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Posts from the ‘Blood Sugars’ Category

How Often Should I Change My Lancet? (A “Grost.)

source: Type 1 Diabetes Memes

(Taking a cue from Glu today because when this post rolled through my feed, I was like, “Hmmm.  A lot now, but before?  NEVER!!”)

Every single time there’s a new meme about changing the lancet in a finger pricker device (nope, that is not the technical term), I laugh because they are all true in that “whoops” sort of way.

Upstairs in the bathroom closet, I have boxes and boxes of lancets for all kinds of different poker devices (again, not the technical term).  All different sizes and shapes and gauges … years and years worth of lancets for half a dozen different devices.  (Except The Guillotine.  That thing was retired decades ago, thank goodness.)  And the reason I have so many lancets stashed?  I went years without regularly changing my lancet.

Gross.  I know.  And I’ve seen that photo of what a needle looks like before use, after one use, and after six uses and yes, it grosses me right the hell out.  But for a long, long time, I changed my lancet once a month.  Maybe once a week, depending.  And I only changed it if it didn’t procure a good blood droplet or if it went into my fingertip and got “stuck.”  (You know what I mean … when you press the button and the lancet deploys, only it lodges itself into your fingertip and has a weird suction feeling when it pulls out?  Horribly horrible.)  Lancet swapping-out was a shameful non-priority for a long time.

Two things made me start changing my lancet regularly:

ONE.  A friend told me about how she’d heard a story about a person with diabetes whose fingertips were downright gangrenous because they didn’t change their lancet.  “Ew, really?”  “Really.”  And even though I stand firmly on the “hope vs. fear” motivation concept, this story about mostly-dead fingertips made me want to throw up.  Then I started searching the Internet for information on needle reuse and the photos made me want to apologize profusely to all my digits.  I had no idea how nasty and serrated the needle edges became after just one use.  I thought about all the times I had injected syringes through my jeans in high school.  I thought about how a box of lancets could last me two years.  I thought about how gross I was.  Gross, gross, groooooosssssss.

TWO.  And then I explored lancing device options.  I had heard really good things about the Accu-Chek Multiclix (mostly from Sara, because she frigging loves hers), and the device was snazzy because it comes with a drum of lancets that automagically swap out, but the size of the thing was too big for the case I kept my meter in.  Switching to the One Touch Delica was the winner, for me, because the lancet gauge is so thin that I’m forced to change it regularly because otherwise, I don’t bleed.  (It becomes that dance of pull back the device, press the button, nothing happens, repeat 10x, change lancet and curse.)  Like it or not, I have to change my lancet regularly or the device becomes useless.

Now I change my lancet once a day.  Every day.  And every time I kill a box of lancets, I feel accomplished because in the last four years, I’ve gone through at least two dozen boxes.

In the 20+ years prior?  Probably the same number of lancet boxes.

 

 

CGM in the Cloud: Personal Preferences.

“Why would you want your continuous glucose monitor information in the cloud?”

Fair question, especially coming from folks in the CGM in the Cloud Facebook group, which is heavily dominated by parents of children with diabetes.

I didn’t want to answer, at first, because I didn’t want to say the wrong thing.  When I meet with parents of kids with diabetes, the instinct to protect them is undeniable.  I want to tell them stories about people who are thriving with type 1 diabetes – “Hey, have you heard about the guy who is running across Canada?  Have you heard about the woman who gave birth to twin boys?  Have you heard about the couple who met and fell in love via the diabetes community?” – because that is the perception of diabetes that feels best to share.  It feels good to share successes, triumphs, proud moments.  You can thump your fist against your chest in pride; we are not held back by diabetes.

This is what I want to tell the parents of kids with diabetes.  Their kids will be okay.  Because that’s true – their kids will be okay.  But not without compromise, and that’s hard to articulate because it seems to fly in the face of “your kids will be okay.”  I don’t like reminding people that their kids with diabetes will become adults with diabetes because this disease is forever.  It’s uncomfortable to admit that diabetes is hard.  It’s hard to find words to illustrate the concept of, “I’m fine … sort of.”

“Why would you want your continuous glucose monitor information in the cloud?”

I’ve had some low blood sugars that have rocked me so hard I couldn’t recover, even after I had technically recovered.  Whether you want to admit it or not, diabetes requires extra planning.  Even the best and tightest and most well-controlled diabetes still comes with the threat of lows or highs.  This is why glove compartments end up crammed with jars of glucose tabs, and why back-up insulin pens litter the bottom of purses.  I was always taught to hope for the best – you can do anything with diabetes! – but to have a plan for the worst, should it happen.  Never ride a subway without snacks.  Never put diabetes supplies in checked luggage.  Always check blood sugar before driving.

“Call me when you wake up so I know you’re alive,” is a phrase casually uttered by my mother when my husband is traveling, but the honesty to it stops me cold.  Does my mom worry that something will happen to me at night?

Before Birdy was born, I had a healthy fear of lows, but after she arrived, that fear became something different entirely.  Now, a debilitating low blood sugar doesn’t just touch me, but it could hurt her, too.  When she was a few months old, my husband went away on a weekend trip and it struck me for the first time that if I didn’t wake up, no one would be there to take care of my daughter.  I pictured her in her crib, crying, alone, and without care.  The idea of her going without breakfast hurt me more than picturing my own unresponsive body.

Sounds dramatic?  It’s dramatic as fuck, because diabetes is quiet, until it’s not.

“Why would you want your continuous glucose monitor information in the cloud?”

Why?  Because having someone else able to monitor my blood sugars makes me feel safer.  I can’t make insulin anymore, but I can create peace of mind for myself, and for my family.

So I’m not waiting.  I’m not waiting for bad things to happen.  I’m taking a preemptive bite out of fear by putting another safety net into place.  When I’m traveling for work, I will have my CGM data streaming to the cloud, and my husband and my mother (as needed) will have access to it.  When I am alone in a hotel room, my family will have the peace of mind knowing that they can see my blood sugars while I sleep.  Same for when my husband is traveling and I am alone with our daughter.  As much as I know the CGM companies are working hard to bring this technology to patients, waiting removes the safety net that would help me sleep better at night.

I am not waiting.

 

 

We Are Not Waiting: CGM in the Cloud (Part 2).

Continuing from last week, I’m picking up this morning with Laurie Schwartz, mom to Adam (T1D) and an active and supportive voice in the CGM in the Cloud group.  In the last week, I’ve had many interactions with people from the CGM in the Cloud group and every single person has been happy to share their experiences, eager to share their expertise, and more than patient with my questions because their goal is to help people.  Laurie is no exception.  Laurie Schwartz is a retired dentist, now residing in Colorado and partnering with her husband in life, love, home-education of three kids, and pursuing a better understanding in diabetes management for her son.  And today, I’m really pleased that she offered to share her experiences with CGM in the Cloud here on SUM.

Kerri: What’s your connection to the diabetes world?

Laurie:  Diabetes has been a very large and recurring theme in my life since 1980.  
I have lived with diabetes from the perspective of a child watching a diabetic parent struggle.  I have experienced the disease as pregnant woman fearing the damage to an unborn child when diagnosed with gestational diabetes. The most emotionally challenging connection is definitely as a parent caring for a child with this disease.  Recently, I have added the view from an early diagnosis for myself as I become more and more glucose intolerant.

My father was a brilliant physician who suffered for decades from the complications of insulin dependent type 2 or he might actually have been misdiagnosed and was LADA.  His struggles with fears of lows as a surgeon, to poor control and long standing hyperglycemia from lack of frequent monitoring, to my witnessing all of the devastating complications he lived with has influenced me heavily in my approach to our son’s current management.

My third and youngest child, Adam was diagnosed in June 2008 with type 1 at the age of five years old.  Our diagnosis story is included in a book “Lifesaving Labradors.”

Kerri:  So how did you find out about the CGM [Continuous Glucose Monitor] in the Cloud group?

Laurie:  In the pursuit to have every tool possible for maintaining “normal blood sugar”,  I found myself embracing the benefits of the diabetic alert dog.  I have been active in the Diabetic Alert Dog community since training our alert dog in 2010. Willow Wonka is our son ‘s alert dog. Willow is a very skilled and polished dog, who has contributed significantly to our ability to maintain Adam’s a1c between 5.4 and 6.0 since June 2011. My use of the alert dog with the CGM has been our focus for better management.

On April 20, 2014, our close friend who heads a wonderful diabetic alert dog organization, Crystal Cockroft of Canine Hope for Diabetics, screenshot and texted me a picture of a Pebble watch with CGM information.   She thought I would like the technology.  I immediately wanted to jump on a plane to San Diego and pay any amount of money to acquire the technology.  I was shaking with excitement over the envisioned benefits the system could offer.  We had to have it!

The picture was posted on her Facebook friend’s page, Jason Adams. 
I contacted Jason minutes later on Facebook and he” heard” my desperation.  He assured me that a plane trip or an expensive fee was not required.   By April 22, just 48 hours later, we had purchased everything and had the system working.   Then, remarkably within just 3 hours, the CGM in the Cloud potentially helped us avert a dangerous medical crisis.

Kerri:  Within three hours?  What do you mean?

Laurie:  My desperation to acquire this technology resulted from a culmination of stress due to five months of bitter fighting with our mail-order pharmacy to stop shipping us 90 day supplies of warm insulin. Just the days earlier, I had finally gained approval from our insurance to receive local retail pharmacy, in the hopes it would be properly stored and handled cold insulin.  My recent success was a result of my efforts the previous week frantically arguing that bad insulin would kill my child because his body and our pump settings were all adjusted to the unknown effectiveness of warm less effective insulin. My claims were my true fears but I didn’t truly understand what that could look like.

We have had our kids in year-round swim team for four years mostly because the exercise is fantastic for blood glucose control.  We have systematically created a process to maintain stable blood sugars during practice with Adam’s consumption of simple glucose drinks.  We check blood glucose midway through practice or more frequently and one parent is always close by.

Our prior success in managing to maintain steady blood glucose even with potentially weak insulin gave us a false sense of security.  In hindsight, it was a recipe for disaster.  We were so comfortable with our carb/exercise protocol that I was even taking the alert dog to classes away from our son during some swim practices.

University of Denver Hilltoppers has 80-100 kids in the pool every evening.  On this night, when we had the Cloud system for the very first time, I was at dog agility class with Willow.   My husband was swimming his own laps in the open adult lane with Adam just 2-3 lanes away.  I watched on the CGM in the Cloud Adam’s CGM readings decreased and then report a 49 mg/dL.  I repeatedly texted my husband, then determined he was probably unreachable by text because he was swimming and for the first time since Adam was on the team, called the pool office and asked that Adam and my husband be removed from the pool to check his blood glucose.  The BG check revealed Adam was 70. For us, a BG of 70 is not necessarily an emergency but Adam had been consuming simple glucose all through the practice and should have been 100-140.   My husband gave him (an unusually large amount for us) 15 g of carbs without additional insulin, waited 15 min. and with Adam’s insistence that he was fine, let him back in the pool.  Adam got out five minutes later reporting feeling extremely low and sick.  His feelings of that symptomatic persistent low did not resolve appropriately as his BG would not increase above 70 mg/dl for about an hour even with additional large amounts of dextrose and interrupted insulin.

We can only attribute this never before seen persistent low to the use of the new effective insulin combined with the effects of heavy exercise on his body’s insulin sensitivity.  The timing of our access to the CGM in the Cloud was so fortunate, and I believe lifesaving.  The realization that we so narrowly escaped a tragic situation motivates me to continue to express my gratitude and assist in other T1 families learning about this amazing system.

Kerri:  That’s some tech validation, right there.  Is this in line with what you see being discussed in the CGM in the Cloud group?

Laurie:  The group was created to share the personal experiences and observed benefits of the system.  Our swim practice incident was just one instance that demonstrated that this technology advance to the CGM system was too important to keep private.

The group discussions are varied from sharing success stories, sharing how distance monitoring allows for parents to coach grandparents and friends while away with a T1 child, to assisting in technology set up questions, and to discussing future development ideas and approaches.

All of the contributions made by the group members assist in the direction of the future advancements to the system.  [Editor's note:  The emphasis added was mine, because her statement is beautifully true.]

Kerri:  How is this group moving current diabetes technology into tomorrow’s tech space?  

Laurie:  This is a technology was created out of necessity by real parents living with the shortcomings of what the industry had to offer.  The ever-growing bank of ideas and knowledge is flourishing with new approaches from all over the world.  This group is collaborating to create software and hardware advancements for T1 monitoring, data transfer, and utilizing this community’s conversation to draw the direction to which the effort should be best focused.

Kerri:  As I had asked John last week, do you fear the FDA?  Or the companies that make the CGMs?  What are your concerns about how Big Companies might view this movement?

Laurie:  I am concerned that greed or other human failings might slow the progress of this technology.  The FDA has its role to review the safety of medical devices.   In this case, the FDA has played its part by testing the inserted sensor materials, the exposure to the transmitter signal and reviewed the data reliability in studies comparing the BG and venous draws to the CGM readings.

In my opinion, the FDA has little place in restricting how the patients use their own medical data.   Once collected, the data is used for improving and intelligently monitoring diabetes management decisions and should not be restricted.  How the data is usefully transmitted is not an FDA matter, it should not be restricted or slowed.

The cloud group is not about redesigning wonderfully effective medical technology, but rather improving user interface. The biggest facet to effective diabetes management is constant awareness of your body and its metabolic status.  Making that information as convenient as glancing at your watch or smart phone is invaluable to the process. Dexcom is a leading company in the CGM industry, approved by the FDA as a medical device company and should focus its efforts on continuing to improve materials for interstitial fluid monitoring of glucose.  How the patient uses or shares the medical data should be a patient decision.  If the open market technology world designs advancements to support the Dexcom technology, the tech advancements can promote the company’s continued success in the industry.  This can be a win-win for Dexcom and the T1 community through the careful construction of continually improving the technology bridge.

Kerri:  Okay, so let’s look at some of the nitty-gritty.  How easy is it for members to get one another suited up and running on a remote device, and how does the CGM in the Cloud community help one another in this process?

Laurie:  Many new members have assisted each other in the set up process.  Jason Adams had contracted a freelance university student, Rajat Gupta to help him set up his own Cloud system.  Without hesitation, Jason shared that with me, a complete stranger, connected by desperation to help one’s child. Jason and Rajat assisted in our set up and many many more set ups since.  Rajat’s system has been very successful and easy to utilize for the non-tech families.  Our setup was literally a 20 minute process once the android, pebble watch, cords and case were purchased. Our heartfelt gratitude goes out Rajat for continuing to support this community with many uncompensated hours.

Jason Adams started the Facebook group to help share the clear benefits that having the Cloud system offered.  Since that beginning where Rajat offered an emailed application, the group has grown and and additional option to acquire the Cloud system has emerged with community support for a “Do-It-Yourself” system.  Regardless, of which way a PWD or CWD acquires the CGM in the Cloud, the system offers unique access to real time distance monitoring of CGM data.

Kerri:  And last, but certainly not least – why is this CGM in the Cloud technology important to you?  

Laurie:  Personally, every single advancement is an opportunity for better control.  I remain tormented by my father’s struggles with diabetes, and I am driven to help my child live better with diabetes.  We have many systems in place to assist us in our management goals.  We strive to maintain non-diabetic glucose ranges to the best of our ability.  The effort it takes to manage tight control is very complex. and requires constant vigilance  We appreciate various devices for their contribution and do not focus on shortcomings. We embrace any and all systems that can help us to make better, faster and smarter management choices.  We pursue the latest most accurate blood glucose meter, the least intrusive pump, the best trained alert dogs, the newest generation and best rated CGM and any extension that can be added to those systems.

The BG meter is a static point in time and as quickly as that reading is offered in a few short minutes a very different glycemic situation could be occurring.  Considering the margin of errors each and every BG reading may reflect, it is almost based upon tradition or superstition to why anyone uses a BG meter for making important decisions regarding the titration of a lethal drug like insulin.

The alert dogs are preemptive tools requiring proximity to the T1.  The DADs (diabetic alert dogs) give a signal that alerts us to impending changes prior to the meter and CGM. The dogs give us a heads up that we need to pay attention.  That heads up is usually significant in shortening the amount of time or our son is out of range with a high or low event.   The biggest drawbacks to their service is the necessity of proximity (limits set by distance scent can travel) and the handler’s ability to interpret and utilize the advanced warning alert.  By proper interpretation of the dogs alerts extremes glycemic events can be minimized and ranges tightened.

The CGM shows trends and data.  Reviewing data gives valuable information for discrete dosing adjustments to basal rates and bolus ratios in the short and long term.  There is overlap with the CGM high and low alarm alerts with the dog’s alerts to some extent, but not quite.   The diabetic alert dog’s alerts are usually ahead of the meter, CGM and symptoms and the CGM historically lags the event.  Similar to the dog’s scent ability, the CGM is also restricted by proximity through the limits of range of signal from the sensor’s transmitter to the receiver.
 
What the CGM in the Cloud uniquely brings to our arsenal of management tools is real time distance monitoring.  No other tool allows for the person with diabetes to have the assistance of a person at distance contribute to the management in real time.  The distance component is lacking in the current management tools.  By having the Cloud broadcasting a constant flow of information that can be accessed by interested parties, those parties can assist in collaboration for better treatment decisions, faster or slower or more discrete interventions.

From a social and emotional perspective, the Cloud system also offers a more discrete monitoring contribution.  With this technology, we can assist our child in treatment decisions in a more timely fashion but also with less unnecessary intrusions to the parent-child relationship.  We can lessen our queries for CGM readings or BG results and more unobtrusively suggest a timely intervention of a BG check, suggest a small carb snack or insulin dose.

 By utilizing the Cloud, some of the relationship interruptions caused by diabetes are minimized.

With more intelligent distance monitoring by parents; the teachers, babysitters, grandparents and parents at play dates have support staff, experienced diabetic managers on their team to help the T1 child safely stay closer to normal ranges.

For a parent to develop strategies to promote safe independence, safety need not be compromised.  Traditionally, parents gave their children carbs before bed.  The bedtime snack was to help prevent a low during the late hours.  That same snack probably caused a high but without testing or monitoring the highs were not confirmed and the child was hopefully expected to survive the night without a deadly low.  Sleepovers and bedroom assignments were dictated by proximity to parents’ bedroom because that was needed for monitoring.

Sending a child to participate in a sporting event or physical activity usually involved increasing the blood glucose, so there was a margin of error for the exercise induced energy drain.  With the CGM in the Cloud, more timely monitoring can provide the opportunity for the parents to avoid unnecessary highs as a prevention technique for lows.

The real story is in those who created this technology. The determination and drive of these parents with T1 children to work tirelessly to create a system that overcomes the limitations of current medical technology is so impressive.  The value in this system is that it was forged out of necessity.  These parents had a vision and they created and labored to succeed. 

Their decision to their solution with complete strangers speaks to their integrity and generosity.  Our interest, gratitude and support should be focused on their efforts and selfless contribution.  These individuals have careers, families, sleep-deprivation from living with children with T1 and they are not looking for the fast buck or to “cash in.”   Subsequently, others will come looking to help and develop this process. There will undoubtedly be some looking to make a quick buck,  but the developers released their work to open source for the good of the T1 community.  Regardless of who continues to develop this system, my hope is that the diabetic community will be improved as this much-needed technology continues to develop.  I offer my information as an end user of the CGM in the Cloud and my enthusiastic support of the system for its life saving and life improving capabilities.

Thank you so much, Laurie, for sharing your story.  To find out more about CGM in the Cloud, you can visit the Facebook group (up to 2,779 members now) and connect with folks who share your desire to have the data where, when, and how you want access to it.  And later this week, I’ll show you the system they helped me build and why it matters to me, as an adult with diabetes.

Sparkly, Like Her Shoes.

As a family, we went to dinner and Birdy’s sequin-covered shoes sparkled furiously in the afternoon sunlight.  Her shoes were downright distracting and I found myself low-staring at them, focusing on the individual sparkles being projected onto the tablecloth at the restaurant.  My brain had hit an uncomfortably steady pace with the anxiety of being under 60 mg/dL for more than two hours, adjusting to the panic but still needing an outlet.  Staring at the glitter on my daughter’s shoes calmed my brain down just enough.

We ordered and ate, and a meal plated with carbs and less-than-normal bolusing still didn’t battle back against the low alarm from my Dexcom.  I felt like a failure, asking Chris to grab a glass of juice from the waitress as my empty dinner plate sat in front of me.

“I’m still low.”  I tested my blood sugar again, hoping to see a number that didn’t require more glucose tabs, hoping the Dexcom was wrong, but a bright 43 mg/dL grinned back at me.  I knew the food would hit but not fast enough.  “Yeah, I need juice now.”

In a quiet hurry, I heard the background noise of hypo management done from a distance.  “I need a glass of juice.”  “Would you like lemonade?”  “No, juice.  Do you have orange juice?”  “We have apple juice.”  “That, then.  Please.”  Chris sat back down at the table while Birdy bounced and played beside me, her shoes throwing sparkles onto the table that were spreading out everywhere, my eyes starting to cave to the low blood sugar.  Peripheral vision was being replaced by these starbursts that were sparkly, like her shoes.  I felt my body pulling in tight and rallying glucose, sending it to the places that were necessary and not caring that I couldn’t hold a fork or keep my mouth from twisting into a resting bitch face/uncomfortable grimace.

Dinner tumbled into a pile of apologies and distractions because I couldn’t get my wits about me, and even once my blood sugar was stable (back up to 72 mg/dL), it still wasn’t staying up, and tumbled again a few more times before bed.

It doesn’t look like much, from the outside.  It’s hard to explain how silent the panic is, how evacuated my brain feels when the hypos hit and stay for too long.  I don’t know how to show someone a Dexcom graph that looks like this and explain how it’s not just the blood sugar number, but the cumulative effect on my body – the exhaustion in my muscles from being clenched in fight-or-flight mode, the sleep my brain needs after a five hour low blood sugar experience, my inability to find the words for what I want to say because my mind is just like, “We’re DONE.”

I woke up with a blood sugar of 230 mg/dL this morning, the product of answering low alarms with frustration and marshmallows, and I corrected the number with the predetermined, carefully calculated amount of insulin.  And I hoped that, for today, diabetes would leave the sparkles on my daughter’s shoes.

Hypo Effery.

BEEEEEPBEEEEEPBEEEEEP!!

My purse start vibrating in a panic.

79 mg/dL and two arrows down – how the hell did that happen?  I just dropped my daughter off at preschool.  My blood sugar was 139 mg/dL before leaving the house with a steady, easterly arrow.

I pulled the car over and put on my hazard lights so I could bust out my glucose meter.  (Oh hell yes I treat low blood sugars purely based on a Dexcom reading from a trusted sensor, but this sensor is on Day 14 and due to be changed this afternoon, so my trust was getting rusty.  Trusty?  Rustworthy.  Bah.)  Meter said 68 mg/dL.

The symptoms, which weren’t strong when I pulled over, were starting to edge in.  Shaky hands and blurred vision (almost wrote “blurred bison,” which sounds like a band name) paved the way for clammy skin, which let the fog of hypoglycemia settle into my brain.

Fine then.  I reached into the glove compartment for the ubiquitous jar of glucose tabs.  Chomp, chomp on four of them only to realize they aren’t Glucolift but instead the generic chalkified glucose tabs from CVS and became grossed out.  The low symptoms were intensifying as I sat on the side of the road, so being picky about my glucose sources wasn’t an option.  Chomp, chomp on another tab, wishing I could somehow keep a soft-serve ice cream machine in the glove compartment instead.

Moments pass.  I’m still buckled into my car, eating snacks, watching cars whiz by.  The Dexcom finally shows an upward climbing arrow.  My hairline feels less clammy.  The shape of the steering wheel and the radio control knobs come back into sharp focus.  Better.

“Did you check your GPS?” my mom asks me whenever we’re about to get into the car together.

“Mom, it’s a CGM.  And yes, I did check it,” I reply, usually laughing because no matter how many times I tell her it’s a “CGM,” she still calls it a “GPS.”

But as I think about what may have happened if the low symptoms hit in full while I was driving instead of after I had pulled over, GPS might me just as accurate, giving me the location, in context, of what the hell my blood sugars are doing.

 

Put On Your Listening Ears.

Our backyard is big and lovely and fenced in on all sides so that when Birdy and I are playing outside, we’re both safe from cars and giant woodland creatures (except the ones that can shimmy underneath the fence … I’m looking at you, groundhog).  I don’t keep my eyes glued to her while she plays, and we can enjoy the sunshine and the garden without feeling paranoid about passing cars, wandering off, etc.

Which is exactly what sucks about the front yard, because that’s the part of the house that the road is closest to.  So while I still need to do things in the front yard (getting the mail, tending the front garden, drawing hopscotch in the driveway), I don’t do anything of those things without having Birdzone front and center in both my mind and my actual line of sight.

Yesterday evening, Birdy and I were working in the front yard garden (I was clearing out some weeds and she was making “houses” for worms we discovered underneath a rock), when my Dexcom started wailing from my pocket.  In retrospect, I felt a little “off,” but it wasn’t until I heard the low alarm blaring from the Dexcom receiver that the symptoms kicked in fully.

“Hey, your blood sugar is whoa, Mom,” Birdy said absently, placing another worm onto a pile of dirt.

“Yeah, we need to go inside and get some snacks, okay?  It’s important,” I replied, looking at the “UNDER 65 MG/DL” warning on the Dexcom screen.

Normally, she listens.  Especially when it’s about blood sugars, because Chris and I have talked with her a few times about how listening is important, particularly when I tell her my blood sugar is low.  But she wanted to stay outside.  She liked playing with the worms.  She liked being in the dirt and gardening.  She didn’t want to have to cut playtime short because Mommy needed a few glucose tabs that she should have brought outside with her in the first place.  [Insert Mom Guilt here.]

“Nooooo waaaaaaay!!!” she said, flouncing away from me and refusing to turn around.

Under normal circumstances, I would have laughed (because “No way!” is a great response), but I was starting to feel shaky and my brain cells connections felt loose, like thoughts weren’t coupling up the right way.  We were in the front yard and I knew I needed to gain control of all potentially dangerous situations in a hurry.

“We need.  To go.  INSIDE right now.  My blood sugar is low.  This is not a joke.” I said.

“No!  I don’t waaaaaaant to!!”

My blood sugar falls fast.  It always has.  I don’t get the long, lingering slides towards hypoglycemia but instead the quick, breathless plummets.  Knowing that I was dropping and watching yet another car drive by our house meant I needed to get control fast and without issue.

Before my body completely caved to the low blood sugar, I scooped up my flailing daughter and walked into the house.  She was freaking out and still forcefully asserting her right to “NOOOO!” but I needed sugar more than I needed her to like me.  A few seconds later, we were both safely contained in the kitchen.  I had a few glucose tabs and waited for my brain to acknowledge them.  Birdy pouted in the corner, staring at her hands and still mumbling, “No way.”

A few minutes later, I felt more human.  “Birdy, I’m sorry we had to come inside.  But my blood sugar was low and it could have become an emergency.  So that’s why you needed to put your listening ears on and come inside.  I wasn’t doing it to be mean; I was doing it to be safe.  Does that make sense?”

“Yes.”

“I’m sorry we couldn’t stay outside.  But we can go back out now, okay?”

“Okay.  I’m sorry I didn’t listen.”

“It’s okay.”

She turned around and pressed her hand into mine.  Something wriggled.  She smiled.

“I brought a worm inside.”

No way.

 

The No Good (Sort of Good) Food Diary.

It was easy to avoid food logging because, on the whole, my blood sugars aren’t a disaster.  I bolus for the foods I’m eating, and I don’t graze much so stacking insulin doses isn’t as much of a problem as it has been in the past.  But the other night, when 9 pm rolled around and I was asking Birdy for the fifth time why she isn’t ever tired ever, I realized I’d had six cups of coffee that day.  Technically, it may have been seven cups of coffee, because one of them was an iced coffee and those don’t follow any rational serving size.  And I couldn’t remember if I had eaten more than a handful of almonds as a snack earlier in the day, and did I end up actually sharing a doughnut with Birdy at the coffee shop, and I know I had a wrap sandwich at some point but some grapes ended up in the mix somewhere and where the hell did that glass of wine come from??

My schedule throughout the day doesn’t afford for much consistency.  Each day is pretty different from the previous one, and sticking with a set schedule is challenging on the days when I’m both working and playing with Birdzone.  Not that it can’t be done, but it isn’t usually done.  I’m becoming more scatterbrained as time goes on, to the point where I am actively forcing myself to take certain actions in order to reclaim and make sense of my days.

Which is why I decided to start logging food for a week or two, because it’s clear that I have absolutely no frigging idea what’s actually happening each day.  (I’m using MyFitnessPal for the time being, until it frustrates me and I revert back to keeping a list in my bottomless basin of a purse.)

I don’t like it, though.  It’s a level of accountability I don’t joyously embrace.  (“YAY!!  Writing down everything I’m eating?  So that I’m now tracking blood sugars and exercise AND food intake so that I can feel both powerfully informed and terribly guilty about every single choice I’m making all day long?  OH YAY!!!”)  I don’t like having to be honest and log that, yes, I ate chicken and green beans for dinner but yes, I also went berserk and had a big, fat slice of banana bread for no reason.  I don’t like looking at the food log and noting that less-than-healthy food choices really toss the calorie count for the day up into the air and then out the window.  I don’t like logging anything (read: blood sugars), and keeping a food diary is no exception to my pre-established log loathing.

But … big, reluctant sigh … it’s useful.  (bah.)

After only a day of logging foods, I realized that my coffee intake is abysmal.  Way too much.  Blood sugars don’t seem to care, but the caffeine influx makes for trouble sleeping, and I’m in no position to sacrifice sleep.  After three days of logging foods, I realized that my willpower and organizational skills are top notch in the morning and afternoon, but around 7 pm at night, I lose control over what I’m thinking/doing/eating and I consume most of my unneeded calories at night.  And while I don’t like writing down every healthy (and otherwise) decision I make during the day, the food diary does hold me accountable for my actions.

Fine. I’ll curmudgeonly accept that logging foods for a week or two is useful.

I’m already looking forward to stopping the food logging in a few days, but I know it’s a good way to realign my brain, and my schedule … and my stomach. I have already seen for myself that there are choices I can improve and decisions I can pat myself on the back for. And it’s confirmed, officially, that I drink way too much effing coffee.

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