The Curious Case of Rotten Insulin

I spent half of the month of August high.

NOT THAT KIND OF HIGH.

I’m talking about blood sugar here, people.

And I’m not talking about scary-high levels. I’m just referring to levels that are higher than I’d like – between 160 and 200. And I’d stay stuck right in that range, even after bolusing quite aggressively.

I chalked it up to stress – life has been a little unkind to me this summer. I also blamed it on making less-than-healthy food choices, and questioned whether I needed to seriously start thinking about taking Metformin again (even though I had a shitty experience on it).

In other words, I took the brunt of responsibility for my highs. I was angry with myself for letting my diabetes get out of my control, and was just starting to accept responsibility when it hit me that it might be something other than my body rebelling against me at play here.

As it turns out, I should’ve suspected an outside factor from the beginning. That’s because my insulin had, somehow, gone bad.

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The vial in question…it caused me a boatload of stress.

I’m still very confused about how or why it happened. My insulin had an expiration date that was like, 2 years from now. The contents within the vial were totally clear – discoloration would’ve indicated an issue – and everything about this vial of insulin looked completely fine.

It was, and still is, an utter mystery to me as to how or why the insulin spoiled.

If nothing else, the case of the rotten insulin made me wonder…why hasn’t anyone developed strips that can check the effectiveness of insulin yet?

Can somebody please get on that (and give me partial credit for helping to spark this genius idea)?

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How I’m Changing My Reaction to High and Low Blood Sugars

I’m doing a total system reboot…of myself.

I want to change how I react to high and low blood sugars.

Why?

Well, I think that it’s about time for me to address my intense fear of low blood sugars, but I also feel that I need to reconsider how I define high blood sugar. I’ve been sick and tired of dealing with constant highs, sprinkled with a few lows, so all of that together has motivated me to come up with a plan.

My plan is two-fold:

Step 1) Change the low and high thresholds on my CGM from 80-180 to 75-160.

Step 2) Pay closer attention to my body’s cues when my blood sugar is low.

how i'm changing my reaction to low and high blood sugars
It won’t be easy to change how I react to low/high blood sugars, but I think it’s necessary.

The first step was extremely easy to follow. I modified the settings on the Dexcom app on my phone so I’m only alerted when my blood sugar goes above 160 and below 75. I’m hearing my Dexcom alarms more often as a result, but I’m also responding to these alarms more frequently, meaning that I spend less time overall above/below my goal blood sugars. It requires a little more work and patience, especially since I experienced a lot of stress and a cold in the weeks since I’ve made the change (stress + sickness = shitty high blood sugars), but I know that it will be worth the effort.

The second step is slightly trickier. I’m the kind of person who starts treating a low blood sugar early – I’m talking as “low” as 90. And that’s not low. Unless I have several units of insulin onboard or I’m about to do a moderate intensity workout, there’s no need for me to eat anything when my blood sugar is 90. But it’s easier said than done, because I actually do start to feel low blood sugar symptoms at 90 (not all the time, but definitely a chunk of it).

So I’m hoping that this is where step one will come in handy. I’ll use my new low threshold on my CGM to reorient my body’s recognition of low blood sugars. I’m also going to work on not panicking when I start to feel low…because I think that’s the real root of my problems. In the last several years, I’ve developed – for no apparent reason – a serious low blood sugar phobia. I do everything I can to avoid them at all costs, and that’s probably contributing to my recurring high blood sugars. And that is definitely not good.

I’m over living my life on a blood sugar roller coaster…so I’m looking forward to smoother sailing with this plan of mine. Updates to come, for sure.

 

 

Stress: The Root of my Diabetes Problems

My summer hasn’t gone as I imagined it would.

I’ve had a lot of unexpected shit to deal with. I prefer not to get into details, because too much of my time and thoughts have been preoccupied by aforementioned shit. In the grand scheme of things, though, I have enough common sense to acknowledge that the shit I’ve dealt with isn’t too terrible…I’ll be able to learn and grow from it, ultimately.

In fact, I’ve already started taking in a lesson it’s taught me about diabetes and stress.

Before all this stuff started happening, I knew that stress could affect blood sugar levels. But I guess I never gave much thought as to how long or how dramatically it could affect blood sugar levels.

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This image of Dwight Schrute basically sums up how I feel lately.

Unfortunately, I found out firsthand how much havoc stress can wreak on blood sugars. I received some stressful news one Monday afternoon and had to combat high blood sugars between then and dinnertime. Into the evening, I was munching on a bunch of different snacks – I tend to stress eat – so I chalked up the resulting high blood sugars to my lack of restraint.

When the high blood sugars continued for three straight days, though, I knew something was wrong. I’d eat meals that I’d had plenty of times before, and contend with elevated blood sugars for hours after. I’d give myself bolus after bolus, sometimes even stacking insulin, and my blood sugar would barely budge. It was maddening, seeing my levels hover stubbornly in the 190-240 mg/dL range. It was only when I started bolusing very aggressively for food and increasing my temp basal that I finally got a reprieve from high blood sugars.

This whole ordeal has taught me that I’ve grossly underestimated stress when it comes to its impact on diabetes management and blood sugar levels. Not only does stress drive my blood sugar levels up, but it also makes it that much harder for me to confidently manage my diabetes, overall. It’s very sneaky in how it attacks blood sugar and, frustratingly, there’s never any surefire way of telling when my diabetes will calm down again when I’m undergoing a stressful situation.

Maybe this is a sign that I’ve got to find a better way to cope with stress. Meditation, yoga, exercise, more self-care…I’ve definitely been slacking on all of that lately. Just like I won’t be underrating how stress affects my diabetes any time soon, I’ll also remember to take into account how beneficial it is to just…relax.

 

 

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.

A Tough Week

It’s like you’re always stuck in second geeeear

When it hasn’t been your day, your week, your month, or even your yeeeeear!

*Ahem* Oh! Pardon me, I was just singing that line from the Friends (yes, the TV show, of course) opening credits theme song. It describes how I’ve been feeling lately – maybe not for a full year, but most certainly this week.

It all started with high blood sugars. Not just any kind of high blood sugars, but the inexplicable sort of numbers that were happening for no apparent reason. Running temp basals, bolusing, stacking, drinking tons of water, testing for ketones, increasing activity levels, and reducing food intake were all steps that I took in order to combat the highs. But still, it seemed like every time I put food into my mouth, my blood sugar would jump up way too high, even though I was aggressively administering insulin to cover it. I was taking almost double what I should’ve needed to take, with less than stellar results.

I was dumbfounded. And angry. And incredibly stressed over it.

Ah, stress…the possible culprit?

I’m still not sure, but it seems to be the likeliest possibility. I’ve been running around like a mad woman since I returned to Massachusetts for a two-week visit. I’ve been busy planning my cousin’s bridal shower, meeting up with family and friends, going into work at the office Monday-Friday, contending with other health issues (scratched corneas…don’t ask), and calling various companies for health-insurance-related issues. I’ve had little time for myself, so it really isn’t a wonder that stress could be to blame for my hyperglycemic patterns.

That, and my tendency to forget that haste makes waste. Let me present to you the following photo:

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Yep, that’s little old me at my work cubicle, pointing out my barely-hanging-on pod. In my hurry to get to work and start my day, I had removed my tote bag from its spot on my shoulder in a rush. The force from the movement peeled half of my pod up and off my arm, leaving the cannula (mercifully) still stuck under my skin. I was furious at myself because the pod was less than a day old, and I couldn’t bear the idea of tossing it with more than 100 units of precious insulin left inside it. So I did what I could to cobble it back onto the site on my arm with copious amounts of medical tape, cursing myself for being so careless and exacerbating my stress levels.

There’s a lot more I could say and explain when it comes to the level of tough this week has been, but I think it’s time to move on. Life with diabetes means good weeks and bad weeks. The good weeks are to be celebrated, whereas the bad weeks ought to be acknowledged for how physically and emotionally challenging they are, but also for the lessons to be learned from them.

With that said…

It’s been a tough week, but a new one’s right around the corner and I’m determined to make it a good one.

Brunching with ‘Betes

Confession: I’m a brunch lovin’ millennial who also really hates brunch.

The reason I hate brunch (besides waiting all morning long to eat my first meal, I get hangry) is that it annihilates my blood sugars.

Breakfast Alley
It’s not uncommon for me to spend several hours after brunch trying to correct a high blood sugar.

It probably has a lot to do with the aforementioned fact that the timing of a typical brunch is typically not favorable when it comes to my basal rates and insulin-to-carb ratios. On a normal weekday, I’m used to eating breakfast within an hour of waking up. My body and my blood sugars are very much so accustomed to this pattern, so when it’s interrupted, it shouldn’t be any wonder why they don’t respond well.

It’s not that I don’t try. I do everything I can to offset the lateness of a brunch meal by running a temp basal and ordering as low carb as I can. And it seems to work well, up until I get up to leave the table and head home. Often, I find myself correcting two or maybe even three times after brunch, and it’s extremely annoying.

Maybe I could help curb spiking blood sugar by ordering just one mimosa, as opposed to two or even three (or just skip drinking them altogether, but seriously, I’ve had enough mimosas in my life to know how to properly bolus for them). Maybe I could insist to my friends that brunch plans should be earlier and force all of us to wake up early on a weekend morning. Maybe I could skip brunch plans altogether.

But that would be accepting defeat. Just like I refuse to let diabetes ruin any aspect of my life, I won’t let it stop me from enjoying brunch with whomever I please. I’ll figure out how to avoid post-brunch highs, I just know it. It’ll just take a little more time and patience…and several more brunch outings. Yum.

8 Things I Hate About High Blood Sugar

High blood sugar, high bg, hypergycemia, sky high…whatever you want to call high blood sugar, it doesn’t change how I feel about it. I hate it. My loathing of high blood sugar is probably not unique among other T1Ds – I’m sure most would agree that it’s the worst – but on a recent and particularly bad day of high blood sugars, I started thinking about why I hate being high so much and it turned into this blog post…which turned into a very cathartic thing for me to write.

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What do you hate about high blood sugar?

What are the eight things that I hate about high blood sugar? Here they are, from least to most detestable:

8. It makes me thirsty.
This reference may be lost on some of my readers, but to those who get it, it’ll be wildly funny (or at least it will be in my mind): *Parched Spongebob Squarepants voice* “Waaaaaaaaater! I neeeeeeeeed it!” When my blood sugar is high, I basically turn into that shriveled-up version of Spongebob that appeared in the episode in which he visits Sandy the squirrel’s treedome for the first time. He doesn’t realize that, being a mammal, Sandy doesn’t depend on water like he does to be able to live/breathe. Hence, he struggles throughout the episode to stay hydrated. I bet that if he were dealing with a high blood sugar at the same time, his desperation for water would become much more dire…because let me tell you, I simply cannot drink enough of it when my blood sugar is above 200. This results in many trips to the bathroom, and as I’m sure you can imagine, it’s pretty annoying.

7. It turns me into a major grump.
Nothing kills a good mood quite as swiftly as high blood sugar…I don’t like admitting it, but I tend to snap at people when my blood sugar’s elevated. So really, it’s a lose-lose situation for everyone.

6. It’s a weight on my shoulders.
If my blood sugar is high, I can’t help but wonder what I did wrong to make it so. Did I miscalculate my carbs? Should I have given myself more insulin? Should I have timed my exercise better? Is my insulin pump work properly? The list of questions and possible answers are practically endless, and it weighs heavily on me when I’m dealing with an inexplicable high.

5. It’s disruptive.
When my blood sugar is high for a prolonged period of time, I can’t focus on anything else but that. I’ll do anything and everything I can to take my mind off it and just let my corrective insulin dose go to work, but I can’t help but worry. This can be especially disruptive when I’m trying to get work done at my desk job, or when I’m trying to enjoy a night out with friends. It can suck the joy out of any situation, and that can be incredibly disheartening.

4. It doesn’t get along with exercise.
High blood sugar is weird, because sometimes it cooperates with exercise, and other times it reacts very badly to it. I find that if I workout at 250 or below, my blood sugar responds wonderfully to the movement and it’ll drop my blood sugar down to a better level much faster than insulin. But if I dare to workout above 250, then things can go terribly wrong and my blood sugar will go up even more. I learned that lesson the hard way in college, when I went to a high-intensity spinning class…I was so nervous about going low in the middle of the class that I overcompensated with a pre-workout snack. So over the course of the class, my blood sugar shot up to 300 due to the strenuous exercise coupled with the extra carbs. Not fun.

3. It makes my CGM wail.
I appreciate the alarms on my CGM, but NOT when they go off over and over and OVER again. It feels like my CGM is judging me for being high and it couldn’t be more obnoxious…and I just want to throw my device across the room to get it to shut up.

2. It prevents me from eating when I’m hungry.
I don’t always want to eat when my blood sugar is high, but occasionally, high blood sugar coincides with mealtimes and I end up staring longingly at food while I wait for my blood sugar to stabilize at a better level. Depending on when the high happens and how badly I wanted to eat some food, I can get very hangry (angry AND hungry), which is never a good state of mind to be in.

1. It’s stubborn.
The worst part about high blood sugar is that sometimes, it feels like it takes FOREVER for it to come back down. During the waiting period, anxiety, irritation, and anger are all emotions that can manifest themselves within me. And it sucks. The mental games that high blood sugar can play with me are straight-up cruel, and since a high can be so damn stubbornly slow to respond to insulin, it makes it that much harder to handle…which is why, I can say with 100% certainty, that I hate high blood sugars with a bloody passion.