high

We Interrupt This Irregularly Scheduled Diabetes

I’ve been running high lately, and I don’t know why.

BG 220

That’s a lie. I know why. I eat too much, too often, and too late. Or I don’t eat, and then I go low or get super hungry, and then I eat all the things. Dang those holiday treats!

Eat All The Things

I haven’t been working out, exercising, or bringing sexy back. I have a gym membership, so accessibility to a place to exercise certainly isn’t the problem. I always find some seemingly good excuse for not getting there. First I was busy trying to find a new place to live. Then I was busy moving. Then I hurt both hands during the move.

Hurt Hands

Then I got even busier than usual at work creating something that I am extremely excited about. We are starting a new diabetes journal, available to all, and we’re now accepting research and volunteers to be peer reviewers. Check out The PLAID Journal. You can see a couple of videos and news articles about the The PLAID Journal on the Announcements page. Also, the Facebook page for PLAID. (Lots more to come on PLAID, so stay tuned.)

PLAID - Start the Conversation

Then the knee that I hurt while cycling several years ago flared up again. Add to all of that an ever-growing to-do list, and there is always something that keeps me focused on something other than me.

I hate it. I hate the feeling of my blood sugar being high. I hate that I can’t get my BG to stay where I want it. I hate when I prick my finger and see a number that is dramatically higher than I feel because my body is getting used to it. I hate being thirsty. I hate waking up in the middle of the night to go pee. I hate thinking about it. All. The. Time.

I also hate being overweight. I hate feeling like I am the overweight that I am. I know that we’re in an age where we are supposed to accept our bodies and all that jazz, but this is not normal. I can’t just accept this. I don’t feel like me at this size. I feel like I’m stuck in a heavy fat suit, and everything I do is just that much harder because of it.

But for whatever reasons, I can’t seem to change it.

Before April of this year, I was on Weight Watchers, and I was doing pretty well with it. I had lost over 10 pounds in three or four months, and was feeling pretty good. I was on track to get back to a weight and size that I wanted to be. And stronger. And back to a more human shaped geometry, instead of just round.

Martin and Amanda on Bicycles

Today, I’m the heaviest that I’ve every been. Almost 207 whopping pounds. I put that out there for no other real purpose than to make it real. I should be about 170, in an ideal world. And I’ve seen a human skeleton. Short of an anatomical anomaly, there is no such thing as “big boned.” I’m just plain old overweight right now.

As joyous as April started out with Amanda and I tying the knot in beautiful Key West, it ended in tragedy with the loss of our precious little cat Squirt, and I know that losing her has played a role in where I am now. To some it may sound silly (she was so much more than “just a cat”), but she was a part of my life every single day for nearly 14 years. It feels like the loss of an immediate family member, because that is exactly what it is. I think dealing with that loss, on top of everything else already mentioned, has made me do things like eat my emotions and talk myself out of doing fun active things.

Squirt in the Window

Working out and exercising has always been like therapy to me. Be it gym, walking, running, or cycling, it’s a safe place for me to get out all of my stress, frustration, anger, aggression, sadness, and any other negative emotions that I’m dealing with. Some days I only need 30 minutes or so. Other days I might need a couple of hours. It also makes sure that I have a few minutes during normal human hours of the day that are just for me, Martin Wood, where I’m not making sure that the needs of everyone else are being met.

It’s my career choice to help people, and it is a major part of who I am, and I love it, but sometimes in order to help people we have to make the time to help ourselves. I haven’t been doing enough of that. Now that we are in a neighborhood where there is less chance of going for a walk or run and interrupting a drug deal, I finally feel that spark of motivation to get out of the house and move around.

I also enjoy doing other things, like reading, video games, movies, and basically anything that doesn’t involve repairing yet another kitchen appliance in my house. Sometimes it’s hard to make room for those things, but we have to. Down time is as necessary to life as to-do lists and full calendars. A friend said recently that “cancelling a holiday commitment is like heroin.” Try it. Substitute an evening on the couch with the dog and the first half of this season of The Walking Dead. (Beth…noooooo!!!)

Life with diabetes is freaking hard, man. Life with diabetes is about so much more than just diabetes. Life with diabetes is a complicated balance of biometrics, medical therapies, activities, unexpected events, important considerations, random emotions, bright sides, dark places, and things left unsaid that have to be factored into an inarticulate equation that hopefully results in a personal definition of success.

All of this is what it takes to get my A1C where I want it, to get my BG’s on a more level plain instead of high or bouncing all over the place, to get back to Weight Watchers and better control of all of the delicious things that I’ve been cramming into my face hole, to develop the strength and stamina to avoid future injuries, and to drop some pounds and be able to haul ass without it taking two trips. That is what it takes to focus more on the things that I do have in my world that bring joy, for me, Martin Wood. Like these two…

A and H

That is what it takes to start to feel better. To feel happy. To feel able. To feel normal. And if I can’t do it on my own, then I’ll have to figure out who the right people are and get them on my bus to help me get further along down that road. For now, it’s one mile at a time.

–MW

The Case for CGM

It can be extremely difficult to get an insurance company to cover the costs of continuous glucose monitoring (CGM) systems. The excuses that these holdout insurance companies provide as to why they don’t want to cover CGM are becoming less justifiable thanks to research and advancements in the way we think about the needs of people living with diabetes. This is why I am a Diabetes Advocate.

So far in 2014, I have only been able to get four Dexcom continuous glucose monitor sensors out of my health insurance company. Four sensors is a one month supply. It is now July. That means for five months out of this year (so far) I have not been able to wear my CGM or benefit from the data that it gives me and the alarms that it uses to tell me when my blood sugar is dropping too low or rising too high. Each time I try to get more CGM sensors, I have to restart the approval process with my insurance company, spend weeks going back and forth between Dexcom, my endo, and insurance trying to get all of the documentation together to submit for approval, just to be denied because either Dexcom isn’t a preferred provider, or because the insurance company has decided that there isn’t enough evidence to support that CGM is a benefit and results in better control of diabetes. So then I appeal. And I know there are many, many other people struggling with getting CGM coverage by their health insurance just like I am.

This is also why I am a medical librarian. Challenge accepted, health insurance industry. Bring it on.

The most dangerous side effect of insulin is hypoglycemia, or risk of dangerous low blood sugars. The ability of CGM systems to alarm and notify a person with diabetes is one of the most valuable and beneficial advances in diabetes technology ever. EVER. The fact that there are small devices now that can warn us, as if to say, “Hey dude, your blood sugar is dropping. It might be a good idea to get a snack or something,” is incredible. This is an incredible benefit to people with diabetes so that they don’t get in a dangerous situation with a low blood sugar that can leave them incapacitated, unconscious, or possibly even dead if it happens in the middle of the night while they are asleep. Do you know how health insurance companies make money off of a dead person with diabetes? They don’t.

CGM technology benefits insurance companies too. It is incredibly cheaper to provide the technology that will alarm and cue someone to get a sandwich, a juice box, or a Level gel to get their blood sugar up on an ongoing basis than it is to pay for home or work visits by paramedics, rides in the back of an ambulance, hours in an emergency room, and likely overnight stays in the hospital depending on the severity of the lows. A low blood sugar can happen at any time, and is usually unpredictable based on varying amounts of food, activity, stress, varying absorption rates of body tissue from one spot to the next, and any other factor in life that can cause any amount of change. Sometimes they happen for seemingly no reason at all, and therein lies the danger.

How about…

…a systematic review from 2012 that concludes, “There are indications that higher compliance of wearing the CGM device improves glycosylated haemoglobin A1c level (HbA1c) to a larger extent.”

http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD008101.pub2/abstract

…the research that concludes, “CGM with intensive insulin therapy appears to be cost-effective relative to SMBG [self-monitoring of blood glucose] and other societal health interventions.”

http://www.ncbi.nlm.nih.gov/pubmed/21917132

…the research that finds that regardless of prescription approach, “…patient-led and physician-driven prescription. Both modes of using CGM provide similar long-term metabolic improvement.”

http://www.ncbi.nlm.nih.gov/pubmed/22208716

…the one with early analysis of cost-effectiveness of CGM that says…well, I’ll just let is speak for itself. “…the overall quality-of-life effect of CGM arises from its ability to both improve the immediate quality of life of diabetic patients as well as reduce future complications through enhanced glycemic management.” But wait, there’s more! “The provision of greater glucose control data may have improved the quality of life of patients by facilitating decisions related to food intake and insulin regimens as well as by reducing the risks and fears of hypoglycemia.”

http://www.ncbi.nlm.nih.gov/pubmed/20332354

…real-world benefits of CGM. “Personal CGM, in a real-world setting, improves glucose control and reduces the rate of severe hypoglycemic episodes.”

http://www.ncbi.nlm.nih.gov/pubmed/20551007

This is only a start. There is more research out there, and more research on the way that shows the benefits of CGM on the lives of people who use insulin to manage their diabetes. It is time for health insurance companies to get with the program, and it is time for us to speak up and shout from the rooftops what we need, and make it happen. Some health insurance companies are better than others (PPOs tend to be more willing to cover CGM than HMOs, for example). Until coverage of CGM is non-negotiable, our work as advocates for our own health and well-being is not done. We should not have to beg and plead to get this widely accepted diabetes technology that has already been and continues to be proven to improve and save lives. Coverage of CGM should be non-negotiable, expected, and mandatory.

Now that we are staring down the barrel of the potential for the bionic pancreas in a few more years, the need for CGM acceptance by insurance companies is only going to grow. Without insurance companies accepting that CGM is indeed a good idea for people with diabetes, and without insurance companies making CGM technology accessible without the barriers and complicated processes of getting approval, and without more research documenting the cost benefits and effectiveness of CGM versus emergency responses to hypoglycemic episodes (low BGs), the bionic pancreas will never make it past the prototype phase. And we need this forthcoming technology that the bionic pancreas, and the research behind it, provides.

I’m tired. I’m so very tired. I’m tired of living every single day and running every decision that I make through a diabetes filter. I’m tired of having to prick my finger before I leave for work in the morning to make sure that my blood sugar level is okay for me to be able to drive. I’m tired of checking before meetings to make sure that my blood sugar isn’t dropping, for no other reason than so that I don’t get caught in the middle of a meeting not making sense because my blood sugar dropped too low. I’m tired of having to check before I put any bite of food in my mouth, and then having to check an hour or two after to see if that food and the insulin that I took to cover it worked the way that I thought it would. Sometimes it does, and sometimes it doesn’t. Most of the time it defies explanation. I’m tired of having to decide if I get to go to the gym and workout today based on what my blood sugar is right before I go. I’m tired of having to check so that I can drive home. I’m tired of having to check before I can go to bed. I’m tired of not being able to go to bed because I did check, and having to wait for my blood sugar to go up or come down.

I’m tired. I’m tired of the hassle. I’m tired of the bullshit. I use that word because that is just how tired of it I am. I don’t have pipedreams of a cure for diabetes. I’ve had diabetes for 33 years. It’s all I know, and all I have ever had to deal with, and I don’t walk around with imaginary hope that a cure is coming in five years, ten years, or even necessarily in my lifetime. I hope it does. Maybe it will, but short of a scientific breakthrough, I don’t feel like that is the best place for me to invest my energy. In this age of technological advancements, this age full of the smartest people that have ever lived on this planet, and this age where people are open to change and progress and opportunity, I want to be able to rest my mind when it comes to diabetes. Let’s work together to support things like the bionic pancreas, CGM coverage by insurance companies, and these things that simply make life with diabetes easier and better.

I don’t feel like making life easier with diabetes is really asking too much. If you think it is, then you try it. See if you can make it 33 years counting fingerpricks, carbohydrates, activity levels, insulin doses, times you’ve found yourself in a room waking up and not knowing where you are because of a severe low blood sugar, a tongue chewed up from a low blood sugar seizure, bruises that you don’t know how you got, and cracked ribs from the physical exertion of just trying to survive that low. Survive that, and then I dare you to tell me how CGM isn’t effective and isn’t necessary.

I double arrows down dare you.

CGM Double Down Arrows

Update, 7/30/2014:
I am so fortunate to have received a few sensors from other PWD who had the extras to spare. Thank you! You know who you are, and you have been a big help (he types, as he is recovering from a BG of 39 and still a little shaky). I received a call from Dexcom this afternoon, confirming that they finally got all of the pieces that they needed with insurance approval and documentation from my endo, and they are overnighting me new sensors. Yay! It took 7 months, which is ridiculous, but people with diabetes are experts at being stubborn and steadfast until we get what we need (*cough* bionic pancreas *cough* encapsulation *cough* smart insulin). So thankful that it appears to have finally been worked out. Ciao for now! (Did I really just type “Ciao for now!”? I must still be low…)

Update, 8/21/2014:
Order got delayed, again, before it could be shipped to me. Today I finally received a 90-day supply of Dexcom sensors, allegedly with auto-renew when I need more. Still not clear on what took so long, aside from the explanation from my Dexcom rep that it was dramatically delayed by all of the authorizations required in order for insurance to approve. I’d demand more of an explanation, but it’s been a long battle, and I’m tired. Glad to finally have CGM data again, even if it did take 8 months longer than it should have.

High Times in Jacksonville

For my birthday, A-Flizzle surprised me with a trip to Jacksonville for a weekend of good food, good times, and great friends. It was such a surprise! I never saw it coming. I was all, “Hey, I’m going to work” and she was like, “No, we’re going on a weekend getaway” and I was like, “Oh wow, I’m so surprised! This is so cool!”

Okay, who are we kidding? I hate surprises, and she knows it. That’s why she’s a keeper. To prevent me from freaking out, A-Flizzle made this awesome timeline of what was going on and where we needed to be. Actually, calling it a timeline doesn’t really do it justice…it was a FUNline. Look at this picture while I do the pencil sharpener…

Birthday Funline 2013

Friday started with a beermaster’s tour of the Budweiser brewery in Jacksonville. Upon arrival, I struck up a conversation with the tour guide who noticed my insulin pump. She couldn’t quite grasp how in the world I could possibly have Type 1 diabetes and drink a beer, at the same time. It’s not an exact science, but I explained to her the basic idea of factoring in blood sugar levels and counting carbs and dosing enough insulin to cover the difference, just like anything else we people with diabetes (PWD’s) eat or drink. Yes, I know there’s some long division and a square root of Pi and other fuzzy math that goes into calculating carbs and insulin when drinking alcohol for some PWD’s, but your diabetes may vary (YDMV). Suffice it to say, it was nice to meet someone in the beer brewing industry who was legitimately interested in how everyone might be able to enjoy what they put so much effort into making.

Birthay 2013 - Beer from the Keg

The tour was fascinating, and getting to sample beer directly from the ice cold tanks was delightful. There is no way to get a fresher beer than that. One lady on the tour, who didn’t even like beer, even became a convert. I’ve got a newfound respect for the Budweiser brand of beers now, and the care that goes into making each and every one. It’s a process of Willy Wonka proportions, and I’d highly recommend the tour if you every have the opportunity. Also, the gift shop is a great place after you’ve had a couple. Just saying. (I left with a Landshark beach umbrella and a hoodie with a built-in beer koozie on the front. So…yeah. In my defense, I did pick those things out BEFORE the tour.)

Birthday 2013 - Amanda and Martin and Beer Kegs

I also found my dream job in the Budweiser brewery…

Birthday 2013 - Dream Job

Afterwards, we met up with Jacquie and the family for dinner: Mediterranean food, for the win! Nothing chases an afternoon at the brewery like chicken shwarma. Shwarma…mmm. Just sounds delicious, doesn’t it?

The next morning, my pal Bob and I were supposed to get up and go for a bike ride. However, it was cold-ish, and the temperature was not appealing to my sense of get out of the warm bed and go pedal at all. After texting back and forth for a bit about it, we decided to do what any normal person who doesn’t feel like braving the cool air to go on a bike ride does on a Saturday morning.

We went and ate bacon.

After that, A-Flizzle and I made our way toward the spa, where she had us lined up for a facial and a 1-hour deep tissue massage, respectively. Now, I’ve gotten a massage before, and my pump was never a big deal for the masseuse. In fact, every massage that I’ve ever gotten, I was able to keep my pump on and just slide it to the side and the masseuse was able to work around the tubing and the infusion set. No big deal, right?

Except, this masseuse was different. Although she was plenty nice enough, and she did a spectacular job of getting some of the knots out of my back and neck and shoulders, she was really weirded out by the idea of having to work around my continuous glucose monitor (CGM) sensor and insulin pump and infusion set. Because I needed that ding dang massage more than I needed diabetes at that moment, I decided to dose a couple of extra units for the hour, and then I took off my CGM sensor and my insulin pump so that I could get some relief. Stop me if you’ve heard this one before.

In hindsight, I should have just let the masseuse be uncomfortable. Once the hour was up, I was a blob of mostly relaxation. A-Flizzle and I took a leisurely pace back to our room, at which time I stupidly decided a birthday cupcake was in order. A cupcake? Really?! Dumbass. Then I proceeded to get a shower, which was delightful, and full of hot water, and a window that I could look out of while scrubbing off eucalyptus oil. I’m like a cat. I can’t resist a good window to look out of. Hours of entertainment. Fortunately, the hot water didn’t last.

Keep in mind, I failed to put my insulin pump back on through this entire episode of Birthday for Dummies with Diabetes.

By the time I got done taking my sweet time with everything, my blood sugar was through the roof. I don’t even remember what it was by the time I put a new infusion set in and reconnected my insulin pump. Probably somewhere around 1,000,000 and rising. I felt like crap. Way to ruin your own birthday there, Wood. Brilliant.

I dosed the snot out of the high in hopes that I could get it at least dropping by the time we had dinner at one of my favorite restaurants in the whole wide world, 13 Gypsies. I was moderately successful, but really had to focus dinner on the lower carb items and lots of water to try and offset the effects of the afternoon.

Birthday 2013 - Martin and Amanda

See those eyes? That’s not glassy eyed from birthday beers. That’s worn out from fighting a high blood sugar all afternoon. I’d have preferred the former.

I guess the moral of this story is to never disconnect your insulin pump and remove the inset unless you have another one handy for immediately after whatever necessitated your getting naked. Because I am the last person in the world to vote against being naked. Also, maybe tell the spa and masseuse that you have type 1 diabetes and use an insulin pump so that they don’t freak the eff out when they see that you’re bionic.

Maybe also do this in an Austin Powers voice, just for style points. Yeah baby!

FFL12 - Team Type 1 Session

Team Type 1 and Life With Diabetes

Friends For Life is not just for children with diabetes. It isn’t just for adults with diabetes. It is also for parents, grandparents, siblings, significant others, and friends of people with diabetes. Friends For Life is for those who need hope, who need help, and who need reassurance that anything is possible for people with diabetes, whether they themselves have diabetes or not.

Phil Southerland, founder of Team Type 1, lives to prove that anything is possible with diabetes. I’ve seen the presentation of the story of Team Type 1 several times, but Friends For Life was the first time that I’ve seen it directed to parents and caregivers of children with diabetes.

FFL12 - Team Type 1 Session

Phil started by introducing himself, and sharing the story of how he and his mom dealt with the reality of the diagnosis of Type 1 diabetes when he was a small child. I can relate to Phil’s story, as I was diagnosed at about the same time he was. I was two years old when I was diagnosed, and though doctors tried to fill my parents with hope that a cure was on the way, the reality of the diagnosis at that time, and for me at such a young age, was not as optimistic as it is today.

But Phil and I both made it, and we got to experience the Team Type 1 session at Friends For Life 2012 with one of us on stage, and the other (me) out in the audience observing how parents with the same diagnosis as our parents received about us were trying to figure everything out.

I was so happy to see the room full of orange bracelets (worn by those without diabetes). Friends For Life is ultimately a Children With Diabetes conference, and with the exception of an Adult T1 Track, it is geared primarily to children and their caregivers. For this session, I was actually the one in the room that wasn’t where I was supposed to be. Not really a surprise, as I’m rarely where I’m supposed to be, but still, it thrilled me to see so many parents who were interested in learning that their kids can do ANYTHING with diabetes.

Several of the parents in the room had specific questions for Phil about how to manage their child’s diabetes in various situations, such as while swimming, playing soccer, and other sporty situations. Something I see often with parents, especially those parents whose child is recently diagnosed, is that they want black and white, straightforward, no argument answers about how to deal with some aspect of their child’s diabetes. They don’t want it to be as “bad” as it is.

The truth of the matter is that diabetes is not black & white. It is gray, purple, green, yellow, and every other color of the rainbow. Although it has its tough days, living with diabetes is one of the best things that ever happened to me. If you ask Phil, he will tell you the same. With diabetes, you have to really know your body, pay attention to it, and as a result many people with diabetes (PWDs) are as healthy or healthier than a lot of people without diabetes. I find a lot of strength in that.

The specifics of diabetes varies for every single person. Honeymoon periods (the period of time for some recently diagnosed Type 1 diabetics where their body is still producing small amounts of insulin, which typically decreases as time goes by) last for weeks, or months. Low blood sugar symptoms show up at a BG (blood glucose level) of 110 mg/dl or 45 mg/dl, and sometimes not at all. Every single person with diabetes varies.

Phil’s best advice to the parents, and something I agree with him 100% on, is to let children become the CEO of their own body. Keep focused, but learn and let children learn from their diabetes successes and mistakes. Blame does not breed learning.

If your child has a low blood sugar, it’s not your fault, and it’s not their fault. If your child has a high blood sugar, it’s not your fault either, nor is it their fault. The same applies if you have Type 1 diabetes yourself. That is diabetes, and over three decades of living well with diabetes has taught me that it is critical to remove the emotion from diabetes numbers, such as blood sugar levels and A1C values.

It’s just data, and it isn’t telling you that you are doing it right or doing it wrong. Only a human can assign emotion to math. A blood glucose meter cannot do that. Take diabetes data with the same face value as a road sign or a traffic light: It is a cue that some sort of action needs to take place, whether that action is to make an adjustment, stop, proceed with caution, or keep going and you’re doing great!

The next time your child comes home from school, resist the urge to immediately ask them what their last BG reading was, or how they are feeling, if they need a snack, or how many carbs did they eat for lunch. Instead, ask them to tell you about the most exciting thing to happen to them that day. You may be surprised to learn that diabetes is not the most exciting part of their world, so don’t make it the most exciting part of your world either (unless you’re at Friends For Life).

Life comes first.

Friendly Neighborhood Tyrannosaurus Rex

Just Another Day

This past weekend was a good weekend. No deadlines except that one that made a nice whooshing noise as it went by, nowhere to be, just an opportunity to enjoy things at a leisurely pace.

Saturday, A-Flizzle and I got a wild hair and decided it would be fun to go on a six mile urban hike, which is a more adventurous way out saying that we walked through a few neighborhoods and down a few sidewalks. It’s kind of amazing the things you notice when you are on foot that you never see from driving around in a car. We found a house with a dinosaur in the front yard, several Florida rooms off the sides of houses with beds in them that we were hoping to catch someone dozing in, a new sports bar and restaurant being built, and we learned that the pedestrian crosswalks have absolutely no rhyme or reason for when they decide to let you cross the street.

Friendly Neighborhood Tyrannosaurus Rex

Throughout the day, I thought I had done a really good job of counting carbs, factoring in activity, and doing a good job of keeping tabs on things so that I didn’t go low from the activity or high from any of the delicious things that I ate, like the banana and Nutella crepe that I may or may not have had for lunch at about mile 4.5 of our urban hike. And by the way, this is my blog post, and I call it Nutella, not Noo-tella…because there’s a freakin’ “nut” in it. YPONMV. (Your pronunciation of Nutella may vary.)

After a day of near perfect BG’s, around bedtime on Saturday night I realized that I wasn’t feeling too well, so I did a quick check to see where things were. 342. I was pissed. Are you for real?! I counted everything! I know I got the math right, or at least in the ballpark enough to not merit a stupid 342 BG. What the #$@#%#$?!!!!

After I got done pitching a fit, I tried to think what might have jacked my BG up so high. Surprisingly, I don’t think it was the banana and Nutella crepe. There was nutritional info, and I’m pretty sure I was in the ballpark on that one. Since it was sunny and over 90 degrees outside when we were urban hiking all over town, I settled on the idea that the insulin in the tube of my pump probably got a little too warm during the activity and had lost its effectiveness. Insulin is supposed to be kept cool or at room temperature, and let’s face it, late Spring and Summer in Florida is far from being room temperature by any stretch of the definition. Something you have to be aware of if you’re going to sport an insulin pump is that, every once in awhile, heat happens.

I dosed down the 342 BG with a shot of insulin via the old faithful syringe, and then switched out the insulin in my pump. Either I overestimated how much I needed to pull that 342 BG back down to normal, or the activity of the day finally caught up with me, because I woke up around 3:00am at BG 35. After a juice box and a couple spoonfuls of peanut butter (which I may or may not have shared with Hopper dog), I woke up in the morning with a perfect BG of 88.

Diabetes is a total game of numbers. In order to stay alive we have to count everything. And guess. A lot.

We have to know how many carbohydrates are in everything that we put in our mouth, what our blood sugar (BG) level is at the time, and guesstimate how much activity (or lack thereof) is going to affect our metabolism and BG level. Then, on top of that, there are ever present questions about how accurate our BG meters are, we never really know for sure how effective the insulin that we’re injecting is going to be (especially after it has been in an insulin pump for a few days), and our bodies sometimes process that magical life elixir differently than yesterday, when we had the same food, the same activity, and the same BG levels.

My endo says that “doing the same thing over and over again and expecting different results is insanity…unless you have diabetes.” In Martin World, it’s just another day.

Why You So Stubborn, Diabetes?

I think of myself as a typically optimistic person, especially when it comes to my diabetes, because really my life with diabetes is better when I’m able to cast it in a positive light. Even so, that doesn’t mean that I don’t spend a few days in the trough of a wave every once in awhile.

Today was one of those days. I didn’t sleep much over the weekend, so this morning I got up early and fed the dogs and then decided I would try to sleep a little bit longer, considering it was Sunday and all and I didn’t have to go to work or anything. About the time I got comfortable, some masochist with a lawnmower decided that 8:00am was a fine time to mow the grass next door. Seriously, how do you get up so early on a Sunday and think, “I’ll go mow the grass this morning.” Read the paper and have a cup of coffee for Pete’s sake. Have a whole pot if it tickles you. Just don’t go outside and crank up the mower and wake up the neighborhood! </rant>

I like to make a big breakfast at least one morning on the weekend. I’m doing good to get dressed and get to work on the weekdays, so Sunday mornings are my time to pause and enjoy the thrills of a pot (or two) of coffee, eggs, sausage or bacon, and Meet the Press with A-Flizzle. If you ordered that meal at Denny’s, it would be a Grand Slam Nerdy, and could you leave a carafe of coffee on the table please?

I found a little bit of Bisquick left in the fridge, which is weird because most people put that in the pantry, but I decided to use it up and make a couple of pancakes. I limited myself to just one pancake, the one that came out looking like it had been put in somebody’s pocket instead of in the skillet, because I didn’t want my blood sugar to go through the roof or anything crazy. And it didn’t. It just hovered around the stinkin’ penthouse suite all day long, making me real frustrated because it wouldn’t come back down to the lobby where all the normal BG’s hang out.

That was the only starch that I had on the day, and I hovered around 200 mg/dl all day long. Being used to running a BG of around 100 lately, I felt that 200 in full effect. I even resorted to rage bolusing, just throwing a max amount of insulin at it to try and get it to budge. We went to see Hunger Games with some friends, and I barely touched the popcorn. Then we went to dinner afterward, and I couldn’t even eat because I was so nauseous and thirsty from the stubborn high BG. Finally, after I got home and gave up, I started to sink back down to normal again.

Stubborn CGM

I ended up having to take over 100 units of insulin today to combat diabetes. That really, REALLY frustrates me, considering how a normal day for me (with carbs) is closer to 60 or 70. In hindsight, I shouldn’t have eaten that pancake, but there was no way of knowing that it would have been so stubborn all day long. The beauty of the conundrum is that it might not have even been the pancake. It could have been that my insulin lost its potency, or that I’m fighting off a virus of some kind, or that I was wearing green today instead of blue and my diabetes was offended. In other words, who knows?

Some of you may be reading this and thinking, “Wow, he’s got the diabetes real bad.” You may be thinking, “He really isn’t taking care of himself having to dose that much to get his blood sugars to cooperate.” You might even be thinking, “I would have been pissed too if that guy had woken me up with that damn lawnmower!” Or you might just be thinking, “Yup, been there, done that.” I’m convinced that some days diabetes has a mind of its own and does whatever it damn well pleases, regardless of what we try to do to “control” it.

Fighting back the tears, I was telling A-Flizzle about how frustrated it makes me when I feel like I have no control over what my body and diabetes has decided it wants to do. I hate feeling like I’m just strapped in and along for the ride, wherever it may take me. That is why I have the CGM, why I check my blood sugar on average 6-8 times a day, and why I try and count everything that goes in my mouth so that when I do make a mistake, hopefully it isn’t a complete disaster.

This situation is a good reminder to myself that we can do seemingly everything right in our lives with diabetes, from correct carb counting, insulin dosing, BG checking, and everything else, and yet we can still have those days where all of the pieces just refuse to fit together.

Tomorrow is a new day, with a new inset, and a fresh reservoir of insulin in my pump. So bring it beetus! I’ll be your Huckleberry.

Cake or Death?

If you have diabetes, regardless of type, it is inevitable that at some point you have encountered some form of THE question…

“Can you eat that?”

Sometimes it takes on the shape of “Should you be eating that?” or “Is that good for your diabetes?” or “I’m eating for two, even though I’m a dude, so why are you eating that when I was counting on eating your share?!”

When I’m asked this question, sometimes I will respond with some well-deserved diabetes education. “Yes, I can eat this. I just have to know how many carbs (carbohydrates) are in it, and what my blood sugar is, so that I can give myself the correct amount of insulin to keep my blood sugar from spiking too high due to not enough insulin, or going too low because I dosed too much.”

That is usually enough to get either understanding or slightly confused looks of acceptance. Math and science, for the win! And truthfully, I’m typically happy to educate. I like it when people learn about real life with diabetes.

If I’m in a mood though, or if I’m having a low BG (low blood sugar) and don’t have the patience for a diabetes learnin’ session, I might just respond with a snotty little question of my own, such as, “Should YOU be eating that?” That’s always a show stopper, as the guilty party takes that last bite of chocolate cake and shamefully makes their way back to the other room while I feel only slightly guilty with my shaky, moody, slightly confused, sweat-drenched self. Cake or death? Whatever, I’ll apologize later…GIVE ME CAKE!

Since I got my CGM (continuous glucose monitor), even more questions have been introduced to my world with diabetes. A-Flizzle is getting good at recognizing the different tones of the CGM alarms, but most people around me and my beeps and bonks aren’t able to decipher if I’m low, high, have a low reservoir, a low battery, or if I just forgot to hit “OK” after my last BG (blood glucose) check. Still, I’m glad when it beeps and they stop to ask, “What does that alarm mean?” It doesn’t matter to me if they were able to define the alarm or not. What matters was that they heard it, and recognized that it was diabetes related, so that if I need something, I have their attention. Diabetes win!

Another diabetes win happened this past weekend when A-Flizzle was supervising, I mean, helping me organize my diabetes supplies. While sifting through test strips, glucose gels, infusion sets, and alcohol swabs, we came across this little gem when I got my paws on a fresh box of CGM sensors.

Cake and CGM Sensors

Do you see it? Look a little closer.

Cake (forget the CGM sensors)

Cake! On a diabetes supply container! For a device that helps monitor glucose levels!

Cake or death, you ask? CAKE! Definitely, cake.