Trying to Outwalk a Low Blood Sugar

I was a mile into my regular morning walk when the beeps started.

Dammit.

The beeps were coming from my Dexcom app on my phone and they were alerting me to a low blood sugar. Rather than correcting the low, though, or even opening up the app to dismiss the alarm, I just kept walking.

Outwalk the low blood sugar, Molly.

Outwalking a low blood sugar is easier said than done.

I really couldn’t understand why my blood sugar was low in the first place considering that I had no food in my system or insulin on board (other than my standard basal rate). Fasting workouts tend to virtually guarantee stable blood sugars for me, which is wonderful because otherwise exercise tends to make me crash. But what was different about this morning? I was utterly befuddled. My Dexcom alarm chimed a second time.

Outwalk the low blood sugar, Molly.

Even more confusing was my complete and utter determination to not treat the low blood sugar until I got home. I had glucose tablets on me, so it’s not like it was a matter of lacking a treatment. Rather, I think I was more focused on maintaining my fasted state for as long as possible, since I almost always do an exercise circuit (weight lifting, cardio training, HIIT intervals, etc.) when I return home from my morning walks. My low alarm rang a third time, just as loudly as it had before.

Outwalk the low blood sugar. You’re only 15 minutes from home.

I was deaf to my Dexcom’s persistent alarms for the next 15 minutes as I somewhat floundered down the road home, letting my impatient puppy tug me along. It’s almost like she knew that I was low and was trying to hurry me home, and I was 100% okay with that because my brain was starting to get fuzzy.

Outwalk the low blood sugar…

At long last, nearly half an hour after my first low alarm sounded, I was crossing the threshold of my front door and fishing my phone from my bag. I tapped through my notifications and cleared the low alert, noting that I was 66 mg/dL and definitely needed to eat something before continuing on with my morning routine. I sighed, set my sight on the kitchen (where a low blood sugar food stash awaited me), and resigned myself to the fact that I couldn’t outwalk the low blood sugar this time.

Underrepresented Communities and Navigating the System – A Post by Alzahrra Almajid

This was originally published on the T1International blog on June 8, 2021 and it is written by Alzahrra Almajid. I decided to share it on Hugging the Cactus because it is my goal to understand the challenges faced by the BIPOC community and learn what can be done to help. Alzahrra’s experience is a massive wake-up call that we still have a long way to go when it comes to advocating for marginalized groups. Thank you to Alzahrra for sharing her story.

I was diagnosed with type 1 diabetes when I was 8 years old. Having parents who were immigrants from Iraq and people of color was especially hard in navigating diabetes. My mom dealt with a lot of demeaning comments from healthcare providers because she was not taken seriously. In the initial months after diagnosis, her ability to care for me and help manage this new disease was often questioned. It felt like they thought she was too incompetent to understand how diabetes is treated. I remember how disrespected and vulnerable I felt because of the tone doctors spoke to us with.

When I was about eleven years old, I was hospitalized for having a high fever and diabetic keto-acidosis (DKA). On the second day of my stay at the hospital, a nurse asked me if I was purposely not giving myself insulin because it “did not make sense” that my blood sugars were still elevated. I was stunned by how demeaning that comment was. I felt so belittled in that moment that it has stuck with me all these years. Why would I want to feel that way? How could I fake it if the nurses were the ones administering my insulin at the hospital? It turned out I had an infection that was causing the high blood sugars and fever so no, I was not purposely not giving myself insulin. After that day, I started to notice how different my life was compared to other diabetics I met.

Alzahrra noticed her experience with diabetes was very different compared to that of other people with diabetes she has met.

There was not much awareness about type one diabetes in my community so it was difficult for me and my mom to find resources about what treatments were out there. We were not aware of what an insulin pump was or what a continuous glucose monitor (CGM) was. We had no idea that they even existed until I began to research diabetes on my own when I was about eleven years old. Only after I mentioned insulin pumps to my doctor, did we start discussing them as a viable option. When I learned about CGMs later on, I wanted one so bad because I was certain it would help my elevated A1cs. However, after hearing how much it cost, I knew that it was nearly impossible to get it.

Seven years after my diagnosis my brother was also diagnosed with type 1 diabetes which made the already bad financial burden worse. Although all people with diabetes struggle with how expensive diabetes can be, immigrants and people of color often do not have access to quality health insurance (or any access) so they are less likely to benefit from advanced diabetes technology. As I got older I began to understand how difficult it is to navigate a system that makes it harder for people in underrepresented communities to get adequate care.

I knew from early on that I wanted to advocate for marginalized groups. Being a person with type 1 diabetes is already mentally draining and expensive. When you add the challenges of navigating through racial or ethnic disparities, diabetes becomes agonizing. Black, Indigenous, and People of Color (BIPOC) deserve to have representation in the diabetes community and have their concerns addressed. They deserve the same level of care and access to resources that their white counterparts have. I chose to become a Communities of Color Lead for the Illinois #insulin4all Chapters because I want to influence positive change by making sure BIPOC are not left out of the conversation.

T1D and “Inspired” Food Choices

There’s no doubt that T1D directly affects my relationship with food.

Sometimes, I eat whatever I want with zero guilt. Other times, I painstakingly count not just the carbs, but every single macro of any morsel that meets my mouth. And more often than not, I fall somewhere between those two extremes.

But no matter what, my relationship with food is exhausting and probably one of the most inconsistent relationships I’ve ever had in my entire life.

It’s also a relationship that causes me to make what I’m calling “inspired” food choices.

Diabetes certainly impacts my food choices…especially when it comes to blood-sugar spikers like pizza, pasta, waffles, cake, and more.

Choices like eating dessert before dinner because my blood sugar is low.

Choices like only eating low- or no-carb foods because my blood sugar is high.

Choices like timing my meals down to the minute because I know that my body functions best when I eat regularly.

Choices like keeping snacks in my purse, my overnight bags, my car, and miscellaneous other locations because I never know when I might need food on the fly.

Choices like restricting my eating because a low blood sugar made me binge on food one day, and the guilt carried over to the next day.

Maybe “inspired” isn’t the right word to describe my food choices here. There’s so many more that could apply: weird, strategic, healthy, unhealthy…the list is limitless.

Just like the number of “inspired” food choices that my diabetes triggers.

Good, bad, and everything in between, though, the first step in making changes to my relationship with food is acknowledging the flaws in it. While I admit that I’m not sure what the next step is, I do know that I’m feeling determined to finally establish a guilt-free relationship with food.

Diabetes already takes too much from me…I refuse to let it continue to make my relationship with food negative.

Temp Blog Post Decrease

Hey, it’s me, Molly, the blogger behind Hugging the Cactus. 

As you may or may not be aware, I’ve had a lot going on lately.

The newest, most exciting thing in my life is, of course, my new job (I’m aware that I keep gabbing about it…I can’t help it and there’s definitely more to come about that in the future).

I’ve been busy getting acclimated to my role at CDN. When I’m not working, I’m taking care of my dog, Violet, maintaining/cleaning/attempting to update my relatively new-to-me condo, and trying to keep some semblance of a social life – which, now that summer is here, is getting downright crazy with plans. And I love it! I truly love staying busy in some form or fashion.

This blog is great at keeping me busy when everything else in my life is slow or when I need a distraction. But lately, life’s been so hectic that I’m getting distracted from the blog, so I’ve decided to temporarily decrease the frequency at which I post…from 3 to 2 blogs per week, posted on Mondays and Wednesdays (instead of Monday/Wednesday/Friday).

I’ve decided it’s time for a temp basal – I mean blog – decrease.

It’s not a dramatic change and I’m certain it’s only temporary…just like a temp basal decrease on my pump can improve my blood sugar levels, cutting down on the number of blogs I post per week will help me improve my overall blogger abilities and prevent me from feeling too pressured to keep churning out posts at the pace I’ve been doing so that last few years.

So I won’t have new content posted here on Fridays for the time being, but never fear: I’ll pick it up again before long. And maybe now this will mean that I can interact a little more with the diabetes community within other platforms, like Twitter and Instagram, which will be a nice change.

As always, lovely readers…stay tuned for more.

My New Role as Community Engagement Manager at the College Diabetes Network

This blog post was written by me and it was originally published on the CDN website on June 8, 2021. I just wrapped up my first week as their new Community Engagement Manager, so I figured it’d be fitting to share the post I wrote for their website here so my readers can get a better understanding of what this role means to me! Read on for more…

Growing up, I wanted nothing to do with diabetes. My parents and doctors encouraged me to attend diabetes camp so I could meet and make friends with T1D peers, but I stubbornly resisted the notion…until it was time for me to go off to college at the University of Massachusetts Amherst.

I was nervous about making this transition, but this changed when I had a chance encounter with someone named Christina Roth. She told me all about a group she started when she attended UMass herself: And that happened to be the College Diabetes Network.

In September 2011, I attended my very first CDN chapter meeting and I couldn’t believe I had waited so long to hang out with people my age who knew exactly what it’s like to live with diabetes. I was hooked and wanted to make as many connections as possible! In my three-and-a-half years at UMass, I served as the Chapter President and started writing for an online diabetes magazine in my spare time.

CDN…the best thing since insulin.

When I graduated, I put diabetes work on the backburner and started my career as an Editor in the financial technology industry. But I still kept in touch with my contacts at CDN and volunteered at the annual student retreats and provided my editorial skills to some of their resource guides. Eventually, I missed actively forging connections within the diabetes community, so I decided to blend this with my love for writing/creating content by launching my own diabetes blog, Hugging the Cactus, in October 2017. My blog has cultivated and deepened my relationships within the diabetes community, and by choosing to leave the corporate world behind and officially joining the CDN team, I will continue to do so on a new, exciting level as the Community Engagement Manager.

I’m thrilled to be part of an organization that has given me confidence, skills, connections, and so much more over the years. I can’t wait to jump into all things CDN and help provide young adults with what they need in order to live their best lives, despite diabetes!

Ask Yourself These 6 Questions Before Trying New Diabetes Technology

This blog post was originally published on Hugging the Cactus on May 13, 2020. I’m sharing it again today because I think it’s super important to weigh the answers to these questions before deciding to try new diabetes technology. This is coming from someone who waited 17 years before she tried her first insulin pump, and even though it has had an enormously positive influence on my life and sometimes I wish I’d tried it sooner, I’m ultimately glad that I waited that long! Read on for more details…

So you want to try your first continuous glucose monitor. Or maybe you’re ready to leave behind multiple daily injections and switch to insulin pump therapy. Whichever diabetes device you’re looking to start using, there are some questions you’ll probably want to have answers to before decide that now’s the time to introduce new diabetes technology into your daily routine.

The following is a compilation of the questions that I thought long and hard about (literally for years) and that I wish I’d thought long and hard about before I made the transition to the OmniPod insulin pump.

1. Am I ready for it? It took me 17 years before I decided that I was ready to try an insulin pump. 17 freakin’ years!!! I spent most of that time being too afraid of introducing such a drastic change to a routine I’d had down pat for such a long period of my life. There are times when I wish I’d gone onto my insulin pump sooner, but ultimately, I’m glad that I wasn’t swayed by my family or doctors to go on it before I truly felt ready. By the time I started using my OmniPod, I had the maturity, responsibility, and emotional intelligence that I felt that I needed for an insulin pump.

2. Will I be able to afford it? Obviously, this isn’t a question that I wondered about when I was younger, but it’s one of the first things that comes to mind as an adult on her own health care plan. We all know that diabetes supplies are expensive, and it seems that the more technologically advanced something is, the more money that has to be forked over in order to obtain it. This isn’t right or fair, but it’s a simple truth and an important one to think about before choosing one pump or continuous glucose monitor over another.

3. Why do I want to start using it? I wanted to start using my OmniPod because my mom experienced great success when she started using it. And I decided to get a Dexcom CGM because I fell in love with the technology after undergoing a trial period with my endocrinologist. In both situations, I felt very much in control of my decision to start using these devices and I didn’t really listen to anyone else’s opinions. But I am very aware of the fact that social media and real-life friendships with other people with diabetes can often sway people in different directions. After all, if I saw a post on Instagram from a dia-influencer who was singing the praises of a Tandem T:slim pump, then I might seriously start thinking about switching to it (this has actually happened to me). But the bottom line is to think about the why – will this device enhance quality of life for me? Will diabetes be easier to manage with it? Will it help me achieve my A1c and/or blood sugar goals? Do I need to add something new to my routine because I’m feeling burnt out by doing things the same way all the time? Knowing why I wanted to use an OmniPod or a Dexcom CGM made me feel that much better during the whole process of learning how to use them – I felt like I had clear goals that would help me navigate the integration of these new technologies into my daily routine.

Did you know that Insulet/OmniPod has demo pods that you can wear? They don’t hold insulin or deploy a cannula, but they can give you a good sense of what it’s like to wear a pod on a daily basis!

4. Will I be comfortable wearing it 24/7? This is a big one! Pods, pumps, and CGMs are very visible, and it can be jarring to go from being “naked” to having bumps and lumps underneath clothes that can get caught on doorknobs, chairs, and the like. Personally, the benefits of my OmniPod and Dexcom outweigh something like this which is a bit superficial, but that doesn’t mean it’s not something to think about. But it’s also worth thinking about comfort and what is least painful when it comes to insulin delivery, so that’s why this is an important question to ask.

5. Do I know anyone else using it who can provide feedback from a patient’s perspective? I’ve talked about this before, but I’m not sure when, if ever, I would have seriously considered using the OmniPod if my mother hadn’t tried it first. The fact that we both have diabetes has probably made us a little closer and strengthened our bond, so if there’s anyone’s opinion that I’m going to trust when it comes to something like this, then it’s hers. I can actually remember her first few weeks on the OmniPod – in which she learned a lot of valuable lessons – and how pleased she was with it once a few months with it elapsed. She taught me the ins and outs of the OmniPod when started to use it, and I’d argue that her advice was more helpful than that of my diabetes educator. So I’d advocate gathering opinions from family and friends (if either is applicable) or the diabetes online community before going on a new diabetes device, in addition to the research component below…

6. Have I done enough research on it? …Like any smart shopper, it’s crucial to really consider all options and research them thoroughly, especially when it comes to the top contender. I definitely did not complete sufficient research before going onto the OmniPod or Dexcom; rather, I trusted that they were just right for me. If I were to switch to something else tomorrow, though, you can bet that’d I’d spend a lot of time scouring the web for every last bit of information on the device so I could make the most informed decision possible.

New diabetes technology can be both scary and exciting. But more than anything else, it can really make life with diabetes much more carefree, and I’m glad that in this day and age there are so many options available to people with diabetes that continue to be technologically impressive

Reflecting on my Experience with Metformin

A couple of years ago, I wrote a blog post series about my experience with Metformin. As I was paging through my blog, looking for either an old post to republish or inspiration for a new post to write, I came across that series and got to thinking about how I felt on Metformin.

If you aren’t familiar with what Metformin is, it’s an oral medication that’s typically used to help stabilize blood sugar levels for people with type 2 diabetes. This is where you might be thinking…I (Molly) have type 1 diabetes, so why was I prescribed this medication?

Well, my endocrinologist at the time wanted me to try taking Metformin in tandem with doses of insulin in an attempt to reduce my overall insulin needs. She expressed concerns that my daily insulin intake was high (something I disagree with now, as I think about it a couple of years later), and that she had some general awareness of studies that indicated it might not be good for my future health if I continued using so much insulin each day. (Note: I don’t know what study or studies she was referring to, and this is where I should’ve done more research before just taking her word for it and going on the pill. This is an example of poor patient advocacy on my part.)

I did not enjoy my time on Metformin.

Even though I met her sentiments with skepticism, I trusted this endocrinologist, so I decided to give Metformin the old college try. And I hated it. Hated it! I tried taking it per my doctor’s instructions for two separate spans of time (each lasting a month or so) and made the decision to stop using it because I simply didn’t see that it was making any sort of difference. Actually, it was affecting something, just not my blood sugar levels or insulin intake – it was affecting my anxiety levels. I was afraid that Metformin, coupled with my insulin, would cause me to have low blood sugars all the time. While in reality, I didn’t experience many lows, I was still always paranoid about them and it was an unpleasant thing to have to deal with.

So now, about two years later as I think about these ineffective encounters with Metformin, I realize that I should have done a lot more before even considering taking it. I should’ve asked more questions. I should’ve done more research. I should’ve asked around the diabetes online community to see if anyone had advice for me. I should’ve pushed back more with my doctor to get to the bottom of the reason(s) why she wanted me to take Metformin. Going back to my point above…this was a big lesson in patient advocacy. It’s important to ask questions and gather all the facts, especially in situations like this where there was so much uncertainty, in order to receive the best care possible. And it’s important to remember that even the most trusted and well-liked doctors aren’t always right when it comes to the medical guidance they suggest or give. At the end of the day, I’ve got to keep in mind that nobody knows my body and brain better than I do, so it’s okay to challenge the authority of the experts (in a respectful, kind way of course).

Change is on the Horizon

In the last year and a half, change and I have grown to be more than just acquaintances: We’re very good friends now.

The big changes that I’ve experienced in that span of time (to name just a few) include buying my first home, getting my puppy, Violet, and naturally, coping with the numerous ripples of change that were brought about by the pandemic. As someone who has always found comfort in the “known”, these changes made me anxious and scared because of all of the uncertainties associated with them…but they also taught me that I’m capable of adapting to them.

So I figured, why not add one more change into the mix?

Another big change is headed my way.

Today is my last day with my employer of the last six and a half years. On Monday, I start a brand-new job at an organization that means a lot to me, one that I’ve happened to write about here many times before…

…and that is the College Diabetes Network!

I’m pleased to share that I’ll be joining the talented CDN team as their new Community Engagement Manager.

This job represents so much to me. It’s a career shift, for sure, but it’s a shift into a field that obviously is very near and dear to my heart. I’m excited to see how my personal passion, advocacy skills, and creative energy will translate to this professional role. And I’m even more thrilled to know that I will be working with an absolutely amazing group of individuals, both internally within CDN and externally with a community that I care so much about.

While I will miss my colleagues from my now-former employer very much, I do feel that taking this opportunity with CDN is the best possible decision I could’ve made. It feels like a dream come true. I’m honored that I was selected for this role and I am determined to achieve a lot with it.

For the first time in a long time, I’m looking forward to going to work on Monday and starting this new chapter…and I really can’t wait to see (and share) what the CDN team and I will accomplish in the future!

What My Dog Thinks About My Diabetes

The other day, I decided to ask my puppy, Violet, what she thinks about my diabetes…

…and she just stared at me, nonplussed, because obviously she’s a dog and she can’t respond to me with anything other than tail wags, barks, or playful growls.

Violet’s expression when I asked her about my diabetes.

But really, I’ve been thinking about how much she notices my diabetes. I know that she sees my devices from time to time – and sheer curiosity causes her to poke and prod them with her nose in what I perceive to be an attempt to dislodge them from my body.

I know that she wakes up in the middle of the night when I’m experiencing a low blood sugar and have to come downstairs to correct it.

I know she watches me during every pod change, gazing up and tilting her head from side to side whenever my PDM beeps throughout the process.

I know that she gets excited when I get a box of insulin or Dexcom sensors in the mail – she’s right by my side, jumping up and down as I tear into the packages, thinking that it might be a special delivery for her.

I know she waits patiently when I have to pay more attention to my diabetes in a given moment than I can pay to her.

It’s just interesting to bunch all of these moments together and mull over the fact that she is definitely aware of my diabetes, though her understanding of what it is and why it takes up so much of my time is just as likely to be something she’s not aware of.

For her, it’s blissful ignorance.

For me, it’s blissful knowledge that my dog is seemingly patient and understanding when it comes to all diabetes matters.

I’m lucky to have her.

5 Ways Hot Weather Affects Diabetes

This blog post was originally published on Hugging the Cactus on August 6, 2018. Call it an “oldie but goodie” because the ways in which hot weather can affect diabetes haven’t changed in the last few years and they won’t be changing any time soon…and with summer just around the corner, it’s good to remind ourselves of the extra precautions we might want to take in order to combat the heat. Read on for more on the ways summer weather can affect people with diabetes…

The summer heat seems to be here to stay in Massachusetts. We’ve experienced several weeks of soupy, high-heat weather that *almost* makes me long for cooler, autumnal days…but not quite, because that just means winter (and snow – blech) is right around the corner.

Truly, I do enjoy the summertime. To me, summer is about trips to the beach, ice cream consumption (and lots of it), barbecues with family and friends, long walks in the neighborhood, and endless outdoor adventures. Aside from all of those lovely things, summer also means that it’s time to be a little more diligent when it comes to my diabetes. That’s because hot weather can play some cruel tricks on a T1D’s body. What do I mean by that? Here’s five ways diabetes can be affected by hot weather.

Mr. Sun, Sun, Mr. Golden Sun, please shine down on me (and don’t make me go low or high…)
  1. Dehydration can lead to high blood sugar. Everyone knows that it’s important to stay hydrated when it’s hot out, but it might be less common knowledge that dehydration can directly affect blood sugar. There’s a scientific explanation for this: If not properly hydrated, the body sees an increase in blood glucose concentration because blood won’t flow as easily to the kidneys, making it difficult for the kidneys to get rid of excess glucose in urine. The best way to prevent this, naturally, is to drink plenty of water and monitor blood sugars.
  2. Sunburn can drive up blood sugars. I’m very familiar with how a sunburn can result in higher blood sugars; in fact, just last week I was dealing with a particularly gnarly sunburn on my thighs and belly that not only made my numbers higher, but also really hurt. My skin was literally damaged, so the stress from the injury lead to retaliation from my blood sugar. Luckily, it only lasted about 48 hours, but those couple of days were challenging as I dealt with sticky highs that were practically resistant to insulin. And for the record, I DID apply sunscreen – numerous times – when I was at the beach. Next time, I’ll seek shade under the umbrella.
  3. Sweat can make it difficult for devices to stick. I don’t know a single medical device that’s immune to prolonged exposure to moisture/water, but that doesn’t prevent me from spending as much time as I can outdoors/at the beach/by the pool in the summer. Thank goodness for Skin-Tac wipes and medical adhesive tapes that help preserve my precious pods and sensors!“
  4. Insulin can overheat. There’s a reason why insulin vials come packaged in cartons with directions that specify what temperature insulin should stay at in order for it to be safe to use. Insulin can spoil easily when it reaches a certain temperature, so it’s important to store it in a cool place when the weather’s warm. I alternate between a mini portable cooler (that can hold 3 vials of insulin) and a pouch from FRIO – both do an excellent job at keeping my insulin cool.
  5. Low blood sugars can occur more frequently. Summertime is prime time for outdoor activities that result in higher energy expenditure. So it’s no wonder that blood sugar tends to plummet in hot weather. Looking at it on the bright side, it’s an excuse to eat even more ice cream – but it also means that monitoring how I feel and checking blood sugars often is that much more important.

Regardless of the diabetes challenges it may cause, I love summer weather, and I know I’ll miss it the moment the first snowflake falls this year.