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.

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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.

When it Comes to Dexcom Alarms…Never Assume

I may have had diabetes for more than three-quarters of my life, but that doesn’t mean that I don’t make silly mistakes with it from time to time.

But I must admit, I still surprise myself on the occasions that I make a slip-up that’s incredibly stupid…and incredibly avoidable.

When it Comes to Dexcom Alarms...Never Assume
In life with diabetes (and in general), mistakes are bound to happen…

For example, one morning my Dexcom started alarming, and I thought that I knew exactly why it was sounding off: It sounded like the signature triple buzz of a high alert, so I did what anyone else would do when it’s very early in the morning and not quite time to wake up yet…I ignored it and fell back asleep.

But true to typical Dexcom alarm nature, my sleep was interrupted again by continued buzzing. Rather than pick up my phone to dismiss the alarm, though, I decided to bolus for a couple of units without ever verifying that I was, indeed, high.

Yikes. Can you say rookie mistake?

Fortunately for me, I really did have to get up and start my day within a couple of hours of taking that bolus. Thank goodness I did, because when I got up, I immediately glanced at my Dexcom and was taken aback to see that my blood sugar had not ticked up past my high threshold in the last several hours…it had actually lost reception completely.

Ahh…so that’s what it was trying to tell me. Oops.

Furthermore, my blood sugar was inching below my low threshold – the two units I’d carelessly taken had kicked in, and all I could feel in that moment was relief that I hadn’t taken more insulin.

This story could’ve had a very different ending. I’m still kind of in disbelief that I didn’t just roll over to check my Dexcom and confirm the reason why it was alarming in the first place. I mean, that’s what I do any other time it goes off, regardless of the time of day. I suppose that I was just overly confident in what kind of alarm it was. Coupled with the fact that I was barely awake when this all went down, then it really isn’t all that crazy that this happened…but it doesn’t make me feel any less dumb.

Lesson learned. When it comes to Dexcom alarms, always check them, and never make assumptions.

 

4 Cocktails That Have Little or No Impact on My Blood Sugar

YAY, it’s FRIDAY! *Does happy dance*

In order to “cheers” the weekend’s arrival, I might indulge in an alcoholic bevvy or two tonight.

And if you’re like most people who are curious about my diabetes, you may be wondering…how does alcohol affect my blood sugar?

Remember that it’s different for everyone, but personally, alcohol itself (hard liquor/spirits) doesn’t really impact my blood sugars too much. More often than not, it’s the sugary juices, syrups, and sodas that are found in mixed drinks that are wreaking havoc on my levels. That doesn’t mean I don’t allow myself to have a carb-o-licious margarita or a frozen cocktail (a local bar makes them with ice cream and they’re incredible) from time to time, but I definitely don’t do it frequently because the inevitable blood sugar spike just isn’t worth it.

So what do I stick to instead? I have a few go-to cocktails that play nice with my diabetes:

1 – Gin and tonic. Did you know that diet tonic water is a thing? It is, and it can be purchased by the bottle from just about any grocery store. I love having diet tonic water as an option because it eliminates the carbohydrates that are found in regular tonic water. This means that any carbs in this cocktail are coming from the gin, and it’s such a trace amount that I don’t need to factor it into a bolus (again, this is just what works for me). All I do is pour my gin and diet tonic water over a tall glass of ice, add a squeeze of lime juice, and enjoy knowing that I’ve created a nearly carb-free cocktail.

2 – Rum and Diet Coke. People always seem surprised when they see me drinking rum because of the connotation that it’s a sugary spirit. But I’ve never noticed rum impacting my blood sugar more than any other spirit such as bourbon, scotch, tequila, or gin. So when I’m leaning towards something that’s on the sweeter side in terms of taste but not heavy on carbs, I’ll go with a rum and diet coke.

4 Cocktails That Have Little or No Impact on My Blood Sugar
Raise a glass to the weekend…and to drinking *safely* with diabetes!

3 – Whiskey on the rocks (or mixed with diet soda). This is pretty bare-bones in terms of mixology, but I’ve found that I can’t go wrong with this simple combination when I’m in the mood for something to sip slowly and enjoy. Whiskey purists might disagree with how “on the rocks” I tend to get, but I like whiskey best when it’s as cold as possible and, truthfully, a little watered down. But ice or no ice, I know that whiskey won’t make my blood sugar budge, which makes it a-okay in my book.

4 – A glass of wine. Okay, so this isn’t technically a cocktail, but it’d be very remiss of me to exclude wine from this roundup. Not only am I a big fan of whites, reds, and bubbly alike, but it just so happens that wine gets along very well with my blood sugar. The only time that I run into real trouble is if I’m drinking something super sweet like Moscato (which is rarely, if ever, because it’s waaaaay to saccharine for my tastes) or mixing the wine with something (such as Prosecco and orange juice for a mimosa). Otherwise, I know that a glass (or two) of most wines is the perfect way for me to unwind without it having a negative impact on my blood sugar.

To wrap up this particular post, I’m including a few links from Beyond Type 1 below about drinking and diabetes. I’ve found that this topic in general invites a lot of questions, so the resources on their website can help address some of the trickier ones. Remember that if you have diabetes, make sure that you go about it safely if and when you decide to drink alcohol (and if you don’t, that’s perfectly okay, too)!

How much alcohol and what type is best with diabetes?

Why doesn’t glucagon work with alcohol?

Why and how to adjust your basal rate when drinking

The Alcohol and Diabetes Guide

 

 

A Full Vlog Review of my Livongo Meter

As promised, here’s my vlog showcasing my thoughts on the Livongo meter! (Yes, I know it’s 10 minutes long, but I couldn’t help going into detail and really tried to showcase all of its features. Hopefully, my rainbow nails and peppy personality keep you engaged.) Like I say in the video, be sure to ask me any questions you may have about the meter – as I use it more, I discover additional details that I will cover in a follow-up post in the future. But for now, ENJOY the video and know that all opinions are my own: I am not being compensated in any way, shape, or form for creating this video and sharing my views.

5 Reasons Why I Took a Break from Continuous Glucose Monitoring

I’ve decided to take a break from continuous glucose monitoring. This means that for an undefined period of time – maybe 3-4 days, a week, or a few weeks – I’m not going to wear my Dexcom G6 CGM.

Initially, I wanted to give myself a break because I was just burnt out from wearing it all the time and feeling so dependent on it. But as I started thinking about more, I realized that there were some other really great reasons for me to take a break from my CGM:

1 – I wanted to wear one less device. It can be tough to wear two medical devices 24/7. Sometimes I get super self-conscious of them. Other times they just aren’t comfortable to wear, such as when I roll over one the wrong way when I’m sleeping at night. So it’s nice to feel a little more free with one less device stuck to my body at all times.

2 – I was sick of the constant data feed. All those alarms going off whenever I cross my high or low threshold are straight up annoying!!! I know I could just turn them off on my CGM receivers, but the point of them (for me) is to try to maintain as tight of a control on my numbers as possible. But now that I’m intentionally not wearing my CGM, I’m realizing how much I appreciate the reprieve from all that buzzing and beeping.

Pink Minimalist Kindness Quote Instagram Post
There’s lots of reasons to take a break from continuous glucose monitoring, but sometimes one is enough.

3 – I have some new blood glucose meters to try. The only way that I can really put my new meters to the *test* (lol) is to use them – and goodness knows that I have very little desire to do manual finger stick checks when I’m wearing my CGM.

4 – I’d like to hold myself more accountable. I rely on my Dexcom heavily at all times. I look to it before I start exercising, before I eat something, before I do anything, really. I bolus using the data it provides and trust it implicitly. But I’ve recognized that by developing this habit, I’ve become lazy. I don’t measure out food as much because I figure that if I bolus too much or too little for it, I can just watch what my Dexcom tells me and treat from there. It’s kinda sloppy, in my humble opinion, so I’m trying to put more of the trust back in myself for my diabetes monitoring.

5 – I’m trying to reacquaint myself with my body’s cues. Before CGM technology, I was really good at recognizing high and low blood sugar symptoms…but then I started using a CGM and found myself reacting to highs and lows (e.g., treating them prematurely), even if I didn’t feel those high/low symptoms. So I want to retrain myself so I can make sure I never lose that ability, because I think it’s important to know exactly how my body alerts me to various blood sugars, rather than depending solely on a piece of technology to do it for me.

 

First Impressions: My New Livongo Blood Sugar Meter

I shared that my company is offering a sweet new benefit for its associates with diabetes: a free blood sugar meter with free refills on test strips and lancets as the need arises.

Great perk, right?!

Naturally, I took advantage of this offer as soon as I could, seeing as I was eager to start playing around with a new meter (I talk about the reasons why in this blog post).

While I waited for my new meter to come in the mail, I did some research on it. I was excited to learn that it would be a back-lit, full-color touchscreen. It looked sleek and modern, and I was impressed that it seemed to have a lot more features compared to my blood sugar meters of yore (I still remember having to use a giant droplet of blood and waiting an entire minute for my blood sugar results to appear on a very clunky screen…oh, the 90s). I couldn’t remember the last time I was so pumped about a new piece of diabetes equipment – my anticipation for this Livongo meter was hiiiiiiiigh.

First Impressions_ My New Livongo Blood Sugar Meter
Here she is – my new Livongo meter which I’ve dubbed Livi. Because what else would you call it?!

So when it arrived, I eagerly checked out all of its features. It is, indeed, a well-designed meter – though a bit heftier than I was expecting. Maybe I’m too used to the lightweight nature of my Verio IQ, but this Livongo meter almost feels like a chunky smartphone. It’s not as big as my OmniPod PDM, but it’s in that neighborhood.

I was more so surprised by the test strips – they looked and felt huge compared to my Verio strips! They reminded me of the test strips I used in the first few years of my diabetes diagnosis.

I admit that I didn’t have the patience to read through the instruction manual, I just jumped right into my first blood sugar check. After all, once you’ve used any one type of meter, it’s pretty easy to figure out how the rest of ’em work: insert a test strip, prick a finger, swipe blood onto the strip, and wait for results.

That’s exactly how this meter works, with one caveat. Once I inserted the test strip into the machine, I got a message that notified me the machine was “checking” the test strip. Uhh…checking for what, exactly? I’m not really sure, but the “check” took about 3 seconds before a soft-pitched beep let me know that I could put my blood onto the test strip.

So I did, but I was mildly bemused by the actual amount of blood the strip needed – it felt like it needed more than my Verio strips. I have no idea if this is truly the case, but there is distinct design difference between the strips beyond the hardiness of the Livongo strips, which are not only at least double the size of Verio strips but also feature a vertical line for the blood sample rather than a horizontal. It’s slightly trickier to get just the right amount of blood onto the strip, and I admit that I’ve wasted 2-3 test strips at a time with the Livongo machine so far because I was unsuccessful in getting enough blood on the strips.

Anyways, once I applied blood to the strip, I noticed that the machine didn’t countdown to my results – it merely informed me it was processing them. My very first check with the Livongo was high, in the 250s, and I was yet again surprised when I received an actual message along with my results.

“Your blood sugar is high. Did you know that exercising after meals can help lower blood sugar?”

(I should note that the meter knew I’d just eaten dinner because once it makes the blood sugar result available, you notify the machine whether or not this result was before/after a meal/snack, and then you let it know how you feel – you can select from a handful of pre-loaded options.)

I was taken aback by the message because, well, of course I knew that my number wasn’t great, and I’ve always known that exercising after meals can help bring blood sugar down. This meter is kind of funny, because as I continue to use it, it populates a bunch of different messages depending on my blood sugar in a given moment. Sometimes I get a “kudos”, other times I get random facts about nutrition like, “did you know that spinach is a great source of potassium?” Maybe if I was a newly diagnosed person with diabetes who didn’t know much about nutrition or ways to improve blood sugar levels, I’d find these tidbits of advice more helpful, but for someone as experienced as me they come across as both funny and judge-y.

Since receiving the meter, I’ve used it to check my blood sugar dozens of times and I’m still formulating my opinion on it in terms of its accuracy, usability, design, and overall appeal. I’ll say this for now: I’m intrigued enough by the meter and its ability to immediately send blood sugar data to a cell phone/computer via Bluetooth. It’s definitely one of the most high-tech blood sugar meters I’ve ever used and the touchscreen does make it kind of fun to play around with.

I plan on making a video to better showcase the actual experience of doing a blood sugar check with the Livongo, and I’ll have a full review available in the coming weeks. Stay tuned!

4 Ways Diabetes Makes it Difficult to Sleep

I’ll never forget the first time I saw my mother’s bio in her high school yearbook: She’d listed “sleep” as one of her favorite past times. I though it was hysterically funny then, and I still do now, but I also think it makes her incredibly relatable. Who doesn’t love catching some z’s?

I may not be unique to others when I say that I love a good night of sleep, but only people with diabetes know the real struggles that we, without functioning pancreases, face virtually every night at bedtime.

Because that’s right, diabetes doesn’t just make life hard for us when we’re awake, it also disrupts our precious slumbers. How dare you, diabetes!

Here’s four ways in which diabetes can make it difficult to sleep:

1 – Beeping and buzzing devices. Nobody actually likes waking up to a blaring alarm clock. Imagine not only having to contend with that, but also the possibility of low and/or high alarms going off at any hour of the night. The shrill alarms built into my Dexcom are very rude awakenings and definitely serve as an extra incentive to do everything possible to try to stay in range overnight, but we all know that diabetes can be unpredictable, so this isn’t always possible.

2 – Rolling over on uncomfortable sites. I toss and turn throughout the night: Usually, I fall asleep on my back, then switch to my side, and roll over on my stomach…multiple times throughout the night. And I never seem to be able to do it without rubbing up on a site. It doesn’t matter where it is – my arms, legs, stomach, or back – any rockin’ and rollin’ I do in my sleep is almost always bound to push my CGM sensor or pod uncomfortably harder into my body, and it can be the reason why I wake up in the middle of the night to make yet another adjustment in how I’m sleeping.

4 Ways Diabetes Makes it Difficult to Sleep
At least my diabetes has zero impact on Clarence’s ability to sleep. Was this another excuse to use my adorable dog as a good photo for this post? I shall neither confirm nor deny.

3 – Waiting for a high to come down. There have been a handful of occasions in the last year of life with diabetes ALONE in which I’ve been so, very tired but too afraid to go to sleep until my blood sugar has come down to a “safe” level. It doesn’t matter if the high was caused by incorrect carb calculations or a site that I’m not sure is working properly – I just want to avoid sleeping knowing that I have a hyperglycemic blood sugar because waking up to one in the morning is bound to start my day off on the wrong foot. And it even resulted in a trip to the ER one time, which I don’t want to experience again.

4 – Waking up to a low. Just like high blood sugar, low blood sugar can also delay and/or interrupt sleep. Whether the low happens just after brushing my teeth and I’m forced to ruin my fresh breath with something sugary (just thinking about the orange juice and mint flavor combination makes me wanna yak) or if it wakes me up from a sound slumber and I proceed down the stairs to eat the entire kitchen because I’ve run out of low supplies on the nightstand next to my bed…you get the picture. It’s downright annoying and honestly I bet that I’ve had at least a couple hundred nights of sleep in my 22+ years of diabetes disrupted to a low.

So you see, as much as a person with diabetes like me enjoys a full night of sleep, I’m always aware of the fact that my diabetes doesn’t sleep…and instead keeps me on toes.

 

From Anxiety to Adrenaline Rushes: How Extreme Emotions Affect My Blood Sugar

You know that feeling you get in the pit of your stomach when you receive bad news? It’s like your heart falls to the floor and your stomach starts swirling from the perceived sensation.

That’s unpleasant enough on its own, but for me, it can also cause blood sugar issues.

The same thing can be said for when I’m on a literal roller coaster (which doesn’t happen often, but when it does, involves extreme coercion from family or friends) – I get that awful swooping sensation on top of some sort of blood sugar impact.

Every leaf speaks bliss to me, fluttering from the autumn tree.
Do you know how difficult it is to find a picture depicting an adrenaline rush that isn’t a cliche shot of a roller coaster or skydiver? Hence…a slew of moody “smiley” faces.

Whether it’s anxiety, adrenaline, fear, or just a rush of unidentifiable feelings, there’s no doubt about it: Extreme emotions tend to make my blood sugar unhappy by causing it to spike.

I’ve always been somewhat aware of this phenomenon, but I started thinking about it more last week when I got some upsetting news. (I’m okay, please don’t start to speculate on what it was…just a personal matter that I don’t care to discuss in greater detail here. Love y’all for understanding and respecting that.)

Actually, it’s kind of interesting to think about how the sequence of events unfolded last Thursday. I received a message that caused me to instantly panic. I was going to learn the context behind the message about a half hour after I got it, so in the interim, I was pacing all around the house and trying to figure out what exactly was going on. My stomach was roiling, my palms were coated in a light sheen of sweat, and my already-unruly hair frizzed out even more….

…and my CGM trend started going up, up, up, ever so slowly but noticeably.

I didn’t do anything to correct my blood sugar – at least, not right away. I waited until after I heard the specific news that had gotten me so worked up to really pay attention to my rising levels. I probably could have made my high blood sugar less severe by running a temporary basal increase right after I initially freaked out, but obviously, I had other things on my mind than my diabetes at that moment in time.

The whole experience was a stark reminder that food and insulin are far from the only things that impact blood sugar levels. Raw human emotion did that to me, and it will do that to me again in the future.

It sucks, but isn’t it also fascinating to think about how diabetes is totally a physical and emotional chronic condition, in every possible way?