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Posts from the ‘Blood Sugars’ Category

DBlogWeek 2017: Diabetes and The Unexpected.

Diabetes Blog Week prompt for Monday: Diabetes can sometimes seem to play by a rulebook that makes no sense, tossing out unexpected challenges at random.  What are your best tips for being prepared when the unexpected happens?  Or, take this topic another way and tell us about some good things diabetes has brought into your, or your loved one’s, life that you never could have expected?

Diabetes Blog Week YAYYYYYY!

Unexpectedly, my iPhone decided to update itself on Saturday night.

I must have “agreed” to terms of service and scheduled the update, but I didn’t think the process through, because if my phone is updating the operating system, that means the processes on my phone are sort of stalled.

Including my Dexcom data transmission.  Which means I didn’t have any CGM data streaming overnight.  The low blood sugar came out of nowhere, a product of stupid poor planning and over-correcting a high in the wee hours of the morning.

Mother’s Day morning broke open with my body outlined in damp sweat, my color ashy, hands shaking, but my mind still sharp, considering my blood sugar was 35 mg/dL.

Super low glucose result - crappy way to start the dayOnly once or twice before, in thirty years of diabetes, have I ever felt close to passing out, but the precursor feelings seem to be waves of unconsciousness that lap at the edge of my mind coupled with a calm, reasoned mind, as if I knew I was about to go under and I needed to mentally take the biggest breath I could.

I had the sense to call Chris (he was downstairs with the baby) and ask him for juice.  I was afraid to sit up, thinking that might be enough to tip me into the abyss.

I asked him to put the baby in the crib in case I needed physical help.  I spoke to him through a mouthful of glucose tab dust, asking if he knew how to use the glucagon on the bedside table.  He said yes.  I asked if he could please hand me a towel so I could mop the sweat off my forehead.  The whole discussion was so calm, so structured, so oddly practical in contrast to the panic of being intensely low, the voice in the back of my mind screaming “AAAHHHHHHHHH!”

Makes me think I could solve quadratic equations while putting out a car fire while sitting in said car.  And the car is moving.  Fast.

Actually, that’s sort of what we do when severely hypo.

Unconsciousness due to a low blood sugar is the unexpected I think about the least, but prepare for the most.  I mean, I think about it, but not obsessively.  I just prepare all over the place, just-in-casing myself with juice boxes and raisins stashed in my frequently visited spots.  I try to always have fast-acting sugars on hand no matter where I am.  I share my CGM data while traveling. I keep that glucagon shot on the bedside table.

We’d talked about glucagon a few weeks early, after I’d refilled my prescription.  We almost used it when I was throwing up from the flu and my blood sugar was stuck at 45 mg/dL, not able to keep down the juice or tabs I was consuming.  It’s part of planning for the scary moments while simultaneously pretending, “Oh, that could never happen.”

Eventually, my blood sugar came up.  Exhausted from treading the hypo-waters for so long, I almost immediately fell back asleep on the damp pillowcase.  When I woke up again, I looked over at the glucagon kit, thankful for the fact that it was still sealed and hoping it continues to collect dust.

What to Work On.

I’ve gotten lazy in my diabetes management.  And I’m not proud of it.  My recent A1C result was still in my goal range but not where it was a few months ago, and I’d love to return to that level of control.  Thing is, I’ve gone soft when it comes to following through on my daily diabetes duties.

Yeah.  I’m at that point in the postpartum recovery thing:  finding ways to up my diabetes game.

I can check two things off my to do list with confidence:  I wear  my Dexcom every, single day and I also have been on top of my doctor’s appointments.  Those two things get big, fat gold stars.

Other stuff needs some grooming, though.  Here’s my wishlist:

  • Check fasting BG immediately after waking up.
  • Calibrate CGM right when it requests calibration.
  • Pre-bolus at least 15 minutes before eating.
  • Exercise 3 – 5 times a week.
  • Sleep more than 5 hours a night.
  • React faster to the high alarm from my Dexcom.
  • Rotate my device sites better.
  • Remember to eat more than coffee before 1 pm.

Hmmm.  That’s a lot.  Plan of attack for each:

  • Check fasting BG immediately after waking up.  We just moved the little Guy out of our bedroom and now he’s sleeping in his crib in his own room, so I have a little more time (3 min versus zero min) in the morning before I have to run and grab him.  I need to return to the habit of keeping my glucose meter on the bathroom counter and using it before I brush my teeth in the morning.
  • Calibrate CGM right when it requests calibration.  Ugh.  This just requires being less of a lazy tool and just checking/calibrating ASAP instead of ignoring the little red blood drop.
  • Pre-bolus at least 15 minutes before eating. This one is admittedly going to be challenging, as my schedule is a little non-scheduley these days.  My son is a busy little creature and also unpredictable, so it’s challenging to find the “right time” to do things like change out my insulin pump, eat breakfast, schedule conference calls.  But as he gets older, he does seem to be settling into something resembling a pattern, so maybe this will get easier.  I’ll try to pre-bolus.
  • Exercise 3 – 5 times a week.  This one is already going in the right direction.  As mentioned, I joined a gym and that gym has childcare, so there’s no excuse.  Except days like over the weekend, when I was away for work, or today, when the little Guy is so sniffling and booger-gross that I don’t want to bring him to the daycare and expose any other kids/adults to his germs.  We did go for a walk around the neighborhood today, clocking in at least a little bit of exercise, so that helps.  The weather warming up will help here, too.  This bullet point is one I’m putting like half a gold star on.
  • Sleep more than 6 hours a night.  OH HA HA HA HA.  The baby thinks 5.30 am is when human beings should wake up.  The early morning hours are gorgeous and I love the quiet of being awake that early, but around 10 pm my body starts to give up on doing body things, although I rarely make it to bed before 11.30 pm.  I need to work on this sleep thing.
  • React faster to the high alarm from my Dexcom.  Again, this one is something I just have to DO.  No excuses and no reason not to.  My high alarm used to be 140 mg/dL (pre-pregnancy and during pregnancy), but I’ve moved it to 180 mg/dL in the last few months.  I should be responding to 180s.  I will work on this.
  • Rotate my device sites better.  Yep, this is also a need.  My thighs have become a permanent home for my Dexcom sensors, but I am okay with the back of my hip or maybe my arm.  I’ll try to get creative.  As far as pump sites, I’ve been working on rotating those better, too.  Maybe it’s time to try a lower arm site?  (Has anyone ever done that and does it hurt??)
  • Remember to eat more than coffee before 1 pm.  Yeah, this is another whoops.  My mornings are generally a bit crazy, and sometimes I’d rather keep my CGM graph steady instead of interrupting it with breakfast.  But this is backfiring because I then get so hungry around lunch time that I eat the fridge, causing a nasty post-lunch bounce.  Moderation here.  Eat regularly throughout the day and I’ll be less likely to unhinge my jaws and devour the contents of the cupboard.

I hope writing this crap down will help up my accountability and will inspire me to keep moving forward.  If I can make one or two of these become habit in the next few weeks, I’ll mark that as a success.  Because backwards is all gross and disgusting feeling and also it looks like there’s a c-section back there and I am NOT going back to that.

Body Wars.

The Good:  Birdy’s seventh birthday party went off without a hitch.  The cake was made, the guests were fed, the bouncy castle was a source of glee for kids and adults alike, and my daughter spent the day red-faced from jumping, laughing with her friends, and covered in cake frosting.  Cannot ask for more than that.

The Bad:  On Friday morning, my right eye was sore and puffy and those familiar “corneal tear” feelings were close to the surface.  Sometimes this happens and my eye settles down after a few hours (after lots of preservative free tear drops and very little screen time).  And other times, this means the eyeball is cooked and the cornea is going to fully tear.

Which it did.  Friday afternoon, I was lucky enough to get in with my local ophthalmologist, and being the hero human that he is, he was able to confirm the tear, give me some antibiotic drops to help minimize swelling and speed up healing, and then he slapped a bandage contact on my eye so I could function almost normally.  “Your vision out of that eye will be cloudy because of the contact, but hopefully the pain will be greatly reduced.  Come see me next week and we’ll take it out before you travel again.”

Awesome.  This went from bad to better.  Thank goodness for modern medicine.  (More on the eye thing in a bit because that’s an ongoing story.)

Emergency eye appointment (torn cornea, round 8). PWD everywhere … even in the magazines. #waitingwithdiabetes

A post shared by Kerri Sparling (@sixuntilme) on

The Ugly:  Armed with the bandage contact and a babysitter, we took Birdy out on Friday night for a show she wanted to see.  And she loved it.  And we loved it (as much as parents love kids’ shows sort of thing).  And about halfway through the show, I decided I didn’t love it because my stomach was churning and my blood sugars were rising quickly.

Figuring I had a busted infusion set or maybe this was a blood sugar response to eye pain, I sat in the lobby for the rest of the show and tried to get my head straight and stomach settled.

But on the ride home from Providence, my purse went from carrying my wallet and car keys to holding my puke.  Not my best moment.  But it all went in the bag so that’s something.

And for the rest of Friday night, well into Saturday morning, my body spent those hours rejecting all of its contents.  I haven’t thrown up from being sick in at least 15 years (the only times I’ve vomited in the last whatever decades have been after c-sections).  This was a whole new and horrible party, which gave way to severe dehydration (despite sucking down diet flat ginger ale and water), fever, high blood sugars, and small to moderate ketones.

I spent Saturday in bed, sleeping or throwing up, while my kid’s birthday party took place outside.  It took about 48 hours to fully clear this bug, and the aftermath still included ketones and a general dizziness.  And it totally threw me because I’m usually able to work through sickness pretty quickly, if I get sick at all.  I don’t ever spend the day in bed, unable to stand up because I’m too weak or too sick to eat.  This was gross and new territory for me.  And it forced a quick and necessary review of the sick day rules.

This is what 24 hrs of violent vomiting did to my blood sugars. #insulinbecamewater

A post shared by Kerri Sparling (@sixuntilme) on

The Recap:  The circus of vomiting has stopped.  My blood sugars, thanks to a 200% basal rate and some injections and plenty of hydration and vigilant ketone testing, have come down quite a bit and hopefully will be less offensive soon.  My family seems to have escaped the germs so far; hopefully locking myself into the master bedroom and hiding like The Big Man on Campus helped. No cats have puked yet. And once this eyeball heals up, diabetes can go back to being the top health dog.

… oh, and I cleaned out my purse.  I plan to keep using it.  And I’ll never tell you which one it is.

Dealing with Overnight Low Blood Sugars.

Quick confirmation:  Yes, you are reading this on the Internet.  No, this website is not written by a doctor.  Or a medical professional of any kind.  (Or a professional of any kind.) This is not medical advice.  I have been living with type 1 diabetes for over 30 years and this is just how I do it.

Such a good song.

Anyway, overnight low blood sugars are gross.  During the day, am I struck by the urge – need? – to consume 10 times more carbohydrates than I need to correct a low blood sugar?  Nope. I don’t eat glucose tabs by the fistful at 11 am.  But in the middle of the night I am able to consume 1400 calories without blinking twice thanks to the panic and chaos of middle of the night low blood sugars.

Over-treating lows has been a tricky trap for the last three decades, but there are a few strategies I use to hit back against hypos.

No IOB before BED.  
I try to keep my snacks very low-carb after 8 pm in order to keep my boluses at bay.  While I’d love to dive head first into a bowl of rotini before bed, I feel safest going to bed without insulin on board.  Sometimes it’s hard to avoid a bolus here and there, but on the whole, a big fat zero on my IOB brings better sleep for me.

Timing Exercise.  
This is a tricky one because my schedule changes every day, but I do my best to exercise before 4 pm on most days to mitigate midnight lows.  If I exercise in the evening, the chances of bottoming out overnight are high, so if I’m able to get things done before dinner, I feel safer.  (This does not always work out for my workouts because of kid 1, kid 2, work stuff, family schedule, etc. but I try.)

Pre-Counted Carbs.  
What do you mean, eating two nutella and peanut butter sandwiches to treat a 54 mg/dL at 3 am isn’t a good idea?  If I wake up low, I want to inhale the fridge.  Sometimes I over do it so hard that I’m bolusing while low to compensate for the carb overload.  This usually results in a high blood sugar.  And also bigger pants.  Keeping my low blood sugar treatments pre-carb counted helps a lot.  This means using glucose tabs or a juice box instead of a bag of candy that I can take too much of or a bottle of juice that I can drink too much of.

Bedside Snack Table.  
I need to keep snacks on the bedside table instead of daring my low legs to make it down the stairs.  My bedside table is almost always armed with a jar of glucose tabs or a juice box.  This is easiest because it keeps me from taking field trips while low.

Continuous Glucose Monitor.  
THIS.  This thing is the best battle tool against nighttime hypos because I can set my threshold to 80 mg/dL which, in turn, alarms and wakes me before I actually end up low.  In the last ten years, since starting on a CGM, my overnight hypos have decreased significantly simply because I catch them before they become disasters.  Of course lows sneak in here and there, but they are fewer in number thanks to this technology.

My next goal is to figure out how to stop the cleaning fits while low … although they are terribly productive …

Target Lows.

“Can you scan these so I can open them now?”

“Sure thing,” as she reached her arm over the conveyor belt to scan the package of Skittles in my sweaty palm.

BEEP.

I ripped open the package clumsily, my phone screaming out the Dexcom urgent low alarm tones.  Jammed a handful of Skittles into my mouth – way too many to be chewed at once – while simultaneously and awkwardly unloading the carriage.

“Do you have a Target red card that you’ll be using  today?”

” … mmmfff …”

My jaw was busy processing a dozen Skittles at a time.  I took a second to hang on (hopefully casually but most likely looking like a drowning man clutching the edge of a raft) and concentrated on chewing.  When I remembered, I would retrieve another item from the cart and place it on the moving track.

The lady behind me switched lanes, properly assuming I was a hot mess.

“Are you okay?”  The cashier was about 20 years old and probably accustomed to a flurry of weirdos coming through her cashier line.

I finally mashed the Skittles into something I could swallow.  “I’m fine.  Sorry – I have diabetes and my blood sugar is really low.  It happens here a lot.  Target makes me low.”  I was rambling and couldn’t stop.  “It always makes me low.”

She nodded slowly, putting my items into a bag as I loaded them onto the conveyor belt, one every fifteen seconds or so.

“I bet.”

She was kind.  I was probably drooling colorful drool.

“You can keep eating those,” she added.

So I shoved the rest of the package into my mouth, a hypoglycemic cow chewing on taste-the-rainbow cud.

BG 56 mg/dL. Eff off, Target. You always make me tank. (But I ❤ you anyway, you sassy store, you.) #diabetes

A post shared by Kerri Sparling (@sixuntilme) on

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