll bring diabetes into the conversation (did you know that everything relates to diabetes?). A week ago I fell down the stairs (or more like I fell on the stairs while going down them). When I fell, it scared the woman who was climbing up from the other direction and she gasped and grabbed her heart. For a moment she looked worse than me. It was captivating to me that my movements and an action occurring to my body could move her too – that we were connected in this way. Later, in dance class with my leg hurting badly, I realized that my blood sugar was very low and that maybe that was why I had fallen. The level of sugar (glucose, officially) inside my body influences my movements in the world. This is a perfect metaphor for the influence that we have on our surroundings. Our thoughts, beliefs, prejudices, and personal histories have an impact on our environment whether we like it or not. We are connected. We can only operate in the world without recognizing that we depend on each other while we maintain power, or rather, until we lose control. For me, when I fell I lost control. It was a humbling experience that temporarily transformed my body. We’re always talking about shoes, but this journey taught me that a novel way to experience empathy is to imagine what life would be like in another body. Empathy is the key (for me) to being a good neighbor. Obviously, there is another moral here too for my friends who have Type 1 diabetes (or Type 2 for that matter), that is, please check your blood sugars regularly and be careful when you’re having a low.

Today my leg is feeling much better (I danced – joyously, today), and once again I’m thinking about how we can use the word gratitude as a verb. If our heart is struggling to let empathy in, maybe gratitude can help us tear down the wall.  

Free Range Humans

Against a deep black sky, a perfectly halved moon illuminated our small campsite set within the welcoming confines of a scrubby circle of tall grasses and short trees. Nearby, a tributary flowing down into Flat Laurel Creek gurgled the sound of its boundary.

We arrived at our home for the evening before nightfall, when the sun was just releasing its hold on the day. We’d hiked since noon, eating a picnic lunch on the crest of Tennant Mountain, right below the plaque that marks its peak. We hiked over wet and rocky trails where blobs of clear eggs, punctuated by the promise of new frog life, bobbed in pools and puddles. The only other real wildlife we saw was a pack of undergrad males on their spring break, all having reunited in Pisgah Forest from their various schools.

DSCN2764

I hadn’t been back in the mountains, like really back in them, since I moved away from AVL in August. I was afraid to return sooner – afraid that if I didn’t separate myself enough and bond with the land and people in the Piedmont that I’d just live in the mountains in my mind instead of in the world all around me. But coming back home on this trip to Black Balsam and Sam’s Knob felt solid. My friend from school, my backpacking buddy two trips in a row now, couldn’t stop commenting on just how perfect everything was. That’s a heavy word and yet she was so right. You know those moments when you have an awareness of how totally happy and satisfied you are at the time? The whole trip was like that for both of us (I’m willing to say from our continual debriefing). And I was aware, maybe because we’d spent the previous week running from classroom to computer to meetings to google hangouts, that it was so perfect because we had so much less. So much less stimulation, so many fewer options, so many less modes of communication.

And yet I felt more connected.

Laying under the stars, dreaming of life thousands of years ago, my mind was at peace.

It was a good break for my mind all the way around. Only reflecting back now, since this is a blog about life with diabetes, do I realize that thoughts about diabetes don’t dominate any aspect of the trip (except one, and I’ll get there). Of course I thought about diabetes the whole time, as a backdrop to everything else, but I didn’t notice so much that I was thinking about it. It didn’t frustrate me to be thinking about it and I didn’t worry about it. When I reached a level of competency with diabetes I assumed that I had grown with it as far as I would. I had learned that diabetes was in fact manageable but thought that it would never get easier. And that is true; the actual management and burden of diabetes doesn’t necessarily get easier in and of itself, although it does change. But it’s sort of like (I would imagine) a marathon runner training for something and then experiencing a level of ease with certain aspects of it. Yes the last couple miles, or shaving speed, or steep courses, are still a challenge, but there is a certain level of ease with running a distance that to me, a non-runner, seems insurmountable.

Ok, so I mentioned that one aspect of the trip when diabetes did announce itself loudly: the great Bear vs. Nightime-Low debate. If you’re a person with T1d you understand that you can’t go to sleep without knowing where the food is in the house. For me, I keep a honey bear right by my bed. But when I’m backpacking, my goal is to keep bears far, far away from my bed. So what to do?

And I really don’t know. What we did was secure and hang our food appropriately, far, far away from our campsite. One of the recent times that I went backpacking I had to tear the bear bag down from a tree in the middle of the night to get to more carbohydrates, and I just wasn’t prepared to do that again, so I decided to keep two honey zinger packets in the tent.

Sure enough I woke up in the middle of the night with a serious low. I’m not proud of these backpacking lows and I’m still trying to work them out. Walking all day with an extra 30-50 lbs. on my back exhausts my muscles in an unusual way. Even if I got to bed at 175 mg/dl, with very little insulin on board, I could wake up in the 30’s, like I did on this trip. Luckily I had the zingers. This time I stored them in my empty nalgene, which I thought, with it’s good seal, thick plastic, and odor of aquamura, would deter a bear as well as anything else I had. A pelican case could be another option.

So here’s the part where I need some diabexpertise: what do people with T1d who backpack do when they’re camping, say out West, where the stakes involve grizzlies? What do you do here in the East? I really appreciate your comments and dialogue!

DSCN2774

Spice of the Unknown

“Well thanks for coming on this adventure with me today,” I said to my friend, without really thinking about it. We had planned to take a walk after class in the forest together and we accomplished that, but only because she stuck with me as I rode the waves of my blood sugar.

First as my post-lunch bg got up to 170 or so I stood by her at the bus stop, drowsy and dull. The bus was 11 minutes away so I suggested we walk down to the next stop or so, hoping that might bring me down a little. She pushed her bike alongside her and I tried to explain why I felt dizzy and why walking would help. Fifteen minutes later we got onto the bus and 45 minutes after that made it back to my house and my car, to the forest entrance, waited behind men in trucks doing something, and then onto the access road.

I loaded up my Ecuadorian fanny pack with glucose tabs and as we headed off into the woods I felt the muscles of my face and neck finally relax. Sometimes I hold tension when my blood sugar is high and I can’t exercise to bring it down but I also can’t take insulin because I’ll be moving soon. Since we had plans to walk together, I couldn’t just abandon my desires to walk in the forest and respond to high blood sugar by walking around campus in uncomfortable shoes to bring it down. I followed through. Sometimes I feel like following through is a rare event for me because blood sugar sidelines me. Or because I’m not feeling great I’ll decline plans with friends because I don’t want to drag them onto the rollercoaster with me.

We walked 2.5 miles in the splendid mid-October falling leaves, a little less luminescent here than in the mountains but still beautiful. Back at the parking lot I checked before driving and I was 67 mg/dl, so I suggested we wait while my bg came up. As I ate glucose tabs we talked about our classes. When I said, “I’ll check again, I think we can go now,” my friend admitted she had no idea what we were waiting on. People just don’t know! When you live so intimately with a condition you start to assume that it’s evident on your face or in your words, that people understand it like you do, but that is so rarely the case. I explained why before when my bg was high movement helped me feel better, and that when I am low I need to eat something. I explained why I would treat a mild low before driving vigorously with several glucose tabs whereas if I was just going back home I might eat one tab and then have a snack.

After I thanked her, back at my house, she thanked me for the education. I thought about the name of my (somewhat dormant) blog. Diabetes has a way of making everything an adventure because it always throws in that spice of unknown. You have to adapt to it constantly, get creative, think about solutions. You have to be willing to change plans, be thrown off course, and clamber back to your path. It’s like inviting that oddball friend on the road trip, the wild one who is always suggesting weird detours. How wrong my thinking was ten years ago when I was diagnosed: that life with this condition would be boring.

And maybe most importantly, letting my friend come along on the adventure of blood glucose with me and being vulnerable in that way created a deeper trust between us and gave to us both.

surfing with friends
surfing with friends

Getting Found in Lost Cove

Here’s a link to a recent article from Blue Ridge Outdoors online that I wrote after a backpacking trip with a bunch of friends in the Wilson’s Creek area of NC. It reminded me how much my friends care about my health and well-being and the way that Type 1 makes me think on my feet!

http://www.blueridgeoutdoors.com/go-outside/getting-found-in-lost-cove/

This is my friend Laura and I, super excited about life and the trail!
This is my friend Laura and I, super excited about life and the trail!

Ponies, pods, and Backpackin’ with Diabetes

I’m waking up dreaming of the trail and wishing that I was still out there in Grayson Highlands on the AT, trudging along with my loaded down pack and passing fields of wild ponies.

I want to talk in this blog post about packing the backpack with diabetes in mind because it’s a challenge on a physical and emotional level. Whenever I get ready for a backpacking trip, especially the first one of the season, I experience some level of dread at the thought of forgetting something vital. When I’m going through my mental and paper list I find myself playing through some of the ‘what if’ scenarios, that I might encounter if my pod alarmed, if my insulin vial broke or got too hot, if my pdm malfunctioned all together. To a large extent this sort of preventive troubleshooting is necessary, and it’s a little necessary, or has been for me, to spiral into the worst case scenario so that I’m literally prepared for it, because that is what T1 diabetes requires.

The problem for me is when that attitude carries over into the rest of my packing, and sometimes my life in general. I think the necessary preparedness of Type 1 makes it easier for me to keep this worst case scenario thinking, which often leaves me with a very heavy pack and a pretty stressed out mind, until I get about a mile down the trail and feel my whole body and being relax into the mountains.

On our trip this past weekend this moment came decisively after we had crested a small windswept knoll and entered a calm stretch of forest full of ferns and rhododendron, tulip poplar and beech trees. I was breathing heavier because my pack was so gigantic and on one inhale it felt as if I’d taken in the peace and simplicity around me. I exhaled out and came into the environment and felt my worries about the future and the stress I was holding onto from the past week fall away completely.

I did find that I could have left out a lot from my load. After all the necessary diabetes supplies and back-up supplies were in I didn’t have much time for finesse with the rest of my packing. Next time I will not throw in a whole pack of tortillas for one overnight trip in which I might eat 3, maybe 4 maximum. I won’t bring tupperware, but instead will use baggies for my celery and carrots. I won’t bring 5 oranges! Whoops. I wasn’t counting, I was just tossing things in.
I also probably didn’t need two water filtration systems on a trip with others who were bringing their own method too, but this is something I go back and fort on. I have really enjoyed using aqua mura because to me it is simple, I know it’s working, and it tastes…frankly I like the way it tastes which is almost imperceptible, but a little lemony. However I’m looking for any good water filtration recommendations and leaning towards a ‘Sawyer System’ that my friend recommended.

I plan on designing some methods and gear to help myself stay organized and cut weight on the trail, but I’m not there yet. Right now all I can think about is the next trip. One thing I won’t cut out is the tiny bottle of hot sauce I brought, because it easily pushed our food experience from good to great.
Wearing the pump was a really positive experience on the trail but only because I avoided disaster and changed a pod early the night before we set-off. I could see in the pod window that a little blood was pulling up and even though I was getting insulin because I was trending low, I decided to change it there on my wooden cot, versus in the woods. As soon as I removed the pod blood streamed from the infusion site and I knew I would have soon enough encountered a problem with poor absorption. My next placement seemed perfect, pod right below where my waist belt would fall, and it held firm the whole trip. I was also able to turn my basal rate way down and lessen the constant lows that I usually just eat my way through, drinking honey straight from a honey bear or eating clif shot bloks or glucose tab after glucose tab on the trail. I still ate constantly, but my mind was clear and my body felt strong most of the time.

I’m eager to hear any other T1’s experience’s hiking and backpacking, so please leave your tips and comments!

A Change-Up

So I’m pretty excited about this. A few days ago I wrote about my recphoto 3(4)ent disgust with my own optimistic attitude about diabetes, even though that attitude is what has pulled me through over the past nine years. I’m happy to announce, I can feel it coming back! Largely because diabetes does teach me some strange and interesting things.

For the past few days I haven’t been sleeping well at all. I’ll feel tired, reading my book wrapped up in an afghan in a cozy chair, spits of snow coming down outside. Then I’ll lay down in my cozy bed, warm and tired. And then…

I’ll get this feeling like my bones are hollow and I’m a little bird on a windy branch and I could just blow away, and the feeling is sort of in my heart and mind too, like I’m a reed humming in the wind.

Being low around bedtime often feels to me like I’m vibrating slightly, but lately that feeling has extended to include a low-grade but constant mental agitation. Even when my blood sugar has been elevated, I’ve been edgier. The only and best way I can describe it at this point is a swirling feeling of being unsettled.

A couple of weeks ago I was craving more carbs and food in general at the same time that it felt like my blood sugar was frequently stuck. I wasn’t receptive to insulin like usual. I would hit 250 and stay there on and off for hours. I woke up one morning, mouth dry, feeling like I’d been on a long road trip with no water, and I could tell I hadn’t been getting the insulin I needed from my pod.

So I switched from my usual sight on my upper glute to my belly. I don’t really like having the pod on my belly because I’m more aware of it and it gets in the way of yoga, but immediately my insulin needs and the time it took for insulin to start working went down.

Unfortunately these benefits came at the same time as my sleep troubles. At first I thought I wasn’t sleeping well because the different site was less comfortable to me, but I sensed that there was something beyond that at work.

For two pod changes I kept the pod on my belly. For nearly a week I slept like a guard dog, waking up at every creak and rattle in our albeit pretty noisy house.

Then, suddenly it hit me. That swirling unsettledness was centered around my navel.

Yesterday I changed my pod back to its old favorite spot.

Last night I slept like a champ.photo 1(9)

Now the good news is I’m back to better responsiveness to my insulin with the pod in that old spot. I suspect that area did need a break; maybe I had hit some scar tissue or my bun muscles of steel were bending the cannulas. Who knows, maybe I’ll have to eat some more of these truffles from the Chocolate Lounge where I’m writing this.

It’s snowy out today, but not icy, so we spent all morning building snowball players. The title of this post comes from the lady pitcher who’s about to throw a change-up. It’s a pretty weak pun, but she is very strong, so I wanted to put in a picture of her.

So I’m curious to know what other people’s experiences have been with how their blood sugars, emotions, and sleep patterns respond to varying pod or infusion sites. Any feedback or comments are welcome.