Feeling low

I buried my head in my pillow, the soft fabric muffling my frustrated screams. I hate it. I hate it, I hate it, I hate it.

I was low. AGAIN. It seems to be the trend lately. My efforts to keep my blood sugars from spiking has resulted in more lows. Lows that seem unexpected because I really thought everything I was doing seemed right. Lows that have been incredibly disruptive, making me stop whatever activity I’m doing. Stubborn lows, that a couple glucose tablets don’t seem to solve. Lows that wake me up at night, lows that won’t go away, lows that leave me feeling awful. And upset. And frustrated.

I don’t want to treat the low. I’m tired of stuffing my face with sugar, not because I want it, but because I need it. I’m tired of working so hard in my workouts, only to have to later eat everything I burned off or sit out because I can’t continue with a low. I’m especially tired of eating when I’m not hungry and feeling awful while I wait for my blood sugar to stabilize.

I can see the extra weight creeping on, and I hate it. I hate that I don’t have a choice when I’m low. I hate that those forced extra 80 calories of my fruit snacks add up. I hate that insulin makes it harder to lose weight. I hate that these lows are often then leading to later highs, sending me on a blood sugar roller coaster. I hate not feeling my best.

I’ll talk to my doctor, I’ll make adjustments. We’ll work to get rid of these lows. But for now I just want to scream into my pillow and wish for the day when all of this will disappear. When sugar will just be sugar and not a substance that often feels like its controlling my life.

Some days, weeks, months are better than others. I’ll make it through this rut, I know I will, but today, right now, I really hate my diabetes.

Oh crepe!

When I was first diagnosed, I carried a little book around with me to look up the carbohydrates of everything I ate. Since I didn’t always have access to the packaging of the food, I would look up every food and add up all the carbs in my meal. Now, that same information is available right on your smartphone. However, after adding up the carbs for thousands of meals over the years, I’ve memorized the majority of the foods I eat and have gotten pretty good at estimating.Yes, there are times when I over or underestimate, but I generally feel pretty confident in my abilities.

In fact, one could say that I’ve gotten a little too confident and maybe even lazy when it comes to carb counting these days. And this attitude is dangerous. Because when I am significantly wrong in my counts, the results can be pretty catastrophic. The continued importance of being accurate in my carb counting was made abundantly clear to me last week over a meal of crepes.

I was excited to try a new crepe restaurant for dinner with a coworker. Although I knew what a crepe is, I greatly over estimated the number of carbs for the thin pancake like wrap. While a typical crepe is about 10 carbs, I had figured it was at least double, thinking of it as more of a tortilla.

Everything was fine for awhile and I figured that I had successfully calculated the meal. I drove home and decided that I was going to go for a run, never mind that I was still really full from dinner. After my second mile, I started to feel off. I figured it was just from running on such a full stomach. I headed home and showered. It wasn’t until after I finished my shower that I realized that the weird feeling was feeling more like a low blood sugar. I checked my blood sugar. 34!! Ohhh crepe!

I treated the low and eventually felt better, but the experience was definitely a reminder that even after all these years, it’s still important to look up foods that I’m not as familiar with. It’s easy to fall into old habits of guessing and being a little lazy, but I realize it’s definitely worth the extra time to look something up in the beginning than to deal with a low blood sugar later. Next crepe, I’ll be ready.

The boot camp bond

The sun burned brightly in the sky as sweat dripped down my face, falling on the concrete below. My legs burned as I jumped from one side of the block to the other.

“10 more on this side! Keep going!”
The instructor urged us on. It was halfway through the boot camp class, and today we were outside using stepping blocks, jumping up and down, side to side. 
My body was shaking, I was getting light headed. “It’s just the heat,” I thought, “Your body is just getting tired. Don’t give up now.” I encouraged myself, trying to push through. But this feeling wasn’t exhaustion, it was something different. 
As everyone continued with their workout, I pulled out my glucose meter and tested my finger. 52. Once I stopped, the low hit me full force. I rummaged through my bag looking for my fruit snacks. I couldn’t find them, but remembered I have a whole box in my car. I walked silently behind the class towards my car, ignoring the questioning looks. I grabbed a couple packets and poured the contents in my mouth as I headed back to my mat.
The instructor had moved on to the next exercise. I stood there awkwardly, waiting for my blood sugar to come back up so I could join back with the class. I don’t usually get self conscious while treating a low, but this time I did. I was sure everyone was wondering why I had suddenly stopped exercising, why I was standing there while everyone continued to jump around. When I tried to join back in, my body felt weak and dizzy. I couldn’t do it, I knew I would just have to wait it out. The class is only an hour, and I knew I would be wasting 10-15 minutes waiting to feel better. And while I know this is necessary, I was mad. I was mad that I was missing part of a workout that I wanted to do, that I paid to do. I was mad at how disruptive my diabetes can be. I was mad that I was being forced to eat sugar that I just worked so hard to burn off. And I was mad that my diabetes had singled me out once again.
I sat there as the instructor walked over to ask if I was okay. 
“I have type 1 diabetes and my blood sugar went low. I’m fine but I just have to wait for it to come back up.” My voice was full of emotion. I don’t know why, but this particular low had made me feel vulnerable. I was afraid that the instructor wouldn’t understand. I was fine, I just needed time, but I’m strong and capable. I didn’t want her to underestimate me.

But the instructor looked at me and said something that made me confident that she understood.

“My son has type 1 diabetes.”
I looked at her and smiled, instantly relieved. As a parent of a T1D, I knew she got it, and I knew I was in good hands.

Oh the Irony

I have this ritual. Almost every time that I go for a long grocery shopping trip, I treat myself to a cold bottle of diet A&W root beer on my way out. I don’t drink a ton of pop and root beer has always been one of my favorites. Having performed this ritual enough times, I’ve come to recognize the diet bottle just from the color of it. I was finishing up a particularly epic grocery shopping trip and grabbed the A&W from the cooler as I got in line to pay, confident that it was the right one.

Parched from my long shopping excursion, I got into my car and immediately cracked open the pop and starting chugging, relishing the cool and refreshing taste. With half the bottle gone, I glanced down at the bottle. Something was off. I didn’t see the “Diet” sign anywhere! Shit.

Two thoughts immediately crossed my mind. Well technically first I silently cursed myself. But then my first thought was “What a waste of calories!!” followed by, “Holy crap that’s a lot of sugar!” A bottle of regular A&W root beer is a whopping 80 carbs! And here I had just drank close to half.

I took out my insulin pump and immediately started figuring out how much insulin to give. It looked like I drank half, but the top half of the bottle is skinnier than the bottom half, so maybe its not actually 40 carbs. I decided to subtract some to account for bottle shape and gave myself some insulin.

Within 5 minutes Gigi (my CGM) was already buzzing, displaying the two upward arrows showing that my blood sugar was rising quickly. I cursed again. Maybe I should give a little more insulin. I could just picture my blood sugar rocketing to the 300’s. I was pissed. What a stupid, careless mistake. Really I was thinking that if I was going to have that many calories and sugar, I would have preferred ice cream or at least a root beer float!

I went about my afternoon and tried to put the incident behind me. That is until about an hour and a half later.

Something wasn’t right. Gigi was being quiet, but all of the sudden I did not feel well. I got out my glucose meter and tested my finger. 37. Ummm what?! The low caught me off guard, as I was sure that I had given the appropriate amount of insulin according to the label. I needed sugar, and fast.

The bottle that only an hour earlier I was cursing, was now my salvation.

Ohhh the irony.

Diabetes Blog Week- Day 6: The Diabetes Lens




“Back for another year, let’s show everyone what life with diabetes looks like! With a nod to the Diabetes 365 project, let’s grab our cameras again and share some more d-related pictures. Post as many or as few as you’d like. Feel free to blog your thoughts on or explanations of your pictures, or leave out the written words and let the pictures speak for themselves.”

In many ways, diabetes has become a lens through which I see everything in life. Thus every picture becomes a diabetes-related picture. So for this post, I chose 4 pictures that at first glance don’t seem “d-related,” but as you’ll see, my diabetes is there in all of them.
Voted Best Tacos in My City
The newspaper of city where I live decided to have a poll to see what the best tacos in the city are. These are from the restaurant that won first place. Having never been before, my friends decided that we had to try them. I have to say, I definitely agree. But looking at this plate, I see more than the delicious food, I see a complicated equation of trying to figure out how many carbohydrates exactly I’m eating here and how much insulin I need to give.
Spring Is In The Air
On this particular day, my coworker and I decided to take a walk after lunch around the city. Since we’ve been having unusually cold weather lately, we were excited to see that the flowers were now in bloom and stopped to take a picture. My coworker walked out of the office for our walk carrying nothing besides her phone. I on the other hand knew that I had to be prepared while away from the office. As I pulled my phone out to take this picture, I reached into a bag that also had 2 packets of fruit snacks, my glucose meter, and a little money just in case. The thing is, I can never walk out of the office empty handed because I never know when I might drop low.
The New Dress
Wedding season is upon us and I’ve been shopping for some new dresses to wear. With any dress, I look to make sure that I like the style, the cut, the fit, the color, and the material. As I try on each dress I ask myself, will it match the occasion? Is it flattering? Will I get good use out of it? These are the normal considerations. But with every dress or outfit that I try on, I also have to consider my diabetes and specifically, where my pump will go. Does it have pockets? Will my pump show if I strap it around my leg or wear it on my hip? How easily will I be able to access it? My diabetes can influence what I end up buying and wearing.
The Bike Ride
 
Within the last year, I’ve gotten pretty into bike riding. My mom and I would go for beautiful, long rides in the summer together. I love the exercise, the scenery, and this quality time that we spend together. I look at this picture and I see the beautiful lake, my awesome jersey with the Detroit cityscape, and my bike. But what you don’t see are the 2 packs of fruit snacks and granola bar stashed in the pockets on the back of my jersey. You don’t see my CGM and more emergency sugar in the red pack attached to my bike along with my phone, ID, and insurance card in case of a real emergency. Having diabetes means always having to be prepared, especially when you’re out exercising.

Diabetes Blog Week- Day 2



“This year, Diabetes Blog Week and TuDiabetes are teaming up to bring out the poet in you! Write a poem, rhyme, ballad, haiku, or any other form of poetry about diabetes.”

CGM, Go To Bed

An ode to my continuous glucose monitor


10:30 pm:

I put you on my nightstand, I lay you down to rest,
In case I don’t feel well, my blood sugar you will test.

My blood sugar is steady, not too high and not too low,
That ice cream after dinner, I hope you will not show.

An undisturbed night of sleep is what I really need,
A steady line on your graph in the morning, I truly hope to read.

Slumber is upon me, I’m drifting off to sleep,
I beg you CGM, a quiet night without a peep.

1 am: Buzz buzz buzz

Double arrows pointing up I awaken with a start to find,
Of all the arrows, up and down, you’re my least favorite kind.

Not much I can do, laying here with insulin on its way,
Groggily back to sleep I go, and hoping this time to stay.

2 am: Buzz buzz buzz

My eyes spring open, you caught me quite off guard,
My bg’s now over 180, you just had to make this hard.

My number is too high now, but I’m hoping not for long,
It may start to drop too fast, but hopefully I’m wrong.

4:30 am: Beeeeeep Beeeeep Beeeeeep

From my nightstand I hear your sound, which can only mean one thing,
“You’ve dropped below 55, wake up, wake up!” your beeps eagerly sing.

I take my fruit snacks and into my mouth I dump them all,
For the last time tonight, please back to sleep I hope I fall.

4:45 am: Buzz buzz buzz

Now you say I’m under 80, well at least I’m on the rise,
Maybe giving insulin for that high wasn’t all too wise.

Please CGM, let this be all, I’m really very sleepy,
If you wake me up one more time I may get a little weepy!

7:30 Ringgg Ringgg Ringgg

You’ve got to be kidding me, what is it now? You haven’t had enough?
With all the ups and downs this night, my sleep has been quite rough.

It’s my alarm! Time to get up; to work I must get ready and go.
Oh what’s that on the graph? A perfect number NOW you decide to show!

Superpowers and Kryptonite

I tend to not remember a ton from the time when I was diagnosed, but I clearly remember one conversation with a doctor that I had when I was 12 and probably type 1 diabetic for only a couple weeks.  I remember the doctor telling me that I would get to know my body so well, better than most people without diabetes, and know roughly my blood sugar just by the way I feel. It was such a foreign concept to me at the time. At that age, I wasn’t paying attention to my body for the most part, maybe the way it looked since I was at the beginning of puberty, but not how I was feeling. I was skeptical, but I found the concept intriguing. “It’s kind of like I have a superpower!” I thought. “I’ll be able to feel my blood sugar. You ordinary humans can’t do that!”

The doctor was absolutely right. As with many health conditions, you become hyper attuned and aware of changes within your body. Sure, I can feel a low blood sugar, but more specifically I can often feel the difference between a 90, 70, and a 50. Between 120 and 220 and even 320. I can feel the low coming sometimes even before it’s reflected in the number on my meter. With my CGM, these feelings are often confirmed by the device, but the discrepancies between how I feel and what the CGM says are often in agreement with how my body feels.

DC Comics, The Adventures of Superman

I’ve been without my CGM, Gigi, for close to a month now. It wasn’t a purposeful decision, but when my transmitter battery died, it’s been taking longer than expected to get a new one sent. So I’ve gone back to using my superpower more, for better or worse. But during these past few weeks, I’ve learned that my power is not perfect and indestructible. Rather, my superpower has a kryptonite. These dangerous forces weaken my power, they confuse me, and they ultimately make me unable to accurately predict what my blood sugars are. Perhaps T1Ds have different forms of kryptonite, different interfering forces, but below are the 5 that I have had to battle against:

1. Adrenaline. I remember before my big interviews or doing something crazy like going bungy jumping or even before a first date, constantly testing my blood sugar because the adrenaline rush that I felt mimicked the feelings of a low. I’m shaking, my heart is racing, am I excited or am I low?!

2. Anxiety. Similar to the rush of adrenaline, my feelings of anxiety often get mistaken for a low. Context is obviously important, but in the middle of the night when I can’t sleep and feel shaky and unsettled, there are times when it’s been nerves rather than a low.

3. Alcohol. I was warned about this one even years before I could legally drink. “Alcohol is dangerous,” my doctors would says, “You can’t always feel your lows when you drink.” While this hasn’t been too much of an issue for me, I do notice that I don’t feel my lows until they are much lower, so in the 50s as opposed to catching them in the 70s.

4. Other medications. I hate using my asthma inhaler even when I need it. After using it, I always get this shaky feeling and my heart races. But usually the desire to breathe normally wins out over potentially feeling low.

5. Nitrous oxide (laughing gas). When I got my wisdom teeth pulled out, my dentist turned on the gas and in less than a minute, I was telling him to turn it off. The feeling reminded me so much of being low that instead of the serene feeling that others get, it made me feel anxious, uneasy, and just uncomfortable.

Unfortunately, a few of my kryptonites are unavoidable and thus my superpowers are always in jeopardy. But part of being so vigilant and aware is also knowing when these weakening forces may be at work, and then taking extra precautions. This may mean more finger tests or checking my CGM more often. But in the end, I may not have the world to protect with my power, but I will do what it takes to protect the one life that is mine for the saving.

 

The Ticking Time Bomb

I held in my hand a ticking time bomb.

One of my worst fears was unfolding right before my eyes. But I was too late. The wheels were set in motion, I couldn’t reverse it, take it back, start over. I would have to let it play out and hope that I was wrong. 
This had never happened before. At least not to this scale. My heart rate started to quicken and I began to prepare myself for the worst.
I held in my hand my insulin pump. 
I had just finished an incredibly heavy italian meal including sangria, bread, appetizers, pasta, the entree, and dessert. I started the meal with a high blood sugar and counting the carbs in this meal, I knew it would be a lot. I had given the insulin. It was already in my body, there was no taking it back. I was uncomfortably stuffed, so full that the thought of eating more made me feel sick.
My CGM buzzed, but instead of telling me that I was high like I expected it to say, it was telling me that I was quickly dropping. I looked at the number, 190 and dropping fast. I pulled out my pump, there was an alarming amount of active insulin in my body, wayyy more insulin than I would need. I knew I was going to crash. It was only a matter of time.
Tick. Tick. Tick.
I pulled out a pack of fruit snacks, and although it physically pained me to eat more, I swallowed them down. I was determined to catch this low before it got bad. An hour later I was still dropping, but it seemed to be leveling off and I started to think that maybe the low wouldn’t be as bad as I thought. I was right around 70 and so I took another pack of fruit snacks.
Tick. Tick. Tick.
At 11 pm,  it hit me. In the span of 10 minutes, that 70 turned into 42 and then that 42 turned into 28. 
KABOOM!

 I was falling, crashing. I stumbled out of my room, downstairs and grabbed a small gatorade and another couple packs of fruit snacks. At this point the low had hit me full force, I couldn’t think straight, walk straight, or make much sense of anything around me. I’m moving out of my parents house in a week, but today I was glad that my dad was just a few doors down. I knew that I was in danger of passing out and just wanted someone to make sure I was okay. I knocked on the door. “My blood sugar is 28” I slurred, falling into bed. After confirming that I had already treated the low, my dad continued to ask me questions, making sure that I stayed conscious. The words felt heavy in my mouth, my sentences barely reflecting the thoughts in my head. I could hear myself slurring my speech. Eventually my sentences and speech became more coherent as I became more aware of my surroundings. I tested my blood sugar again, 67. 

I knew the worst was over and I made my way back to my own room, drenched in sweat from the low. My stomach hurt from all the sugar I had just consumed on top of my heavy dinner. And while I was sure I would probably be facing a high blood sugar in a few hours, I was relieved that the worst was over.
The low has come and gone, but was has managed to stick with me is that feeling of both impending danger, but also of the unknown. I’ve never experienced such a helpless awareness. It was like being in a runaway cart rolling down a hill, knowing that you would crash at the bottom, and not being able to stop it. And yes, sugar could and did slow it down, but I didn’t know how much would be enough to stop the crash, but not send me soaring in the other direction.

My insulin pump is my lifeline, but that night it truly felt like a ticking time bomb.

Diabetes Art Day 2014

I’m so pleased to be participating in the 5th Annual Diabetes Art Day! This is my second year participating. Art has always been valuable to me in my life as a form of expression, and I love creating art with a purpose. It’s a way to express thoughts or feelings that can sometimes be hard to articulate when it comes to my diabetes, and Diabetes Art Day is a great opportunity to share those feelings through a unique medium.

This year my piece is called “The Low Journey”. It’s an abstract interpretation of what low blood sugar feels like for me using sharpie and water colors. It begins in the first picture with the realization that you are going low, that dark, confusing feeling of being disoriented and out of sorts. The feeling is confirmed with a finger poke and reading on the meter. In the next picture, the treatment of the low is depicted. I use fruit snacks to treat my lows. Then comes the agonizing 15 minutes of waiting to feel better, but feeling helpless in the mean time. Finally, the last picture shows how the dark clouds hanging over you eventually begin to lift as your blood sugar returns to normal and the sun finds its way through the dark clouds.

The Low Journey
Thank you to Lee Ann Thill from the Butter Compartment for organizing Diabetes Art Day. Be sure to check out everyone’s wonderful submissions in the 2014 Diabetes Art Day Gallery!

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.