Category: Blood Sugar

Molly and the Terrible, Horrible, No Good, Very Bad Diabetes Day

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(Gotta give credit where credit is due on inspo for this blog post’s title – Judith Viorst authored the children’s book Alexander and the Terrible, Horrible, No Good, Very Bad Day in 1972 and a movie that was loosely based on it came out in 2014. I admit that I’ve seen neither but as someone who has appreciation for books and movies, I can at least claim an awareness of both and a deep appreciation for such a memorable title.)

At the end of July, I had my worst 24 hours of diabetes in literal years.

I’m being a little dramatic, but really, everything that could go wrong pretty much did. And what made it that much worse is that it just happened to coincide with my girls’ weekend with my college friends.

It all started after dinnertime. I had flatbread from a local restaurant that I frequent, and I substituted traditional crust in favor of cauliflower crust – my hope being that this would have less of an impact on my blood sugar levels.

No such luck. In the 3-4 hours post-dinner, my blood sugar steadily climbed, reaching a peak of the low 300s at its highest. It just didn’t make sense! I had 4 pieces of flatbread. They weren’t massive. Veggies were the only topping. Maybe it was my pod? When I went to check my PDM to see how much insulin I had on board for what felt like the fiftieth time that evening, I discovered that I’d been burning through so much insulin that I only had a few units left in the pod, meaning that I’d definitely have to change it before I went to bed to ensure I didn’t run out of insulin overnight.

I was super annoyed as a result of my hyperglycemic state and the need to do a premature pod change, but apparently also exhausted by the ordeal as I lapsed into an early sleep in my armchair while my friends stayed up. By the time I snapped out of my slumber, I was groggy, thirsty, and upset that my diabetes was affecting my ability to hang out. When we all turned in for the evening around midnight, I went to bed hoping that my mood and blood sugars would be turned around by the time I woke up in the morning.

Except they didn’t. I woke up in the middle of the night with not one, but two separate low blood sugars. My broken sleep combined with the wild oscillations of my blood sugar caused me to roll out of bed with a stinging pain in my eyes and a defeated spirit that I tried my best to hide from my friends, but to no avail. In fact, I ended up in a heap on the floor, crying to them as I apologized for my grumpy mood and attempted to explain to them what had gone wrong in the last 12 hours. They were all very understanding and supportive, but I felt horrible for being so temperamental and curt with them; after all, none of this was their fault. I promised them that I’d cry it out, wash my face, get dressed, and spend the rest of my time with them with an adjusted attitude.

This mostly worked – we were able to enjoy bagels and lattes for breakfast, as well as a long walk in the first truly gorgeous morning of weather we’ve had since May. My attention was absolutely still partially focused on my diabetes, especially since bagels are notoriously tricky to bolus for, but my resulting spike from indulging in one wasn’t too bad since it was offset by the walk.

By the time my friends departed, my blood sugar was mostly back under control. This must be when things started turning around for me, right? Wrong! As I cleaned up my condo, I ripped my pod – the one that I had just applied the previous evening – clean off my leg. Cursing, I tried to calm myself down because this was something I could easily fix. I decided to call my boyfriend while I did the pod change routine, which was yet another mistake on my part as I accidentally deployed the cannula before the pod was even on my body.

It was like a comedy of errors. I shouted – yes, legitimately yelled – to my bemused boyfriend that I had to go. I needed to get this pod change done and over with, distraction-free. So I repeated the process, only to find that pod #2 was unusable because the cannula was poking out.

Was the universe laughing at me at this point? It sure felt like it.

Third time’s the charm, I told myself as I audibly sighed out of frustration. And thank goodness that it really, truly was – the third attempt at putting a new pod on was the one that did the trick. I remember falling back in my chair after the pod was securely attached on my body. The rollercoaster blood sugars and the unpredictable technology demands truly drained me, and this was just one 24-hour window of dealing with diabetes.

Thank goodness most days aren’t like this terrible, horrible, no good, very bad diabetes day!

10,000 Steps a Day to Keep Blood Sugars at Bay?

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Without a doubt, insulin injections are primarily responsible for keeping my blood sugar levels in range.

But I’d be remiss if I didn’t also consider how movement factors into the equation.

Yup, gettin’ steppin’ is key in helping me maintain tighter control over my blood sugars. If my levels start spiking after a meal or a snack – and I didn’t pre-bolus my insulin – then I start walking for as little as 15 minutes as a surefire means of getting my number back down. If I need to get up during my workday for a quick stretch and blood sugar level-set, I start stepping. If my blood sugar is higher than I’d like it to be before I go to sleep at night, then you guessed it: I get those steps in, whether it’s just marching in place or literally doing laps around my tiny condo.

I don’t always get 80,000+ steps per week, but when I do, it’s a terrific feeling!

All this movement not only means that I hit my daily step goal of 10,000 steps, but it has also obviously proven successful in helping me deal with high blood sugars (the kinda, sorta high ones and the really, super-duper high ones). In the case of the latter, I’ve found that coupling a dose of insulin with 10-20 minutes of movement is really effective in bringing me back within range in about 45 minutes, whereas I might have to wait an hour or more if I rely on the insulin alone. That shows how powerful – and so stinkin’ simple – it is to get those 10,000 steps in on a given day.

The added bonus? It feels good to get all that movement in a day, especially considering I spend 40+ hours a week sitting at a desk for my job. My body, my mind, and my diabetes benefit so greatly from it, and it’s been part of my routine for so long that I know that I can consider my 10,000 steps a day a permanent part of my diabetes management toolkit.

Sweat, Tears, and Blood (Sugar)

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I ran a marathon the other day.

Okay, okay, I didn’t – but I sure looked like I did. Isn’t that close enough? One moment, I was sitting at my desk and the very next, I registered beads of sweat forming and dripping down my forehead, back, and chest.

It was pretty disgusting, but also pretty alarming as I knew almost immediately that this was a blood sugar-induced sweat.

In my haze of hypoglycemia, I started reaching for anything and everything that would bring me back up. A leftover Reese’s egg from Eastertime, a handful of Wheat Thins crackers, and a whole bunch of Lucky Charms marshmallows (and I’m serious when I say just the marshmallows, my boyfriend knows how much I love them and bought me a bag of the colorful shapes sans oat pieces not too long ago) were among the items that I ate in hasty desperation, as if the faster I downed them, the sooner it would be for the sweat to evaporate off my body.

The whole episode couldn’t have lasted longer than 10 minutes, but it was an absolute frenzy as I hunted down and devoured each carbohydrate separately. By the time I decided I had eaten enough, I was exhausted, so I collapsed onto my bed in a gross, sweaty heap. I guess that the low blood sugar and the subsequent snacking really took a toll on me, because within minutes, my eyes were drifting shut and I flat-out fell asleep for an unexpected 20 minute catnap.

I woke up to my CGM buzzing, signifying to me that my blood sugar was coming back up. I silenced the alarm, doing my best to snap out of my haze, and felt a little emotional about the ordeal. Tears stung the corners of my eyes, but I did not let them fall as I registered what had just happened. I was embarrassed about the excessive amount of food I’d just eaten to fix a fairly run-of-the-mill low blood sugar. I was mad at myself for losing control. I was stunned that it had knocked me off my feet, literally, and lulled me into an afternoon nap that I wouldn’t have otherwise taken.

Sweat, tears, and blood (sugar)…all within 10 minutes or less. Just like running a marathon, except much, much faster. Guess that makes me some sort of athlete!

My Secret to Keeping Blood Sugar in Check at a Wedding

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Who doesn’t love a wedding? I love the opportunity to witness family and friends come together to celebrate the marriage of a couple. I like getting all dressed up and sampling a little bit of everything at cocktail hour. And I have a blast on the dance floor and always eagerly await that slice of wedding cake.

But wait a second, I just thought of someone – or rather, something – that doesn’t love weddings as much as I do. Yup, you guessed it, my diabetes (or more specifically, my blood sugar levels).

At just about every wedding I’ve attended in my adulthood, I’ve dealt with some sort of blood sugar issue. There was the time that I went sky high after eating one too many hors d’oeurves and had to spend the entire rest of the evening rage bolusing. There was the time that I accidentally ripped off my pod at the rehearsal dinner the night before a wedding, causing whacky blood sugar levels and major frustration. And there was the time that I decided it was wise to eat a humungous blueberry muffin in the hours before making the waltz down the aisle as a bridesmaid in my cousin’s wedding, causing my blood sugar to go high then low then high again as I figured it would be better to be running on the higher side rather than run the risk of an “urgent low” alarm going off in the middle of the vows.

In a nutshell, my diabetes tends to throw curveballs at me when I’m partaking in wedding festivities.

But the good news is that I think I’ve finally figured out the secret to keeping blood sugar well-behaved for the full duration of a wedding! Besides monitoring blood sugar levels early on in the day and often, and making sure to make wise food choices pre-wedding, I think the trick is…

…dance like a damn FOOL at the reception.

Sweaty selfie at the reception (yes, I did the best I could to filter the sweat off my face in this photo. I’m unashamed to admit that!)

I’m not kidding. Most weddings follow the same structure in which you arrive, attend the ceremony, transition into cocktail hour, sit down for dinner, and then spend the rest of the evening enjoying the reception by dancing and socializing. I’ve been to plenty of weddings in which the vibe wasn’t super dance-y, and those weddings almost always ended with me having a higher-than-ideal blood sugar level because I’d spent them mostly stagnant in my seat. Other weddings, though, I’ve danced from the very first song to the last, and this was exactly my strategy at my cousin’s wedding earlier this month. Post-dinner buffet, I knew that I needed to curb some of my carbohydrate consumption with a little activity, so I was ready to go when the DJ cued up the music. This attitude paid off the rest of the night, too – a surprise Ben and Jerry’s ice cream truck, followed by a cake-and-cannoli dessert spread (major props to Matt and Janet for appealing to my sweet tooth by serving up some of my all-time favorites), meant that I was doubling down on dancing and insulin intake. My dancing, which was flat-out jumping up and down to some songs, resulted in stellar blood sugar levels that I’d be happy with any day of the week, but especially on a day filled with lots of food and drink that I don’t consume on a regular basis.

So even though I was a sweaty mess by the end of the night, that was a price worth paying in order for the peace of mind I had by the time I went to bed, knowing that I’d finally been able to play nice with my diabetes and my blood sugar levels for a wedding.

The Unexpected Blood Sugar Buster

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Spring cleaning is more than a practice of tidying one’s home. It’s also a great way to keep blood sugar levels down, as I was reminded when I decided to take on the long overdue task of cleaning out my closet.

Ever since I moved into my home (nearly 3 years ago), the clothing and random other junk taking up space in my decently sized walk-in closet has largely remained untouched. Not in the sense that I don’t take things in and out of my closet every day, because I do. Rather, I haven’t sorted through anything in my closet since I decided what would go in there and what order it would stay in. Forget clearing out clothing with seasonal changes or refolding items as they got jostled out of place, no way! It’s really no wonder that over time, my closet grew more and more cluttered until finally I couldn’t take it anymore and devoted a few hours to cleaning it out.

It was an exhausting exercise – and yes, the word exercise really applies here because I was sweaty, huffing, and puffing in no time. I had to take everything out, lay it in heaps on my floor, go through each pile individually to see what I wanted to keep and toss, and either refold or rehang garments as I filed stuff back into place to my liking. I’m not sure how many pounds worth of clothing I actually sorted through, but it was definitely a sizeable amount as my arms ached from pulling clothes down from shelves and my hanger bar. And it definitely made sense that I was getting overheated, as I kept walking back and forth between my closet and my bedroom floor with my arms weighted down and in a space that was overly warm due to insufficient air conditioning.

So when my blood sugar levels started tanking 30 minutes into my organizing process, I shouldn’t have been particularly surprised. But in hindsight, it makes perfect sense as the cleaning was basically an extended moderate-intensity cardio AND strength session. What I should’ve been was more prepared for the possibility of going low by enabling activity mode on my Omnipod so that my blood sugar target could be increased from 100 to 150 for the duration of my cleaning, but instead I was crashing and cursing that I had to interrupt my workflow with a fruit snack break.

Maybe next time I’ll do better and coincide my spring cleaning with a high blood sugar so I could reap the benefits of the extra exercise, thereby turning the unexpected blood sugar buster into a welcome one.

Why I Put My Diabetes in a Timeout on Vacation

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Do you ever wish that you could put diabetes on pause? I sure as hell dream about it, but remain grounded in the reality that it’s not exactly practical since it demands so much of my attention on a daily basis.

But that doesn’t mean that I don’t do my damnedest to make this wish come true on occasions in which I really, really, really don’t want to diabetes to dominate my mind.

Take my recent trip to Nashville for example. I went with my boyfriend and a couple of our friends for a long weekend – not much time at all when you think about how how much there is to explore in a happening place like that. So I was determined to make the most of every moment and went into the trip with a plan to cut myself some slack on the diabetes front. Sure, I’d do what I could to maintain solid blood sugar control, but I was also excited to indulge on a variety of yummy foods and drinks that I wouldn’t normally consume out of fear over what they might do to my levels.

So this meant I ate things like:

  • Fried chicken (still drooling just thinking about my meal from Prince’s)
  • Hush puppies
  • Beer
  • Margaritas
  • Moonshine
  • Deep fried cinnamon roll bites
  • A nutella milkshake that had TWO donuts – yes, donuts – blended in with the ice cream
  • Red velvet cookie dough (literally served in a cup from NoBaked in Assembly Row…check it out)
  • And plenty of other things!

Don’t get me wrong, a lot of these items were shared with my partner and friends. It’s not like I was consuming a full plate of cinnamon roll bites (described as “cubed, deep fried in waffle batter, tossed in cinnamon sugar, and topped with cream cheese icing”) on my own! But I was happily sampling and doing my best to carb count, making educated guesses and combatting my (several instances of) high blood sugar with extra insulin and exercise (we got upwards of 20,000 steps each day).

Putting my diabetes in a timeout for this trip initially felt unrealistic, and maybe even a little unnecessary. After all, I didn’t have to eat so many carb-heavy foods that I knew would annihilate my blood sugar levels. But it was important for me to be able to enjoy every aspect of this vacation and not let my diabetes take away from that. I didn’t want high blood sugar alarms to interrupt my appreciation of all the live music, so when I got them, I either took more insulin or silenced them. I didn’t want pesky pod changes to interfere with our plans for the day, so I monitored how much insulin was left in my reservoir and changed it when I was in my hotel for the night rather than waiting to do it at a less-than-ideal time, say, right before we hopped onto our pedal tavern tour of downtown Nashville. I didn’t want to chance my CGM sensor failing on me, so I brought extra, plus my test kit (neither of which I ended up needing to use). Above all, though, I didn’t allow every out-of-range blood sugar spoil my day. I figured that this 4-day trip was a single, small puzzle piece in the big picture of my diabetes, and this mindset contributed to a much more fun vacation.

Maybe next time, though, I won’t have to resort to putting my diabetes in a timeout because I’ll master bolusing for the full list of treats mentioned above…we’ll see!

An Ode to Log Books

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This was originally published on Hugging the Cactus on December 11, 2017. I’m sharing it again today because of all the outdated diabetes tools that I used to rely on, log books are something that I find myself wishing I still used, or at least kept to look back on, because they held me accountable. It’s funny how much that opinion contrasts with how I felt about them when I wrote this post! Read on for my full reflection…

Remember when log books were a THING that PWD used to track blood sugars?

Log books were pocket-size diaries (of a sort) designed for PWD to keep track of blood sugars, insulin and carb intake, mealtimes, etc. Basically, it was the old-fashioned way of recording blood sugars so that you could bring it with you to your endo appointments so your doctor could review the book for patterns.

I remember HATING having to write down my numbers. I felt like those little log books were contraptions put in place to judge me and my numbers. Imagine an eight year old who felt judged by something like that? It’s just wrong. But I get that they had a purpose to serve, and even when I was little, I knew it was important to write everything down even if I resented doing it.

That’s why I made it more fun by drawing doodles next to certain blood sugars – a frowning face would appear when I was high, and a mini burst of fireworks would find their way next to a blood sugar of 100 (which I now refer to as a unicorn bg, along with much of the rest of the DOC). I also distinctly remember using the log book to keep track of where I was injecting my insulin: “RL” would appear on the page if I was due to give a shot into my right leg, or “LA” for my left arm. These days, I’m really good about swapping sites, mainly because it’s easy to remember, thanks to my pods. But as a kid, it was more challenging, so writing it down helped.Thankful that my meter tracks my blood sugars for me now (also, that 230 mg/dL would’ve totally gotten a frown-y face back in the day).

Thank goodness for modern meters and insulin pumps that keep track of my blood sugars for me now. It’s so much easier to show up to an endo appointment and hand over my meter for the nurses to download. Plus, doing so means that my doctor and I get to review all sorts of colorful charts showing my blood sugars over a certain period of time, which is more telling and helpful than a doctor thumbing through my log book and murmuring, “I see,” every few moments.

Log books are such an archaic artifact of my diabetes history that I don’t even own any nowadays. I trashed them all, years ago, when I realized that my blood sugars from 2001 were sort of irrelevant to now. Do you still have any of your log books lying around?

An A1c Achievement

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Since transitioning to the Omnipod 5 roughly 8 months ago (and obtaining a deeper understanding of how the algorithm works), I strongly suspected that I would be pleased by the results of my next A1c reading. What I did not expect that it would be my best reading in four years – maybe even longer than that, if only I could see my results dating further back!

While I’m not going to share the exact number here, for reasons I’ve written about in this past blog post, I am writing about this little victory of mine because I needed to take a moment and reflect on how far I’ve come in my diabetes journey. For many, many years, I rejected the notion of diabetes technology. I was stubbornly resistant to exploring it whatsoever, likely out of fear that the change would have negative consequences on my health or standards of living. While I wish I could go back in time and encourage my younger self to give it a chance or explain how it would benefit me, I’m just grateful for the fact that I did eventually come around to trying it and realizing how much it changed my diabetes care and management for the better.

Don’t get me wrong, I’m still very much a proponent of time in range compared to A1c – and I’m thrilled to report that my time in range has also significantly improved since I switched to the 5. But for me, I can’t help but attach some extra value to my A1c, maybe because it was the standard measurement of diabetes “control” for most of my life with diabetes so far. So it feels really good and natural to celebrate my latest A1c achievement.

A Temporary Diabetes Cure

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I always envied people who experienced a diabetes “honeymoon” period. I used to think, how nice it must be to have some extra time to prepare for fulltime life with diabetes and not quite rely on insulin injections right off the bat! I also always assumed that, after 25 years living with diabetes, that the honeymoon phase had absolutely skipped over me, and I was positive I’d never get to experience it.

Turns out, my diabetes – that saucy little minx – likes to keep me on my toes as it recently surprised me with an abrupt 48-hour window of time in which it seemed like my diabetes was cured.

That’s the only way I can describe what transpired. It was the strangest thing. One day, I woke up, ate breakfast, and took insulin for it – just as I always do. Except instead of my blood sugar spiking or even leveling out after eating, it started to drop, which was strange because I ate a fairly typical meal that morning. At the time, I thought nothing of it and just ate some extra carbs before my blood sugar went too low.

No big deal, right? But this phenomenon happened again, following both my lunch and dinner. It was especially inconvenient in the evening, as I had a volleyball game and wanted my number to be up so I could play. I had some fruit snacks before the game to keep my levels up, but was surprised when even after that, I was dropping by the tail end of our third and final match. I remember being out on the court, trying to track the ball as my team bumped it back and forth over the net with the other team, knowing full well that my blood sugar was going low but feeling determined to stay in the game until it was over. The moment the final whistle blew, I ran to grab even more fruit snacks, and felt both annoyed and confused by the whole situation.

The following day, I decided I wasn’t going to mess around anymore. I wanted to cut my mealtime insulin doses in half to see if that helped me at all. It was a solid idea, but it didn’t prove to do much to help as I again dropped after breakfast and lunch. Okay, so clearly that course of action wasn’t enough. Maybe I could try switching from automated mode to manual on my Omnipod 5 PDM and put myself fully in control, rather than leaving it up to technology. I set a temp basal decrease to ensure I was getting very little basal insulin, and resolved to enjoy my pizza dinner that evening with friends.

Of course, pizza is notoriously difficult to bolus for, so I knew I’d have to do even more extra work in order to prevent my blood sugar from dipping. So not only did I take half the amount of insulin than normal, but I also did an extended bolus so that I wouldn’t get it all upfront. I ate two fairly large slices of pizza and also had a generous serving of chips that I technically didn’t include in my bolus calculations. So imagine my bewilderment when, 2-3 hours post-pizza, I was still going low. I poured myself a glass of regular soda, and it became my companion for the remainder of the evening. I’d take sips as I saw my graph report blood sugars that never went higher than 110, but fluctuated for the most part between 60 and 90.

It was wild, and I was actually getting pretty worried about the whole situation. I couldn’t make sense of it. I ran through all the variables that could’ve caused this to happen – was I wearing my pod in a strange site? Was it because of my period? Could it be due to my activity levels or changes in the weather? I weighed so many possibilities in my mind and came up with nothing definitive, so I went to my next best resource for input…the diabetes online community.

I asked around for input and was – as always – so grateful to the folks who reached out and served as thought partners with me. Based on what I learned, the most likely culprit is hormonal changes. In fact, perhaps it was a bit of a birthday gift from my diabetes as I ushered in a new age/phase in life. It’s still totally bizarre that it happened, but a friend reassured me of her own experiences with the same temporary phenomenon as she’s experienced menopausal shifts. So, maybe…just maybe this was the explanation I was looking for, and perhaps the whole thing happened to signify the start of my upcoming cycle.

I won’t ever know for certain if that was indeed the cause of my temporary reprieve from diabetes, but at least I can find a little comfort in knowing that I got through it (as my blood sugars and insulin needs bounced back with a vengeance the following day) and that I had the support and feedback from friends and strangers alike the whole time.

Flatbread Failure

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Any type of pizza, plus diabetes, usually equals one giant headache in terms of nailing a correct insulin dosage.

Nine times out of ten, my blood sugar ends up high in the hours following a pizza meal. This is a fairly common phenomenon for people with diabetes, because even though pizza contains high amounts of carbohydrates, it also contains a large amount of fat that ends up delaying the digestion of pizza – resulting in a belated blood sugar spike. My go-to workaround for this is to do an extended insulin bolus, meaning that I take part of my insulin dose at mealtime and my pump will deliver the remaining dose later on, but it can be tricky to nail the timing of it.

So imagine my surprise when, after enjoying an evening out with my boyfriend in which we split a very tasty flatbread pizza (half buffalo chicken, half brussels sprouts and bacon), my blood sugar didn’t spike even a little bit post-meal. In fact, it actually ended up tanking – so much so that over the course of 2 hours, I had to eat 3 packs of fruit snacks and a handful of leftover Easter candies in order to keep it from dropping too much.

My mind was blown. I had actually eaten more flatbread slices than I normally do during this meal – the two of us nearly demolished a large-size flatbread, which is quite a feat – and so I bolused for 60 grams of carbs, using the manual mode on my Omnipod 5 PDM to enable an extended bolus in which I gave myself half my insulin dose upfront with the remaining half to follow 1 hour later. I actually thought I was underestimating the total carbs I’d consumed, especially considering I had two cocktails with my meal. But nope, I had completely missed the mark on this one and paid the price as I did whatever I could to keep my blood sugar up in the hours before I planned to go to bed. You can see from my CGM graph below that this was a bit of a prolonged struggle, one that kept me up much later than I would’ve liked.

But, oh well. That’s just how it is with diabetes sometimes, and I remain optimistic that I can nail the pizza bolus next time. After all, I’ve done it before, so I can do it again. And this is the kind of bolus experiment that’s kind of enjoyable – any excuse to have some delicious pizza.