Friday, October 15, 2010

Relearning "Normal".

I am Kim’s Diabetes Paradigm Shift.

A large part of getting my A1C into range has been changing the way I think about, and react to, lows. The physiological and psychological effects of hypoglycemia are quite uncomfortable, if not a bit terrifying, to experience. This leads many of us to do whatever we can to avoid the feeling. As Henry Stewart put it in his series Insulin is Not a Cure, “hypoglycemia feels like a slow descent into death”.

For my readers without diabetes, allow me to give you some analogies of what severe hypoglycemia feels like.
  1. Imagine yourself at your most hungry state. You haven’t eaten all day, and it’s now 9 p.m. You are ravenous, and feel like you could a horse.  And then maybe the barn he was in, too. Your brain and stomach are both in Full And Complete Panic Mode.
  2. Think about a rollercoaster ride. The particular moment I want you to envision is the moment when you’ve reached the top of the first incline, and you start to see how far down you’re about to go. Think about the rush of adrenaline, how your body starts to shake a bit, and how you feel a little bit scared about what’s in store for you. Now, take out the fun part.
  3. Now, for those of legal drinking age (because you’re all good boys and girls, right?), think about how you feel when you've overdone it. You lose a good deal of your motor skills, balance, and rational thinking. Also, again, take the fun part out.
  4. Now, I want you to add in heart palpitations, a really bad case of the shakes, and a general feeling of helplessness. You can also add in “taste buds going numb”, or “feeling like you’re vibrating”.
So, to recap: You’re eating a horse, on a rollercoaster, while drunk.

Here’s the issue. Blood glucose has a very large range – you’re probably dead at 0 mg/dL, and you’re probably in DKA at 600 or so. The target area resides within a very small fraction of that range – 80 to 120, if I'm being strict. If I fall outside of that, I’m taking some sort of action: more or less insulin, or more food. That’s a very small range to shoot for, and when so many factors out of your control can influence the results, you can start to see how this disease can be a frustrating monster. You can also see how scary it can be to try to aim for 80, when a mere 30 points less than that has you wanting to crawl out of your own skin.

In the past, I was always trying to avoid going low, at whatever cost. If I ran a little too high, that was okay with me, because it was better than the alternative in the short term. But, priorities have shifted. I’ve got something I’ve been working towards being ready for, and this has required me to re-evaluate what my goals are.

Using a CGM has made all the difference for me. I talk a lot about why I love it, but I really can’t ever stress enough the difference it’s made in my life, diabetically speaking. To put it simply, my CGM is a safety net I can rely on while I walk the tightrope of glucose control.

I don’t have to fear a lot of things anymore.  Going low while sleeping is less of a concern, as Jim will do his best beeping and vibrating in order to wake me up.  While I may never have taken corrective insulin for a reading of 130 in the past, I feel comfortable doing that now, for the sole reason that I can see in almost-real time what will happen.  And I can feel confident when I walk to the other side of our neighborhood, because Jim will let me know if the exercise has caused me to bottom out.  I don't have to wait until I feel the lows anymore.  I can take pre-emptive measures.

A reading of 80 mg/dL doesn't seem "low" to me anymore, and it turns out that, for me, a fasting blood sugar of 65 doesn't need to be treated.  If I can force myself to just wait it out (which I usually can, lately), I have learned that the mere act of waking up will cause my glucose level to rise about 20 points - which puts me right back in range.

This is a whole new world for me.  Trying to change two decades' worth of viewpoint is hard, and anything but easy.  I'm retraining my diabetes brain.  I'm still not "perfect", but I tend to question anyone with diabetes who claims to have "perfect" control.  Diabetes is a fickle monster, but it's not the whole picture of your health.  I'll do what I've always done, which is to do the best I can.  It's all any of us can do.


  1. This may be too early in our relationship to share with you, but I just can't help myself... I think I love you. :D

    Ah, "perfect" control. So enticing, yet so elusive. I'm so proud of you! Your "best" makes me want to try my best too.

    Yay, textingmypancreaspants! <-- THIS JUST MADE ME THINK OF A DIABE-TEE! A picture of a pancreas holding a cellphone and texting. IT'S PERFECT!

    I digress...

  2. This is the greatest post ever. I find myself deeply desiring your life. I hope I can join you on the tightrope soon.

  3. Great post, I know the up and down, crawling out of skin feeling. Right Now, it sucks. Not the post, how I'm feeling.

  4. Holy snap, "you're eating a horse on a rollercoaster while drunk" is such a perfect analogy but "WITHOUT the fun part"
    I'm going to come back to this post again. thank you!

  5. I totally agree that the cgms has created a safety net that frankly, I never knew I needed, but would never give up now that I know the comfort of it.

  6. Thanks so much for this post (and bonus Fight Club reference, nice!). We are hoping to get a CGM for my daughter before the end of the year, and this just confirms it's the right decision for us.

  7. I love this post! I always thought I was a defective diabetic because I don't correct fastings unless I'm under 60 (my CGM has confirmed it usually comes back up on its own). My endo was NOT happy with me when I told her that. Glad to know someone else does this too!

  8. Good for you Kim.

    I've been targeting 85 since I read Dr. Bernstein's book and learn that IS normal. Not 110. Not 140. 85!

    I was looking for "better" primarily due to joint problems that my rheumatologist said were caused by "advance collagen degeneration." I researched it and golly gee - NON-normalized blood sugar (not the label of diabetes) is the cause.

    So, then I found Dr. Bernstein's book and it's been a huge difference.

    I did decrease my target 10-20 points at a time so I could reset my normal without feeling low. It worked. I feel like I should at 70 or 85. I function well. Never had a seizure or passed out anyway but my brain definitely retrained itself lower. That's a good thing. It's much safer if you can think, don't pass out and are not beligerent.

    So - good for your girl. I don't know what made you do it. We do all have motivations. But I'm glad you know, found and target the REAL normal now. I just wish it didn't take me 29 years to find it. Shame on those who try to tell us that an A1C of 6.5 is "normal" and that post-meals of 140-180 or fine and dandy. They're not and they do damage.

    FYI - I have a few "rules" that might be helpful. I do not eat carbs >110. I fix anything >100. And I use Dr. Bernstein's theory of small numbers. Small doses - doesn't matter if it is in a syringe or a pump. It's a lot less dangerous.

    Doris J. Dickson

  9. Hi Doris! Thank you for leaving a comment with such encouraging words. I do appreciate every comment that gets left on my posts here.

    While our beliefs and methods may differ, I do commend you for doing what you feel is best for your own health.

    My reasoning for a lower BG target than I would normally shoot for pertains to my wanting to start a family soon, and the BG targets that are recommended during that time.

    I wish you the best and am glad you've found something that works for you!


  10. Okay so I know I'm a little late on the comment here but i just found the website and starting to catch up on everything... you don't know how long it took me to figure out who Jim and Ping were. :)
    But I thought I would say that based on my experiences and this was spot on. The "with out the fun" part made me laugh because it's completely true. Thanks


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