The Low I Didn’t Feel

Do you ever feel so engrossed in a task that something (like the time) sneaks up on you, and totally disarms you and puts you in panic mode?

That’s sort of what happens when you don’t feel the symptoms of a low blood sugar. Usually, I’m lucky enough to say that I feel my low blood sugar symptoms – shakiness, sweating, dizziness – but unexpectedly, I didn’t feel them during a recent low blood sugar episode. And it nearly knocked me off my feet.

I’d been traveling all day long. I’d taken an Uber from my apartment to the airport, where I waited a couple hours to catch my flight, which was so turbulent that I nearly yakked on the tarmac. When I finally arrived to the airport and lugged my bags up to the hotel room that I was staying at, I was struck by how queasy my stomach still felt and chalked it up to after effects of the turbulence.

I figured my body was just mad at me for skipping dinner. It was already 9 at night and I didn’t really want to go back down to the crowded terminal just to get a mediocre fast-food dinner. That’s when I decided to check my blood sugar: That would determine how necessary food was for me at that point in time.

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The low I didn’t feel.

Just as I was taking my kit out of my bag, my CGM alarmed. According to it, I was low – low enough that I’d be below 55 within the next 20 minutes. “Impossible”, I thought. I feel my low symptoms coming on when I’m 80 mg/dL sometimes, so I was convinced there was something wrong with my CGM. I proceeded with the fingerstick check. The result popped up on my screen: 65. What? How? I could’ve chalked it up to a long travel day, but at that moment in time, I didn’t care about the cause. I only cared about the fact that I didn’t feel it whatsoever.

It was scary and an unpleasant surprise. As I sat down on the hotel bed and crammed M&Ms in my mouth, I felt a little confused about how I got so low (especially since I’d been eyeing my slightly-elevated blood sugar all day). But mostly I felt gratitude for my CGM. Times like these make me feel incredibly privileged to have one. I find its alarms annoying and I don’t love wearing an extra thing on my body, but its functionality makes it totally worth it.

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Managing T1D at Sea

Yo ho, yo ho, a pirate’s life for meeeeee…

I gleefully sang this song multiple times throughout my short Disney cruise getaway earlier this month. I love cruises. I love Disney. I love tropical islands. So I got to combine my love for all three by embarking on a cruise to the Bahamas with my boyfriend that was planned sort of last minute, but desperately needed nonetheless.

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When it comes to diabetes management on a cruise ship, I’m the captain (who does what she can to navigate safely through rough waters).

I’m so glad we went, even if it did involve a helluva ton of preparation time. Because as you’ve probably figured it out by now, traveling with diabetes requires extra work. But traveling with diabetes knowing that you’ll be stranded in the middle of the ocean for part of the time necessitates apocalypse-level planning.

There was a whole list of questions I needed to answer as I packed my bags for the trip. How many pods should I bring with me? How much insulin? How would I keep said insulin cool? What types of snacks should I have on hand? Should I bother bringing Glucagon? What about chargers for all of my devices?

The answer to most of those questions was…just bring more supplies than I think I’ll need. For instance, I brought triple the number of pods than I’d actually go through over the course of a four-night trip. I packed extra snacks – a few unopened boxes of granola bars and a whole bottle of glucose tablets. I don’t even know how many alcohol swabs or spare syringes I brought, that’s how many I crammed in my luggage. And I deemed that two bottles of Humalog, plus Glucagon, would be ample (after all, I’d rather have it all and not need it than need something random and not have it).

I ended up purchasing a cooling case on Amazon that would allegedly keep my insulin cool during the day trips we’d make to the islands. I say “allegedly” because it wound up not being that great (otherwise, I’d add a link here to purchase it). After a day on Disney’s private island, Castaway Cay, in which the cooling case never left the shade of our umbrella, I returned to our state room to discover the contents of the case were a bit warmer than I had expected. Disappointing, but the insulin still seemed safe to use.

In terms of meals and snacks on the boat, there was a plethora of foods to choose from. Oh, and virtual 24/7 access to a soft-serve ice cream machine. Aaaaand a lot of tempting tropical libations. I tried to stick to healthy options and incorporate vegetables or proteins at each meal, and of course I drank plenty of water, but it was vacation and I couldn’t resist a Mickey waffle at breakfast each morning or the occasional mojito-filled coconut. So it’s not totally surprising that on average, I ran a bit higher than I’d normally like for the whole cruise, but I don’t regret it because it’s really hard to judge how much insulin to take or food to consume when the days are jam-packed with physical activities and sun exposure. And I accomplished my goal of avoiding low blood sugars as much as I could, because I absolutely did not want to be stranded on the sand treating a low when I could’ve been swimming in the most gloriously warm turquoise waters with sea creatures.

Even though my diet wasn’t the healthiest, I was able to combat some of those choices with a lot of movement during the cruise. Between strolling the walking track that was on deck three of the ship, bicycling on Castaway Cay, snorkeling/swimming at the beach, and walking ALL OVER both land and ship to get wherever I wanted to go, I clocked some seriously miles on this vacation. Who would’ve thought that being on a boat would lead to so much exercise getting automatically incorporated into my day?

So sure, going on a cruise vacation does add an extra layer of stress to trip preparation. But trust me when I say it’s worth it. I was blissfully happy during the whole cruise and, even though I didn’t need more than half the supplies I brought with me, I enjoyed the peace of mind it resulted in because I’d taken the time to think things through. It just goes to show that diabetes can’t prevent the enjoyment of any type of travel.

3 Things I Learned About T1D From my 10-Hour Road Trip

What do you do when a road trip that’s only supposed to last 7 hours turns into a 10 hour trek?

The answer isn’t cry, or whine, or freak the eff out. The answer is to roll with the punches…because you have no other choice.

At least that’s the way I saw it when my journey from Virginia to Massachusetts dragged out from 9 A.M. to 7 P.M. a couple of Fridays ago.

As someone who loathes driving, I was dreading this trip. But I knew it was important for me to conquer a fear of long-distance driving, as well as bring my car back to Massachusetts for a cutting-it-close car inspection. Plus, driving is much cheaper than flying, and you can’t beat the convenience of loading up your car with as much crap as you need to pack.

So I made myself do it, and besides teaching myself that I can handle a longer road trip, I also learned three interesting things about my diabetes from the many hours I spent in my car:hugging the cactus - a t1d blog.png

1. My diabetes doesn’t like for me to stay idle for so long.

This trip was an excellent reminder of how much my body and my diabetes rely on me to get up and move throughout the day. Throughout the workweek, I tend to get up from my desk chair at least once every hour, if only to stretch my legs. But that frequency of movement must make a difference, because I only visited a rest stop once during the full 10 hour trip. It felt awesome to move around for a few minutes, but I was eager to get back on the road and didn’t walk much while I was at the rest stop. Now, I’m wondering if I should factor that into my next long drive, but the idea of taking too many rest stops and prolonging my travel time is not exactly favorable to me…unless it means that my diabetes is guaranteed to be better behaved.

2. My diabetes is better behaved when I eat regular meals.

I eat a lot throughout the day. Breakfast, lunch, dinner, and at least two snacks are part of my daily meal plan. I typically eat all three meals and two snacks around the same times each day, to boot, so my diabetes depends on that consistency. It’s no wonder that I was dealing with rebelliously high blood sugars for most of my drive home, because I was fueling myself with absolute garbage: chicken nuggets (and only chicken nuggets for lunch), Fritos for a snack, and a granola bar for ANOTHER snack. In hindsight, it would’ve been much easier for me to pack a healthy lunch and maybe an additional, in-case-of-emergency snack, because I could’ve had a low-carb option available to me whenever I was ready for it. Plus, chicken nuggets and Fritos are things that I rarely consume, so of course my blood sugar wasn’t loving them.

3. My diabetes HATES stress.

And my goodness, was I stressed. I hate driving, period, so I doubly hate it when it’s a long distance. And my stress was exacerbated by the fact that I had to transport 60 cupcakes, on ice, back to Massachusetts with me for a bridal shower that I was planning for my cousin. That’s quite a bit to contend with, so it makes sense that my blood sugar shot up within minutes of me hitting the road. Even though I ran temp basals and bolused somewhat aggressively, it didn’t make much of a difference in my levels. And I suppose that I was hesitant to give myself too much insulin while I was behind the wheel, because going low seemed more dangerous and difficult to contend with than going high. Truthfully, though, there’s nothing fun about high or low blood sugar. It doesn’t matter if I’m driving, sleeping, exercising, whatever – anything other than “in-range” is just a pest to me.

So now that I’m aware of these three things, what am I going to do about it? For starters, I’m definitely going to get better about planning my meals for long car trips. I’m also going to try to take it easy a little bit…I put so much pressure on myself (I’m very good at working myself up into hysterics, really). So I might try some mindfulness exercises (e.g., meditating) before the next long drive…because anything I can do to take back control of my diabetes before going on my next one will be worth it.

4 Things That Make Traveling with Diabetes Easier

Throughout June and July, I’m going to be a travel fiend. I’ve got plans to travel by plane at least twice, and by car countless times. My trips will vary in length from just a couple hours to eight or nine hours. My head’s spinning just thinking about it, but I’ve got to get it together enough to think about how I can make traveling with diabetes a little bit easier. Given my past travel experience, I can think of four things that are absolute musts for me to take on any trip…

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Some of my favorite things to have with me when I travel.

4. Packing cubes
I always thought packing cubes were a total gimmick…until I actually started using them. I got a set of four for Christmas and they’ve really turned me into a much more efficient packer. They help me visualize the space that will be taken up in my suitcases, and what’s even better is that one of the cube’s is the perfect size for my diabetes supplies. I can fit 15-20 pods, a handful of CGM sensors, various device chargers, alcohol swabs, IV prep wipes, and more into the compact little cube. It’s so much better and more organized than the lame-o gallon-size Ziploc bag that used to store all my diabetes supplies for a trip.

3. My Myabetic backpack
I don’t know how I ever traveled with a purse as opposed to my Myabetic backpack. I can fit way more things into my backpack than I ever could put into my purse, and I love that there are specific compartments in the backpack for certain diabetes supplies. I know exactly where things I might need during a flight are stored, eliminating that panicky feeling I used to get when I would dig frantically through my purse in order to find my tube of glucose or my PDM.

2. Snacks and water
This is an obvious one. In my opinion, traveling with diabetes shouldn’t even be attempted without a refillable water bottle or at least two emergency-low-blood-sugar snacks. Even though it’s basically diabetes 101, I’m guilty of going places without water or snacks…and I’ve always regretted it. There’s not much worse than being in an unfamiliar place and unsure of where the closest food and water is located, especially when dealing with a blood sugar crisis.

1. My CGM
The most important tool in my travel kit is, without a doubt, my CGM. More specifically, my receiver is key, particularly when I’m traveling by air. I am religious about turning my phone off for the duration of a flight (just a weird paranoia thing, don’t judge me), so my receiver becomes my go-to whenever I want a status update on my blood sugar without taking out my meter and kit. It helps me handle any weird blood sugar spikes and drops that occasionally happen when I travel, and it provides me with a peace of mind that makes traveling with diabetes much more bearable.

 

The Hellacious, Headstrong High

There’s lots of different “kinds” of high blood sugar. There is the type that is self-inflicted due to inaccurate carb counting or insulin dosing. There’s the sort that can be blamed on technological error – an insulin pump failure or a cannula kink, for instance. And another kind is linked to illness, when a cold or other sickness prevents insulin from working efficiently, thereby stopping blood sugars from coming down to normal levels.

And then there’s the type of high blood sugar that simply can’t be explained. It’s high for seemingly no goddamn reason, and it’s the most frustrating high of them all.

That kind of high is also the kind that takes what feels like forever to come down.

I experienced this after a Saturday of travel earlier this month. I’m fairly accustomed to traveling, especially if it’s a quick trip on a plane or just a few short hours in the car. I say this because I’m almost positive that my hours-long high blood sugar had nothing to do with my travel day…although when it comes to diabetes, nothing can truly be ruled out.

Anyways, I digress. That day involved me heading out of the house at 10 A.M. I drove to the shuttle that would take me to the airport. I got to the airport about an hour before my flight was due to take off. I went through TSA Pre-Check – my first time using the service, which I totally recommend – without any issues. I had enough time to pick up some food for a small lunch, but when I checked my CGM and noticed that my blood sugars were hovering in the 200s, I decided to deliberately pick lower-carb snacks to munch on in lieu of a real lunch. Turkey jerkey and cheddar popcorn weren’t the most filling snacks, but it was something.

I figured that by the time I got on the plane, my blood sugars would be stabilizing. No such luck. I was still in the low 200s. I took one or two more boluses during my quick hour-and-a-half long flight, thinking that I must be heading for a blood sugar crash by the time I deplaned. Nope. I was still running high, even by the time I met my partner by the baggage claim. I raised my temp basal and kept my fingers crossed that by the time we reached the restaurant we were bound for, I’d be coasting down. As we got settled at our table, I checked my blood sugar and felt slightly relieved to see that I was 183. At least I was finally below 200.

Teacher's Month 2020

I pushed blood sugar worries out of my mind for the next hour or so. I just wanted to enjoy my meal and my time with my significant other. But as we finished eating and made our back to the car, I couldn’t help but notice the repeated buzzing coming from my CGM. I was rising gradually, well on my way to 300. I tried to not panic and gave myself more insulin. We arrived home and the vicious cycle truly began. For the next three or four hours, I tested and corrected every hour, on the hour. Midway through that interval of time, I changed my pod – perhaps it stopped working properly – and prayed that the new pod would finally bring me back down.

And, spoiler alert: It eventually did. But in the agonizingly long hours I had to wait before my blood sugar was down…I experienced a bevy of emotions. I was mad. I was upset. At one point, I was very technical and rational, going through my next steps both in my head and out loud to my worried partner. He asked me what we should do in the event that my blood sugar was still elevated after a certain length of time, and that’s when I started crying tears of fear and frustration. It all felt so unfair. I was doing all the right things and it wasn’t make a difference. That was a hard reality to swallow. And I couldn’t help but cry harder when he asked me to show him how to use glucagon again (it’s been at least 3 years since he had formal training with my diabetes educator). Part of me felt better, knowing that he was prepared for adverse affects of taking so much insulin to combat a high, but I think I was more focused on and distraught by the fact that he might need to intervene, which was an especially upsetting scenario because I never want to put that responsibility on anyone.

Once I calmed down, I filled a water glass, sat down on the couch, and texted my mother, who is always my T1D sounding board. She reassured me that I was doing the right things, and that I should continue to wait and see what happened. She also advised me that I should be prepared for a crash, because sometimes, it seems like all the insulin kicks in at once when blood sugar drops too quickly/low from a high.

So I waited. I drank water. I showed my boyfriend the app on my phone that simulates glucagon injections – just in case. I played video games. I tried to keep my cool. Before long, it was nearing midnight, and I desperately wanted to curl up in bed. I went through my pre-bed routine, washing my face and brushing my teeth, knowing I’d check my blood sugar for the umpteenth time that night once I was done.

And…it was 153. Better yet, it didn’t go as low as it could have overnight: I dropped to about 75 by 8:30 A.M. All things considered, it was a decent outcome.

The hellacious, headstrong high had finally subsided. I was so, incredibly relieved. And I’m so, incredibly hopeful that I don’t experience a day like that again any time soon.

T1D Plus the TSA Equals Trauma

I had a bit of a traumatizing experience at the airport a few weeks ago.

I travel fairly frequently – I’d estimate that I hop aboard a flight a dozen times or so per year. As a result, I’m well-versed in the TSA routine that goes down at every airport: Remove shoes/belts/items from pockets. Take laptops and electronic devices of similar size out of bags. Place 3-1-1 liquids in a visible spot. Let TSA agents know before stepping into the full-body scanner that I have T1D and wear a couple of devices. Step out of scanner and allow them to do a hand swab. Wait patiently for the results to come back clean, gather belongings, and move on to my gate.

It’s a very precise routine that I’ve come to anticipate and accept, so really, it’s no wonder that it was bad experience when it deviated sharply from the standard format on my last trip.

I was returning home from a long weekend in Washington, D.C. I queued myself up in the TSA line and when I got close enough to an agent, I let her know that I didn’t want to go through the full-body scanner, because I was wearing a medical device that couldn’t handle it. (The manual for my Dexcom G6 advises users to avoid full-body scanners and opt for pat-downs, metal detectors, or wands, as available. I’m a stickler for following the rules, so that’s why I stuck with the manual’s advice). I’ve had the pat-down before, and while I don’t love it, I knew it wouldn’t be intolerable.

As soon as another female agent was free to conduct the pat-down, I was waved over and subjected to the semi-embarrassing “free massage”. Once it was done, my hands were swabbed. If you aren’t familiar with the hand-swab process, it’s a protocol in which the TSA checks passengers’ hands for any traces of explosives. In other words? My swab always comes back clean.

Except this time, it didn’t. The machine dinged. This prompted a couple of TSA agents to consult one another before coming over to me and informing me that I’d have to wait an undisclosed period of time for another, higher-up female agent to come over, conduct a “more-thorough” pat-down, and forfeit my luggage for a closer inspection.

Deep down, I wasn’t worried because I knew that the more meticulous inspections would clear me for travel. But I couldn’t fight back against the anxiety that flooded throughout my body as I wondered how long I’d have to wait and how much more invasive this next pat-down would be. I struggled to conceal the tears that rolled down my cheeks as TSA agents seized my bags and rifled through them, ruining my careful packing techniques. I was humiliated, and practically had to beg them when I asked to see my cell phone and OmniPod PDM. (I could practically feel my blood sugar going up due to the stressful nature of the situation, so I wanted to check and correct it A.S.A.P.) It only got worse as I was pulled into a separate room and given a pat-down in which the agent actually pulled my pants away from my body to look down inside them, which is just as awful as it sounds. I know that they’re merely performing their job – I don’t fault them for that and appreciate that it’s far from glamorous – but it was horribly demeaning.

When I was finally told I could go, I wordlessly collected my belongings, fighting to shove them back into my suitcase. I made a beeline to the restroom to splash water on my face and calm down. As I waited to board my flight, curiosity took hold of me and I posted a poll on Twitter. I wanted to know if anyone else has ever had an experience like mine. Nearly 241 people answered my poll.

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And I was fascinated by the results. There was no overwhelming majority; in fact, it was rather solidly split down the middle, with only a few more people reporting a negative experience with the TSA. Many of those people responded directly to my poll with tweets of their own that described their experiences:

They nearly ripped my son’s inset out of his thigh for his pump one time. Another time they took his bottle of insulin & tested it & I understand explosives come in liquid form but he was 8 years old. Another time they performed a very thorough and humiliating body pat down on me in order for him to bring his insulin on board.

I’ve never had a difficult experience w/TSA on any flights- international or domestic. They’ve all been very professional & understanding when I said I have an insulin pump/all supplies. I’m sorry you had a tough time.

My husband has to take my daughter through because I completely lose my shit on them. Every single time a hand swipe test. Unbelievable and stigmatizing.

Almost every single time and it infuriates me. They treat your supplies like you’re part of the drug cartel. One held up my bag and with so much attitude “excuse me? What is this?” And I said my medicine and another passenger screamed at the agent saying “you can’t do that!”

Same thing happened to me! They tore apart and destroyed so many of my supplies and I just watched helplessly while crying. If 29 million Americans have diabetes why is TSA so oblivious to what it looks like?!!

While these replies validated to me that I wasn’t overreacting, they also made me sad. Angry. Frustrated. Why is this a thing in some airports? Why isn’t there a better protocol in place for people with diabetes?

Perhaps the most irritating part of it all is that I don’t know for sure why this whole thing happened in the first place. I assumed that it was a fluke on the machine’s end, but after corroborating stories with so many other T1Ds, it’s got me wondering…was my diabetes a red flag of sorts to the agents? Did they think that my supplies were disguised and could be something harmful?

Again, I don’t want to discount the work that the TSA does to help keep travelers safe. I truly do appreciate it and I know that experiences vary at airports all across the world. But…we can do better. Traveling should be fun and exciting, not traumatizing.

Diabetes in the Renaissance

Can you imagine having diabetes in the 14th – 17th centuries??? The answer to that is no, you probably cannot…because without modern medicine, it wouldn’t have been possible for a T1D to survive in the Renaissance. And ‘cuz, well y’know, the Black Plague was a thing back then and lots of people didn’t survive.

But fortunately, we’re living in the 21st century, which means we have access to all sorts of things that help us manage diabetes. Still waiting on that cure, though.

Where am I going with all this?

I wanted to recount my recent trip to a Renaissance festival, in which I spent a day taking care of my diabetes while jousting tournaments, Shakespearean performances, and drunken debaucheries took place all around. And you know what? It was easier than I thought it’d be.

Sure, I didn’t check my blood sugar with my meter as much as I should have. My inner germaphobe was reluctant to rely on my meter for accurate results, seeing as there weren’t really any hand-washing stations on the fairgrounds. (Remember, this is the Renaissance…things were a little grimier in those days.) I used hand sanitizer whenever it was available to me to keep my hands clean, but it was a bit of a challenge, especially when my mitts got caked in mud post-ax throwing.

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Enjoying a turkey leg alongside a serving of Chardonnay at the Renaissance Faire – y’know, to keep things classy.

Thankfully, I had my Dexcom G6 to help keep me on track as I ate my way through the fictional 16th century village. I was jazzed that several low-carb options were available to me; throughout the day, I snacked on a giant turkey leg, a Scotch egg, and spiced nuts. Maybe a “diabetes-friendly” diet would’ve been easy to follow in the Renaissance? Though I will admit that I gave in to temptation and ate (devoured) a slice of cheesecake. On a stick. And dipped in chocolate. Not low carb, but super YUM.

So even though my diet was far from nutritious at the ye olde faire, I think that all the walking around and sharp-objects-throwing kept my blood sugar in check, much to my relief. My experience at the fest is just another example of how diabetes won’t prevent me from living life to the fullest, whether it’s in the reality of 2018 or the fantasy of the 16th century.