Monday, August 2, 2010

Unintended Consequences.

Like many other people living with diabetes, I tend to struggle a bit with balance.  It's pretty easy to swing to one end of the pendulum or another - you either eat, sleep, and breathe monitoring yourself and freaking out over every out-of-range number, or you resign yourself to the fact that you can't control it, and stop trying.  I've swung out to both ends of that over the last 24 years of being diabetic, and I still struggle with where the "happy place" is.  (I know it involves scampering puppies, abundant cheese snacks and limitless rounds of Skee-Ball, but where is it, exactly?)

Right now, I definitely know I'm more towards the compulsive side.  As I've mentioned, I check my blood sugar a lot.  There are days I'm putting up numbers in the twenties - as in, I'm doing over 20 finger-sticks in a 24-hour period.  While this change in my behavior has brought me some happy results, I also must admit that it comes at a cost.  A few costs, actually.

The first - and this is tough to admit - is that I haven't been working out, with few exceptions, in the last 3 months.  Running, which I love doing (even though I'm not very good at it) always messes with my blood sugars.  I know, I know, exercise is supposed to be good for you, right?  In the sense of general health, yes.  But, it involves some extra work for me to make it happen.  How many carbs should I eat before my workout to avoid going low?  How long of a workout do I plan to have?  How far ahead of exercise should I eat?  What combination of carbs and protein should I have?  How much insulin is still active in my system?  Did I remember to turn down my basal rate an hour before I start?  Then, there's The After.  Even though I burn through many of those calories and carbs during the workout, my blood sugar starts steadily rising after working out, no matter what combination of things I've tried in order to avoid it.  So, let's recap:  I have to eat something (which sort of cancels out the workout, right?), I have to time it exactly right so I don't have to quit mid-workout due to a low blood sugar, and then I need to take even more insulin after I'm done moving.  When my goal became lowering my A1C (which determines an average of my blood sugars over the past 2-3 months), my first thought was those skyrocketing highs after workouts.  So, unfortunately, I cut those out for the most part.

Secondly, trying to gain tighter blood sugar control means that, inevitably, you're going to have more lows -  and aside from the general unpleasantness associated with hypoglycemia, it's darn inconvenient.  Sometimes it means I'm eating half of my lunch early, because I need to eat the crackers I brought to treat a low.  Sometimes it means I have to turn down an invitation to eat outside during my lunch break at work, because I didn't have enough lead time to prepare myself, health-wise, for the ten minute walk.  Yes, ten minutes of walking makes me drop - by 50 to 60 points, if there's active insulin in my system.  So, when my dear co-worker asks me at 11:24 if I want to eat outside with her (and I go to break at 11:30), and my blood sugar is in range, I have to turn her down.  At that point, I've already bolused for lunch at 11:15, so the walk will make me drop dangerously low before I can even get a bite of lunch in.  Having to turn down her invitations doesn't sit well with me - it makes me feel guilty, even though I've done nothing wrong.

And third - it's just darn exhausting.  When I'm testing that often, and checking my Dexcom every five minutes to see what the new reading is (which, by the way, will drain the battery like you won't believe), and setting temporary basal rates in an attempt to correct every little thing, it's difficult to think about much else.  Diabetes is always in my brain, somewhere.  I'm looking at the clock to see if it's time to test again, checking to see how I feel and wondering if it's diabetes-related or not, and wondering if I bolused correctly for whatever I ate last.  There are so many variables to consider when trying to figure out "what went wrong".  Am I 200 because there were more carbs than I thought there would be?  Do I need to re-evaluate my insulin-to-carb ratios for this time of day?  Is my pump site clogged?  Did my insulin get too warm, and start to deteriorate?  Have leprachauns been messing with my basal rates while I sleep?  (Really, really hoping the answer to that one is "no", because... um... creepy.)

So, now that I've proved to myself that an A1C below 7 is attainable for me, I need to work on better ways of maintaining that.  I need to work regular exercise back into my routine, most importantly.  I can't let the tough path to get there prevent me from even trying to walk it.  I have to remember - an optimist sees stepping stones, where a pessimist sees stumbling blocks.


  1. Hello, Miss Kim. Wicked Mother-in-Law, here ; ) Just have to say, surprised by how much we have in common with our daily battle. Didn't realize. Of course different meds for different reasons but similar frustrations and consequences. You're so on top of your game, though. Very impressive : )

    Love the blog. Question: what is bolused?

  2. oh, kimface. we are the same person in different bodies... in different states... a few years apart. :o) as i've shared (probably too much) with you, i've been struggling a lot recently. i've definitely moved to the "obsessive" side of the spectrum, as i'm almost out of my month's supply of test strips in only 2 weeks.

    thanks for somehow looking inside my head and blogging my frustrations. you remind me i don't struggle alone and the fight isn't needless. your positive attitude about d - and everything associated with it - keeps me going :o) ~C

  3. D - "bolus" is a fancy term for "took insulin". :) I take insulin in three ways, really - a "bolus" for food, a "correction" for too-high numbers, and my "basal" rate, which is the little bit of insulin my pump is giving me every three minutes.

    And thanks! :)

  4. C - I, too, am glad to find I'm not the only one who faces these issues. Besides, we've got to stick together, or those dang leprachauns will mess everything up.

  5. I totally understand. Balance is SO HARD. And the exercise thing is ... ugh. I haven't been riding my bike to work because I've been testing dual waves at breakfast and riding my bike will mess with my experiment. I guess we have to focus on the good parts, like you getting your A1C lower than 7.0%. Now that's something GOOD.

  6. Thanks Abbey. :) I can definitely be happy about that part.

  7. Congratulations on a great A1C, that is fantastic, and well deserved after so much hard work.

    That balance is SO hard to find, and I hate to say it, but it's a moving target. I think that is stinks how we have to battle between quality of life and quality of diabetes management. There's so much not right about that.

    But the strength we demonstrate day after day is something really special.


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