When Carbs Collide with a Bent Cannula, Chaos Ensues

Sushi. Wine. Not one, but two slices (I swear they were slivers, honest) of cake. A pod with a cannula that got bent out of shape accidentally due to clumsiness.

The above sounds like some sort of weird laundry list, but it’s really just all the factors that contributed to a night of high blood sugars and relative sleeplessness.

Let me explain what happened: The night started out fabulously! I got sushi for dinner from a local spot that I was trying for the first time. I was excited about it because sushi is a rare treat for me, and I figured the occasion warranted some wine – my first glass(es) that I’ve had in about 2 months (I gave it up for Lent).

Those two things right there are definitely a “dangerous” duo that can cause carbohydrate calculation errors or prolonged blood sugars, but I tucked that in the back of my mind because I wasn’t done with indulgences for the evening.

I want to say I regret nothing about this carb-o-licious evening, but…

That’s right, I kept up with the carb-loading by enjoying some cake (white chocolate blueberry cake that I made myself that is just as decadent as it sounds) soon after dinner was done. My problem is that I thought I’d curbed the impact of the carbs by setting a temporary basal increase and stacking a small amount of my insulin, but no such luck. I’d destroyed my second piece (it was just a tiny sliver, people) and noticed that I was creeping up. I took more insulin and soon forgot about my high blood sugar as I immersed myself in episode after episode of Impractical Jokers, which, side note: It’s a series I just discovered and it’s hilarious cringe comedy that is the perfect thing to watch after a long day.

A handful of episodes later, it was time for bed. Or so I thought…because soon after I was settled in bed, I twisted around in just the right – or in this case, wrong – manner that was rough enough to loosen my pod from its allegedly secure location on my back. The smell of insulin was pungent and indicated to me immediately that the pod would have to be ripped off completely and replaced. And the sooner, the better, because my blood sugar was getting closer and closer to 300…definitely not a level I want to see before I go to sleep.

By 12:30 A.M., the new pod was on my arm and a temp basal increase was running to combat my lingering high blood sugar. I also gave myself yet another bolus and crossed my fingers, hoping that the combination would be enough to bring my levels down overnight.

At around 2 A.M., my PDM started beeping to let me know that it’d been about 90 minutes since the new pod was activated, so in response I woke up to silence it and glance at my CGM. My blood sugar barely budged! Frustrated, I gave myself more insulin and fell back into a restless sleep.

Several hours later, my alarm was blaring, far sooner than I wanted it to. I hit the snooze button, also taking care to check out my CGM yet again before I made an attempt at 15 more minutes of sleep. And guess what – I was still high. Quite high. Not 300, but in the mid-200s.

It was official: My blood sugar was punishing me for my night of careless carb consumption and reckless pod-handling. I shouldn’t have been surprised by the resulting chaos, but at least I was able to restore peace again the next morning…eventually.

Luck O’ the Irish Diabetic

Happy St. Patrick’s Day!!!

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

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

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

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

Let me explain.

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

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

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

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

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

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

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

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

The Truth About My Carb Counting

One of the many reasons why I love the diabetes community is that I’m constantly learning new information, finding inspiration, and enjoying support from my fellow friends living with T1D. Sharing our stories with one another leads to us finding that it’s more than diabetes that we have in common.

Here’s an example: My friend, Cherise Shockley, recently wrote an article for DiaTribe in which she made a confession to herself regarding how she counts her carbs. I recommend reading the extremely well-written article to get a full sense of what she discovered, but in short, Cherise recently realized that her carb counting is inaccurate because of the “glass ceiling” for entering carbs into her pump for bolus calculations. In other words, Cherise’s personal maximum of carbs that she was comfortable with dosing for using her pump wasn’t aligning with the actual amount of carbs she was consuming. This excerpt explains part of it:

That was my moment of truth. I told Natalie I ate my favorite chocolate chunk cookie that day. She asked me how many carbs the cookie contained, and I told her 68 grams; she wondered why I only bolused for 55 grams. I paused before I replied – I did not know the answer.

Natalie then asked me if I had a glass ceiling for entering carbs in my pump. She explained that this means even though I know I eat 63 carbs, I will only enter 50 carbs in my pump because anything higher than that concerns me. What she said was interesting; I had never heard anyone describe it to me in that way.

-Cherise Shockley

When I read this, I said, “Yes! Finally, someone is able to articulate exactly how I handle carb counting!”

This is the truth about my carb counting: I have limits when it comes to how many carbs I will bolus for at a time, but those limits do not apply to the actual number of carbs that I consume.

In my 23 years of life with type 1 diabetes, I never knew the meaning behind my carbohydrate glass ceiling.

To explain, I am only comfortable with bolusing for a maximum of 60 grams of carbohydrate at a time. I do not know how I came up with this particular number, but I do know that there are situations (e.g., holiday celebrations) in which I am absolutely consuming more than 60 carbs in a sitting, and yet I only bolus for that amount.

Still confused by what I mean? Read the full article to understand, but this excerpt from it helps to explain why this fear of bolusing for more than 60 carbs at a time exists for me:

To learn more about carbohydrate glass ceilings and why some people have one, I talked to Dr. Korey Hood, a professor of pediatric endocrinology and psychiatry and behavioral sciences at Stanford University who has lived with type 1 diabetes for over 20 years. Dr. Hood told me that all parts of diabetes management can be challenging, and carb counting is particularly tough because it is hard to be accurate and precise. He always recommends people with diabetes meet annually with their diabetes educator (CDCES) to get a refresher on different aspects of diabetes management, including carb counting.

Dr. Hood said that the glass ceiling is most likely due to one of two issues – worries about hypoglycemia or the meaning behind taking such a big dose of insulin. Dr. Hood said that “many of us with diabetes, particularly those on insulin, worry about going low. Why wouldn’t we – it is a terrible feeling! We often experience fears of hypoglycemia because we had a terrible low in the past and have a desperate desire to avoid it in the future. When we worry about hypoglycemia, we scale back our insulin dosing. This prevents the low but also likely results in high glucose levels. So, it really is not a good strategy.” 

-Cherise Shockley

This was a major revelation for me because suddenly I realized what my reasoning is for my carbohydrate glass ceiling: I have a hypoglycemia fear. I have experienced scary episodes in the past (fortunately, none of which have required medical attention). I have friends who have experienced severe hypoglycemic episodes, and when a colleague of mine experienced a low episode that was so bad that I had to call 911 for him, it left a mark on me. So on the occasions that I do eat more than 60 carbs in a sitting, I simply don’t take the amount of insulin that I should to account for those carbs, and I wind up going high, exactly as Dr. Hood describes in the quote above.

When it comes to diabetes, there is no such thing as “perfection”. My blood sugars cannot and will not be perfect 100% of the time. But one thing that I do have control over is doing the absolute best that I can with carb counting and bolusing. It’s time I hold myself more accountable to my carbohydrate glass ceiling…in fact, it’s time for me to smash through it.

A ginormous thank you to Cherise for being so open and honest in this piece and for inspiring me to own my carbs, too.

Why I Refuse to Quit Carbs

This is an original post I wrote that was published on Hugging the Cactus on January 26, 2018. I am republishing it now because there’s been some buzz on the Diabetes Online Community recently about different diets people with diabetes “should” and “shouldn’t” follow…and this sums up my feelings on being told what choices I should make when it comes to my own health!

Recently, a random person on the Internet criticized my choice to incorporate carbohydrates in my daily diet. Thanks for the unnecessary judgment, stranger!!!

I’m not really upset about the comment, though, because it prompted me to reflect on why I consume carbs.

Have a slice!
*Oprah Winfrey voice* I. Love. Bread.

For me, it’s about more than just enjoying (relishing, adoring) the taste of carb-heavy substances both starchy and sweet. Carbs also help me achieve balance in my blood sugars. For instance, I find that consuming a serving of carbohydrates at dinnertime keeps me steady as I move through the evening hours. Say that I’m eating grilled chicken with a side salad for dinner. That’s a good meal by itself, but I like to complement it with a carb like half a cup of mashed potatoes or brown rice. I’ve noticed that the carbs kick in more slowly when they’re consumed with minimal or zero-carb foods, thanks to the power of the glycemic index.

The glycemic index is, in short, a measure of how quickly the carbohydrate content of foods will affect blood sugar levels. Since learning about it in college and subsequently researching the glycemic indices of various foods I eat, it’s been an immensely useful tool in determining the makeup of my meals throughout the day. Knowing the glycemic index of a wide array of foods also helps me figure out the timing of my insulin doses; in turn, preventing crazy spikes or crashes after eating.

I can’t shortchange carbs for the fact that they literally save my butt sometimes, too. When I’m experiencing a low blood sugar, nothing BUT carbs will bring me back up to a normal level. Whether it’s carbohydrates from healthy fruits or straight-up candy, it’s giving my blood sugar the surge it needs to keep me going. Like many things in life, it’s a matter of moderation – making sure I don’t consume TOO many carbs when I’m experiencing a low.

If you’re someone who thrives on low carb, high fat diets, that’s great! I know that many people find this to be a successful method in achieving target blood sugars. But for me, my tried-and-true technique of balancing carbs, fats, and proteins is always going to be my ideal strategy. Just because that’s what works for me doesn’t give anyone a right to criticize me for it. I’m here to live my best life, as we all should try to do. Shouldn’t we encourage one another to thrive, instead of judging?

The answer, if you didn’t realize, is YES.

5 Tips for T1Ds Dining Out

Nothing beats home-cooked meals. But it is nice to go out to eat after a long workweek or to celebrate a special occasion. It’s a good way to unwind and socialize.

And like many other things, it’s also a little bit more complicated when you have type 1 diabetes. Not every T1D might feel the same way as I do, but there are times when I feel worried about going out to eat. Specifically, I start asking myself questions like, “Will there be a decent variety of lower-carb choices on the menu? Have I had this kind of cuisine before, and can I accurately predict how it will impact my blood sugar? Can I order what I actually want to eat without worrying about the carb content? Will the portion sizes be too small or too big? How long will it take for my meal to arrive, and does this mean I can safely pre-bolus for it?” Sadly, those are just a few of the questions that come to mind before some restaurant excursions.

5 tips for t1ds dining out

That’s why I like to remind myself of the following five tips. They’re pretty common sense, but then again, they’re also key for me to enjoy a meal out guilt-free and in a way that works best for my diabetes.

  1. Cut down on carbs, as needed. I’ve learned that one of the best ways to make sure my blood sugars cooperate during a dinner out is to try to reduce my carb intake as much as possible. After all, most restaurants don’t have nutritional information readily available for diners to consult. As a result, it’s impossible to know every single ingredient that could be in a given dish, let alone their carbohydrate content. So that’s why I cut corners where I can. If I’m craving a burger, I order it and ask for it without a bun. I substitute fries or other starchy sides for a salad or seasonal vegetables. If I notice that a pizzeria can make a cauliflower crust instead of a normal one, then I ask for it. I find that using this strategy helps me in just about any kind of restaurant. And if I find myself wanting to order something really high carb (which is rare), then I rely on tip #2.
  2. Ask for a doggy bag. Say I ordered pasta at a restaurant. At most places, there could be upwards of 80 or 90 carbs in that one dish, which is just too much for me to consume in one meal. So I make a plan to eat half of it and bring home the rest. It’s a tried-and-true technique that works for anyone who’s trying to watch what they eat, not just people with diabetes. It’s a win-win because I can still order that carb-y dish, but I don’t have to worry about potentially taking too much or too little insulin to cover it. Fewer carbs in one sitting means less room for error.
  3. Load up on veggies. I incorporate as many vegetables as I can into my meals at restaurants. In addition to subbing sides, I also will focus on eating those if they come with an appetizer. For me, it’s all about filling up on the healthy stuff so I don’t leave the restaurant with too much food guilt.
  4. Share with your table mates. Whether I’m with a large group or just part of a pair, I almost always offer to share appetizers or desserts as a subtle form of portion control for myself. Who doesn’t love splitting an order of nachos or a slice of cheesecake? It’s a great way to start off or end a meal out that involves minimal guilt or blood sugar concerns.
  5. Order drinks with care. I’m very careful when it comes to choosing drinks that have zero carbs, or at least very few carbs. More often than not, I stick with water or unsweetened iced tea with lemon to accompany my meals. But when I choose to drink alcohol at a restaurant, I try to order a glass of wine or lower carb cocktails. I tend to have better luck with those, because I can more accurately predict how they’ll affect my blood sugar, if at all. I do like beer and order it from time to time, but I limit myself to no more than two – any more than that and I push my luck by running the risk of experiencing high blood sugars.

But arguably my most important, unofficial sixth rule is to remember to enjoy myself. There’s no sense in stressing too much about what my blood sugar might or might not do (unless there’s extenuating circumstances, then I totally pay it proper attention). I like to bear in mind that no matter how my blood sugars may react to certain foods, I still have to eat. Why not appreciate every aspect of the experience?

Breakfast or a Plateful of Carbohydrates?

Look at the following image: What do you see? Breakfast, or a plateful of carbohydrates?

4B3EFDB5-F145-49D4-A3D1-7C87C4526847
Breakfast, or a plateful of carbs? Trick question, it’s both.

Trick question, it’s both.

I seldom enjoy large breakfasts like this, but when I’m treated to them, it’s more than just a savory, delicious meal. It’s also a math problem. So besides looking at a plate full of yum, I’m also looking at this:

Screen Shot 2018-02-18 at 10.11.21 AM
Looks like I’m having approximately 60 grams of tasty carbohydrates.

I can’t help it, I HAVE to look at my food this way because it helps me determine how much insulin I have to take. Once I add it up, I take the total amount (60) and divide it by 8, because that’s my morning insulin-to-carb ratio. From there, I take about 7.5 units of insulin to cover my breakfast. Of course, I’m not doing the division by myself – my pump is programmed to know all my mealtime ratios, so the only steps I’m responsible for is adding up my carbs and entering that information into my PDM.

You might think it’s a lot of work, but it’s what I’m used to, along with my fellow T1Ds. It all comes with practice, and before long, calculating carbs becomes part of the normal daily routine.

So this example is both breakfast and a plateful of carbohydrates, but that doesn’t make it any less enjoyable. After all, I’m used to crunching numbers along with my food.