T1D is like a prickly cactus (literally and figuratively), but I've learned to embrace it, thorns and all.
My diabetes journey began on Christmas Eve in 1997. That day, I became the third person with type one diabetes in my family. I was four years old at the time, so I've lived most of my life with diabetes. While some people may view this as sad, I've learned to embrace my chronic condition and live my life without limitations. You might say that I've taught myself to hug the cactus, so to speak.
When I'm not blogging, you can find me enjoying any or all of the following: time with family and friends, a quality cocktail, Harry Potter, a good book, General Hospital, pop culture from the last three decades, and tasty foods.
I love connecting with other members of the DOC (diabetes online community) - so please don't be shy, find me on Twitter or Facebook!
27 units. That’s exactly how many units of Humalog were left in my pod, and I had no choice but to literally throw them away. My pod was expired – it had been for 8 hours – and to my knowledge, 8 hours after a pod expires, it will cease working entirely.
I kept the pod on those 8 extra hours because I couldn’t bear the thought of wasting insulin.
It’s a strange, messed up game that I played. I was taking a bit of a risk by wearing my pod for so long after it expired. After all, it’s just a piece of technology, and it can sometimes be difficult to know whether or not it’s working properly when it’s brand new, let alone within the window of expiration. But this is the game that I have to play, along with so many other people with diabetes, because insulin is precious.
With that in mind, tell me…would you feel comfortable throwing away even one single unit of it?
One could argue that maybe I could’ve tried to extract the 27 units from the old pod and reuse it in a new one – but to me, that’s an even more dangerous game to play. I have no clue whether that’s safe, or if there’s too much risk involved with germs and cross-contamination. Maybe I’m just paranoid, but when it comes to my health, I have to be.
So as much as it pained me to be unable to use every last drop of insulin, I made the only viable choice for me and disposed of 27 units of Humalog.
27 units, 16 units, 3 unit, 1 unit…no matter what the quantity is here, every last drop of insulin is invaluable.
When will we see change? Is it really too much to ask for insulin to be affordable to all?
Normally, if you asked me if I would willingly go into a 105 degrees Fahrenheit room for 90 minutes for a workout, I’d say ohh HELL nawwww before you had the chance to finish asking your question.
I’m not someone who has a passion for exercising. I tolerate it. I try to do it daily for two very important reasons: 1) It keeps me in shape and 2) it helps me manage my blood sugars better. Otherwise, there’s very little about exercise that I actually enjoy. I’m not a fan of feeling out-of-breath for long periods of time. I have a love-hate relationship with the post-workout soreness that floods my body after a particularly intense session. And I definitely cannot stand sweating – on just about any given day, I’d rather be freezing cold and wearing layers of clothing than dripping in sweat.
All that said, though, I willingly participated in a fitness class called Bikram yoga…which is also known as hot yoga because you’re in a temperature-controlled room heated exactly to 105 degrees for the duration of the workout. For 90 minutes, you slowly move through 26 poses, and that’s that.
I wasn’t worried about the latter; it was the former that had me sweating (both literally and figuratively). I wondered whether I’d be able to tolerate the heat for a full hour and a half. I also had concerns about my diabetes devices – would I be sweating so much that they would fall off? Would they be able to stay safely in the room with me, or would the heat be too extreme for them? And how would my body and blood sugars respond to the hot yoga, anyways?
I knew the only way to get answers to my questions was to show up for class and find out for myself.
And that’s exactly what I did. I went to a morning class with my stomach empty and my backpack full of diabetes supplies. My blood sugars tend to respond better to exercise when I don’t have any food in my system or insulin on board, so I made it a point to wait to eat my breakfast after yoga instead of before. But I still wasn’t entirely sure if or how my blood sugar might react to a brand new kind of workout, so I wanted to be armed with several different low snacks. I felt fairly confident about its stability, though, as I headed into the class sitting pretty at 110 mg/dL.
In addition to extra diabetes supplies, I also thought to bring with me some water that I’d filled and frozen the night before the class so I could stay hydrated throughout it with water that was sure to be extra refreshing in the heat.
Even though I had all this stuff with me, I chose to leave most of it in a cubby outside the studio, save for my CGM receiver, a tube of glucose tablets, and my water bottle. I didn’t want to take any chances with my cell phone, PDM, or glucometer and expose them to the heat – I have firsthand experience with an overheated cell phone, and while it does eventually cool back down its own, overheating my devices is not something I’d actively seek to do. I was taking a bit of a risk with the CGM receiver, but since I have the Dexcom app on my cell phone, it’s not like I’d be at a huge disadvantage if something were to happen to my receiver.
So with my gear in hand, I stepped foot into the yoga studio…and immediately started sweating. Yes, that quickly! It was a heavy, stifling, and moist heat – the exact kind that I hate the most. I started to question whether I had the endurance to even sit in this heat for 90 minutes, let alone move seamlessly through yoga poses in it. In the minutes before the class began, I sipped water slowly and told myself that above everything else, I needed to listen to my body throughout the class. I started to feel better as I reassured myself that it would be perfectly acceptable to walk out should I start to feel light-headed, low, queasy, or anything else abnormal.
Fortunately, though, an exit plan wasn’t needed as I made it through the full class! That’s not to say it wasn’t challenging or extremely sweaty – seriously, my body was so covered in sweat that it looked like I’d just come out of a swimming pool – but I proved to myself that I could do it. And the best part was that my blood sugar behaved beautifully: As a reminder, it was 110 mg/dL at 8:30 A.M. Class started at 9 and lasted until 10:30 A.M. I was home by 11 and when I checked my blood sugar there, I was at 118 mg/dL. I couldn’t have asked for better pre-, mid-, and post-workout blood sugar levels.
Was it scary to try this new, moderately intense exercise? Yes. Was I concerned about my diabetes before, during, and after the class? Yes. But was it all worth it? I’d say yes. I overcame my fears and was met by blood sugar success, making hot yoga a diabetes win in my book.
My short answer to that question is YES. Yes, it’s absolutely possible to eat pizza – and just about any food, in my opinion – without experiencing turbulent blood sugars.
It all just comes down to serving size, timing, and method of insulin delivery. Piece of cake, right? (Or should I say, piece of pizza?)
Well, it really isn’t THAT simple. Other factors include the exact type of pizza (Is it gluten-free? Are there toppings? Is the crust thick or thin?), whether or not other food/drink is being consumed with it, whether exercise or inaction will follow in the hours after eating it…truly, there’s all that (and more) that people with diabetes need to think about when eating any type of food.
But what’s different about pizza is that it has a particular combination of fat and carbohydrates that can make it a tricky food for people with diabetes to figure out how much insulin to take and when to take it. It’s a little easier for those of us who have insulin pumps, because we can utilize the extended bolus (or square wave) feature that allows us to give a certain percentage of a mealtime bolus at once, and select a time later on to receive the rest of the bolus.
If that last sentence didn’t make any sense, here’s an example of what I mean:
It’s dinnertime – 5:30 P.M. I have two slices of pizza that I plan on eating. One’s plain, the other has BBQ chicken on it. I figure that there’s 50 grams total of carbohydrates in the two slices of pizza. My blood sugar before eating the pizza is 130 mg/dL. I put that number into my pump, and also input 50 grams of carbs. My pump wants me to take 8 units of insulin to cover the pizza. Instead of administering the full 8 units at once, I hit the “extend” option and opt to take 75% of the dose now, and the remaining 25% an hour and a half from now. So I get 6 units of insulin at 5:30, and 2 units at 7:00. This extended bolus typically has the power to prevent my blood sugar from crashing and spiking hours after eating said pizza, and in turns, saves me from dealing with a massive headache and questioning why I ever ate pizza in the first place.
Granted, an extended bolus isn’t the end-all, be-all. It relies heavily on me and my ability to count carbs correctly and time my boluses perfectly. But I have had fantastic success using it, particularly in a recent situation in which I ate two large slices of whole wheat pizza, a side salad, and a bit of pita bread without spiking beyond 160. I can’t say whether it was the whole wheat crust that helped me out (maybe it has a lower carb count compared to regular crust?), or if it was just supremely accurate calculations on my end, but it really doesn’t matter to me in the end…because I know that I can eat and enjoy pizza – and again, virtually any food – without my diabetes ruining it for me.
“Dawn phenomenon” is not a phrase that’s used to describe someone who wakes up each morning with a certain vigor and urge to immediately start enthusiastically dancing (even though it does kind of sound like it should describe that).
No, “dawn phenomenon” as I know it, and as many other T1Ds know it, is a term that describes an abnormal early-morning blood sugar spike, usually occurring within the first hour or so of a person with diabetes waking up.
And it seems to be something that my body is dealing with lately, much to my annoyance.
Since I moved to Virginia, my overnight blood sugars have been pretty stellar. I think this is mostly due to the fact that I’ve cut back on my pre-bedtime snacking, though it might also be a result of some anticipated changes in my blood sugar patterns because of the move. Whatever the case may be, I won’t complain about waking up to blood sugars within 80 to 100 mg/dL most mornings. It’s a great way to start the day, and since I begin most of my days with a fasting workout, it’s an even better feeling to know that my blood sugars won’t – or shouldn’t – fluctuate for the duration of my exercise. Rather, my CGM graph will stay nice and flat while I workout, and I don’t need to worry so much about what my blood sugar is doing for that period of time.
But another trend has emerged since my move to Virginia, and that is…you guessed it, dawn phenomenon. I’ll still wake up with excellent blood sugars and workout first thing, but the only difference is that now, my CGM shows my blood sugar slowly but steadily climbing up while I workout.
I’m trying to make sense of this sudden change, and I’m reacting to it by pre-bolusing for breakfast as often and for as long as possible (which just means that I take insulin that both corrects my blood sugar and covers my breakfast, then wait at least 20 minutes before eating anything). Mainly, I’m just hoping that it’s short-lived. Whether or not dawn phenomenon becomes a new normal for me, it is a good reminder that diabetes has an agenda of its own sometimes. I could have the exact schedule, with the same meals at the same times every single day with the same activity levels, and diabetes could still decide to throw me for a loop with a random low or high blood sugar.
It’s just up to me to figure out how to handle it.
Before I jump into this post, let me make this unequivocally clear: The DOC (Diabetes Online Community) has been an incredible source of support, advice, and education to me ever since I discovered it (roughly seven or eight years ago). This post isn’t necessarily about the DOC; rather, it was inspired by a recent experience I had with a totally different online community. But what I’m about to say here can be applied to just about any kind of virtual support group in existence…
In addition to the DOC, I consider myself a member of a few other online communities. One of them is focused on fitness. (I’m not going to specifically name the group here, mainly because I’d like to maintain its privacy as well as the privacy of its members.)
Anyways, said group was formed to provide members with a place to post about their respective fitness journeys. Members are encouraged to post daily about their workout routines, nutrition plans, and any emotions that might arise as they work toward building a healthy lifestyle. It’s common for members to interact with one another and show support when someone is struggling, as well as applaud victories big and small as they’re met. Unsurprisingly, negativity and criticism aren’t welcome in this group, as it can be detrimental to the goals that each member has for himself/herself.
In keeping with the spirit of the group, I posted a photo a few weeks back of myself (making a grumpy face) after a particularly challenging cardio workout session. In the caption, I wrote: “Excuse my pissed off expression…I had to cut cardio fix short because my blood sugar was getting too low. Only worked out for about 20 minutes this morning. I really wanted the full one cuz I treated myself with food just a tad too much yesterday…but I don’t totally regret it because it reminded me that I just don’t feel good when I snack unnecessarily. I’m always struggling to remember to only eat when I’m hungry or if my blood sugar is low, not because I’m bored or emotional. I know one day I’ll fully accept this and practice it!”
I wasn’t seeking sympathy or anything, I was just being honest with the other members of the group and channeling a bit of my frustration. Regardless, a few people did comment on the post with some reassuring words, like “you’ve got this”, “thank you for sharing”, and “one day at a time”, which I appreciated.
But what I did not appreciate was the comment thread that followed and involved myself and two other group members (my thoughts as I initially responded to this chain are denoted by asterisks):
Group Member #1: Oh no, be careful! Do u usually run low?
Me *Not wanting to dive into a long explanation*: I’m pretty well controlled for the most part, but exercise can make me go low sometimes!
Group Member #1: do u have diabetes?
Me: yes, type 1 diabetes for 21 years now
Group Member #1: oh wow! Be careful!! Do u carry glucose tabs with you?
Me *Rolling my eyes as I respond, and adding a “haha” to keep it light*: of course! Haha I’ve had T1D for a very long time so managing it is second nature.
Group Member #1: okay good! Just making sure. Sorry, this was the pharmacist in me asking (an annoyingly cute monkey-with-hands-over-eyes emojis PLUS smiley face emoji followed this comment)
Group Member #2: The nurse in me wondered the same. 🙂
Group Member #1, responding to Group Member #2: haha! (followed by a stupid heart emoji)
What exactly is my issue with this thread? It starts with the “be careful”. It was probably an innocuous comment on the poster’s end, but I thought that me telling her that I’ve had diabetes for 21 years might signal that I know a thing or two when it comes to managing it. It also mildly irked me that she was qualifying her comments to me by saying that she was a pharmacist. That’s great and all, but that doesn’t make her an expert by any stretch of the imagination on diabetes…same thing to the girl who also chimed in by saying she was a nurse.
Now, you might be thinking that I’m overreacting to this whole thing – and part of me agrees, I’m sure that both girls just had pure intentions and wanted to offer support in their own ways – but if that’s the case, then this is a perfect example of how things can get misconstrued in an online setting. My interpretation of this thread is that both girls were trying to tell me that their expertise in their respective fields meant that they knew a good bit about diabetes, and rather than come off as supportive, the comments felt like show-offish (like, oh, look at me and how much I know!) and as if they thought I couldn’t take proper care of myself. Again, my interpretation may or may not be true, but it’s fact that we all need to be careful when choosing our words in situations like this. Even better, when something isn’t totally clear, we can choose to say nothing rather than chime in with a comment that might come off wrong or sounds misguided.
With that in mind, I now get why some people say that online support just isn’t for them. Personally, though I appreciate and like being part of online communities, this experience did teach me a lesson about being careful with my interactions in these spaces, and that I should always try to remember…it’s impossible to gauge tone/emotion in the comments section, and coming across as a know-it-all isn’t a good look on anyone.
It seems like everywhere I go these days, there’s a cactus. (Or more often than not, cacti.) They appear in practically every form: I’ve spotted t-shirts, erasers, mugs, earrings, pool floats, and even stringed lights bearing the barbed plant’s likeness. The popularity spike of the cactus collided, by total coincidence, with the debut of my blog.
I’ve rapidly amassed a small collection of cactus items in the past year and a half, with no signs of slowing down. It’s certainly made it easier to represent my brand at all times, without even really trying. And it’s caused my family and friends to associate cacti with me – it always makes me smile when someone spots a cactus in their travels and lets me know that it made them think of me.
But even better, the cactus has spurned creativity in some of my friends who have been especially supportive of my blog and its mission since its incarnation.
Hence, The Cactus Corner – a little stretch of shelf space devoted to some of the cacti creations that my friends have made for me in honor of my life with diabetes as documented through this blog. There’s a cheerful, polka-dot-potted cactus that my friend hand-stitched in one section, and a painting of a blooming cactus set against a lovely pink background. Also pictured is a painfully cute pin that I’ve attached to my meter case – a portable cactus that I carry everywhere with me, along with all my diabetes supplies, as a reminder of my blog and of the diabetes obstacles I’ve overcome over the years.
The Cactus Corner is small and humble, but it represents so much to me. It is tangible evidence of the friendships I’ve been blessed with in life. It’s also symbolic of how I’ve chosen to embrace diabetes – pricks and all – for what it is.
So as my Cactus Corner continues to grow and thrive, I will, too.
If you’re reading this post and knew immediately what the title was referring to…rest assured that what you’re about to read is not nearly as dramatically violent as The Rains of Castamere episode of Game of Thrones. I just chose the title because it semi-accurately described what I encountered with my CGM at a weekend wedding I recently attended. And because the final season is here in a mere FOUR DAYS and I’m struggling to hold in my excitement/terror/anticipation.
Anyways, the day of said wedding began normally, if not a bit early. I put on makeup and a nice dress, tried (and somewhat failed) to curl my hair, and ate a light breakfast. Somewhere between slipping on my jewelry and singeing my hair with the curling iron, I heard my CGM’s alarm blaring, notifying me that my blood sugar was going up. That wasn’t surprising, since I’d just eaten food. But I was caught off-guard when it stopped alarming after two alerts went off…I hadn’t dismissed the previous two, so why was it no longer making any noise?
I checked the app on my phone and saw “sensor error” on the screen…and said out loud, “NOT today, diabetes,” as I promptly stopped my sensor and ripped it off my body. I didn’t even hesitate to do it because I knew that the sensor was due to be changed that evening, anyway, so I saw no harm in doing it a bit early.
“What?” My partner yelled from behind the bathroom door.
“Nothing, nothing,” I said dismissively, which reflected my determination to just brush this inconvenience away and stick a fresh sensor on my body.
Oh, if only it were that simple…
It should’ve been an easy, routine sensor change; alas, upon pressing the button on the insertion device, I let out a little pained squeak. Sensors don’t normally hurt, but every now and then, I get myself in a sensitive spot. And I definitely did this time around. Before popping the transmitter into the sensor, I noticed a bit of blood pooling underneath the sensor’s adhesive.
Pools of blood as I make my way to a wedding…do you get the red wedding connection now?
Fortunately, this tale has a happier ending than it did for much of the *spoiler alert* Stark family. Sure, my sensor kinda freaked out when it warmed up two hours later and measured blood instead of interstitial fluid, and it took like 12 hours for it to get its act together and display my readings accurately, but…it all worked out in the end. And thankfully, not a single person had any clue that there was a patch of blood on my belly throughout the wedding…it didn’t even stain through my dress.