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.

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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!

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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!