# MATHter Mind

Math is a powerful force in my life.

In school, you are taught how basic math skills will become part of your everyday life. It’s not just a problem on the chalk board or on your homework. You will use math every day in countless ways: figuring how much change you’ll get when you pay with a \$20, what is a 20% tip on a \$15.65 meal, how much flour do you need if you are doubling the recipe, etc. It’s easy to think of professions and situations where a miscalculation can be disastrous and detrimental. A mistake in a budget can cost a company thousands or even millions of dollars, a builder’s wrong measurement can compromise an entire structure, or a doctor’s miscalculation of dosage could be lethal. However, for most of us in our every day lives, the consequences of our calculations are not as significant or potentially harmful.

Diabetes changed all that for me. It’s a disease of countless and continuous calculations. And while technology has aided with some of the calculations thanks to features like the bolus wizard, there is still so much that the individual must figure out. But unlike a school assignments where a wrong answer is designated with a red “X” or minus points, a miscalculation for me has a direct effect on my health. This was clearly demonstrated to me last night.

Carb counting in theory is simple, you take how many carbs are in a food and divide by your carb ratio (how many units of insulin to give for a certain number of carbs) which is determined by your doctor. For instance, if your carb ratio is 1:15, for every 15 grams of carbohydrates, you would give 1 unit of insulin. However, in actuality, carb counting is never that simple. When it comes to meals, you can rarely just look on the box and have a magic number, most meals are a combination of foods in different proportions, and many not coming from a box. Even looking online for “lasagna” can give you a rough idea of the number of carbs, but it’s still going to vary based on the ingredients you used and your serving sizes. I’m also more of a grazer when I eat, a little of this, a little of that, more of this, which definitely doesn’t make the process easier.

Here’s what went down last night:

Pre-dinner blood sugar: 244
Too high so should correct for that first. 244- 120/40= 3.1 units
Dinner: Smorgasbord of leftovers and prepared food from local grocery store.

Spoonful of brussel sprouts and small serving of grilled vegetables. Well there probably isn’t a lot of carbs in the vegetables, maybe around 10 based on my serving.

Sliver of pizza. Well I know roughly how many carbs are in a normal piece of pizza, but is this piece bigger or smaller? But I only had 1/3 of the piece, so should I just divide a typical piece of pizza by 3?

1/2ish cup of risotto. Granted I didn’t actually measure it, but it was roughly 1/2 a cup, I think? But I don’t have a box to look at since we bought it prepared. I guess I’ll estimate based on looking it up in the past.

A few more bites of pizza. How many carbs in a few bites?

I added this all up and put the total carbs into my pump which divided it by my carb ratio for this time of day.

Then it was on to dessert. I made a cup of decaf coffee and put some flavored creamer in. A few carbs in that. Then the desserts came out. I couldn’t even tell you what I was eating, let alone how many carbs are in them. Some kind of sugar covered fried muffin, a lemon cake thing, and some other kind of bar. My family cut off little pieces of each and picked from the plate, a typical style of eating in my family, but hard to determine just how much I ate and how many carbs it is. I took my best guess.

I felt relatively confident in my decisions that night. It was a more difficult meal with so many different types of foods and different portion sizes. However even if I was off, I didn’t think I’d be off by more than 10ish carbs.

Boy was I wrong.

Somewhere along the way I had miscalculated, and around 10:30 pm about 2 hours after our late dinner and when I was all ready to go to sleep, my blood sugar fell to 42. Not that a low is ever pleasant, but this particular low was a bad one. I laid in my bed, shaking, light headed, disoriented, feeling awful. Where did I go wrong?! How were my calculations this far off??

It’s not often that this happens, when I am so off in my calculations. When I think about the fact that I do this at least 3 times a day, every day for 13 years, I can say that I’m typically pretty good at carb counting. When I am off, I more likely end up with a high blood sugar instead of a low. However, it’s these rare instances that remind me how important math has become in my life. One miscalculation hours earlier can drastically effect my health and how I feel.

Now that is some powerful math.

# The Other Room

I sit down at the table to eat. It’s past 1 and I’m starving. I don’t know what my glucose number is; my meter is upstairs. I take a bite. I don’t want to go up and get it. Pretty soon my lunch is gone. I left my diabetes in the other room.

I’m snuggled under a blanket. Snow is falling outside, piling high against the window. Flames flicker and dance in the fireplace as the heat warms my frozen toes. I hear a faint buzz from the other room. My CGM is telling me something: too high, too low, dropping, rising. I don’t listen. I left my diabetes in the other room.

We’re gathered around the table, 6 friends enjoying each other’s company and a delicious dinner. The waitress asks if we want dessert. A slice of giant chocolate layer cake is served with 6 forks. I take one and dig in, savoring each rich bite. Chocolate cake, chocolate frosting, raspberry sauce. I left my diabetes in the other room.

My pump lays on top of a pile of crumpled clothes. I’m untethered, liberated, disconnected. I jump into the pool. I left my diabetes in the room.

I’m in a meeting, staring at the computer projection on the screen. The words are there, but I can’t make sense of them. My head feels heavy, my hands shaky. My CGM is back at my desk. I left my diabetes in the other room.

Didn’t I?

My heart rate quickens, my hands get clammy. I can’t think straight. I’m getting dizzy.

I didn’t leave it. I can’t leave it.

It’s always here.

# One Handed Independence

My CGM has changed real estate. While it says it is only approved for use on your abdomen, I know that people have had success wearing it other places, such as their arm. This cold weather has left my skin rather dry and sensitive to the tape. For this reason, I decided to switch things up and move the sensor to my arm, giving my stomach a slight break. This is a move that I have done once before, with assistance. Inserting the sensor isn’t exactly difficult, but it does have multiple steps. Push down on the plunger like piece then pull back up removing the needle. Hold down the two side pieces while you pull off the top plunger piece and snap the sensor into the plastic piece. Then I always cover it with another piece of tape, fitting the hole around the sensor. Not necessarily difficult, but also a process that typically requires two hands. When inserting the sensor on your arm, you can obviously only then use one hand, making this feat much more challenging.

This time though, I didn’t want to ask for help. I was going to do it one handed. And I did. And it was hard. At one point, I had the needle pushed into my arm, but I couldn’t get the piece to pull back up. The apparatus was just hanging from my arm, held on by the tape as I stood there taking deep breaths, silently coaching myself through the task. Then the piece wasn’t disconnecting, I tried jiggling it with one hand, trying to get it to cooperate. And the tape, yea it’s hard with one handed and limited vision to line up a piece of tape so that the hole fits exactly over the sensor while still lying flat everywhere else.

So why didn’t I ask for help? Well because I know this is something I need to be able to do on my own. I started a new job this week (which is partially why it has taken so long to post this week). In a few months I hope to move to the city where I am working. While I’ve always lived with someone else, whether it was my family or roommates, I’m now looking at places by myself. The thought is half terrifying and half exciting. But living alone means that there won’t be someone there to help me insert the sensor in my arm. Or to keep an eye on me when I’m feeling low. Or grab me orange juice when I need it. I am independent when it comes to my diabetes; I know I can take care of myself. But that doesn’t mean that I don’t have these moments where I catastrophize a situation. What if I drop so low that I pass out, no one will even know. How long before someone realizes or finds me?  Granted in 13 years of living with diabetes, I’ve never passed out, but I can’t help my mind from jumping to the worst case scenarios. But I’m not one to let the “what ifs” (especially the irrational ones) or my diabetes hold me back.

For some, independence is being able to support yourself financially or living on your own. For others, independence means being able to jab a sensor in your arm with one hand.

 Sensor through the sweater

# Going to Extremes

Two nights ago I had one of the highest blood sugars that I can remember in years. I wrote a whole post about what potentially may have led up to it, where my self-management went wrong, and just how horrible the experience was. I was ready to publish the post today, but then last night I had one of the lowest blood sugars that I’ve had in years as well. I can only think of 2 other times in the past 13 years when it was this low. I went from 515 one night, to 22 the next (for those who aren’t familiar with blood sugar numbers, I strive for a blood sugar around 100-120).

Both numbers are scary. The 22 was much more of an immediate danger, but the 515 was disappointing, perplexing, and just overall awful. Both numbers are extreme. Both are dangerous in their own way and both have left me feeling out of sorts.

As I write this, my blood sugar is at a comfortable 125, clearly recovered from both incidences. I’m mad at myself, especially for the high number. I know that it’s my fault. I wasn’t as vigilant and careful as I should have been, and because of that, I faced the consequences. Looking back there are certain moments where I could have intervened earlier so that the results weren’t as catastrophic, but at the time I did not realize how important those moments were. Even with the low, I heard my CGM buzzing, but I ignored it because I felt fine.

The high number was in part a result of my first spinning class.  Before I started the class I checked my blood sugar. It was 248. This number is too high, but I figured the intense exercise would lower it (my first mistake) and didn’t want to drop low during the class. So I didn’t give any insulin and disconnected my pump.

When I finished the class, I took out my CGM Gigi, but it was giving me the out of range signal and hadn’t been tracking my blood sugar. I should have tested my blood sugar at this point, but I didn’t. I went home and ate a low carb dinner, but I forgot to bolus for the few carbs I did have, only making the situation worse.

It was now a little before 10 and I started to recognize the symptoms of a high. I took out my meter and tested my finger. 439. WHAT?! That can’t be right. I tried a different finger, 498. Shit. One more finger, 515. At that point a said four letter word that I will not write here. I immediately took out a syringe and gave myself a shot of insulin and changed my infusion set. At this point I started to feel really sick, the nausea had started to set in. I laid in my bed feeling awful. It wasn’t until around 1 am when my blood sugar finally returned to normal.

I honestly don’t know what caused the 22 or why I didn’t feel it sooner. I must have overbolused for my dinner and just didn’t feel the symptoms early enough. I didn’t believe the number on the screen at first, testing 2 more fingers for confirmation. What was so strange about this low was that even though it was so drastic, the symptoms weren’t as strong as even when I’m in the 40’s or 60’s. Probably why I didn’t catch it earlier in the first place. I know that much lower I am at risk for passing out, so I ripped open 2 packs of fruit snacks and chugged some orange juice. I didn’t care if I went high, I just needed my blood sugar to go up. And it did, it kept going up and up until I was woken at about 2 am with a blood sugar now in the 300s. Clearly stuck on a roller coaster of highs and lows, I gave insulin and went back to sleep, waking up to a low in the morning. Low, high, low…it’s exhausting. And frustrating. And annoying.

No more extremes. I can’t take it. Even though it feels like my diabetes is all I think about at times, I have to do better. I have to be more vigilant, more cautious, more disciplined. I know it’s my responsibility. I cannot have another night like the past 2 nights, I hope that I never see either of those extreme numbers again.

# The Voices in my Head

I have voices in my head. And I would argue that you do, too. I have an inner dialogue that to me is the voice of reason, logic, health and morality. It’s the voice that tells me to offer to help the woman who has her hands full as she tries to open the door, to help those that are less fortunate than I am by giving my time or money, to right the wrongs that I see happening, and to be an overall good person.

It’s the same voice that tells me that I should probably order the side salad instead of the fries, that I should turn off the TV and go workout, that one cookie is enough. Oh actually, it’s telling me that one bite is enough.

This voice is not always a popular one. After all, it’s usually telling me not to do something that is inherently pleasurable: eating unhealthy but delicious foods, sitting around being lazy, not drinking too much. Instead, it’s telling me to do something that isn’t always the most fun, easy to do, or popular: getting enough exercising, eating more vegetables, putting on sunscreen, wearing a seat belt or helmet, the list goes on. But what I have to remember is that this inner voice always has my best interest in mind.

The thing is though, I don’t always listen to this voice. I mean I try to, but I have my moments of weakness. This is especially true when it comes to food and my diabetes.

“You probably shouldn’t eat that, it’s going to make your blood sugar soar.”

“You are going to eat pizza now?? Your blood sugar is already high, what are you thinking?!”

“Pasta!? Tsk. Tsk.”

“DO NOT order that frozen coke. Walk away.”

Enough already. I get it. I’m probably not making the best choices all the time, but I know the consequences of my actions. It’s just hard to ignore that inner voice, especially when I’m staring at a table full of treats and just want to indulge.

Which is why what I’m about to tell you is maybe one of the only perks of having diabetes and the rare moment when my inner voice has no choice but to shut up:

Low blood sugar when you are right in front of a dessert table/bake sale/ice cream sundae bar/etc.

This rare event is the holy grail of type 1 diabetes. You see, when you have low blood sugar, your body needs sugar. It’s not a choice, it’s a medical necessity! And it just does not make sense (to me at least) to find glucose tablets or a glass of orange juice when there is a plethora of food items with the sugar that you need right in front of you. Which baked item to eat doesn’t become a pros and cons list of taste and size versus calorie consumption, it becomes the sustenance for survival. And my inner voice cannot not argue this fact. So for these rare occurrences, I take extreme pleasure in my inner silence and relish the permission to indulge.

Of course after a few bites, that inner voice begins to warn me not to overcompensate for the low, but those few indulgent moments are just so very sweet.

# Strange Familiarity

Over 1000 people filled the performance center, all of us sitting with our eyes focused on the dancers on the stage. No one was talking, no one was on their phone, everyone was staring straight ahead.

I had gone with my parents to see a contemporary dance performance by a professional dance company that was touring. It was the middle of the second dance, about an hour into the show. I started to look around at the audience instead of the dancers moving across the stage. What are all of these people thinking in this very moment? Here we all are, physically in the same space, listening to the same music, watching the same dancers, yet each of our experiences could be completely different. Unlike a play or a movie, there isn’t a real plot. While the dances are open to interpretation and inspired by different things, there isn’t a narrative to follow. What I feel and think watching these dancers could be completely different from the person next to me.

 Hubbard Street Dance ChicagoImage from TimeOutChicago.com

My mind had been racing the entire show. My thoughts drifted from the dancers and my fascination with their strong bodies and graceful movements, to thinking about the different relationships in my life at the moment: the ones I had, the ones that I wanted, and the ones that I had and didn’t want.

I looked around again. How many people in the audience were thinking about a fight that they had earlier? How many people were there celebrating some happy occasion? Who was dragged there by a significant other? I looked up at the dancers, moving perfectly together, each movement beautifully synchronized. I wondered if anyone in the audience had been moved to tears.

Feeling nostalgic, I thought about all the times in the past few years that I had been sitting in those very same seats watching this same dance company. I reflected on all the ways that my life had changed in those years, from where I lived, who I was dating, and whether I was in school. But I also considered all the ways that it was still the same. My mind then drifted to the current transitions that I’m going through and the uncertainties and anxiety surrounding them.

Then I felt it. The familiar feeling. My blood sugar was dropping. Waiting until the applause between dances, I opened the crinkling plastic of my fruit snack, pouring the contents out into my hand. It was a process that I had mastered over the years, sneaking fruit snacks while making as little noise as possible.

A lot has changed in my life, and a lot more is in the process of changing. But as I chewed my fruit snacks and admired the dancers, I found a strange comfort in the familiarity of my diabetes.

# One Annoyed Biker

Dearest Gigi (Dexcom G4 CGM),

I apologize for how long it has been since we last talked, but really I saw our lack of communication as a good sign. Things were going so smoothly that I felt no need to address you personally…that is until recently. I think we both know what I am talking about, but allow me to refresh your memory.

It was the day of my big bike ride, 36.5 miles, an organized ride through the city of Detroit put on by the health system where I work. I had been training for weeks for it, building up for the long ride. I was prepared. I had plenty of fruit snacks and granola bars stored in every pocket in case I got low. In order to save room in my little bike pack, I decided to bring you, Gigi, and forego the bigger and bulkier finger prick glucose monitor. I figured you’d be perfect for this type of event. I could glance at you and see what my blood sugar was and if it was rising or falling. I wouldn’t even need to stop riding to check you. Plus you are so much smaller, you could easily fit in my pack.

My blood sugar had been running high, but I wasn’t worried. I knew that biking for 3 hours would drop it. I was just hoping that it wouldn’t drop too low while I was riding.

I checked you right before the ride started at 9 am. You were giving me the “out of range” sign, which made sense since I had walked away from you. The race started. You were stored under my seat in my bike pack. I didn’t think about you for the first 10 miles or so. Then I pulled you out to see what my blood sugar was doing. ???. You were giving me the question marks. Are you kidding me? Why weren’t you working Gigi?! I needed you. I had no other way to check my blood sugar on this ride.

I rode on. I paid attention to how I was feeling. When we got to the halfway point, I could hear you yelling at me from the pack. “Low, under 55.” I knew that wasn’t true, I didn’t feel low, let alone that low. I ate a banana and half a granola bar, but didn’t give any insulin. I didn’t know what my blood sugar was, and you couldn’t be trusted. You were suppose to tell me, Gigi! Maybe I should have eaten the whole granola bar. I didn’t know!

We were at 28 miles. I was starting to feel “off”. Was I dropping low or just getting tired? Gigi, you could have answered that question. I wanted to be safe so I ate a pack of fruit snacks and kept riding. We finally reached the end. It was a little after 12 pm.

Then the craziest thing happened. You started working! And you have been working fine ever since. But Gigi, where were you when I needed you the most?! It’s as if you were trying to spite me, working right before and right after my ride, but nothing in between. And you’ve worked fine on other bike rides, so I don’t know what your deal was today. Your behavior today was unacceptable. I’m disappointed in you and frankly kind of pissed off. Thankfully everything worked out fine, even without your help. You also reinforced the lesson to always bring back up. When I finally tested after lunch, I was 144.  But you completely abandoned your primary task and purpose and really let me down.

So no thanks to you Gigi, I successfully finished my first bike tour! All I can say is that next time, you better show up!
Sincerely,
One annoyed biker

# The Michigan Ave Mystery March

“Urm well thatsh okay, I’m jush lorking, but shanks,” I mumbled with a mouth full of fruit snacks. Sometimes when I get really low, as I was at this moment, I pour the entire contents of the pouch into my mouth at once. Struggling to form a coherent sentence, mouth full, and teeth sticking together, I can only imagine what the woman must have been thinking as she gave me a curious look before walking away to help someone else.

Lost amongst the racks of clothes, I managed to make my way out of the store and outside. There I stood in the middle of Michigan Avenue in downtown Chicago.

There are all different kinds of low blood sugars. Some can feel much worse than others, even when they are the same number. I was experiencing one of the bad ones. In fact, both of my legs had started to tingle and feel kind of numb. What a strange and unpleasant experience to say the least.

I was alone. My friend was sitting in a coffee shop a good 4 blocks away. Not that she could do anything to help me right now. Plus I wasn’t worried. I knew that in about 12 more minutes, I would begin to feel normal again. It is just this waiting period that is the worst.

So hands shaking, head spinning, legs tingling, brain not quite thinking straight, I decided to walk. Where to? I’m not sure. I just focused on putting one foot in front of the other.

“Oh wow,” I thought. “This feels weird to walk when my legs are tingling. I wonder why they are tingling, what does that have to do with low blood sugar? Oh I like that girl’s dress! I wonder where she got it. It probably wouldn’t look like that on me though. Plus it’s almost fall, it’s going to be too cold for dresses like that soon. I wonder how many people are out shopping right now. Are there more or less because it’s Labor Day?”

Lost in thought, I had no idea where my legs were taking me until I stopped in front of a door. I looked up at the sign to see where I had walked to:

Hershey’s Chocolate Company

I laughed to myself. Naturally this is where I would end up with low blood sugar 🙂

# The Costco Curse

Living in the age of Costcos and buying bulk, a lot of the everyday items that I use come in pretty big containers. Items that used to take weeks to finish such as shampoo or ketchup, now end up taking months to get through. That’s probably why when I finally do get to the end, there is this sense of accomplishment and pride. I used that entire box of dish soap! I finished that enormous container of conditioner! It feels good to get to the bottom, to know that you didn’t waste any. I feel this similar way about a lot of household and everyday items when there’s none left. It’s a small joy in life, but a positive moment nonetheless.

However, I recently got to the bottom (and top) of certain items and felt none of these usual feelings. I finished a bag of 100 glucose tablets and filled a sharps container.

I stared at the bottom of the bag and my first thought was, “wow, how many lows have I had that I finished this whole bag?” I felt like I had just bought it.

You see, when you finish a large container of soap or shampoo, the most you can say is that you have good hygiene. You finish the large container of hot sauce or ketchup, well, you like condiments. But finishing a bag of 100 glucose tablets, there’s really nothing good you can say about that…either you’ve had a lot of lows, or you eat a lot of sugar.

Similar for the sharps container. I know I deal with a lot of needles, but it isn’t until a container is at capacity that it really hits me how many it actually is. With all my other supplies, there’s always a constant flow. When I finish one vile of insulin or box of infusion sets, you better believe there is another one ready to replace it. It’s not too often that I stop to think about the large quantity of what I actually use until I either see an empty bag (like the glucose tablets) or a full container (with the sharps).

So there was no sense of accomplishment or satisfaction with these events. Quite honestly, I would prefer that the bag of glucose tablets has to be thrown out because they expired before I could use them. Or that I never have to fill up another sharps container again.

# Wheels yield to heels

Hey everyone. Today we are going for a bike ride. Now we aren’t just going around the block a few times, we are going for a 20 mile bike ride. Don’t worry, there aren’t many hills so it will be quite enjoyable. Are you ready?

So what will we need? We probably should get everything together. Let’s start with our attire.

I’m thinking bike shirt with some workout pants. But what about the pump? Where should it go?

I can:

A. Wear a pair of shorts/pants with pockets and hope it doesn’t fall out
B. Find some pants with a zippered pocket
C. Clip it to my pants
D. Leave the pump at home. I’ll be exercising, it will be fine.

Well, since I don’t really have many shorts with pockets, I’m going to go with option C. That way I won’t have to worry about it falling out of a pocket either. And since the ride may take a couple hours, I’m not comfortable being disconnected from my pump for that long.

 They match!

Great, now that we know what we are wearing, what will we take with us? Here’s what I’m thinking:

• Some kind of liquid. Should I bring water or gatorade? I don’t really like to drink gatorade, but it will keep me from going low.
• A granola bar. In case I need something more substantial to eat.
• Something to treat a low. Probably some fruit snacks. But how many packets? Maybe 4. If I go really low, I might need 2 packets, but I need to have enough in case I go low twice. Is 4 even enough? Maybe 5.
• My phone. Obviously.
• License, insurance card, money/credit card. You know in case something happens or I feel like buying something along the way.
• My glucose meter. Or my CGM? Or both? My CGM is usually pretty good, but it isn’t always accurate so maybe I should have my meter too.
• My helmet. Safety first.
• Bike gloves. Don’t want any blisters.
• Sunglasses. I have to be able to see.
• Sunscreen. That I don’t have to take with me at least, but I will put that on before I leave.
Hmm yea that should cover it. Kind of a lot of stuff. Luckily it all fits in the pouch on the bike. So we’re off!
Okay we’re 8 miles in and you start to feel low. What do you do?
A. Keep riding for now, we can stop when it starts to feel worse.
B. Pull over! Treat that low!
C. Low shmo. No pain, no gain baby!
D. I don’t know what you’re talking about. I don’t have diabetes.
I’m going to go with B! I did get low on this bike ride and so I pulled over to the side of the path, got out a pack of fruit snacks, and sat and waited until I felt better. The last thing I want to do is fall off of my bike because I’m shaky and disoriented from a low. As much as I hate disrupting a workout (or bike ride), I know that I’d also be putting other walkers, runners, and bikers at risk if I’m riding with a low blood sugar.
After feeling better, it’s back to the bike ride. It’s been a long time since I’ve gone for any kind of bike ride, let alone one for this long. 12 miles later we make it back, phew! We did it! What a ride! It really was a great summer activity.

Sure I may have had a few extra items stuffed into my bike pouch, but I didn’t let my diabetes slow me down! Can’t wait until our next ride!

And because it’s Wisdom Wednesday…
 Found on Pinterest