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.

 

 

Doing Everything Right and Still Getting it Wrong

One of the most frustrating things about having diabetes is feeling like you’re finally understanding it, perhaps even mastering it, only for it to lash out at you and make you feel like you don’t know shit about it.

It’s when you do everything right – check and treat accordingly, eat properly, exercise sufficiently – and still get it wrong when your blood sugars don’t behave the way they should.

I really hate when this happens, but I loathe when it happens on vacation…which is exactly what happened to me last week when I was in Maine for a few days.

Things started going awry shortly after I woke up (if only I knew then that I was in for a DAY!!!). I ate breakfast and my blood sugar swiftly started to rise. But I didn’t panic, because that’s what I wanted to happen. We’d be walking all around town for part of the morning and most of the afternoon, so I wanted my blood sugar to be on the higher side so that my chances of dropping dramatically in the heat were lower. I made the right call – soon after we got downtown, I noticed a diagonal down arrow on my Dexcom app. Things were headed in the right direction…or so I thought.

Not long after I spotted the diagonal arrow, I started to feel a little low-ish. Not super shaky or anything, but just a bit disoriented. I decided to pop into my favorite candy store to fill a small bag with treats so I had something sugary to munch on that would prevent a bad low blood sugar.

Those were mistakes number one and two…not consulting with my CGM again before eating candy, and going to town on it because it was CANDY and it tasted delicious.

Doing Everything Right and Still Getting it Wrong

Within a half hour, I was rising up, up, and up. I took a small amount of insulin to correct it, not wanting to be too aggressive and risk a real low. But as I walked around the amusement park with my boyfriend and his family, I just wasn’t coming back down like I thought I would. I lingered in the mid-200s for much of the early afternoon, and by the time we stopped for lunch, I was rage-bolusing to bring my numbers down faster. I even chose a lower-carb lunch option in the hopes that it’d stave off another high blood sugar, but nope, the BG gods were not in my favor that afternoon. As we moved from the amusement park to a brewery (a drastically different change in locale, I know), I bolused once again, and then noticed that the batteries in my PDM were low.

And that actually wasn’t a problem, because I was prepared enough to have spare triple A batteries on me – thank goodness! I took the old ones out, popped the new ones in, and waited for my PDM to come back to life. And it did…but it asked me to input the month, day, and year.

Dammit. THAT’S never a good sign. I entered the information and the system accepted it, and then my pod failed immediately after, which meant that I had to ditch the brewery and the group of people that I was with to get back to the house we were staying at as quickly as possible to put a new one on.

It doesn’t get much more irritating than that.

(Later, I discovered that my PDM’s internal battery was going, and that this behavior would occur every time I replaced the triple A batteries. Needless to say, I’m awaiting a new PDM from Insulet, because it’s just not smart to continue using an aging PDM.)

By the end of this day of turbulent blood sugars and unpredictable medical device malfunctions, I was mentally beat. I felt like I’d been thrown into the roughest of ocean waters and forced to tread water for hours in order to keep my head above the surface. It’s exhausting to know that, when it’s all said and done, I was really trying to do the right things and take care of myself. I was SO DANG PREPARED with those extra triple A batteries, for goodness’ sake! But man, diabetes…just when I think I know it better than anything else, it throws me for a loop and I remember a saying from Professor Mad-Eye Moody of the Harry Potter series (of course I’m talking about Harry Potter again, don’t act surprised): CONSTANT VIGILANCE. I’ve got to be aware of my diabetes at all times. I’ve got to know how to react and when so that my diabetes will remain in my charge – not the other way around.

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.

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.

The Hellacious, Headstrong High

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

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

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

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

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

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

Teacher's Month 2020

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

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

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

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

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

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