Tag: Blood Sugar

Sudden as Lightning

mollyt1d3 Comments

It was as sudden as lightning, when it streaks across the sky just before the rain begins to fall, signs of a storm that that refuses to go unseen or unheard.

“It” being the sweat that began to bead on my forehead, then trickle down fast and furious as I grew more and more aware of a low blood sugar episode.

One moment, I was sitting cool, calm, and collected. I was alert and engaged in the conversation happening around me. And then boom, the sweat started and my concentration on my surroundings ended. Voices grew more distant as I honed in on my outward appearance. Panic struck – could others see how sweaty I was getting? Were they noticing my incessant fidgeting, a coping technique I have when my blood sugar drops and I get paranoid about maintaining an air of everything being just fine? My foot, already jiggling up and down as part of my fidget routine, seemed to pick up the pace as I began to get a grip on the reality that I needed to do something about this low before I further deteroriated.

The door to the room opens. I dart out, walking briskly down the hallway to where my low blood sugar supplies sat waiting for me. I gobble down a pack of fruit snacks as quickly as possible, and then force myself to sit. The sweat’s gotten worse and I worry about it being visible on my clothing. Seconds melt into minutes, somehow, though I pay them little attention as all I can think about is having this low blood sugar episode end, please please please, as soon as possible. I desperately want to escape to a restroom for privacy (and to mop the sweat off my body), but I’m immobilized by the low and also slightly nervous that it’s major enough that I might need help from someone in the vicinity so it’s a terrible idea to isolate myself from others. I push that thought out of my mind – I just need to give the fruit snacks some more time to work, that’s all. Keep it together, you’ve got this, stop freaking out so mu-…

…and just as suddenly as it had struck, the sweat dissipates. My shaky hands steady themselves. I regain an awareness of my environment. I exhale, relief flooding throughout my body as I realize that I’m recovering from the low.

Sudden as lightning, both in how it had struck and then how it had disappeared, leaving hardly any trace that it’d been there at all.

Advertisement

Tingly

mollyt1d1 Comment

I knew something was wrong when my tongue inexplicably began tingling.

It was a sudden, prickly sensation – almost like I had pins and needles on my tongue. (This is a sensation I get in my feet when I’ve had them in a certain position for too long and I need to get the blood flowing properly again. A quick Google search taught me that just about anyone can experience this, so odds are you already know what I’m talking about.) And it lingered for a solid 20 minutes, making my entire mouth feel as though it was simultaneously numb and on fire from the unrelenting feeling.

This is my new(ish) low symptom: tongue tingling.

And I hate it.

It only seems to occur when my blood sugar hits the 50s or 60s, which doesn’t happen too often. But when it does, it hits me so abruptly that it catches me off guard every time. It’s an unpredictable phenomenon – usually, my first sign of a low blood sugar is feeling shaky/sweaty/dizzy. Once I feel those initial signs of a low, I’m pretty good about being quick to do something about it by grabbing something sugary to eat…and when tingly tongue strikes, it can make the entire eating experience unpleasant because it almost feels like I’m having an allergic reaction to my low snack. And it lasts longer than it takes for my Dexcom to pick up on a recovering low blood sugar.

I’ve genuinely been worried that I was having an anaphylactic reaction in addition to a hypoglycemic event, prompting me on more than one occasion to run over to the closest mirror to check and make sure that my mouth and face aren’t swelling up or turning red. Let me tell you, it’s enough to deal with the low blood sugar sensation – feeling like I’m having an allergic reaction on top of that makes a normally easy-to-deal-with low that much, well, suckier, to be blunt about it.

I classify it as only sorta, kinda new because I’ve dealt with something similar in the past. In fact, roughly 4 years ago, I wrote about “a fuzzy towel tongue” feeling that I experienced after a low blood sugar. It’s funny that I wrote about it because I think at the time, I only ever felt that a handful of times, and the symptom seemed to disappear. But now, it’s apparently back with a vengeance, as the tingling feels much worse now than the numbness I’d felt a few years back.

At least I know that I’m not alone. I’ve talked to my fellow T1D mother about this and she’s also experienced it, in addition to the folks I’d interacted with in the context of my original post on the matter. It might not be fun, but there’s (quite literally) strength in numbers.

Sluggish

mollyt1d1 Comment

Pasta for lunch. I knew it was a gamble, but on a snowy Friday afternoon when I had a bowl of leftover spinach-stuffed ravioli in the fridge that was begging to be heated up, I simply couldn’t resist it.

I took a larger-than-usual lunchtime bolus to account for the heavy carbs. Or at least I thought it’d account for the carbs. But I was way off. Roughly 45 minutes after I gobbled up my meal, my blood sugar was beginning to take off – with no sign of a smooth landing in sight.

Not that I noticed. Rather, I found myself feeling…slow. My eyes felt droopy with a gradual drowsiness that I couldn’t fight off. Normally, this would feel quite pleasant, especially if I was about to take a nap. But on a Friday afternoon, when I had some work items to wrap up, it was far from a welcome sensation.

As I sat there, staring blankly at my monitor and pretending I couldn’t hear my buzzing CGM that was trying to alert me to the current state of my blood sugar, I was falling deeper and deeper into a state of utter sluggishness. I craved the warmth emitting from my space heater by my desk, relishing how the heat lulled me into listlessness.

In that moment, I was the human equivalent of a happy little slug, oblivious to the realities around it and going about life at my own passive pace, without a single other care in the world.

A representation of me as a slug in a high blood sugar stupor, complete with pod.

I don’t remember what caused me to snap out of my stupor – perhaps I’d heard my CGM vibrate one too many times, or maybe common sense jolted me into realizing that I had stuff to do and couldn’t afford to be overcome by this sensation. But I did find myself peeking at the number that my Dexcom was reporting to me and being somewhat appalled by my hyperglycemic state, as well as being almost grateful for having a logical explanation for why I’d turned into a slow-moving shell of a person. It’s funny how even after 25 years of diabetes, a high blood sugar can still throw me off my game in such a dramatic way. Luckily, a solid correction bolus, change of scenery from my overly cozy desk in my bedroom to the cooler comfort of my downstairs setup, and a large bottle of water brought me back down to where I needed to be – maybe a bit more slowly than I would’ve liked, but hey, a slug can’t complain about swiftness (or lack thereof).

3 Tips for Going Back to an Office with Diabetes

mollyt1d1 Comment

As anyone who lives with diabetes knows, it’s a condition that dislikes disruptions to a daily routine.

This was one of my main concerns when it came to starting my new job last week. The position is hybrid, meaning that I can work from home and in an office as it suits my needs. The prospect of returning to an office again after more than three years of working remotely positively excited me, but I’d be lying if I said that it also terrified me. I was anxious about my first day back in an office environment (in addition to all the jitters associated with starting a new job), and more than anything, I was worried about how my diabetes would be affected by this change.

This is because I’d settled into a fairly standard routine after all this time working from home. I have a workout regimen, eating schedule, and built-in breaks throughout my day that have greatly benefited my day-to-day blood sugar levels, and I knew that returning to an office setting would prevent me from maintaining these habits.

So that’s why I entered what I’m calling “diabetes hyper-prepare mode” the night before my first day in the office so I could try and think about all the ways my day would differ working in this setting versus my own home. And thus, I came up with these three tips that resulted in a very successful diabetes (and work) day:

Tip #1: Get ready as much as possible the night before. The week that I started my new job, I did my best to recall the routines that had worked well for me when I was regularly working in an office. The first thing that came to mind was the amount of preparation I typically did each weeknight so that I could get out the door as soon as possible in the morning. This included laying out my outfit, making breakfast ahead of time, putting together a lunch, and packing my bag. This extra work the night before really paid off the following morning and meant that I hit the road at exactly the time I had planned to; plus, the food prep worked wonders as I didn’t have to waste brain power in the morning trying to think about what I might eat throughout the day. The food was all set and ready to go, and I knew its carbohydrate contents, which resulted in phenomenal blood sugar levels all morning leading up to lunchtime.

Tip #2: Maintain movement. As it turns out, a 40-minute commute combined with lots of sitting in meetings means that my movement patterns in the office are minimal. I did my best to combat this by getting up a few times throughout the day to explore my new building in 10- or 15-minute intervals. Not only did this give my eyes a break from my dual monitors, but it allowed me to stretch and get familiar with the environment. It also helped to curb my post-lunch upward sloping blood sugar, so it was definitely beneficial to my body and mind to make sure I maintained semi-regular movement during the workday.

Tip #3: Have back-up supplies on hand. When I was packing my bag the night before, I made sure to slip a meter, test strips, and fingerstick device, as well as some fruit snacks, into one of the compartments as I didn’t want to run the risk of something going awry with my CGM or needing a low snack and not having it. Of course, I didn’t experience either scenario in the office that first day, but knowing that I had these items close by went a long way in reassuring me that I was prepared to handle any diabetes scenario that might crop up during the workday. And it turned out to be fodder for reminding me that I should also have an extra pod and insulin in my bag at all times, too – next time, I’ll make sure to bring those items with me so I can have even more diabetes bases covered.

These tips might seem pretty obvious, but I was kind of awestruck by just how weird it felt to be back in an office space after a long hiatus away from one. So I think that following these tips truly did help to ground me so I could stay focused on learning my new job and meeting my colleagues, rather than letting my diabetes take center stage for the day.

What Happened When My Blood Sugar Crashed in the Grocery Store

mollyt1d1 Comment

I knew something was wrong when the walls of the soda and seltzer aisle felt like they were closing in on me, Star Wars-trash-compactor style.

You would think a blood sugar is no sweat (pun intended) in a place where food is so easily accessible, but this experience was far from it.

On a recent trip to the grocery store, I went low. And when I say low, I mean low – I wasn’t just shaky, I was sweating literal bullets and having a hard time seeing straight in front of me.

My boyfriend – thank goodness he was there – knew something was wrong just by looking at me. He suggested that I grab some fruit snacks from my backpack and I heeded, tearing open the small foil packet and tossing the contents back as quickly as I could. I chewed, grimacing as I tasted the strangely saccharine, perfume-y gummies, but I barely cared about the taste. I just wanted to feel better. That’s when my boyfriend placed a hand on my back, noting my clammy state, and escorted me over to the dining area at the front of the store.

“Just stay here, I only have a few things left to grab. Maybe you’ll be feeling better by checkout time,” he said, before asking me if I was okay to be left alone.

I was. I hated that he was seeing my like this, in this vulnerable, sweaty state that seemed impossible in the chilly air of the grocery store. I told him I would sit and wait there for him, fighting the feeling that I was a small child waiting for a parent to finish up some boring adult task. As I nearly collapsed onto a chair, all I wanted to do was shrink so nobody could see me: It seemed as though all sets of eyes in the vicinity were locked on me, the perspiring wonder who looked quite unwell.

I was only on my own for about 5 minutes, but time dragged as I anxiously awaited my boyfriend’s approach to the checkout line. I thought I’d wanted to be alone as I let the fruit snacks kick in, but turns out the opposite was true. I clung to his side as I slowly registered that I felt safer around someone who knew exactly what was wrong with me and how to handle it if things got worse.

As we exited the store and loaded the groceries into the car, I noted that my shakiness was dissipating, as was the beads of sweat on my body. This low episode was over and I was relieved to be on the other side of it. I was also relieved that I didn’t have to go through it alone: turns out lows are a bit more bearable when you have someone else with you to help you through them.

A Weekend of Bagels, Pizza, Ice Cream, and…Good Blood Sugar?

mollyt1d1 Comment

Would you believe me if I told you that last weekend, I ate mostly carbs for 36 hours straight and totally avoided high blood sugars the whole time?

I looooove carbs. Almost as much as Oprah Winfrey loves bread.

It sounds wild, but it’s the truth! I went on my annual weekend getaway with my college besties and it was the loveliest time filled with sunshine, conversation, and tons of delicious food. I can’t remember the last time I ate that much in such a short window of time, but it was all worth it, especially because my blood sugars didn’t pay the price for it for once.

Here’s the breakdown of what I ate:

  • Friday:
    • 2 slices of Mediterranean-style pizza and 3 chicken tenders for dinner, the first official meal of the weekend trip
    • 2 glasses of wine
    • Handfuls of crackers and cheese because who doesn’t love that with wine
  • Saturday
    • 1 blueberry bagel accompanied by 1 fried egg for breakfast
    • Salad and heaping scoop of ice cream for lunch
    • Pita chips for a snack
    • Panko-crusted haddock with jasmine rice and veggies for dinner
    • 2 cans of cider (and maybeeeee a glass or two of bubbly)
  • Sunday
    • 1 everything bagel slathered in goat cheese plus 1 fried egg for breakfast
    • 2 slices of leftover pizza for lunch, which is also when I arrived home from the trip

It definitely wasn’t my healthiest, most balanced weekend of eating, but I’m more than okay with that because it was about enjoying my time with my friends and indulging a little rather than stressing the whole time about bolusing and blood sugars. And you know what, I think that my laidback, let’s-just-savor-this approach is partially the reason why I had such stellar weekend blood sugar levels. That, coupled with extended boluses for most of my meals (you know that pizza and bagels contain alllll the slow-acting carbohydrates), really helped me achieve the relaxing weekend that I wanted.

Now if only I could get away with this on a regular basis – as I write this, my blood sugar is coasting from a peak of 248 back into the low 190s after I dared to consume a bagel at lunch in the middle of my busy workweek. But it’s all good, and maybe just evidence that I should try to remember to live in the moment on weekends of fun like this one and prevent diabetes/blood sugar from taking center stage. Perhaps that’s the key to more stable numbers.

If nothing else, this serves as a reminder to me that even with diabetes, I can still enjoy a sh*t ton of carbs every now and then.

Tricky Timing and the Power of the Pre-Bolus

mollyt1d1 Comment

Pre-bolusing: It’s the term that describes taking insulin before eating food. The “before” part in the definition is key, because the amount of time that “before” is can and will vary among people with diabetes. It depends on a few factors, including the amount and type of insulin being used, the amount and type of food to be consumed, current blood sugar levels, and so forth.

It’s one of those things that’s tricky to nail the timing of, but boy, when it works it’s so worth it.

Pre-bolusing works well, but only when the timing of it is perfect.

I have two examples to complement that belief, one in which pre-bolusing almost lead to a disastrous outcome and the other in which everything turned out ideally. I’ll start with the more chaotic scenario first.

In this situation, my boyfriend and I spent the night in New Hampshire to attend a friends’ wedding and had a pretty late night, which meant we slept in a little later than we had intended the next day…actually, a lot later. We only had about 20 minutes to race around our room, pack up our belongings, and get ourselves looking presentable before we had to check out of the hotel. Luckily, our scrambling paid off and we made it out in time, but sleeping in cost us the opportunity to enjoy a complimentary hotel breakfast. We decided that it made sense to stop for brunch on our drive back home to Massachusetts, so we Googled a diner that was on our route home and stopped there for a meal.

When we got there, the restaurant was pretty crowded, but we were seated and able to place our brunch orders almost immediately – a good sign. I assumed this meant we wouldn’t have to wait more than 20 minutes or so (that feels like a restaurant standard) for our food to be ready, so I went ahead and pre-bolused my mealtime insulin. After all, I’d ordered a hearty omelet that would come with breakfast potatoes and toast, so I wanted to be proactive about avoiding high blood sugar and get my insulin in system sooner rather than later.

Unfortunately for me, our food ended up coming out later rather than sooner. In fact, we waited nearly 45 minutes for our dishes to finally come out. In that period of waiting, I was getting more and more anxious about my decision to pre-bolus with each minute that passed without food in front of me. By the 30-minute mark, I was close to full-on panic. Even though my Dexcom wasn’t indicating that my blood sugar was low (it held out steady the whole time), I was worried that the system delay in reporting my blood sugars would fail to catch a serious low in a timely manner. I told my boyfriend what was going on, and without hesitating he went to his car to grab some packs of honey that he’d stored in his glove compartment in case of emergency. We talked it over, and decided that it was probably best for me to consume at least one pack of honey because we couldn’t possibly know when our food was going to come out, and at this rate, we wanted to play it safe rather than be sorry. That didn’t exactly lessen the sorrow and stupidity that I felt for taking a pre-bolus (even though I couldn’t have possibly known that our food would be so delayed, I still felt badly about the whole thing), but it was what it was. And ultimately, I felt like I paid the price several hours later, when I was dealing with the very same high blood sugars that I’d hoped my pre-bolus would prevent. So much for making the pre-bolus grade that time…

But that doesn’t mean pre-bolusing always fails! This brings me to my other example. My mom and I had a nice lunch together last week. Before we left to go to the restaurant, I noticed my blood sugar was a little high. I decided to give myself a correction dose, plus one extra unit of insulin, because I knew we’d be eating foods that aren’t typical for me to consume at lunchtime that could result in highs later in the day. So again, I was aiming to be proactive and prevent prolonged high blood sugar.

And this time, the strategy worked great! At the restaurant, I stacked that pre-bolus with my actual meal bolus (not always a recommended tactic, but it was useful here) and rounded out my afternoon with a blood sugar in the 120s – a win in my book. Thanks to my pre-bolus, I didn’t experience any pesky blood sugar spikes and still landed in range, which in turn showcases the power of the pre-bolus perfectly.

So just like anything in life with diabetes, when pre-bolusing works, it’s wonderful…but it definitely requires a little finesse to learn exactly when/how/where to use it.

A Rookie Mistake

mollyt1d4 Comments

You’d think that 24 years of living with diabetes would turn anyone into a seasoned veteran of the condition, but even the most experienced people with diabetes slip up and make mistakes every now and then…

Case in point? Me, because I neglected to make sure I had a way of monitoring or checking my blood sugar when exercising…and then experiencing a scary low that I probably could have caught sooner, or maybe even avoided, if I hadn’t been so careless.

This all happened because I inserted a new Dexcom sensor just before taking off for my 3-hour self-defense class. I knew that the sensor’s warm-up period would end and that my continuous blood sugar readings would begin partway through class, so I felt fairly comfortable going without a blood sugar meter as a back-up. After all, my Dexcom sensors almost always start up without any issue, so I was trusting that this one would follow suit.

And that was my biggest mistake: trusting my technology.

Any time I make a rookie diabetes mistake, my palm goes straight to my face in embarassment.

When the warm-up period was complete and the class was taking a quick water break, I decided to check my Dex to see what my first blood sugar readings were. I was surprised (and instantly annoyed) to see that instead of a number, my Dexcom was displaying a request for a blood sugar calibration – just like the old G5s used to ask for upon insertion of a new sensor. I couldn’t understand why this happened, but I knew that pondering the matter wouldn’t make any difference…the only thing that would get my Dexcom running normally again was the finger stick checks, which wouldn’t be possible for me to do until I got home from the class because I was without my meter.

So I had no choice but to rely on nothing but my instincts and sensations in order to get a sense of where my blood sugar was headed for the remainder of the class.

And let me tell you, I can’t remember the last time I felt so vulnerable in terms of my diabetes. I was running on zero information, other than the fact that I typically can feel oncoming low blood sugars and that I tend to feel thirstier when my numbers are on the upswing. It was disconcerting – even more so when a little while later I started to feel shaky and dizzy, like I was starting to go low.

I knew I could either 1) treat what I thought was a low blood sugar and deal with the potential consequences (high blood sugar) when I got home, or 2) take a chance and ignore the low symptoms because I couldn’t confirm whether or not I was actually low. I hate to admit it, but I let a good 15-20 minutes pass before I decided it was better to correct what felt like a low rather than run the risk of passing out in front of the entire class. Turns out that I made the right call to treat my low: I felt much better after I ate some fruit snacks, and my blood sugar when I got home that evening was in the low 80s, indicating that I probably avoided a pretty nasty low in class.

While the whole incident could’ve been easily avoided, it did remind me that I ought to take some of the trust that I have in my technology and distribute it a little more evenly between it and my instincts. I proved to myself that in emergency situations, I don’t need a meter or a CGM to pick up on low blood sugars (though I obviously would prefer to have that equipment at my disposal at all times). Instead, I need to trust my instincts more and procrastinate less when it comes to taking an action – because if I had waited longer than those 15-20 minutes, the situation could’ve escalated and then I would’ve really been kicking myself for leaving my meter at home.

Rookie mistakes suck when they happen, but at least the silver lining is that there’s always a lesson to be learned (or reinforced) when they do.

Stress: The Sneaky Blood Sugar Spiker

mollyt1d1 Comment

Carbohydrates. Insulin intake. Exercise. These are things that most obviously impact blood sugar levels. But things like sleep, time of day, medication interactions, environmental changes, and yes, stress, might be more surprising factors that can wreak havoc on blood sugar in much stealthier ways.

Stress, in particular, is the one that’s been driving me (and my blood sugars) up the wall lately.

Truth be told, I’ve invited most of this stress into my life by committing to one (or seven) too many things this month. My calendar is positively overflowing with meeting invitations, hangouts, classes, and appointments, making the one or two evenings a week that I have to myself feel incredibly precious. Honestly, I kinda knew what I was doing when I flooded my schedule with so much because a significant part of me thrives under pressure and needs to stay busy. This is the same part of me that misses working full-time in an office because it broke up my otherwise fairly mundane routine; ergo, I felt justified in amping up my recent social activity.

Yet, there is another (smaller but still powerful) part of me that wishes I knew when to say “enough is enough”.

This image sums up the month of March perfectly for me: a bit of a time warp.

And now, that smaller part of me is standing with her hands on her hips, looking at the busy bee part of me defiantly, and saying “well, what did you expect?” in regards to the stressed-out feeling I haven’t been able to shake lately, as well as the high blood sugar levels that have been a direct result of that.

I’ve been doing everything I can to combat them – increasing my temp basal rate, lowering my carb intake, staying hydrated, getting daily exercise, and taking (nearly) double mealtime insulin doses at times. Some of these things have worked better than others, but as I sit here and write this post, I’m wondering if taking time to actively destress, in addition to prioritizing sleep, are the missing pieces in the puzzle.

Between jetting off from one thing to the next, I’ve barely had enough time to breathe, let alone practice self-care such as meditation or just…sitting on the couch and just being. And I’ve definitely not been getting as much sleep as I should. My teenage tendency to stay up late has collided with my adult habit of getting up early, which is an unpleasant combination.

So I’m thinking that the best way to evade stress, the sneaky blood sugar spiker, is to tackle it head on by addressing my lack of sleep and self-care. I know that my diabetes, and the rest of my body, will thank me once I take the chance to slow down.

The Daily Drink that My Diabetes Dislikes

mollyt1d2 Comments

I remember my first-ever cup of coffee. I was around 10 years old. I had it at my grandparents’ house, where much of my family was gathered for some sort of holiday or other occasion. Coffee was being served with dessert, and I asked my mother if I could try some – I wanted to know why all the adults in the room were so enamored with the seemingly innocuous brown beverage.

I’d like to say it was love at first sip, but I think it was only after I poured in a hearty amount of cream and 2 or 3 Splenda packets that I felt any affection for coffee. But once I did that? I was a goner. Coffee became a staple for me. I’d get it from Dunkin’ Donuts at the mall whenever I went shopping with friends, pour a cup on the weekends to have at breakfast, and when I was feeling fancy, I’d go to Starbucks and get a couple of pumps of sugar-free syrup to jazz up an otherwise ordinary order.

But whenever I try to add anything like milk, real sugar, syrups, or whipped cream…coffee gets real dicey for me and my diabetes.

Coffee can get real confusing for a person with diabetes.

In other words? I’m at a loss as to how to bolus for things like lattes, mochas, or cappuccinos – let alone any of the crazy, carb-loaded concoctions that you can get at cafes or Starbucks.

As a result of my confusion around coffee drinks and, let’s be real here, my laziness (because I could look up carb counts, but the sugary spike that my blood sugar could experience after having one of these drinks make it not even worth it for me to do research), I tend to drink coffee black. And luckily, I like it that way. But that doesn’t mean that I’m not tempted from time to time – like when the local coffee shop that’s just a half-mile away from my home introduced a winter drink menu with things like an Irish cream latte, eggnog latte, and gingerbread latte on it. I seldom give into the impulse to try those kinds of drinks, but they sounded too good to skip out on.

So rather than have all 3 at once – because I’m not totally reckless like that – I did give the seemingly-lower-carb option a try (the Irish cream latte), while my boyfriend got the eggnog latte. I figured it was the best of both worlds because I could have a fancy drink to myself while also getting to try one of the more sugary options.

And guess what? My blood sugar didn’t spike after I drank it, not even a little bit. I think the secret to my success was being super active all morning long after I got the latte (I was busy running errands and tidying up my home for guests that were coming over later in the day). My insulin intake for the latte, coupled with lots of movement, seemed to prevent any disastrous blood sugars – and I think it also helped that I ordered almond milk in lieu of regular milk to go in the latte. Whatever the actual cause(s), I was just thrilled to learn from this little experiment that I can enjoy specialty coffee drinks after all – probably not all the time, but definitely as an occasional treat, which makes me a happy and well- caffeinated T1D.