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Diabetically Speaking

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March 2011

Master of Disaster

Exercise, for most folks, is hard to get around to doing. Our days are consumed by so many things that we simply don’t always feel there is enough time to add exercise to the mix. By the time we get up, get dressed, work all day, come home, make dinner, eat, wash dishes, chase the dog, pet the cat, do laundry, get a shower, and try to relax for five minutes, there often seems to be little time left to do much of anything else. That doesn’t even factor in those folks that have kids, and all the shenanigans that I can only imagine (for now) comes with offspring.

In the late Summer of 2005, Hurricane Wilma came roaring across the southern part of Florida and left most of us without power, transportation, and necessities for days, and in some areas even weeks. The local weather coverage had prompted everyone to be prepared for a “mild Tropical Storm,” but they did not anticipate that the storm would gain strength while crossing over the Florida Everglades and pound the opposite side of the state, where I was, as a Category 3 hurricane.

While nothing like the major disasters of Hurricane Katrina and the tsunamis in Indonesia and Japan, Hurricane Wilma still left us in a catastrophic predicament. Like fools, none of us had taken the forecast seriously after being told to expect nothing much more than a mild thunderstorm. Meanwhile, the gated archway at the entrance to my apartment community had succumbed to the winds and had landed in a heap of rubble (blocking our escape by car), roads were closed and impassable, power lines were laying on the ground with no indication as to whether or not they had electricity coursing through their veins, and a mandatory curfew was in place from dusk to dawn for all affected areas of southeastern Florida. Everything was a mess, and a dark mess too after sunset with no lights…anywhere. Because of all the lights, stars are not a sight you get to see in south Florida very often, so it was very surreal looking up and seeing them in all their sparkling glory.

Word eventually got to us that some areas had power and supplies, yet there was no way for me to get to them. I was an easy 200 pounds heavy at the time, out of shape (unless you consider “round” a shape), and hadn’t made exercise a part of my life since grad school. It was then that I realized the perils of my choices that had left me physically incapable of getting from points A to B, so I vowed that I would never get stuck in that same situation again.

That was when I started cycling. I went to a bike shop nearby and overpaid the owner for a bike that I could ride a fair distance, and would withstand the abuse of a 200 pound gargantuan (see also: fat ass). At first I couldn’t ride but maybe three miles before I would be out of breath and energy. But I kept riding, day after day, and I got stronger, and I stretched those three miles to four miles…

…then to six miles…

…then to ten miles…

…then to 13 miles…

…and by the following June I did my first 26 miles in an organized charity bike ride.

1st Bike Ride - 2006
My 1st organized bike ride + hair + heft.

By the end of that Summer in 2006 I felt that I’d earned a better bike, so I got a Trek 1500 as my first road bike, and I have been pedaling ever since. I’ve wrote before about how cycling benefits me both physically and mentally, and long endurance riding comes with its own share of challenges, but I know now that in an emergency I could absolutely get from points A to B, and probably to C and back again if the situation called for it. Last April I completed my third 150-mile bike ride from Miami to Key Largo and back.

2010 MS150
Outside of the Team Stormriders tent in Key Largo, my 3rd MS150 with the team.

In my case, dropping the weight and getting fit was a side effect of my desire to be able to get to where I needed to go. In doing that, I discovered a passion for a sport that has partially defined who I am today. No matter your circumstances, don’t wait for a force of nature to force you to exercise. Get moving now, and be the master of your own disaster!

 

This post is my March entry in the DSMA Blog Carnival.  If you’d like to participate too, you can get all of the information at http://diabetessocmed.com/2011/march-dsma-blog-carnival.

5.6 Degrees of Frustration

I like reading about the experiences my friends in the DOC have when they go to their diabetes doctor appointments. Good experiences or bad, it teaches me a lot about what I want and need from my own endo, and things I should be thinking about.

For example, it’s no secret that diabetes and heart disease are BFF’s. Observing the thoughts and conversations that are shared in the DOC about statins, ACE inhibitors, blood pressure, cholesterol, and the effects on the heart of sticking your finger in electrical sockets makes me realize that I  don’t give this component of my life with diabetes near enough attention.

At my endo appointment last Friday, we talked about some of these things. No mention was made about my weight, but I know that I want to be lighter than I am. I’ve lost 7 pounds thus far with the switch to a low-carb lifestyle, and am making satisfactory progress toward my goals, so I have to take things one step at a time on that front.

My blood pressure was normal, so that was good. I’m not one of those folks that shoves an arm in the free cuff & fluff machines at the store, EVER, so if the endo says I’m good and it isn’t an issue right now, I’m taking that and rolling with it. He did order a full lab workup for my next visit, which should add all kinds of interesting new data points to talk about.

The results of the BIG test on Friday, that almighty diabetes report card mother of all tests, the A1C, took the wind out of my sails. I set a goal at the beginning of this year to get my A1C down to 6.2 or better. On Friday, my A1C was 5.6. I have never had an A1C in the 5’s before, so I should be celebrating that, and throwing myself a party. Instead, I feel like a failure.

Diabetes is a candle burning at both ends. You can monitor your BG’s closely, and stay as close to on top of everything as possible, but often when you focus too hard on one problem (too many highs) and fix that, you end up with another problem (too many lows). Diabetes doesn’t give very much room for error, and that frustrates me. Maintaining perfect blood sugar control is like trying to balance on a tight rope, hanging over a cliff, while juggling bowling pins and riding a unicycle. It’s possible, but good grief it requires a lot of attention!

I want to celebrate a 5.6 A1C. I want to upload my pump & BG data to my endo’s computer and see on the screen that I am an all-star diabetic, with nearly flat data charts with very few low or high BG’s. I want to EARN that 5.X A1C, and that is where I feel like I have failed. I did not earn my 5.6 on my terms. I have managed to keep from having very many high BG’s, but in turn I have had way too many lows, some dangerously low, and it leaves me screaming at my diabetes, “I just cannot win with you!” Then I throw a pot and pan at it, tell it to get out of my sight, and pour myself a big glass of Diet Coke and have a good cry while watching an ASPCA commercial. Don’t judge, you know you tear up too every time you see one of those commercials and those poor animals that need loving and adopting.

Friday was a bad day, but it progressively got better the more I digested that 5.6 A1C. It could be so much worse. That 5.6 could have come with severe low side effects, including occurrences of unconsciousness, seizures, ambulance trips to the Emergency Room, car accidents, or the inability to shut up while talking nonsense in front of a crowd of people. It could have resulted in the embarrassment of a low while at work and my coworkers having to help me. It could have included feelings of shame and inadequacy because I needed someone in a way that I can never repay.

My endo and I talked about what I have to treat a low. I have not had a Glucagon pen in…well, maybe not since I lived at home with my parents. That was 13 years ago. It wasn’t until this last year that I even kept a stock of glucose tabs. It’s really a wonder how I survived so many years without them. I did keep glucose gel, so I guess that is worth something, and keeps me from being a total bad diabetic. Now, however, I have an “Emergency Low Kit” so that I have as many weapons in my arsenal as possible to combat diabetes.

Emergency Low Kit
My "Emergency Low Kit" including Glucagon and glucose gel & tabs

I have settled on the fact that it is 100% okay for me to be frustrated with diabetes and an A1C of 5.6 that I don’t feel I earned by being an all-star diabetic. I have settled on the fact that I am going to be working closer with my CDE to adjust my basal rates so that I don’t have so many lows, and still avoid those highs as well. I have settled on the fact that there is no such thing as a perfect diabetic, but striving to be one may very well have played a part in keeping me alive and healthy all these years, and I don’t intend to stop now. I have settled on the fact that there are side effects to diabetes that I absolutely can control, and some that I cannot do a damn thing about.

Diabetes had just better get settled with the fact that I’m not going anywhere, and there is a good possibility that I am more stubborn than it could ever dream of being.

Endo Affirmations

When I set my goals at the beginning of this year, #1 on my list was to get my A1C down to a 6.2 or better. That is a formidable goal, trying to achieve an average blood glucose over time of around 120, depending on what research you consult. At my last endo appointment back in December of last year, my A1C was still reasonable, but it had ticked upwards. I couldn’t let that upward trend continue.

I had gotten my Continuous Glucose Monitor (CGM) and new pump just after my previous appointment in September of last year, and with all the change, I was burnt out. Or maybe just overwhelmed. But really, is there a difference?

I was wearing my CGM intermittently, and was dealing with major information overload with all the beeping and pricking and checking and counting and pumping and beeping and…I was exhausted.

After I wrote my A1C down in my notes, and realized that I had allowed my control to slip in the short three months since my previous appointment, I knew that I had to turn the ship around. I don’t want my A1C to continually creep northward, and me pay for it with problems down the road. I have too much life and dreams ahead of me to get lax with my diabetes management.

So I sat myself down and gave myself a stern talking to. I said to myself, “Self, all is not lost. I want you to look in that mirror, and I want you to repeat after me. I can do better. I have some awesome tools to help me get to where I know I can be. I can wear my CGM all the time, and not take several days off between sensor changes. I can carry around glucose tabs right there in my little pocket to treat a low. I don’t have to be a great diabetic. All I have to do is be the best Martin I can be. Because I’m good enough, I’m smart enough, and doggone it, people like me.”

Stuart Smalley
Daily Affirmations with Stuart Smalley

 

I’m glad we had that talk. Since then, I’ve done really well with wearing my CGM. Every time the sensor battery runs out of juice, it hits the charger, and I’m already putting a new site in and getting everything ready for another round. I’ve gotten to where I really don’t enjoy being without my CGM, and am hoping that I didn’t do too much damage for all the years before now when amazing technology like this didn’t exist.

Lows are still creeping around occasionally, but they are manageable. Nothing a few glucose tabs can’t fix in a pinch. I expect my CDE and endo to want to make some adjustments, and I’m open to that. I’ve started a low-carb journey now, so I don’t expect that I need as much basal rate insulin at certain times of the day as I did with a diet heavier in starches.

Something else that I’m not happy with myself about is that I let myself get lazy, and stopped exercising the way I physically and mentally need to. The scale showed me the truth about that. So far I have lost six pounds, down to 184 lbs. It’s not a lot, but it’s progress, and that is the most important thing right now, to be moving forward. I’m making some big changes to my lifestyle to eat smarter and make better choices. I have my eye on my goal cycling weight, and to slim up and firm up so I look good naked, or at least in a swimsuit. Yes, I’m vain like that.

Back to the A1C, I know that we can’t base our entire diabetes report card on the A1C alone, but it still resonates with all of us where we are in our journey with diabetes when we see that number. I am confident about this upcoming appointment. I am determined. I have a plan. And it’s true, I don’t have to be the best diabetic. I just have to be the best Martin I can be. The rest will find its proper place.

A Moment Without Diabetes

This past weekend was a working weekend. I spent the vast majority of my time on the computer and frequenting my local Starbucks for liquid motivation. I have a big work project that I’m trying to get finished ahead of schedule, so I had to make sacrifices at the expense of my weekend. If I wasn’t certain that the end project is going to be awesome, that might bother me more.

Coffee houses are very interesting places to do work. You get see all kinds of people come in and order their custom cup of Joe. My personal favorite (from Starbucks) is the skinny caramel latte. In my head it is a dark, sexy cup of deliciousness with just enough cream and candy sweetness to indulge in without too much guilt, equivalent to the joys of silk pajamas. In reality, it’s a latte made with sugar free caramel syrup and fat free milk. They would probably sell more of them if they went with my description, but that’s neither here nor there.

Skinny Caramel Latte

While I was sitting in Starbucks on Sunday, something interesting happened. Earlier in the afternoon I had gone to the gym and did hill climb intervals on the stationary bike, and managed to sweat off my CGM sensor. After the gym I went home and put the transmitter on the charger, got a shower, and immediately put a new CGM sensor in and reconnected.

Two hours later, while sitting at a table in Starbucks with my trusty laptop and mostly minding my own business, my CGM alarm screeched at me and notified me that it was time for a calibration. I grabbed my kit, did a finger prick, and took care of business. Nothing special there.

The special part was that, while doing this, I was having a conversation with a gentleman next to me about the oddness of the electrical outlets at this particular Starbucks being located behind the removable back cushions of the bench we were sitting on. Our conversation had taken place despite diabetes trying to interrupt. Neither he nor I had given diabetes the courtesy of the time of day.

Normally I feel like I have to hit the pause button on my life for these moments with diabetes. Even having had diabetes as long as I have, I notice them, like red flags on a green golf course. I have to hide the red blood drop from a squeamish passerby, or ask the person waiting on me to go somewhere to hold the door for just a few seconds so I can check my blood sugar first, or choke down a couple glucose tabs and wait a few minutes before finishing a conversation.

This was different. Although diabetes was there, this was a moment without diabetes, and it was so subtle that I almost missed it. It was nice, and I appreciate it, even if it was only for that one moment.

The Joy of Reading

Sometimes we all need a vacation from diabetes. I’m not burnt out, and I’m not pitching an “I don’t wanna do this anymore!” fit, I’m just tired. Another post on that later this week. For now, here is a post that is NOT about diabetes, because any day can be No D-Day if you need it to be.

One of my goals for this year, among others, has been to find time to do more leisure reading. I am guilty of getting so consumed with the billion things that take moments from my day that I never stop to take a few moments of just quiet time to be still and read.

And I’m a librarian. Shameful, I know.

I wouldn’t trade many of the things that consume my time, but I believe that there is some peace in losing yourself in a good book.

The bit of reading that I’ve been doing over the past year or so has been work related, such as library journals, medical journals, business, political and technology news articles. There is no escape from reality when reading that kind of material.

So here are some things that are helping me get back on the joy of reading wagon:

  1. Be in bed by midnight (or whatever your bedtime may be). Not necessarily asleep, but just in bed and settled. Great time to turn a few pages.
  2. Visit your local public library. My local public library allows you up to six weeks with a book before you have to turn it back in, and it affords you the liberty to try a book that you may know nothing about. If it’s terrible, you’re only out the time it took to go to the library and get it.
  3. Take your book to work with you. I know that not every job allows for the opportunity to crack a book, but I’ve found sometimes when my brain is full and I need a quick mental break, I can open a book and read a couple pages and it helps. Plus, if you use public transit to get to and from work, reading is a much more entertaining way to pass the time than awkwardly trading stares with strangers. Well, most of the time. Sometimes making people in public feel uncomfortable is fun too.
  4. Read when traveling. I have to go out of town and teach every so often, and I try to drag along a book that isn’t work related to read while I’m at my hotel. I like to orbit near the hotel lobby coffee and a big comfy chair where I can alternate between reading and people watching, but that’s me.
  5. Get a bookmark that represents your personality. As crazy as it sounds, I think if you save a place in a book with a bookmark that matches you, it marks that place as YOUR place, and you are more likely to revisit it and continue reading sooner than later. (Sidenote: E-readers and apps need to get on this concept. You read it here first.)

Now I’m going to go continue reading “Pride and Prejudice and Zombies,” because it has absolutely nothing to do with work, diabetes, or anything else.

Pride and Prejudice and Zombies

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