Ketones Strips: To Buy or Not To Buy?

I popped into a CVS store on my way home from picking up groceries to pick up something very important…Starburst jellybeans, because naturally, I “needed” them.

When I was in the store, I wandered over to the diabetes aisle, curious to see if browsing the shelves would remind me of any supplies I should pick up.

My eyes fell on a box of ketones testing strips and I paused, pondering whether or not it was worth it to buy them.

Are ketones testing strips a must-have or no-need item for you?

I admit that I scarcely ever check my ketones when my blood sugar is above 250. I know that I should, but a combination of laziness, anxiety, and lack of unexpired strips usually stops me from checking. And when I do have strips on hand that aren’t expired, it seems that I’m only able to use a couple out of the 25+ strip bottle before the whole dang thing expires, which is frustrating. In fact, prior to this CVS trip, I had a vial of ketones strips sitting in my bathroom that expired more than 4 months ago. I hadn’t trashed them yet because I stubbornly hang onto things far longer than I should.

So I stood in that CVS aisle, my hand hovering out in front of me over that box containing the ketones strips. To buy or not to buy? Do I spend the money knowing that I’ll probably only use a few strips? Or do I save the approximately $12 and walk out the store knowing that I don’t have useable strips at home?

Ultimately, I bit the bullet and bought the strips. I know myself well enough to know that I’ll take comfort in knowing that they’re available to me if and when I decide to use them. Besides, $12 is a fairly small ask when it comes to monitoring something as important as this and granting myself peace of mind.

If only we could have a price like that for life-saving insulin…

Luck O’ the Irish Diabetic

Happy St. Patrick’s Day!!!

Last week, it occurred to me that in more than 3 years of running this blog, I’ve never written anything about St. Paddy’s Day here…so I sought out to rectify that immediately; hence, today’s blog post.

I love St. Patrick’s Day. Always have, always will. I celebrate it each year decking myself out in head-to-toe green. I eat a traditional Irish dinner – always prepared by my mother, until this year when I will attempt to cook the meal myself – that consists of corned beef, cabbage, potatoes, carrots, and Irish soda bread. We eat it while listening to Irish music and more often than not, we’ll have a Guinness or an Irish coffee along with the meal. My family’s attended St. Patrick’s Day parades in various locations in years past, though obviously, we didn’t go to any last year and we won’t this year, either. But we’re still proud of our Irish heritage and we made the most of it in 2020, as I know we’ll do today.

My parents’ dog, Clarence, and I certainly made the most of the day last year. I was dressed up like this for all of my work video conference calls, which made my colleagues laugh at a time when we all needed one.

So you know my plans for St. Patrick’s Day, but what does this have to do with my blog that’s about diabetes?

Let me explain.

The common denominator between this holidays, all the others, and my diabetes is…food.

Foods consumed on holidays are often special and laden with carbohydrates. Rather than deprive myself, I like to indulge on holidays, and worry a little less about my topsy-turvy blood sugar levels.

You might be thinking, “But the food you described isn’t even that carb-heavy!” and you’d be right, for the most part. Corned beef, cabbage, carrots…those are all easy to bolus for seeing as the carbohydrate content is negligible.

It’s the combo of potatoes – which normally, I can bolus for without any troubles – and Irish soda bread – hellooooo, carbs – that really screws me up.

You see, the problem is that Irish soda bread is too delicious. It’s a quick bread that has a buttery exterior and a tender, mouthwatering interior that’s densely packed with raisins. It doesn’t sound like much, but my mother’s recipe is sheer perfection and I can’t resist helping myself to a big ol’ slice (and a couple of mini, just-one-more-taste slices) of the stuff every year.

So more often than not, my St. Patrick’s Days end with high blood sugars (which I suppose is better than ending with a trip to the toilet due to excessive…ahem, celebrating).

The Irish soda bread is worth the high blood sugar alone, but this year, I’m hoping for a little luck when I tuck into this festive feast. I’m tired of simultaneously welcoming holidays and high blood sugars…it’s about time that I make more of an effort to have better levels when I’m eating special meals. I know the extra work will make the day and the food that much more enjoyable and special.

With a little luck o’ the Irish (and some aggressive bolusing), this diabetic will finally have a St. Patrick’s Day filled with lots o’ green, Guinness, and great blood sugar levels.

Hello, Highs: Pooled Insulin Under my Pod Leads to Elevated BG

Have you ever tried troubleshooting a problem so much that you start to feel insane, and then like magic, the solution to it becomes clear and you wonder why you hadn’t tried it earlier?

This was the case with me and the mysterious high blood sugars that plagued me for two and a half days.

Based on this image, can you tell what was causing my blood sugar to be stubbornly high?

Once I started noticing a pattern of high blood sugars that got worse every time I ate food, I started doing everything else except changing my pod. I tried taking insulin for double the amount of carbs that I was actually eating, I ran a 95% temp basal increase for 8 out of 24 hours in the day, I cut carbs altogether and ate only 0 carb foods, I skipped meals altogether, and I even tried marching around the house for 15-minute intervals to try to get my insulin pumping through my system faster.

And nothing worked. I was able to get my blood sugar no lower than 180, but for most of that 60-hour window of time, I spent a good chunk of it in the mid-to-upper 200s.

Finally, on the day that my pod was due for a change, I decided that it must be the culprit behind my high blood sugars. When I removed the old pod, I knew immediately that something was wrong because the smell of insulin was so strong; plus, there was a large, damp spot on the pod’s adhesive, indicating that perhaps my insulin was pooling under my pod instead of entering my body.

It took 5-6 hours after I removed the leaky pod, but I finally did start to come back down to my normal levels, and was totally back on track the next day. It was a frustrating experience to endure, but a stark reminder of something that I’ve known in the back of my mind for years: that when I’m in doubt, I should change my pod.

How I Make Time Fly By When Waiting for High Blood Sugar to Come Down

I can’t be the only one who feels that it takes five-ever (which is even longer than FORever) for high blood sugar to come back down to normal levels.

I don’t use any super-fast-acting insulin (such as Afrezza or Fiasp), so typically, I have to wait about an hour for my good ole Humalog to kick in. And an hour can feel agonizingly long when it comes to diabetes.

Fortunately, I’ve used different tips and tricks over the years to help make that hour fly by:

  • Blast some music and dance around in place. You might feel dorky when doing this, but I honestly swear by it – not only is it fun, but it can also help my blood sugar come down faster because yes, dancing around is still exercise!
  • Sip water over the course of the hour. I challenge myself to drink at least one full water bottle (I’m talking my 25 ounce reusable water bottle, here) in this hour of time. It’s my opportunity to rehydrate myself, and it’s also a good way to flush out the system when trying to bring a high blood sugar back down.
  • Watch episodes of “comfort” television. I know that I can watch exactly one episode of The Boys, two episodes of Sex and the City, or three episodes of Community (yes my taste in TV is eclectic) and allow myself to get totally immersed in the shows as opposed to stressing about my blood sugar. I call these shows “comfort” TV because I’ve seen all the episodes before, but I enjoy them still and I know how much of them I need to watch in order to stay distracted.
  • Read a magazine or a few book chapters. I’m kind of a hoarder and I save old magazines that I’ve purchased at airports over the years…but my magazine stash comes in handy when I need an hour of time to go by faster because I can pretty much read one cover to cover (depending on how big it is, of course) while I wait for my blood sugar to come down. Or I can turn to my book collection, select a piece of “comfort” literature (like the comfort TV described above), and get lost in the words for awhile.
I could stare at a clock and/or my CGM when my blood sugar is high and wait *patiently* for it to come back down…or I could make time go by a lot faster by keeping myself occupied.
  • Get into an arts and crafts project (or anything that requires focus). For me, this is knitting. Depending on the knitting project, it can take anywhere from a day to weeks to complete something. So if I need to wait for a high to come back down, I can focus on making knitting progress as opposed to what my blood sugar’s doing for an hour – and honestly, I sometimes get so into my work that I don’t stop for a few hours. Time goes by quickly when knitting!
  • Make it impossible to keep checking the CGM app. Sure, I could torture myself by checking my app literally every 5 minutes for updates, but that’s one guaranteed way to drive myself crazy for a full hour (or longer, because there’s a 15-minute delay with my CGM). So I force myself not to check it by putting my phone in a different room, silencing it, or turning it off altogether. Removing the temptation to check my blood sugar is majorly helpful when waiting for it to drop down because I’m not constantly stressing over how long it’s taking for the insulin to start working.

It might seem kind of ridiculous that I rely on these strategies to make time go by faster when I have a high blood sugar, but they work – and feel a heck of a lot better to do than anxiously staring at my CGM for a full hour!

4 Tips on How to Handle Hunger Pangs and High Blood Sugar

One of my Instagram followers recently reached out to me and asked for some advice.

…can you make a blog post about how to reduce temptation when blood sugars are high. Whenever my blood sugars are low, I [don’t] really want to eat but of course I have to but for some reason when they are high, I’m soooo hungry and I’m just tempted to eat tons of carbs! Help!!

I liked this comment for several reasons. One, this person told me it was tough for her to ask me about this in such a public forum, so I applaud her for stepping out of her comfort zone. Two, it’s an excellent blog topic suggestion. Three, I can absolutely relate to feeling hungrier than normal when my blood sugar is high. And four, I’m sure others can, too!

Pizza is great (for obvious reasons) but maybe a little less so when blood sugar is high…

I’ve always kind of assumed that I get hungry when my blood sugar is high because at that moment in time, food is practically forbidden…so it becomes incredibly appealing, even though it’s not always advisable to eat with a high blood sugar (because depending on what food it is, it could make high blood sugar go up even more).

So thanks to this comment on my IG profile, I started thinking about the ways I fight off hunger pangs when my blood sugar is high and came up with these 4 tried-and-true tricks I’ve learned over the years:

#1: Make a smorgasbord of low carb snacks. My mom will appreciate my use of the word “smorgasbord” in this tip because that’s exactly what she used to call the plate of snacks she’d fix for me when my blood sugar was high throughout my childhood. She’d assemble an array of low carb goodies – cheese, pepperoni, olives, nuts, pickles – that would satisfy my hunger without raising my blood sugar even further. As a child, I felt special because I was virtually getting my very own charcuterie board (just minus the crackers) and that made high blood sugars much more bearable.

#2: Drink plenty of water (or other low/no carb beverage). I’ve heard medical professionals, nutritionists, fitness experts, and the like say time and time again that one reason we might feel hungry at a given moment in time is because our bodies are trying to tell us that we’re actually thirsty, not hungry. So it makes a lot of sense to stay super hydrated when dealing with a high blood sugar because it can stave off hunger as well as help flush out our systems.

#3: Seek distractions. I write more about this in an upcoming blog post, but when my blood sugar is high, it’s important for me to not dwell on it too much because it seems like it takes it that much longer to come back down. So I distract myself in every possible way: I find an activity to do, TV to watch, a family member or friend to talk to…this helps me forget about the high as well as any cravings for food that may come along with it.

#4: Remember…this too shall pass! Again, I gotta give my mom some credit for this one because she says this motto to me all the time. When I’m feeling extra hungry and experiencing a high blood sugar, I just try to remind myself that both the high and the desire to snack are fleeting. Sure, they’re not fun to deal with at the same time, but knowing that they’re only temporary makes everything easier.

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”.

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?

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.