The Inconvenience of Low Blood Sugar

Blood sugar drops (and spikes, for that matter) are never convenient, per se. They often take my attention away from the moment or experience that I’m in, and it just so happens that there are times when it’s a bigger deal than others.

Case in point? The blood sugar plummet I dealt with in the middle of reactive dog class for my pup.

Let me set the scene: It was a warm October evening in New England – perfect weather for walking a dog around the neighborhood. That’s exactly what my classmates and I were doing: We had about a dozen dogs that were only just outnumbered by humans getting walked in repetitive loops. The challenge was to test the dogs for their reactivity and correct them whenever they tugged too hard on their leashes or got too excited by another dog, person, or squirrel that was also out and about.

The training exercise itself wasn’t difficult; in fact, it was nice to watch the sun go down and chat with the other dog owners in the class while I kept my dog by my side. But what made it a challenge was when all that walking in circles finally caught up with me and my blood sugar and I started to feel an oncoming low.

I was stressed about it, because I was feeling the shaky/dizzy symptoms of a low, but was struggling with finding a good time to correct it. After all, it would’ve been kind of weird for me to randomly start gobbling down some fruit snacks in the middle of a conversation with the other dog owners, and I really wasn’t up for explaining diabetes to everyone and taking attention away from the training. I thought I was in the clear when it was my dog’s turn to be walked by another trainer – my hands were free and I totally could’ve eaten something quickly – but I balked at it because again, I found myself engrossed in conversation as I was given pointers for walking Violet.

In hindsight, I probably should’ve excused myself from the training exercise to sit down and eat my fruit snacks, but I simply wasn’t in the mood for dealing with my stupid diabetes at this point in time. This is the one hour per week that I’ve got with my dog that is solely focused on training her, and I wanted to be present in the moment. But I’ve got to acknowledge that I can only take good care of my dog if I take care of myself first, and I neglected to do that as soon as I should’ve in this situation.

Ah, well. It was what it was, and luckily the low happened towards the end of the class so I was able to eat my fruit snacks in the privacy of my car without having to explain myself to anyone. Next time, I’ll be better prepared with a sugary drink (like Gatorade) that will be much easier to consume without explanation while walking my dog.

Diabetes and Room for Error

I have a confession to make: I’m a bit of a perfectionist. I know that perfectionism can be my own worst enemy and hinder me from accomplishing goals, but it’s just the way I am in some situations – particularly, with my own diabetes.

My diabetes perfectionism means that there is very little room for error when it comes to dosing insulin properly for the foods that I eat. Like many people with diabetes, I strive to bolus as accurately as possible to ensure better blood sugar outcomes, but I don’t always succeed at this.

That’s why I try to reduce the amount of possible error by being very specific about the number of carbs I consume at mealtimes. In fact, I have a self-imposed carbohydrate limit of about 60 grams of carbs per meal. I don’t know where this number came from, and I definitely exceed that from time to time, but for some reason I never input a number greater than 60 carbs into my PDM even when I know I’m probably eating more carbohydrates than that.

This is because of my fear of the room for error, and the potential consequence being a severe hypoglycemic event.

Something I learned by writing this post? My inner perfectionist is at war with my comfort with room for error.

In other words, even when I may be exceeding my “comfort carb count”, I know that the room for error grows with the amount of carbs that I consume. More carbohydrates = more insulin = a greater room for error, something that freaks me out and that I attempt to control by only bolusing for what I feel is an agreeable amount. I’ve written about this phenomenon of mine before and my desire to get over it, but as I continue to work through it, I think it can only be done if I change my thinking about the margin of error that I’m willing to tolerate.

This is where it all comes full circle and I begin to understand how perfectionism, the room for error, and my diabetes management all play off one another…which is to say, they don’t fare well together whatsoever. Because my room for error is low, I don’t dose correctly for some meals, which drives my inner perfectionist crazy because it’s at conflict with my inner scaredy-cat who’s afraid to dose the right amount because I don’t want to deal with any negative outcomes. I’m literally in conflict with myself, which is a wild thing to realize as I write this blog post, but it’s the truth and I’m glad I’m uncovering it.

It will absolutely take time, but as I begin to let go of some of my perfectionist tendencies, I’d like to learn how to also usher in a greater comfortability with the room for error. I’m looking forward to exploring this and hope that I can reconcile the two so me and my diabetes can live in better harmony.

Battery Blues…No More?

Earlier this year, I wrote a post about my dissatisfaction with my Omnipod DASH PDM’s battery life. Basically, I was frustrated that the dang thing needed to be recharged practically every day. But what bothered me even more was how suddenly the battery life would seem to drop – it would dip from 100% charged to 40% in the matter of a few short hours, and worse, it would do this totally inconsistently so it was nearly impossible to predict when my PDM would need a sudden charge.

I thought my PDM problem would be solved when I got my new Omnipod 5 PDM; however, it persisted. And that’s what indicated to me that there was some type of user error going on that I needed to get to the bottom of before I resigned myself to having to charge my PDM everyday.

So I called customer support and told them about what I was experiencing, and explained that on paper, I was doing all the right things to preserve battery life: using the dedicated charger, using minimal screen brightness, hitting the power button to shut off the screen when it wasn’t in use…I wanted to know, could they offer me any battery-saving tips?

Little did I know that a simple solution to my battery blues was just one phone call away!

That’s when I was informed that disconnecting my PDM from Wi-Fi would be a good starting place; after all, the Wi-Fi connection only comes in handy when uploading my data via Glooko. I was amazed, but the moment the customer support rep said this, it made total sense. This whole time, I’d been connected to my home’s Wi-Fi for essentially no reason because it has nothing to do with how my insulin is delivered (the system uses Bluetooth for all communications). I only ever entered my Wi-Fi information in the PDM because silly me thought it was needed for effective operation, but nope, turns out the only thing it’s good for (besides uploading data, of course) is sucking the life out of my PDM battery.

As soon as I ended the call with customer support, I turned off my PDM’s Wi-Fi settings and charged it to 100%. Nearly 24 hours later, it’s sitting pretty at 80%, a much better battery life than it was displaying previously. Problem solved, and proof that I definitely have more to learn about how to best utilize all aspects of my Omnipod 5 system!

Constantly Learning

As I approach my 25th diabetes diagnosis anniversary (coming up this Christmas Eve), I marvel over how much I continue to constantly learn about my chronic condition.

You might think that I should be an expert after all this time, but that’s definitely not true. Sure, there are many predictable aspects about diabetes by this stage in the game. I’ve learned how to read my body’s signals. I’ve got a good grip on the mundane parts of diabetes management (e.g., changing my sites, reacting and treating various blood sugar levels, exercising with diabetes without wild blood sugar oscillations, and so forth). I know quite a bit about diabetes technology, even the kinds that I’ve never used before (and I attribute much of this knowledge to my friends and coworkers with diabetes, as well as the fact that I have an inside scoop on a lot of this stuff because I work in the diabetes sector).

But this doesn’t mean I’ve learned all there is to know about diabetes, the terminology that defines it, the research that is being conducted about it, or the innovations that are consistently occurring when it comes to technologies and therapies.

Little “cartoon me” likes to learn best with a book in one hand and coffee in another – hmm, maybe ACTUAL me should adopt this strategy!

A good example of this? I heard the acronym “FNIR” for the first time the other day when I was at work. A clinician was breaking it down as standing for “flat, narrow, and in range”, which is a pattern that can be visible on a CGM device that indicates tight control over blood sugar levels. My mind was kind of blown when I heard this; while the concept itself isn’t revolutionary, I had no idea that doctors had actually defined the phenomenon. This might seem like an insignificant example about learning something new; but on the contrary, it’s major to me because it’s something I hope to achieve on a daily basis (literally) – I just didn’t have the words myself for it. Now that I know it, I’d like to be able to use it during my upcoming endocrinology appointment as a tool to describe to my doctor that I want her help getting an FNIR graph more often.

Constantly learning can be tiresome at times, but it just goes to show that it’s good for me because all roads point down a better understanding of my diabetes – something that I will always want and always shoot for.

Camping: A Metaphor for Diabetes

I was supposed to spend the first weekend of October camping (and merrily attending the local renaissance fair), but Mother Nature had different plans for me and my crew.

The first night went without a hitch – we’d arrived at our campsite early in the evening and had just enough time to set up our tent before darkness fell. By that time, we were able to get a campfire roaring and cook up some dinner that we enjoyed with beer. After plenty of conversation and laughs, everyone settled in their respective tents for the night and we let the sounds of the great outdoors lull us all to sleep.

The next morning was drastically different as the sound that woke me was the furious pounding of rain against our tent roof.

I wasn’t worried, though – surely the rain wouldn’t deter us from going to the fair. Maybe we’d drive there instead of walking there as we originally planned, but no big deal. I’d be gobbling up a giant turkey leg in no time!

Our campsite on night 1, looking deceptively idyllic.

But I was wrong. As I slowly grew more awake and alert, I decided to check the weather forecast as well as fair hours on my phone. The moment I saw that 1) rain was forecasted to fall at a ferocious pace all day long, and 2) the fair had announced on their website that they’d be closed for the day in order to better protect their employees from the remnants of Hurricane Ian that were striking the south shore of my state.

I couldn’t help but laugh. I nudged my partner (who was still somehow slumbering despite the deafening sound of the rain) and told him what was going on. We figured our options were either stick around and make the most of camping in the rain, and try to get to the fair the next day, or cut our losses by packing up and heading home. After a quick consultation with the rest of our group, it was clear that the latter option was more favorable to all.

So instead of frolicking around the fair in my carefully curated garb on Saturday morning, I was donning a giant red poncho as I helped disassemble our campsite in pouring rain. As I did what I could to shield our belongings from getting completely wet, I couldn’t help but think that this camping trip was becoming a bit of a metaphor for diabetes. In life with diabetes, I spend so much time planning for any case scenario to crop up at any time. And yet, diabetes still manages to throw curveballs in my way that require me to adapt quickly. Diabetes doesn’t care about how much preparation I put into something or that it’s an inconvenient time for it to start acting up – that’s just the nature of diabetes, and…well, the nature of this trip (literally and figuratively).

Ultimately, we regrouped from our change in plans by getting everything packed up in just under an hour, then heading over to IHOP to at least have a hot meal in a dry location together before we all left for home. And even though we would’ve preferred to spend our day at the fair, I’ve got to say, pancakes do help make many situations better – including this one.

Hugging the Cactus Turns 5!

Yesterday, October 4, 2022, marked this blog’s fifth birthday.

How wild – five whole years of writing on this blog, connecting with the diabetes community at large, and gaining invaluable insights from fellow people living with diabetes.

Proudly donning my cactus cap and diabetes devices.

It’s a humbling experience. Any time someone tells me that they’ve read my blog, I’m truly honored that they’ve taken the time to check out my little passion project. And when someone visiting this site turns into a neat opportunity, such as appearing on a podcast, I’m beyond thrilled and appreciative that I get to use other media to reach out to our community.

When I think about where I was five years ago, I marvel over how much has changed not just for me, but for the world. We’ve experienced a global pandemic. We’ve undergone times of enormous celebration, as well as those of great contention. It’s kind of an imperfect metaphor for what it’s like to live with diabetes – it’s filled with ups and downs, triumphs and tribulation – and it takes strength, determination, and resilience to get through it all.

My plan today is to quietly celebrate that, as I reflect on my blog’s birthday as well as the true privilege I have to be able to work professionally within the diabetes space. I am proud of Hugging the Cactus. I am proud of the nonprofit I work for, which has recently experienced its own rebirth into The Diabetes Link. I am proud of all the people with diabetes in my life who live courageously and healthily with diabetes.

And I’m proud of myself for my blog’s milestone, as well as my nearly 25 years of life with diabetes.

Imaginary Beeps

While busy at work one afternoon, I was listening to a Spotify playlist (as I often do), when I could’ve sworn I heard my Omnipod beeping to alert me to a failure.

Oh noooo…I thought. I remember sitting in my chair, with my head cocked and music blaring, as I tried to confirm that the beep was indeed emitting from my pod.

I was so certain that my pod was failing that it didn’t even cross my mind (at least initially) that it could’ve been my music playing a little too loudly.

And then I realized…it wasn’t my pod after all. It was the song that I’d been listening to. Roughly 2:45 into the song “Honestly” by Cartel, the music rose to such a crescendo that I could’ve sworn that it was my pod failing, but nope, it was just the pitch of the sound emitting from my speakers.

What a relief! But also a stark reminder that this phenomenon occurs on the regular. I mistake beeps from standard household appliances, alarm clocks, television commercials, and the outside world in general for Omnipod beeps. And I’m struck by it every single time.

The sounds of diabetes, just like diabetes itself, are just something I’ve come to accept – in the many unique forms they appear in.

Pumpkin Spice: A Very Nice Diabetes Treat

This post is adapted from something I wrote and published on Hugging the Cactus on October 1, 2018. I decided to revisit it as a reminder of the many ways pumpkin spice can be enjoyed this time of year that won’t wind up making my blood sugar spike!

Since pumpkin spice manifests itself in many carb-laden treats this time of year, you might be wondering exactly how I can get away with enjoying a mass quantity of the stuff. And no, my method doesn’t involve dosing tons of insulin so I can down endless amounts of pumpkin spice M&Ms, ice cream, Oreos, yogurt, muffins, or any other kind of pumpkin-spicy product you can imagine (including the dearly beloved pumpkin spice latte).

I love a pumpkin spice latte, but I don’t love what it does to my blood sugars…so I find a way to enjoy the flavor that’s carb-free.

It’s much simpler than that – all that I do is make it my mission each year, right around mid-August, to find as many carb-free or low-carb pumpkin spice products as possible, buy them, and revel in them for the following three months. I’ve been a bit behind this year, but I’m stoked to stock up on favorites from the last few years which includes… gum, tea, coffee, butter (yes, pumpkin spice BUTTER), peanut butter (with pumpkin spice literally swirled in it), English muffins…the list can go on and on, and it does, considering that the gamut of pumpkin spice offerings only increases year after year.

I’ve hunted down foods that have both pumpkin spice and a lower carb count, like Halo Top Pumpkin Pie ice cream or FiberOne bars (ugh, they’re so good it’s not fair). I’ve even mixed it up by combining pumpkin spice with some more manageable carbs, such as plain oatmeal. I just can’t get enough, especially since this is a seasonal offering that plays pretty nicely with my diabetes.

The Numbers of My Diabetes

I studied English in college and I’ve built a career around writing and editing; plus, I run this blog…so I’d say it’s a little more than obvious that I am a words person.

What might be less obvious is that I am not a numbers person

And yet, I was bestowed with a diabetes diagnosis early in life, so that’s forced me to become a numbers person.

Very reluctantly.

Numbers…the necessary bane of my existence.

Of course I’ve got a chronic condition that is centered around math – so much damn math. It’s a lot better now, with technology advancements, than it used to be back in the day. I definitely don’t miss having to take a calculator out at mealtimes to add up all my carbohydrates and then dividing that number by my insulin-to-carb ratio.

But still, there’s plenty of subtle calculations that I must perform on a daily basis. These include:

  • Number of hours it’s been since my last bolus
  • Number of days I have left on a CGM sensor or pod
  • Number of units of insulin I should fill my pods with
  • Number of carbs I need to consume to fix a low blood sugar
  • Number of carbs in every meal I consume (yes, I still have to figure this out on my own – I can’t wait ’til technology can do this for me)
  • Number of supplies I have left
  • Number of visits to the doctor each year
  • Number of dollar bills I spend on supplies
  • Number of hours, minutes, and seconds I spare thinking about the next diabetes decision I have to make
  • Number of blog posts I’ve written about diabetes (this happens to be post #706 on this blog alone…wow!)

Those are just some examples of the mathematics behind diabetes. Some are basic numbers and data points, whereas others are based upon true arithmetic or equations. Nonetheless, what they all have in common is that amount of space they take up in my mind, which is to say…it’s a lot.

No wonder I’m not overly fond of anything pertaining to numerals.

High…Why?!

Ugh, high again? Why does this keep happening?!

I mused to myself as my Dexcom vibrated incessantly, alerting me to the state of my blood sugar.

I’ve actually been wondering that very thought (and cursing out loud about it) more often than I’d like in recent weeks.

High blood sugar = the diabetes version of kryptonite, at least for me.

It’s been about 3 weeks since I started the Omnipod 5, and I guess my high hopes for the system to revolutionize my blood sugars came to be a little too literally. The 5 has been a godsend in terms of 1) helping me sleep through the night as I’ve only woken up once this month to correct a low OR high blood sugar and 2) catching lows before they happen or before I have to eat something in order to bring my BG back up.

But what the 5 and I are struggling with is the exact opposite of the latter, and that is catching highs before they happen – and then reacting accordingly. I’ve found that I’m dealing with more rapid and prolonged spikes than I thought I’d be. I’m doing what I can to proactively treat them myself by bolusing when they occur, but for some reason, it seems to take a solid 2-3 hours for my blood sugar to come back down nearly every time.

After consulting with some of my diabetes pals about this, and giving it some further contemplation, I’ve got a 3-step action plan to combat these highs:

  1. Give my Omnipod 5 more time to learn my body’s patterns – I’ve heard across the community that it can take several weeks for this to happen most effectively, so I need to try to be patient and wait for the results to occur.
  2. Continue to correct for highs when they occur, and do so swiftly. One of my colleagues said this helped a lot in the beginning, so I will continue to monitor for highs diligently and not be shy about bolusing for them (as long as I’m not stacking insulin too much).
  3. Pre-bolus, pre-bolus, and pre-bolus some more. I’ve always been a believer in the power of the pre-bolus, especially since I know that Humalog typically takes 60-75 minutes to start working in my body. I’m going to build pre-bolusing into my schedule and try to do it at least 30 minutes before I actually eat each of my meals, and we’ll see where that takes me.

Hopefully, this plan of mine coupled with my automated insulin delivery system will nip these high episodes in the bud before long. I can’t wait for “why, high” to become “smooth sailing” and translate into beautiful, level Dexcom graphs!