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”.

My Pharmacy Mailed Me a Broken Vial of Insulin. Here’s How I Handled It.

As soon as I opened the package, I knew something was wrong.

The contents of said package were five vials of insulin – my regular 90-day supply. On the surface, nothing seemed wrong. They arrived in their usual styrofoam cooler that was taped shut. After removing the tape, I saw four ice packs next to the plastic packaging containing the insulin vials; again, this was all expected.

When I picked up the plastic package and used scissors to cut it open, though, a pungent odor greeted my nose.

A medicinal, harsh, familiar scent…the smell of insulin.

Upon further investigation, I discovered that one of the five cardboard boxes encasing the vials was totally damp to the touch. Gingerly, I opened it from the bottom flap, which was sticking out slightly due to the wetness. That’s when I saw the shattered insulin vial: Somehow, the bottom part of the vial had broken, spilling and wasting all of its contents.

I wish that smell-o-vision was a thing, because OMG…the smell coming from this was STRONG.

I was shocked. In all my years of diabetes, nothing like this had ever happened to me before!

I didn’t really give my next step a second thought: Immediately, I jumped on the phone with Express Scripts, which is the mail order pharmacy that I use for my insulin and some other medications. I spoke with and explained the issue to a customer service representative, who connected me with a technician that promised a replacement vial would be mailed to me at no additional cost to make up for the broken one. I asked if they needed me to send the broken one back to them, but I was reassured that it wouldn’t be necessary because I had called them so they could document the incident.

My issue was resolved, just like that, in fewer than 15 minutes. While it was annoying to have to take time out of my day to figure that out, I’m very happy that I got a replacement quickly and easily. But really, where was quality control on this one?!

Insulin is expensive, as we all know. And to see that a perfectly good vial full of it was rendered useless due to defective packaging was a major punch to the gut, indeed.

But this reminded me of the importance of being proactive whenever I suspect something is wrong with any of my diabetes supplies…when in doubt, do something about it.

It’s Not Always Diabetes’ Fault

“OMG, it sounds like you have super brittle bones. What’s up with that? Is it because of your diabetes?”

I sighed into the phone, grateful that the telehealth professional couldn’t see my annoyed facial expression.

“Oh no, it’s nothing like that. I’m just clumsy!” I tried to keep my tone light and threw in a little laugh for good measure. She went on to say something about how I might want to consider taking calcium and/or vitamin D supplements, but while she went off on her tangent, my mind wandered.

What does bone health have to do with diabetes? And why does it seem like everyone assumes that all of my health issues are directly related to my diabetes?

it's not always diabetes' fault
When it comes to blaming diabetes for other conditions, some people have their heads in the clouds…

Truthfully, it’s a safe assumption – the vast majority of the time, anyways – that my diabetes does have some sort of influence over the rest of my health. Plenty of studies indicate that comorbidity is common with type 1 diabetes (in other words, other conditions are diagnosed alongside the primary condition, in this case, diabetes).

But is my diabetes the cause for my seasonal asthma? Is it the reason I’m allergic to cats and dogs? Did my diabetes create the digestive issues I’ve faced since childhood? I don’t know, maybe. There could be a tenuous connection there.

On the flip-side, is my diabetes responsible for my (almost always) excellent blood pressure? Does it have anything to do with my slight arrhythmia? It’s not as clear-cut in those areas; in fact, I’d be hard-pressed to find a real cause-and-effect relationship when it comes to those things.

So do I blame my diabetes for “brittle bones”? Heck no. I blame my breaks in the last couple of years purely on myself and my tendency to rush around in an uncoordinated manner. And on top of that, based on how quickly I healed from my last break, I expect my recovery to go as well this time around, and I doubt that’d be the case if I genuinely had brittle bones.

This time around, it’s not my diabetes’ fault, that much is clear. And it’s also pretty obvious that I need to exercise a little more patience with health professionals who 1) don’t know me well and 2) are just trying to help me improve my overall health.

It’s a gentle reminder to be a touch more graceful in how I move…and how I respond to innocent queries about my diabetes and other health conditions.

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

 

 

How a Broken Bone Affects my ‘Betes

I still can’t believe that I broke my wrist…again. At least I changed it up a little this time and broke my left one instead!

A broken bone is a broken bone, but my healing experience has been very different compared to last time.

For starters, when I broke my right wrist a couple of years ago, it was in the middle of winter (I slipped and fell on ice in the driveway). I was put into a cast that I wore for 4-6 weeks that felt like 4-6 months because of the challenges I faced. Between attempting to become ambidextrous as I built up strength in my left hand and taking a solo trip to Atlanta, Georgia to film a commercial for Dexcom, I did my best to work around my injury…even though I felt incredibly defeated in the face of the limitations it imposed; specifically, I felt that I couldn’t keep up with the exercise regimen I’d worked so hard to establish. I feared that I’d exacerbate the injury, so I didn’t even try to work around it.

This time around, it’s summer. The break happened after I tripped and fell down some stairs (klutz, much?). I’m wearing a brace for 3-6 weeks instead of a cast: My orthopedist said it’d be much more comfortable versus a cast, which can get seriously stinky and sweaty in the warm weather. And rather than stressing about how I’ll continue to exercise while also allowing myself to heal, I’ve made modifications that have kept my body, broken bone, and ‘betes happy.

How a Broken Bone Affects my 'Betes
Can anyone else spot the lone strand of fur, courtesy of my dog, stuck to my brace?!

I guess I learned from the last broken bone that it’s better to keep moving in some way, shape, or form than dwell too much on the injury itself. In other words, I’ve been trying hard to focus on the things I can still do while I’m wearing a brace as opposed to the things I cannot do. For example, my broken wrist can’t stop me from taking daily walks or, when I’m feeling more ambitious, going for an occasional run. It can’t stop me from making the shift to lower-body-focused workouts or core strengthening routines. I refuse to let this injury be the reason that I get sloppy with my nutrition or workout routines, and it certainly isn’t an excuse to become unmotivated in terms of my diabetes care. If anything, it might just be the reason that I tighten things up and make some much-needed improvements.

They say that when life gives you lemons, make lemonade…so I’m going to try, because a broken wrist won’t stop me from getting something good out of this less-than-ideal situation.

 

 

 

 

Insulin Pumps and X-Rays: What’s the Protocol?

I’m re-upping this post that I initially published on February 5, 2018, because…it’s happened again. I have another broken bone! This time, it’s a chauffeur’s fracture, which is just a fancy way of saying that I have a break along my radius due to falling on my outstretched hand. Fortunately, the X-ray process went much smoother this time around – I actually referred to this blog post so I could remember exactly what I was told about insulin pumps and X-rays! Hopefully, this helps other people who had the same questions as me. 

“You have to remove your insulin pump before we can take your X-rays,” the technician said to me. I stared at him, and responded point-blank, “What? No, I can’t take it off.” I tried to hide the panic in my voice, but it quavered as tears stung my eyes.

“Well, let me check our insulin pump protocol…” his voice trailed off as he left me in the dark room with my right arm held up in the air in an attempt to mitigate the throbbing sensation going up and down my forearm.

Insulin Pumps and X-Rays_ What's the Protocol_
Here you can see an X-ray that shows where the break is (follow the yellow arrow), me looking miserable in the doctor’s office but still rocking my #insulin4all face mask, and my lovely new brace which I get to wear for 3-6 weeks.

When I fell and broke my ulna a couple weeks ago, my insulin pump was one of the last things to cross my mind as I was shuffled from doctor to doctor and one medical facility after the other. All I could concentrate on was the injury – how severe was it? Would I be able to work? Could I keep up my exercise regimen? Was I going to need surgery? My diabetes, for once, was far from my thoughts.

But this instantly changed when I went to get an X-ray. When the technician told me that I’d have to remove my pump, I wanted to shout at him, “No! If I do that, my blood sugar will skyrocket! You can’t expect me to do that!” It was hard to keep calm, and my emotions were already running amok due to the chaos of the morning so far. So even as I tried to fight the tears, a couple escaped and ran down my cheeks. When he came back into the room, the X-ray technician’s expression changed. He looked at me empathetically.

“It’ll be okay. Come on, let’s call your endocrinologist. We’ll see what she has to say and get this all figured out.”

Twenty minutes later, after a series of phone calls and a few accidental hang-ups, we received confirmation that I could, indeed, wear my pump for the X-ray. The nurse practitioner who I spoke with at my endo’s office said that it was safe as long as I wore the protective vest. “It’s really only a problem if you’re going in for an MRI or a CAT scan, because those involve magnets,” he told me.

Once I got off the phone, I ran over to the X-ray technician and explained it to him. He smiled at me and said, “Got it. Let’s get these pictures over with – you’ve already had quite a day so far.”

I nodded and thanked him for his patience. He was right, I was overwhelmed from the events of the day – it wasn’t even noon yet – but in hindsight, I’m glad that the technician didn’t try to fight me when I said I couldn’t remove my pump. His willingness to hear me out was huge. It’s not easy to be your own advocate in a high-stress situation like that. But I’m proud of myself for speaking up and getting the answers we needed. Everything worked out in the end – well, except for that pesky broken-bone bit.

 

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?

The Periodic Problem

I thought about how I was going to write this post many, many times. I so wanted to come up with a cute or clever euphemism for what I’m about to discuss, but really, that old “Ant Flo” cliche is all I could come up with, and that’s so overplayed.

If that didn’t give you a clue as to what this is all about, then look at the title again.

Still nothing?

Okay, this post is about my period.

Yep, the menstrual cycle, that time of the month, the curse…whatever name you want to call it, I’m talking about it today. And if you’re already cringing, chill. I promise there’s no need to, I’m not about to get graphic on you or anything.

Rather, I’m about to write about a reality that many women with diabetes face: The week leading up to a period, or the week that it starts, can be hell. And I’m not just referring to cramps or mood swings.

The Periodic Problem
This picture is actually a pretty accurate cartoon version of me…cacti plants, GameBoy, and pink included.

I’m talking about blood sugars, of course. I’ve thought about how my period and my diabetes interact more and more lately because of an “interesting” (that’s the nice way to put it) pattern that I’ve noticed each week leading up to my period for the last few months, and that’s how insulin essentially becomes as effective as water when I get it pumping through me: That is to say, my insulin intake has nearly doubled the week leading up to my period, and it’s something I never really noticed until recently.

I think I caught onto the trend in April. The week before my period started, I blamed my bad blood sugars and higher insulin intake on the fact that we were only a few weeks into quarantine, so it was natural that my body was having a tough time adjusting.

In May, I wondered whether I was dealing with faulty pods or bolusing incorrectly for my foods.

By the time June rolled around, though, I realized that there was something different at play here.

Last month, I dealt with the issue by raising my temp basal for most of the day – a 95% increase for 6-8 hours through the morning and afternoon – and giving myself 2-3 units more than I normally would at mealtimes. I still didn’t have great numbers, but they were better, and that was all that mattered to me.

But this month? I’m totally confused because this “periodic problem” did the opposite of what I expected it to do…the week before my period, it seemed like I need LESS insulin! It was simultaneously bemusing but exciting. I’ll never necessarily complain about having to take less insulin, or being able to eat an entire blueberry muffin without needing to bolus for it (yes, that really happened), but damn…some consistency here would be nice.

Who knows what my body will decide to do next month. At least I feel a little bit better knowing that there is some sort of pattern going on here that I need to pay attention to, so I’ll continue to monitor so I can try to anticipate what the week before my period will look like for my blood sugars.

Just one more reason why I kind of dread “that time of the month”, but also another justification to eat more chocolate in order to cope with it when it does come ’round.