If you’ve had diabetes for over, like, a day, you’ve probably been through a product recall at some point. Some are large, some are small. But if you’re a test strip hoarder like I am, they involve giant-geometric-modern-art-like-patterns on you floor while you sort through a list of 15 lot numbers which are all confusingly similar in sequence and figure out what you need to trash and what you should keep. This happened a few days ago when my new box of test strips arrived with a paper declaring a recall for Freestyle test strips due to erroneous low readings. You can find the recall info here, which includes a link to the lot numbers. And then you can totally start making weird test strip art at your house too! Have a great Friday Crafternoon!
Something about that perfect, beautiful, 100mg/dL gives me the warm fuzzies all over. It’s perfectly in range, and such a pretty, round, glorious number. Every time this pops up on a meter, I can’t help but smile and give myself a big ‘ole pat on the back. It’s the number we’re told to shoot for since the day we’re diagnosed. And almost 21 years later, it’s still the number that makes me the happiest. It’s the blood sugar equivalent of a home run, and I love me a good 100.
This year, I pledged to make November not just National Diabetes Awareness Month, but MY Diabetes Awareness Month too. As I’ve struggled to get my A1c back down under 7% since the Great Noodle Fest of 2013 (a.k.a. our Southeast Asia Trip), and been hit by one distraction after another (see: Our wedding. See also: My best friend’s wedding. See also: 2 bachelorette parties within two months of each other. See also: tequila. OK. I’m done now). Suffice it to say, a little focus on my diabetes was long over due. Putting this much energy into my d-management was tough, but eye-opening and well worth it too. Below, a list of things I know I significantly improved upon – and intend to try my best to keep up with:
1.) Actually getting up and correcting high blood sugars in the middle of the night. Yes, this means losing a few minutes of sleep and sometimes getting out of the warm blankets and your slumbering partner but it’s so worth it. Night time highs lead to morning highs which often lead to a day on the Glucoaster which is one crappy day. 30 seconds in the middle of the night to get up, test, and correct won’t kill you. And my fear about being too low in the mornings to work out? Unfounded. This only happened once after a night time correction bolus this month and you know what? I just worked out later. NBD.
2. ) You actually have to count the carbs for carb-counting to work. I know, I know, paging Captain Obvious. But the fact was, I had gotten lazy. This was evidenced by my last glucose log book that I took in to my CDE in October. I noticed there was a common bolus number of two units, regardless of what I was eating. Salad? Take two. Cookie? Probably two units, right? Wrong. By paying more attention to carbs, looking up nutrition info when I don’t know it, and actually using a real, live carb-to-insulin ratio, my post-prandials are starting to improve. Except for on Thanksgiving. But come on, who has good blood sugars that day?!
3.) Bolusing after my morning workouts, even if I’m having zero carbs for breakfast. Nine times out of 10, my liver will drive a post-workout BG through the roof if I don’t get a bolus in before eating my usual egg whites with cheese and a side of coffee. Bolusing early for that meal means I don’t end up at 200mg/dL by 10am and feeling like my workout was a waste because I’m now rage-bolusing to get my liver-induced high down. Because we all know how that game ends up.
4.) My technology is only as good as I’m willing to make it. CGMs don’t mean never testing with a finger stick again. And a “smart pump” can only help you if you help it understand what you need. To maximize the abilities of these gadgets, you have to use them the way they were intended, and not rely on them to put certain d-management items on auto pilot. Just because I can push buttons, take a few units, and check my CGM later and fix something doesn’t mean that’s the best way to manage diabetes. Being proactive, thinking ahead with this disease, and thinking through my food and workouts before there’s a problem is how to truly manage well. I’m still the cruise director of this ship, and that means I have to put the time in. But I know for certain it will be worth it!
As I go further in to the holiday season, I know things will be harder for a little while, not easier. There’s going to be more food, alcohol, and great reasons to not work out. But I hope to keep up with these habits I rediscovered during my Diabetes Awareness Month. Because all I want for Christmas this year is an A1c under 7% Come on Santa!
Remember to bolus early and often, to count your carbs not your calories, and to be very thankful for everything you have. See you Monday for more d-bloggage!
If you’ve never heard of Taking Control of your Diabetes, or TCOYD for short, then you need to look them up now. TCOYD is an organization dedicated to helping people live better with diabetes, and I happen to know the founder. He is an endocrinologist in San Diego and was a long time customer of mine but even longer-standing friend. What he’s done for the nationwide diabetes community is amazing and inspiring. His TCOYD Conventions can be found in major cities across America, but the biggest one is in his hometown of San Diego, and last weekend’s event sounded like it was the best program yet. I was truly sad to miss it for the first time in five years. Beyond the seminars led by leading endos and CDE’s are product fairs, performances, and motivaitonal speakers. But more than anything, there are thousands of people with diabetes under the same roof, all coming together to make living with this disease better.
A friend of mine, Rich Poser, who I know from the Tour de Cure San Diego and several miles on the road bikes together had this awesome quote and photo that summed up the day:
“For every convention, meeting or training session we’ve been to where you can’t find one packet of sweetener in the pile of sugar at the coffee station, here was the choice at the Take Care of Your Diabetes convention:
The self-serve beverages at the breaks were unsweetened iced tea and Crystal Light lemonade. The lunch nutritional info was in the program. Being in the same hall as a few thousand diabetics, gave me the distinct message WE ARE NOT ALONE!!!”
Well said Rich. It’s moments like that which make us realize that we can do this. Together.
When I was in New Jersey a few weeks ago for a speaking engagement, I packed my “professional-looking warmest coat,” which I had not worn in at least a year (hey, it never really got that cold in San Diego…or that professional for that matter). I dressed for dinner on that Sunday night and pulled on the coat as my final step. I slipped my hands in the pockets and found…a honey packet?
The honey was a near-solid brick of sugar at this point, having spent the day in the icy luggage-hold of my east-bound plane and my luggage had not warmed up enough yet to unfreeze the honey. I couldn’t recall where the packet was from. Its design looked familiar and I’m sure it was from the coffee station at some well-loved restaurant but I didn’t know which one.
Wherever the origin of this packet, it’s presence was so funny to me. I don’t eat honey or put it in my coffee. I only use honey for one reason, and that’s to treat a low. Wherever I was on that day that I pocketed the honey I must have A.) been at risk for and/or worried about a low and B.) not had any of my trusty GU packs or glucose tablets on hand to treat said possible low. So I did what any responsible person with diabetes would do. I stole a honey packet and tucked it away for later. Way later in this case.
I was probably annoyed I hadn’t packed any quick-acting sugar, and reminding myself to replenish my stash when I got home. I’m sure I was doing something fun because I was planning ahead to treat a low so I wouldn’t have to stop what I was doing. It’s funny how a little honey packet made my mind wander and wonder what I was doing that day.
Also, these are the good kind of diabetes surprises. The bad kind are when you open the dryer and realize you left a GU pack in your running pants. And it melted. And is now all over the dryer. And your clothes. Oy.
Nope, that isn’t white spray paint on the ground in the photo…it’s frost! Yep, Portland does apparently get that cold in the winter and Thursday morning I woke up to a light dusting of the cold stuff everywhere. I bundled up a little more for my three-mile jog. I threw on an extra layer on top and a hat, plus gloves. My dog – who has become my regular running partner – could not have cared less about the temperature outside (her only concern in life is squirrels and how to get them) and began tugging as soon as I stepped on the porch. In my bare feet.
Yep, I still run in those crazy toe shoes from Vibram. I switched to them about three years ago after reading this book and for me, they’ve solved a ton of hip/knee/joint problems. Although they certainly don’t earn you any style points, they have improved my aches and pains enough that I exclusively run in this type of shoe and have even done half marathons in them. The thing, is, I’ve never had to wear them through a winter in the Pacific Northwest until now. And it’s getting a little (ok A LOT) cold ’round here.
Stepping on the porch Thursday morning, I felt like my toes froze the second the door closed behind me. I could barely pull on my shoes because my feet were so cold that it was difficult to make each toe go in it’s little pocket. About five minutes into the run, I realized my toes actually did feel totally numb, and it was making me run a little wonky. Not good. Although these shoes have helped my joints, they are way less protective than a traditional shoe. Here in Oregon, there’s all sorts of leaves, pinecones, wayward berries and other stuff that falls off the trees making my running paths a wee bit treacherous. More than once I’ve landed on something odd-shaped and spikey and been uncomfortable for a few steps. I can’t be running around not being able to feel pain in my feet because if I did some real damage but was too cold to feel it, the results could be disastrous.
Trouble is, there’s nothing out there that provides a full barefoot running experience without the toe pockets. I’ve tried the Nike Free, the New Balance Minumus, and a random Fila style but nothing allows you to run with a ball of your foot strike like the Vibrams. This wasn’t a problem in my San Diego days, but I’m not sure I can keep up only wearing these here in Oregon. Maybe I can throw them in the dryer for five minutes before I put them on? Any other “barefoot” runners out there have good winter solutions for cold feet? Cuz I’m cold!
I found this video floating around Facebook and it is too hilarious not to share. I absolutely love her way of explaining WHY these things sound ridiculous, and her little side-cuts and illustrations (“goblet full of diabetes” has to be the funniest phrase ever). She nails the explanations of why these statements don’t make any sense when you really think about them and she does it with humor, which is the best way to get people to pay attention in my opinion. The only thing I’d change is the title, because I don’t think the things people say are “dumb,” just maybe “uninformed.” People (usually) don’t say these things because they’re trying to be mean or they’re not intelligent, its just that maybe they don’t know anyone with diabetes. Or perhaps it’s the media’s ridiculous portrayal of our disease that serves as their only education about living with diabetes. Whatever the reason, you’re going to laugh your ass off at this video. Nicely done girl! You can check out her YouTube channel for more diabetes-related videos, or videos about her day job which is being a make-up artist and body painter. “You work that diabetes girl!”
I committed this Diabetes Awareness Month to also making it My Diabetes Awareness month, and henceforth doubling down on my d-efforts in order to get my A1c to that coveted “somewhere under 7″ status. So peeps, I’m trying. And when you pay this much attention to this obnoxious disease, you start to notice patterns. Patterns that you simply can’t ignore anymore if you’re truly going to go from good to great management.
The pattern I’m noticing and quite literally can’t ignore (because it’s waking me up to tell me I can’t ignore it) is high BGs in the middle of the night. I’ve blogged about this before and vowed to do a basal test to see if that needed some tweaking but I haven’t done it. Mostly because in order to test your basals in the middle of the night you have to eat dinner at like, 5pm all early-bird special and stuff and I find that particularly hard to do. Which I am certain is at least part of the problem.
Jacob and I tend to eat on the later side of the evening – 8pm -or 8:30. He usually gets home around 6:30 or 7 and then we often go together to the grocery store and always try to cook with fresh ingredients when we can. Although this is a good way to prepare food (and our bonding time), it means nothing is actually ready to eat until about 2 hours before bedtime. We also rarely cook anything carby, like pasta or potatoes because it’s tough for me to manage and Jacob is a saint, but that means we make up for that lack of volume with more proteins and fats. These macronutrients, as we know, break down hours later. So I’m pretty sure that our late mealtimes and food choices are contributing to peaks in the BG circa 3am.
I’ve been much better this month about actually doing something about those middle-of-the-night highs and not just hitting the Dexcom “snooze” button and waking up all dry-mouthed and yucky, but I’d love to prevent them in the first place. If we don’t change our food choices (which, since we don’t eat any carbs, I can’t really ask my poor husband to also cut all the fat out of diet as well) in the evening, I’ve got to find a basal strategy to combat it, which may mean running temp basals on nights with late mealtimes or just setting a basal pattern that ramps up around 2am.
But to be sure it’s the food and not the general basal rates, I’ve gotta do one of those annoying basal tests.Maybe it’s time to go visit my grandma on the east coast and let her treat me to the 5 o’clock special!
It’s kind of funny to think about Diabetes Awareness Month when you already have diabetes, right? It’s like…yeah, I’m aware of it…literally every day. But of course, the point of this month is to help folks who don’t have diabetes understand it better. And by “understand” I mean help them understand what it really means to live with diabetes, who is at risk for developing it, and how to be a more supportive person to the people with diabetes in their lives. I think there’s no better place to start with than education.
When I gave my talk on Monday about living well with diabetes, I told the crowd about some of the things that are tough to hear when you have this disease. Like the “you must have ate too much sugar as a kid” type of comments. I included the old favorite of “I hate needles, I could never be diabetic.” As all of us with diabetes know that everyone – literally everyone – hates needles, but if the choice is “injections” or “die,” everyone would choose to live. It has nothing to do with “want to.” I told the audience that what I hoped to stress is that the burden of this disease is not with the painful parts of it. Yes, injections hurt, lancets hurt, new CGM sensors hurt, insulin pumps hurt, that won’t change.
But that’s not the tough part about living with diabetes, not by a long shot. No, the tough part is about how much of your brain space this damn disease takes up. It’s the constant worrying and monitoring and guesstimating and checking and planning that takes the toll on you. Injections? Shoot, that’s the least of my worries right now. I’m trying to crunch the numbers to see if the deductible on my husband’s insurance will be cheaper than me staying on the astronomical COBRA right now. That’s what’s taxing. Three hours on the phone with insurance companies. Wondering during your huge work presentation if you’re going to go low. Being scared shitless of your next eye exam because what if this is the year that some retinopathy finally starts. That’s the stuff that really kicks your ass with this disease.
When people say I am so brave for taking injections and lancing my fingers and wearing a CGM and a pump, I have to correct them. I am not brave for withstanding the physical pain of this disease. I am brave because I get up every day and try again.