A Nightmare-Induced High Blood Sugar?

I’d never tried competitive eating before, but there I was, tying a bib around my neck and preparing to eat as many pancakes as I could within a certain window of time.

Sounds like a T1D’s nightmare, right? Attempting to bolus for an unknown amount of high-carb food that will be consumed within a matter of minutes…

…well, that’s because it was this T1D’s nightmare!

Yes, I had an actual dream (but I’m calling it a nightmare because of what happened when I woke up) that I was in a pancake-eating competition. So bloody random, weird, and kind of funny. Unfortunately for me, I never found out how I fared in the competition, because just as it was about to begin I woke up to the sounds of my CGM (both my receiver and the app on my phone) buzz-buzz-buzzing.

Blearily, I rolled over in bed to silence both of them…but my eyes opened wide when I saw what was on the screen(s).

284 with an up arrow!

Look at the stars.
The more I think about it, the more it begins to make sense…nightmares COULD definitely cause high BGs. After all, just about anything else can make my BG go up or down!

Immediately, I grabbed my meter so I could confirm that I was, indeed, that high. One finger prick later, I discovered that yes, I WAS that high – just over 300, in fact.

I was absolutely bewildered. It made no sense that I was so high. I’d been 85 just before bed and had a small package of animal crackers (15 total grams of carbohydrates) to ensure stability throughout the night. That was hours before, at around 8 P.M., so they should’ve been through my system by the time I woke up to the high, at 2 A.M. Moreover, my high alarm on my CGM is set to 180, so I’d slept through numerous alarms. That was frustrating, but I’m relieved I did eventually wake up to correct the high…the alternative, staying in a deep sleep and waking up to a sky-high number to start my day, was definitely worse.

I was struggling to make sense of the high but I knew it was more important to treat it and stay awake until I knew I was coming back down. That way, I could rule out my pump as the problem. Sighing, I took my bolus, got up out of bed, grabbed a cold water bottle from the fridge, and trudged back up the stairs to prop myself up and watch some TV to make the next hour or so go by faster.

By 3:30 A.M., I’d watched three full episodes of Sex and the City (thank you, E! Network, for playing that show at such an odd hour) and my blood sugar had tumbled back down approximately 100 points. I felt like it was now safe for me to go back to sleep, so I drifted back off to dreamland…and continued having really weird freakin’ dreams for the rest of the night (one involving me auditioning to be the voice of Moana, the Disney princess, in the movie…I can’t even begin to fathom how or why I dreamt about that).

Days later, I still don’t know how the high happened. But I think I’m closer to a conclusion: It must’ve been all those damn pancakes that I ate in my dr- I mean, nightmare.

How I Handle “Roller Coaster” Blood Sugar Days

“Roller coaster” blood sugar days happen to the best of us. Wild fluctuations from high to low and back again are sometimes just part of life with diabetes, but that doesn’t make them any less frustrating. So how can they be handled without losing your mind?

The answer is simple, and probably a bit unsatisfying: I just take the highs and lows as they happen. Rather than dwelling on the literal big picture of ups and downs that my CGM displays, I decide to treat each instance uniquely and have faith in the fact that everything will stabilize eventually.

How I Handle _Roller Coaster_ Blood Sugar Days
Honestly, give me high and low blood sugars over the twists and turns of a real roller coaster any day of the week.

For example, a recent weekday started off wicked badly for me when I had a low blood sugar at around 4 A.M. I did the thing that you’re not supposed to do and totally over-treated it (whoops), resulting in me having to take insulin to counteract the carbs. Well, I didn’t take quite enough insulin, because I was pretty high still when I woke up again a couple hours later. I took an aggressive bolus for the high and did my morning exercise routine…

…which backfired on me because soon after completing my workout and eating a quick breakfast, I was dropping like crazy. I’m almost certain that most other T1Ds would agree with me when I say that having a low blood sugar right after eating (and taking insulin for said meal) is SO obnoxious. I knew my carbs would kick in eventually, though, so I opted to suspend my insulin and went about getting ready for work…

…only to be sky-high again when I arrived to the office. I took another big bolus, knowingly stacking my insulin but not caring because I just wanted to get my blood sugar down…

…and that absolutely worked like a charm! By lunchtime, I was low again and literally eating frosting out of a Tupperware container (don’t @ me). Usually, I have zero restraint when it comes to sweet things like frosting and I was worried that I’d gone overboard with my spoonfuls of it. But magically, the low/high roller coaster stopped for the rest of the day after that! In fact, I was level between 90 and 110 for THE REST OF THE NIGHT.

I’m not saying it was worth it to deal with the incessant ups and downs all morning and part of the afternoon; rather, I’m trying to point out that I just did what I could in order to get off the roller coaster ride and it paid off  by the day’s end.

Sometimes, with diabetes, it’s more important to focus on blood sugar in the moment rather than stress about what it did or what it’s going to do. That way, I find that I can help treat my diabetes the way it needs me to treat it then and there rather than trying to anticipate what it might do later on. It’s all about perspective and remembering to keep it simple, even if it doesn’t always yield the fastest results.

An Interview with my Diabetes

Diabetes does not have a life, a voice, or a soul. But many people with diabetes, including me, tend to characterize it like it has human emotions and reactions. “My diabetes is so misbehaved today!”, “Ugh, my diabetes hates when my stress levels get too high”, and “Oh, exercise makes my diabetes very happy!” are among the sentiments that have been said countless times, in a variety of ways, by tons of people with diabetes.

Podcast Logo_
It shouldn’t be surprising that my diabetes, personified, is a cactus. 

So I decided to take it a step further with this blog post and imagine myself conversing with my diabetes…actually, it’s more like an interrogation. There are so many questions I’d like to ask my diabetes so I could maybe, hopefully understand it better. And these are the answers that I can see myself getting in reply.

Me: Hi, diabetes. Wow, 22 years with you and we’re finally just getting to talking now. What’s it been like to grow up with me?

My diabetes: WELL, it’s been a TRIP! Time flies when you’re having as much fun as me, wreaking absolute havoc in your life!

Me: Um, that’s kind of rude. But accurate, I suppose. And it leads to my next question: Why are you so temperamental? Like, one day you’ll be swimming straight in between the lines of my CGM graph…and the next day, I do and eat the exact same things as the day before and you go haywire.

My diabetes: Biiiiiitch, that’s just because I like to keep you on your toes. And I CAN go nuts whenever I want, so why the hell not?

Me: Whoa, relax. No need for the name-calling –

My diabetes: I’ll do what I want! See, look! Your blood sugar is going up RIGHT NOW just because you’re getting all flustered over this interview! Hee, hee, isn’t this fun?

Me: Thanks a lot! Whatever, I’ll just take a bolus –

My diabetes: You’re gonna need a whole lot more than that! 1.5 units to take this 250 down? That’s hilarious. So cute of you.

Me: WHY YOU LITTLE – *lunges for “my diabetes” as if it’s a physical object I can take into a chokehold and strangle, Homer Simpson style*

*Record scratching noise*

That, my friends, is where this totally made-up interview would definitely be cut short because I imagine my diabetes as nothing other than the petulant asshole that it seems to be lately. I’m dealing with a lot of stress lately, and my diabetes is punishing me with plenty of high blood sugars and sluggish responses to my fast-acting insulin.

It’s extremely annoying, but I will admit that writing this fictional interview with it was a little cathartic.

One Night with Diabetes

You settle into bed, ready to fall asleep after another long day.

But first, you check your blood sugar, just like you do multiple times every day.

Your glucometer reads 201.

Suddenly,  you’re a little nervous to drift off to dreamland, because you just changed your insulin pod an hour earlier and you’re not quite sure if it’s the reason behind the high blood sugar.

You wonder: Could my blood sugar be high due to a miscalculation with insulin or carbs at dinner? Is it because of my stress levels? Is it because I’m dehydrated, or because I’m starting to get sick, or because my new pod’s site is on scar tissue, or because…?

Before long, you feel incredibly exhausted because you’re cycling through what seems like an endless list of reasons why you might have an elevated blood sugar and it has zapped you mentally.

You feel your eyelids grow heavy, and just before you go to sleep, you give yourself an insulin dose that should bring your blood sugar back down before long.

You experience a broken night of sleep.

One Night with Diabetes
When you read this, put yourself in the shoes of a person with diabetes…and this is just one night with the damn thing.

Since your Dexcom app is programmed to alert you when you’re over your high threshold for an extended period of time, it goes off, practically every hour, from 10 P.M. to 1 A.M.

Every time it happens, you wake up to the sound of your Dexcom alarm blaring in your ear.

You worry about waking up others in the household before you even begin to worry about your blood sugar.

You’re pretty sure it’s not a pod problem, since your blood sugar would probably be higher if that were the culprit, but you’re too damn tired to care about the cause at this time of night.

You bolus, go back to sleep, hear a high alarm, wake up, and repeat until finally your sleep stops getting interrupted by your Dexcom.

You get a few hours of broken rest.

You wake up at 6 A.M. and realize that, after all that, your blood sugar levels are still slightly elevated.

You’re pissed that your Dexcom was off by 40+ points, as confirmed by a fingerstick check.

You take more insulin, and force yourself to get up and out of bed because it’s time to start the day: Your diabetes is waiting for nothing, least of all you.

Just another night of not enough sleep and too much worry, thanks to diabetes.

The Peanut Butter and Chocolate Punishment

loooooove peanut butter (frequent visitors of this blog are very aware of this fact) and chocolate. It’s the perfect combination of salty and sweet. And Reese’s cups of all shapes and sizes are definitely the most delicious snack in the entire world – though I have a special affinity for Reese’s pumpkins for having the ideal chocolate-to-peanut butter ratio.

Despite my unwavering adoration for peanut butter and chocolate, the dynamic duo doesn’t always love me – or my blood sugars – back…especially when I neglect to bolus accordingly.

It was a lazy Sunday afternoon. I’d just woken up from a brief cat nap on the sofa and felt hunger pangs. I checked my CGM and noticed that my blood sugar was going a little low, so I yawned, stretched, and ambled into the kitchen for a snack.

That’s when I remembered I had a tasty treat in the fridge – crunchy peanut butter chocolate squares I’d whipped up the night before to bring to a friend’s apartment. They were made from, obviously, crunchy peanut butter, but also crushed graham crackers, butter, confectioner’s sugar, and a silky, smooth layer of melted dark chocolate. The squares were chock-full of carbs, but cut small enough and on the thin side…so I naively assumed I could eat a couple without doing any real damage to my blood sugar levels.

The Peanut Butter and Chocolate Punishment.png
The crime? The existence of these peanut butter and chocolate squares. The punishment? High blood sugar for unknown length of time. Cruel.

So I dove in, helping myself to some additional crumbs at the bottom of the bag that had broken off from roughly cut squares. After a couple of minutes of totally pigging out, I made myself stop because I could practically feel my blood sugar begin to rise. I even took a couple of units of insulin (not at all calculated, just two off-the-cuff units) to offset any high blood sugar.

Unfortunately, two units wasn’t exactly enough. Within an hour, I saw my blood sugar go from the 80s to somewhere in the 280s. Not at all what I wanted! I began bolusing and stacking my doses like crazy while I fixed dinner and fretted over how long it might take for my blood sugar levels to come back down so I could eat a real meal. By the time dinner was ready, though, I was still high but confident that the insulin on board would do its job. But it took nearly five hours for everything to stabilize, from when I first gave into the peanut butter and chocolate squares to a couple hours after dinner.

Not my finest moment in life with diabetes since everything could’ve been prevented from the beginning. But maybe it goes to show one of the reasons why people start out each new year with the hopes of eating clean and cutting out sweets – junk food tastes so wonderful when it’s being consumed, but the long-term effects are too much of a punishment to make it worth it.

Now, if you’ll excuse me, time to evacuate the apartment of all carb-y confections…

Dealing with Diabetes When You’re the Maid of Honor

No, no, no. Not today diabetes. Dammit.

The morning of my cousin’s wedding, I woke up to a blood sugar of 237 after a night of fighting elevated levels. There was no rhyme or reason for the high blood sugar – I hadn’t eaten a single thing for 16 hours at that point, but I had changed my pod an hour or two before going to bed.

Why You Should Get a Flu Shot (If You Haven't Gotten One Already) (2)
When you’re the MOH and you also happen to have diabetes, you worry about a lot more than just your speech or your makeup.

WTF was wrong? Was the pod’s cannula bent? Was I high due to wedding day jitters? Would the highs persist all day?

These were the thoughts racing through my mind almost as soon as I woke up the morning of my cousin’s wedding.

I didn’t have time to worry about my MOH speech, or whether my hair would turn out the way I wanted to, or even to drink a celebratory mimosa while I got ready with the rest of the bridal party – I was too preoccupied by my elevated blood sugar.

All I could bother to think about was a potential solution before we all walked down the aisle.

Somewhere between applying my eyeshadow and having the 111th bobby pin secured in my hair (yes, it truly took 111 bobby pins to make my intricate braided up-do possible), I remembered “The Incident” from last year. I’d slept through a high blood sugar that, the following morning, refused to come down. As my frustration grew, so did the pain in my belly that lead me to the bathroom, where I came very close to passing out. One ambulance trip and ER visit later, I discovered that my pod’s cannula was bent, leaving me with no doubt that a pod malfunction was responsible for the whole ordeal.

With that memory vividly replaying in my mind, I made the executive decision to change my pod a couple hours before we were due at the wedding venue. And I can’t even begin to explain how happy I am that I listened to my intuition to do so. Upon removing it, I noticed blood at the site – not as bad of a sign as a bent cannula is, but a possible indicator of a problem. By the time we were in the venue’s bridal suite, my blood sugar was sitting pretty at 90 and I was finally able to focus on the beautiful, meaningful afternoon.

Sure, it was a stressful morning and far from an ideal situation, but I am extremely proud of myself for how I handled it. I didn’t panic the way I normally do. I didn’t shed any anxiety tears. I kept the issue pretty well-concealed from the bride, who shouldn’t have to worry about her MOH’s health on her special day. My calm approach paid off, and though it sucked to waste almost two days’ worth of insulin when I disposed the wonky pod, I knew I should pay closer attention to the fact that I did what needed to be done.

And even better was that my diabetes mostly cooperated with me the rest of the day. It didn’t stop me from delivering a fantastic speech with the matron of honor. It didn’t prevent me from enjoying some tasty wedding food, cake and all. It certainly didn’t keep me from tearing up the dance floor with my enthusiastic family. And it didn’t end my night early as I went out with my boyfriend, the newlyweds, and the matron of honor and her husband to a bar to shoot some pool and continue our celebrations.

Turns out that dealing with diabetes when you’re the maid of honor has a lot to do with keeping a cool head and living in the moment, two things that are so important to do in a variety of situations.

My Diabetes Woke Up When September Ended

Apparently my diabetes has a theme song.

“Wake Me Up When September Ends” by Green Day is the song in question.

The entire month of September, I felt like my diabetes was asleep or something: It didn’t respond the way it should have to my regular dosages of insulin. 

It was truly maddening. I did everything I could to get to the bottom of the mystery.

Why You Should Get a Flu Shot (If You Haven't Gotten One Already) (1)
It’s like my diabetes had it penciled in on its own calendar to get its act together starting on October 1st. 

I thought it was rotten insulin. Nope. I thought it was maybe a bad batch of pods. Nah. I thought maybe there was something wrong with me (well, yes, I’m definitely a weirdo but for real, there was nothing out of the ordinary going on).

I thought I was going to go nuts, trying to get to the root of the problem and coming up with potential causes only for each one of them to be shot down.

I was not happy to be taking higher doses of insulin than needed, and I wanted answers. Luckily for me, I had an appointment scheduled with my endocrinologist (my last one with her, for now, I hope) at the end of the month, so you can bet it was a major topic of conversation.

We came up with a plan for me to resume Metformin. I didn’t really want to, and there’s certainly more on my feelings about that to come in a future post, but I was desperate to reduce my daily insulin intake and find some sort of stability in my CGM graphs between meals.

So I started Metformin…again. And the difference was noticeable within days.

My diabetes woke up to the insulin doses I was taking, and I felt such an immense relief that I can’t really even describe.

Oh, and you’re welcome for getting that Green Day song stuck in your head.

 

The Curious Case of Rotten Insulin

I spent half of the month of August high.

NOT THAT KIND OF HIGH.

I’m talking about blood sugar here, people.

And I’m not talking about scary-high levels. I’m just referring to levels that are higher than I’d like – between 160 and 200. And I’d stay stuck right in that range, even after bolusing quite aggressively.

I chalked it up to stress – life has been a little unkind to me this summer. I also blamed it on making less-than-healthy food choices, and questioned whether I needed to seriously start thinking about taking Metformin again (even though I had a shitty experience on it).

In other words, I took the brunt of responsibility for my highs. I was angry with myself for letting my diabetes get out of my control, and was just starting to accept responsibility when it hit me that it might be something other than my body rebelling against me at play here.

As it turns out, I should’ve suspected an outside factor from the beginning. That’s because my insulin had, somehow, gone bad.

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The vial in question…it caused me a boatload of stress.

I’m still very confused about how or why it happened. My insulin had an expiration date that was like, 2 years from now. The contents within the vial were totally clear – discoloration would’ve indicated an issue – and everything about this vial of insulin looked completely fine.

It was, and still is, an utter mystery to me as to how or why the insulin spoiled.

If nothing else, the case of the rotten insulin made me wonder…why hasn’t anyone developed strips that can check the effectiveness of insulin yet?

Can somebody please get on that (and give me partial credit for helping to spark this genius idea)?

French Fries Are (Still) Evil

In Hugging the Cactus’s infancy, I wrote a blog post called French Fries Are Evil. In this post, I came to the conclusion that french fries are evil because they’re fatty, slow-releasing but high carb little jerks.

I’m here today, almost two years after that post, to let you know that these feelings toward french fries have not changed one bit.

Yep, they’re still evil.

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French fries…a.k.a. little sh*ts.

They straight-up tricked me into thinking that I was bound for a night of beautiful blood sugars not too long ago, despite the less-than-healthy decisions I was making regarding food and drink.

Why did I (naively) think that french fries would play nice with my blood sugars?

Well, for starters, I was doing my best to cut carbs the rest of the carbs I’d be consuming for this particular meal, which was a pulled pork sandwich with a side of fries. I ate less than half of the bun and I certainly didn’t finish the heaping portion of fries. But I did eat a lot more than I normally would (and savored every single one), making sure to bolus semi-aggressively for the indulgence.

And I was literally coasting for hours afterward – I didn’t budge above 130 for at least three hours post-meal. I was confused, but elated! Did I finally figure french fries out? Did I master the correct portion of carbs/protein/fat to eat with them? Or maybe my pancreas decided to resuscitate itself for a narrow window of time that particular evening?

I’m gonna go with the latter.

Because a bit after midnight – a witching hour, indeed – that’s when the crazy corrections, and excessive cursing on my part, started. The french fries had made a proper fool of me again, and I couldn’t believe I’d really fallen for their conniving ways again.

Needless to say, I won’t be ordering french fries with my meal again any time soon. Some foods just aren’t worth it when it comes to figuring out how to make them play nice with my diabetes, and french fries don’t quite cut the mustard.

Oh, and YOU’RE WELCOME for the really silly pun.

How I’m Changing My Reaction to High and Low Blood Sugars

I’m doing a total system reboot…of myself.

I want to change how I react to high and low blood sugars.

Why?

Well, I think that it’s about time for me to address my intense fear of low blood sugars, but I also feel that I need to reconsider how I define high blood sugar. I’ve been sick and tired of dealing with constant highs, sprinkled with a few lows, so all of that together has motivated me to come up with a plan.

My plan is two-fold:

Step 1) Change the low and high thresholds on my CGM from 80-180 to 75-160.

Step 2) Pay closer attention to my body’s cues when my blood sugar is low.

how i'm changing my reaction to low and high blood sugars
It won’t be easy to change how I react to low/high blood sugars, but I think it’s necessary.

The first step was extremely easy to follow. I modified the settings on the Dexcom app on my phone so I’m only alerted when my blood sugar goes above 160 and below 75. I’m hearing my Dexcom alarms more often as a result, but I’m also responding to these alarms more frequently, meaning that I spend less time overall above/below my goal blood sugars. It requires a little more work and patience, especially since I experienced a lot of stress and a cold in the weeks since I’ve made the change (stress + sickness = shitty high blood sugars), but I know that it will be worth the effort.

The second step is slightly trickier. I’m the kind of person who starts treating a low blood sugar early – I’m talking as “low” as 90. And that’s not low. Unless I have several units of insulin onboard or I’m about to do a moderate intensity workout, there’s no need for me to eat anything when my blood sugar is 90. But it’s easier said than done, because I actually do start to feel low blood sugar symptoms at 90 (not all the time, but definitely a chunk of it).

So I’m hoping that this is where step one will come in handy. I’ll use my new low threshold on my CGM to reorient my body’s recognition of low blood sugars. I’m also going to work on not panicking when I start to feel low…because I think that’s the real root of my problems. In the last several years, I’ve developed – for no apparent reason – a serious low blood sugar phobia. I do everything I can to avoid them at all costs, and that’s probably contributing to my recurring high blood sugars. And that is definitely not good.

I’m over living my life on a blood sugar roller coaster…so I’m looking forward to smoother sailing with this plan of mine. Updates to come, for sure.