The Bad ‘Betes Habit I’ve Tried to Break for 23 Years (and It’s Still a Work in Progress)

Bad habits are notoriously difficult to break.

Nail-biting. Forgetting to floss. A social media addiction. Swearing. Luckily, I only struggle with two out of the four of those (I’ll let you figure out which ones are a big fuckin’ problem for me while I go check my Instagram account real quick).

When it comes to diabetes-specific bad habits, though, well let’s just say that in more than two decades of life with diabetes, there’s a biiiiiig bad (Buffy the Vampire Slayer fans, think Big Bad like Evil Willow or Glorificus) habit that feels impossible to break.

And for me, that’s snacking freely without bolusing.

When I’m snacking throughout the day, I am not nearly as adorable about it as this cartoon girl (and I am almost never snacking on something as healthy as the piece of fruit she’s cutting up).

When I say “snacking freely”, I think it’s more accurate to call it grazing…I’m not eating large quantities of food or anything particularly carb-heavy, but it is usually enough to impact my blood sugar, at least moderately.

I’ve acknowledged this as a bad habit in a previous blog post, but for the first time, I’m really taking a step back and thinking about how if I stop doing this, I might see a tangible change in not just my blood sugar levels, but my A1c.

Don’t get me wrong, my A1c reading isn’t the most important thing to me (I’d rather focus on time in range, or the amount of time I spend each day below my high limit and above my low limit). But it is something that does come up, and will always come up, during appointments with all of my healthcare professionals. It’s definitely not something that they will be ignoring any time soon, and this year, I’d like to have an A1c that I’m a little more proud to own.

So I’m going to actively try and break this bad habit.

Whenever the desire to snack/graze strikes, I’m going to do what the pros recommend: Have a glass of water. Walk outside for a few minutes. Play with my puppy. Find a task around the house to focus on instead. Actively seek something else that will consume my time instead of me consuming something that will ultimately have a negative impact on my blood sugar as well as my mood. Be more careful about portion control when treating low blood sugars, because I can really spiral and eat half the damn kitchen when correcting a low, and it ain’t cute. And when all else fails and I need a snack (no shame in that game) actually take a freaking bolus for it because it’s okay to eat something extra throughout the day, I just need to stop being lazy and measure out whatever it is so I know exactly how much insulin I need to cover for it. That part isn’t rocket science, so I should stop treating it as such.

All bad habits are difficult to break, and I know one that’s been around for most of my life will make it particularly challenging…but it’s a new year, a great excuse for making a positive change with my eating habits and blood sugar levels, so I say bring on the challenge.

The Worst Time for a Low Blood Sugar

There’s never necessarily a good time to have a low blood sugar: Whenever they happen, they’re bound to be at least a little inconvenient.

But I was thinking about it the other day and it occurred to me that there is most definitely a worst time for a low blood sugar…at least, for me.

And that time is the middle of the night.

I love sleeping, but like many adults, I simply don’t get enough of it. So when something like a low blood sugar interrupts my slumber, it’s downright intrusive and honestly a bit scary, because I always have an underlying fear that I’ll sleep through my Dexcom alarms.

Take a recent middle-of-the-night low blood sugar for example…I was dealing with a lingering low at 1:30 A.M. I’d only been asleep for a couple of hours when I heard my Dexcom sound. I ignored it the first 3 times it went off, but something – my intuition, maybe – told me to roll over and at least check to see the level that my Dexcom was reporting.

I was somewhere in the 60s: low enough that I needed a juice box. I promptly drank it and got settled back under my covers, assuming that I would shoot back up in no time.

Nothing like waking up to a screaming Dexcom that demands you to eat sugar, stat!

Not quite. I don’t know how many minutes later, but I looked at my Dexcom again and it said I was 56. I did the whole “confirm the number with my meter” shtick and ate some glucose gummies to supplement the juice box. I was irritated and my eyes were oh-so-heavy, but from there I forced myself to turn the television on and try to get distracted by a show so I wouldn’t fall back asleep until I knew that my blood sugars were stable again. Before too long, I was heading up, so I did my best to lull myself to sleep, though I tossed and turned for awhile before I finally did drift off.

All in all, I lost about an hour to an hour and a half of sleep because of this one instance! Not all of my lows are like that – sometimes I can fix them in 5 minute flat, other times they keep me up for upwards of two hours – but it doesn’t even really matter. It’s more so the principle of the thing.

Plus, think about how freakin’ ridiculous it is that people with diabetes have to eat something sugary to come up from a low – that in itself isn’t wild, but it IS grating to have to do in the middle of the night when you aren’t hungry and were enjoying a deep sleep. Also…ever try drinking orange juice after you’ve brushed your teeth? It’s unpleasant, to put it mildly.

So you have it: The middle of the night is the absolute worst time for a low blood sugar, in my semi-expert opinion.

My Lowest BG: How I Handled It and What It Taught Me

There should be an asterisk after this blog title…because this is going to be about the lowest bg that I can really remember and have an actual blood sugar to associate with it.

Let me elaborate…

My real lowest low happened when I was in high school – I got out of bed one morning, stumbled down the stairs, and slurred to my mom that I wanted a bowl of Special K cereal for breakfast (she couldn’t understand what I said and promptly panicked before realizing I must be low). I don’t know what my blood sugar level was that morning because I neglected to do a fingerstick check, but I do know that it was a downright freaky incident that’s cemented in my memory.

But another new incident recently occurred that shook me in a similar way.

It was 1:30 A.M. I was nodding off when I heard my Dexcom alarming. I checked it and was somewhat surprised to see that I was 92 with two double down arrows. (I say “somewhat surprised” because in the earlier evening hours, I spent 3-4 hours chasing a stubborn high blood sugar and definitely wound up stacking insulin doses.)

Even though I wasn’t feeling any low symptoms, I decided to start treating the low. I ate two boxes of mini raisins, equaling about 20 carbs…

…and swiftly grew worried when I saw the number on my Dexcom app to continue to drop.

Below 55.

Okay, let’s have another box of raisins.

Below 50.

Alright, let’s do a fingerstick check.

42.

Sheesh, I’m fumbling around in the dark, trying to locate my meter…

LOW.

By the time my Dexcom said “LOW”, it was confirmed on my meter that I was, indeed, quite low. 35, to be exact.

If only my Livongo meter knew I needed a whole lot more than a tablespoon of sugar, jam, jelly, or honey…

And that was a number that frightened me.

Thank goodness I wasn’t alone when I was dealing with this 35 (that wound up lingering for a solid 15-20 minutes before slowly creeping up about 45 minutes after I ate my first box of raisins).

Thank goodness I had someone there to make sure I had plenty of sugar in my system before I fell asleep.

Thank goodness I had a can of regular ginger ale, some Reese’s, Dove chocolates, and popcorn all within arm’s reach (yes, I really did need to eat all those carbs in order to treat this one low).

Obviously, I recovered from this scary low, but it taught me that now that I’m living alone and won’t always have someone around me in the middle of the night, I should start thinking about inviting someone to follow me on the Dexcom app.

The next day, I talked to my parents about what happened and the three of us agreed that my dad will receive notifications if/when my blood sugar drops below 55. I feel a lot better knowing that he has access to my levels and that he knows to contact me if I’m low.

I’m not exactly grateful that I experienced this very low blood sugar…but I do appreciate that it’s reinforced the importance of having a nightstand fully stocked with low treatments as well as making sure that my family has a way of checking in on me when I may need their support.

How Diabetes Told Me It’s Too Early for Christmas Decorations

We all know that 2020 has been a sucky year, so it’s not exactly surprising that immediately following Halloween, the world seemed to throw itself into the holiday spirit.

Between the commercials on TV, Black Friday sales, sparkly decorations, baking galore, and Hallmark movies, the Christmas season kicked off early and with major vivacity. Normally, I’m the kind of person who prefers to enjoy one holiday at a time, and I was somewhat repulsed to see all the Christmas merchandise in stores before Halloween was over.

So even though Thanksgiving hasn’t even come and gone yet, I’ve abandoned any remaining willpower I’ve had to hold off on decorating for Christmas. Like the rest of society, I simply couldn’t hold back my desire for some cheer!

One afternoon last week, I decided to haul up my Christmas tree and its accompaniments from the basement and start the process of decking the halls…

…but my diabetes had other ideas.

Maybe my diabetes would’ve liked it better if I decked the halls with glucose tablets and test strips…

I’d just finished assembling my modest tree when I heard my Dexcom alarm sounding off, alerting me to a low blood sugar.

And I hate to admit it, but it didn’t surprise me – I’d felt the oncoming low for about 10 minutes prior.

I just wanted to decorate so badly that I was willing to ignore my blood sugar in order to embrace the Christmas spirit!

Alas, not too long after I heard that alarm, I knew I had to change my priorities as I started to get sweaty and a little woozy…so I left my tree naked and sought out a low treatment, slumping at my table in defeat while I ate it.

My diabetes told me it was too early to decorate for Christmas at that moment in time…

But you know that I told my diabetes otherwise later that night when I spent hours trimming the tree!

‘Tis the season and ain’t no way that my diabetes will prevent me from basking in it.

The Strangest Things I’ve Eaten in the Middle of the Night for a Low Blood Sugar

The thought occurred to me that I should write a blog post on this subject sometime around 3 A.M. after I shoveled a slice of cheddar cheese into my mouth.

Low blood sugars combined with odd hours of the night aren’t foreign to most people with diabetes, but they can be…interesting when you aren’t prepared to handle them with low snacks stashed away in or on your nightstand.

To elaborate, I almost always have a box of raisins or a bottle of glucose tablets sitting on top of the nightstand next to my bed – but there are those times that I run out and forget to replace them.

In those situations, I really have no choice but to eat everything in the kitchen head downstairs and scavenge in the kitchen for something that will bring up my low blood sugar.

I love how sassy this cartoon person is as they shamelessly reach into the fridge for a midnight snack or seven (check out that popped knee).

Usually, I consume things that make sense – a handful of cereal, a glass of juice, a few marshmallows…whatever the kitchen is stocked with that will work fast. And this is absolutely the best tactic when dealing with a middle-of-the-night low because it helps ensure that I will be able to get back into bed (and hopefully fall asleep) as soon as possible.

But every so often, I go absolutely apeshit in the kitchen and EAT ALL THE THINGS!!!!!!!!!!

Okay, not ALL the things, but definitely way too many things.

I blame it on the fact that my body is in that savage, must-eat-food now mode: Hungry and full cues aren’t a “thing” in that state. So I kind of mindlessly eat junk until the symptoms of my low blood sugar go away. This can take at least 15 minutes, so as you may be able to imagine, I can go overboard with food consumption.

And my choices can get more than a little weird.

Here are the most bizarre food items that I’ve eaten when dealing with a middle-of-the-night low blood sugar. I classify them as “strange” because either 1) they don’t do anything to help low blood sugar because they’re low carb, 2) they’re kind of disgusting, 3) the quantity is odd, or 4) a mix of all of those qualities:

  • A slice of cheddar cheese (mentioned in this post’s introductory sentence)
  • About one-third of a Nutella jar (that was so yummy but damn I shudder to think about the calories and fat in that serving)
  • Too much peanut butter to quantify (please see above comment RE: Nutella)
  • SUGAR-FREE syrup (emphasis on the sugar-free because WTF was I thinking when I straight up drank two swigs from the bottle)
  • Exactly three frosted mini wheats (I don’t even LIKE this cereal but I guess in this situation I thought that consuming no more, no less than three was a brilliant idea)
  • Pickles (not weird at any other time of the day because I love pickles but maybe not the best snack in the early morning hours)

Welp, now my stomach is churning slightly as I think about all the junk I’ve eaten at ungodly hours of the night…if you don’t mind me, I’m off to go restock my low snack supply on my nightstand so I don’t have to make any early-A.M. hour trips to the kitchen any time soon!

How Keeping Constantly Busy Helps (and Hurts) My Diabetes

I don’t fare well when I have too much idle time.

I’m the type of person who needs to stay as busy as possible: I like being productive and having the satisfaction of saying that I’ve accomplished something each day. That doesn’t always mean that I’m successful, but I do my damnedest to make sure that I check off at least one item from my to-do list on a daily basis.

And I don’t like saying “no” to others, so whenever someone asks for my help, I’m on it. It doesn’t matter if it’s a family member, close friend, or an acquaintance – I do what I can when I’m called on for help, and as you might be able to imagine, this is both good and bad for me.

How Keeping Constantly Busy Helps (and Hurts) My Diabetes
Who DOESN’T love the satisfying feeling of checking items off from a to-do list?!

In terms of diabetes management, it’s great because when I am particularly busy, this means that I’m probably not sitting around a whole lot – the constant go-go-go makes my blood sugars pretty happy. Plus, having a packed schedule keeps my mind occupied when I need to think about something – anything, really – other than my diabetes. If I’m having a tough diabetes day, I don’t have to dwell on it; instead, I have tasks X, Y, and Z to do. If I’m waiting for a stubborn high blood sugar to come back down, then I can start working on a project rather than stare at my CGM for the next hour. 

So in this way, keeping myself busy is a fabulous way to take my attention away from diabetes when I desperately need the mental break from it…but it’s also harmful at times, because let’s face it, there are many times in life where I really do need to concentrate on my diabetes care and management.

Whether it’s a big or small task that I’m working on, I put 110% of myself into it, which means that I really don’t have extra thinking room for my diabetes. Some examples of times that I’ve been far too lost in what I was doing to give diabetes a second thought are when I’ve been in the middle of a knitting project and my Dexcom is went off but I actively ignored it in order to keep my focus on whatever row I was working on (and my blood sugar stayed higher for longer than it should have), or when I should’ve taken a break from writing social media posts for my friend to eat something because my blood sugar needed it, but I just wanted to finish the job first.

Now that I’ve figured out how my diabetes is helped and hurt by my jam-packed days, will I continue to stay constantly busy? The answer is definitely. But I will also try to remember the importance of balance in order to keep my diabetes at the forefront of my mind in a healthy manner.

Why I Decided to Get Baqsimi (and How I Got It)

Say hello to my new little friend…Baqsimi!

For anyone who may be unfamiliar with Baqsimi, it’s a relatively new form of glucagon that comes as a nasal spray. I haven’t had to use it yet (and I hope that I don’t ever have to, really), but there’s a lot of pros to Baqsimi when comparing it to a traditional glucagon kit:

  • It’s shelf-stable – it doesn’t have to be refrigerated.
  • It doesn’t expire until 2.5 years from now.
  • It’s completely ready to go as-is, no mixing or measuring needed.
  • It’s compact and totally portable.
  • It’s easy to use (and understand how to use!).
Baqsimi is incredibly easy to use: remove shrink wrap, insert into nostril, and push plunger all the way in to dose. That’s it!

All of those factors contributed to my decision to finally pull the trigger and ask my endocrinologist about writing a prescription for me. It’s not that I’m suddenly worried that I’ll need Baqsimi; for me, it’s more of a peace-of-mind situation. I always thought that my glucagon kit was next to impossible. Sure, I know how to use it, but I have to refresh my memory every so often because there are so many steps involved in the process: inject the syringe into the vial, mix the contents, wait for the glucagon to turn clear, stick the syringe back into the vial, withdraw the liquid, and then finally do the injection…there’s a lot going on there. And if I actually did need glucagon one day due to a severe hypo, I wouldn’t exactly be able to easily walk whoever I was with through the process because I’m sure I’d be totally incapable of doing so (depending on how bad my symptoms were).

It’s just a lot to ask of every single one of my family members and friends to know exactly how to inject glucagon into me in the event I ever needed one of them to do that, so having Baqsimi on hand takes so much of that fear and anxiety away.

And the icing on top of the cake is that it was super easy for me to get Baqsimi…like, it only took a few hours, which is amazing. All I did was reach out to my endocrinologist’s office using their online messaging system, ask my doctor for a script, and…bam. It was sent into my local pharmacy, and before long, I was cruising through the drive-thru with my dog to pick it up. I’m lucky, too, because all I had to pay was $25, thanks to my insurance (sometimes, it’s not as bad as I think it is).

Twenty-five bucks for peace of mind and a life-saving medication…that’s something I can get behind. I’m glad Baqsimi has finally joined my diabetes toolkit.

Diabetes Detective Work: Solving the Mystery of Prolonged High Blood Sugar

When it comes to solving the mystery of why I recently experienced high blood sugar for a prolonged period of time, let’s just say I was a wannabe Sherlock Holmes.

I’m going with “wannabe” here because I lacked the satisfaction of deducing the exact culprit, but at least I had my wits about me enough to come up with a few reasonable explanations.

Diabetes Detective Work_ Solving the Mystery of Prolonged High Blood Sugar
I wish that a magnifying glass was all it took to figure out the “why” situations in life with diabetes.

The scenario: I was riding between 200 and 250 for hours. I did a temporary increase of my insulin for a bit, took 2-3 micro-doses of insulin (in order to avoid stacking), and did my best to stay hydrated while avoiding carbs. And I barely budged, much to my frustration. All throughout dinner that night, I was anxiously eyeing my Dexcom and hoping to level out before long. It was only after I went on a 45-minute after-dinner walk that I started to drop, and it took me quite a while longer than usual for me to be totally back within range.

The questions: Did my mid-afternoon pod change throw something off? Was my carb counting wrong? Was it something I ate? Was my pod working the way it should’ve been? Did I get enough exercise throughout the day? Too much? Was it due to anxiety or stress? Some other factor that never even crossed my mind?

The clues: A couple of clues helped me eliminate the cause of the high blood sugar. For starters, it couldn’t have been the insulin – it’d been refrigerated and I’d been using the same vial for a couple of weeks without any issue. It also likely wasn’t either of my pods, because the one I’d worn for the full 3 days had worked fine, and the new one that I applied mid-afternoon did work for the full 3 days…even though it seemed to take some time to adjust to my body. I definitely didn’t eat the healthiest meal (my entree may have been a green salad, but I also ordered a sugary cocktail and had fried pickles as an appetizer). And I was dealing with slightly higher levels of stress than usual.

The case cracked (sorta): All of those aforementioned conditions combined could have contributed to the high blood sugar. Unfortunately, I can’t quite say with certainty that they did, because on paper, I did everything right in order to combat the highs. That’s just the thing with diabetes, though: You can do everything “perfectly”, and the way it “should” be done, but sometimes you can’t prevent these little mysteries from popping up and keeping life with diabetes…ah, well, “interesting”.

Is the Livongo Blood Sugar Meter Accurate?

It occurred to me the other day that even though I wrote a couple of blog posts and even made a video about it, I still haven’t addressed one major component of my new Livongo blood sugar meter: its accuracy.

How does it stack up to my Verio meter? More importantly, do I think it’s accurate?

Well…the answer isn’t cut-and-dry because I think it can be accurate…as long as my blood sugar isn’t above 200.

How did I arrive at this conclusion?

I conducted a little experiment.

Bear in mind here, I’m no expert in experimental design, so I established a simple setup for this. During the period of approximately two weeks, whenever I checked my blood sugar, I used the same drop of blood on test strips for two different meters: my Livongo and my Verio.

And the results were interesting, to say the least.

Whenever I was about 80-180, my results from the Livongo meter and the Verio meter were within about 10 points from one another. One instance, I was 86 on the Livongo and 92 on the Verio. Another time, I was 105 on the Verio and 113 on the Livongo. The meters never reported the exact same number at any point during my experiment, but I was happy whenever they showed similar results.

Things got dicey, though, any time I entered the hyperglycemic range.

Add a heading (1)
That 163 and 165 show how at times, the two meters were in agreement with one another…but then there’s that 231 and 262. Those are just a little too different for my liking.

It was weird and I can’t explain it, but the Livongo would report that I was anywhere from 20-50 points higher than what was on my Verio at a given point in time when my levels were 200+. This really surprised me, because I’d suspected that my Verio skewed a little higher compared to most other meters, so I never thought that the Livongo would prove me wrong about that. At times, it was truly maddening: On one occasion, the Livongo said I was 251 and my Verio said I was 204. That’s the difference of at least 1-2 units of insulin for me in order to correct that high! Even more frustratingly, because I didn’t trust the result from either machine, I checked my blood sugar again immediately and the Verio said 242, while the Livongo said 228.

WTF?!

That particular example was extremely confusing because I didn’t know which piece of technology to trust. And that’s the big thing for me: I need to know that I can depend on whichever blood sugar meter I’m using to deliver accurate results.

So again, remember that I’m no good with numbers, and that this is simply an estimation…but if I had to guess how many times the Livongo agreed with the Verio, I’d say it was no more than 7 out of 10 times. And I’m super bummed about that, because I’d genuinely hoped that I could trust my Livongo meter and use it full-time whenever I was taking a break from my CGM. Given the fact that it seems to be accurate when my blood sugar is in range, though, I suppose I could use that as motivation to work harder to prevent hyperglycemic readings…but I’m not perfect and I know that they will still happen from time to time. And I deserve a piece of technology that will accurately report them to me so I can make the best possible treatment decisions.

In theory, I still like the Livongo: It has a great design and some of its features (e.g., test strip reordering) are totally unique. But in practice? It leaves a bit to be desired.

T1D, A1c, and Time in Range

Time in range versus A1c…which measurement matters more when it comes to T1D care and management?

Well, I’m not exactly in a position to answer that, because I think the answer is unique to all people with diabetes. But I can explain what exactly both of these numbers are and how I view them.

A1c: Also known as Hb1c or hemoglobin A1c, this is a test that is conducted every 3 months (or as requested) by an endocrinologist. A patient gets blood drawn to determine the average amount of glucose concentration in the blood during that 3 month period. The result of this test is a percentage amount, with 5% being an average result for a non-diabetic individual. I consider the A1c result to be highly personal, so I don’t often share mine with others; however, I do refer to it when describing ways in which I want to improve my diabetes care and management.

Time in range: This value describes the literal amount of time that a person’s blood sugar is in “range” for a given period of time (e.g., one day, one week, one month, etc.). “Range” refers to above a person’s low threshold and below a person’s high threshold. One person’s defined range may vary greatly from another person’s, but for me, I have my low set at 80 and my high set at 180 on my Dexcom. In a perfect world, my range would be more like 80-120, but I have a higher threshold set to minimize the number of alarms that go off.

Add a heading
Diabetes…the chronic conditions with like, way too many acronyms.

So really, both are just two different ways of measuring blood sugar performance over the course of certain time frames. And while I try to bear in mind that these are both simply numbers that help me see part of the diabetes picture, and not sole indicators of how “well controlled” I am or am not, I do pay special attention to them and have certain goals for myself. (I strive for an A1c of under 7 and I like my time in range to be at least 75%: These are goals I came up with independently, without my endocrinologist’s feedback, because it’s what I feel comfortable with when it comes to my diabetes…other T1Ds feel differently, and that’s totally okay!)

It’s important to me that I remember that my “success” as a person with T1D is not defined by either of these numbers. In fact, I know many other T1D individuals feel the same way that they should be viewed as signposts along the road to achieving desired diabetes results. It can be hard to do, though, because of how much weight is placed on these numbers by medical professionals and from people across the Internet.

The bottom line? I try to tune out the background noise and focus on taking it one day at a time. By no means am I perfect, but nobody is, and I know better than to put pressure on myself to strive for perfection. Instead, I do the best that I can to maintain my A1c and time in range goals, while doing everything I can to keep the bigger picture in mind instead of individual numbers.