There's Always a Way

With so many limitations placed on diabetics by doctors ("You'll never drive a big-rig for a living"), the media (in that news-casterly fake empathy, "Diabetics must watch and measure every thing that goes in their mouth"), and the general public ("Should you really be eating that cookie with your sugar disease and all?"), I sometimes surprise myself but setting up my own barriers.

A few weeks ago, I concluded and posted a blog stating that I should never (a word our pre-marital pastor told us should never be uttered in marriage) take a sleeping pill because it makes waking up and treating low blood sugar very difficulty and could lead to a very dangerous and even life threatening situation. I was certain it was now on the list of things I will never do, right next to eat a scorpion, hike Antiacrtica (I hate the cold), and drive big-rig for a living (I really didn't want to do it, even before the doc told me I shouldn't). The thyroid problems I have been having lately have made it so that it is very difficult to get any sleep of good quality. Its like trying to sleep after consuming 30 cups of espresso and downing a bottle of no-dose. Your mind never really slows down enough to get good sleep. Vivid, anxious, haunt my dreams all night and my body is constantly tossing and turning trying to calm down enough to get comfortable.

After a particularly bad stretch of horrible nights, I revisited the thought of a sleeping pill. I started playing around with how it might be possible. What if I had someone wake me up every hour to test my blood sugars. But, that kind of defeats the purpose of getting a good nights sleep.

O.K. So what do I have? I have a Minimed Continuous Blood Sugar Monitor, Johnny, but, he sometimes won't catch a low until I have been in the 30's or 40's for about a half hour. (For reference, the docs tell you you'll pass out at 30 and if nothing is done, you'll die.)

But I can change the range for which he alarms me. So I tell him to buzz me when I get to 100. One hundred is in the normal range, but I find if my sugars drop, I can feel them going low while Johnny still says I am 100.

And I recently have fixed a series of nighttime lows by reducing my basal rates in the first part of the night. I haven't had a low overnight in 4 days. I can also purposely run my blood sugars a little high, not high enough that I will wake up the next morning feeling hung over, just high enough to guarantee no lows. So I indulge in an extra mother's day cupcake that my daughter made all by herself (yes, I am a little proud that my seven year old can already bake). The evening becomes all about getting everything in order before I take the pill. Sensor in at 6. Calibrate it at 8. Check to make sure it is accurate and trending along with my regular blood sugar monitor which requires a stick every half hour.

At 9, I pop a pill and eat my cupcake. 9:30 and 10 come with more checks of the blood and at 10:07 while watching another episode of my dumb T.V. shows (as Tony calls them), I can feel the pill take hold and get the distinct feeling that I should get into bed rather quickly before I pass out for the night on the hard wood floors of our living room. I wake up the next morning.

I wake up the next morning. It's a funny world when you are appreciative that you actually wake up, when death at night is a constant possibility and every night you lay down could be one that ends up with you coming to while staring at a ceiling that has become so familiar you can recognize which room in the ER they have wheeled you into by the pattern of the roof tiles and lights.

But it is also a life where sleeping through the night is a huge accomplishment. Another battle you have fought valiantly and won. One more notch in your belt of all of the ways you have never let the disease win. My Junior High math teacher always said one day when I grew up I would use all of the skills I learned while solving one stupid word problem after another. I can tell you I do it every day with almost every decision I make to get a leg up on this disease.

So fight on, and make sure you are not adding barriers to the ones the world has already placed for us.

Three at a Time

Three? Three at a time? Really? Three? Didn’t they learned in Kindergarten like the rest of us that’s it is the polite thing to take turns.

I could even have handle two of them at a time, but three? Why couldn’t it be that when the bronchitis wants a turn the diabetes politely says, “Oh, Bronny, you haven’t had a turn in a while, and I’m getting sick of this rain. Why don’t I take a little vacation to the Bahamas and you can have your turn with Erin.”

That way, when I have to take the steroids to return my lungs to the working condition, my blood sugars would remain stable instead of them climbing so high and being so unreasonably determined to remain that way. And when I have to stop exercising because my lungs no longer work it won’t cause my body to be resistant to the very insulin I need to stay alive.

And when my thyroid wants to join in on the party he would say kindly to Bronny and the diabetes in some haughty British accent, “Bronny, Tess, would you two mind considerably if I were to take a go with her. I have learned much from watching the both of you in your differing assaults on her health and would love the opportunity to try my hand.”

They both would acquiesce and be off. And while they are doing such a good job being so polite, possibly they could post a sign on the door that would elegantly deny access to my family from any other sort of illness that was hoping to take up residence.

As if its not hard enough to deal with a “very bad case” (said tongue firmly planted in cheek) of Diabetes, bronchitis so bad that to blow the propeller on my son’s remote control helicopter almost causes me to pass out, and a thyroid that has decided no longer to listen to its regulatory inputs and instead produce copious amounts of hormone whenever it feels the desire, I have a daughter with a stomach ache so bad to keep her out of school for a couple of days and a husband who has come down with a chest shaking cough only days before his biggest triathlon of the year.

So maybe I should bring that exasperated cry up to Five? Five at a time? Really? Five?

Inside the Mind of a Diabetic

If you have ever had the unusual pleasure of having a meal with a diabetic you might have noticed that moment when they look off to the left, appearing deep in thoughts somehow not entirely related to the current conversation. If you have ever wondered what it was running around in their head, here is a small glimpse into the things they have to think about on an almost constant basis.

A little background, last weekend I went on a sailing trip to Catalina with 4 fellow sailors. It is an entirely new situation for me as far as dealing with diabetes goes. Most of my adventures since acquiring this "medical challenge," as my mom puts it, have been very active, hiking the grand canyon, running triathlons, surfing for hours on end. This one would involve sitting or standing for hours on end which can be a total disaster with diabetes. I, also, would be stuck on a boat if anything went south.

Friday morning I wake up high, 241 at 5:30. Correct with 1 unit for every 50 points above 100. 240-100=140/50=Push 2.8 units. I'd been battling bronchitis for 5 days, the extra bacteria will send my sugars higher than usual. I haven't worked out in 5 days so my body will not be as sensitive to insulin until I get in two to three good workouts. Driving in the morning will also send my blood sugars higher than if I drove in the afternoon.

All of this means I will need more insulin. My basal rate, the amount of insulin constantly dripping into my system from my pump to closely mimic what your pancreas does naturally and so much more accurately, needs to be raised. I would have gone 120% of normal for just the sickness, probably another 15-20 % for the car ride, so I decided on a 145%. If I go too high my blood sugar will crash, so I am always afraid of going too high with a higher basal rate, but being high on a trip doesn't sound too good either.

I got to my parents house in Seal Beach, dropped the kids, had a few moments to get a bite and clear my head. I hit Jack in the Box for a soda and went across the street to Starbucks for a breakfast sandwhich (caffeine blasphemy, I know, to bring soda to Starbucks, but I just can't get into the whole coffee thing.)

Check my blood sugars, 271.

My correction was an hour and a half ago so its halfway done with its job, which should have put me at 160. So 271-160=171 more to correct for. 171/50=3.2 but I don't want to overdo it so I pump in 2 more units to correct and 1.5 for the breakfast sandwich, skip the Symlin because it can make me nauseated and no one needs that kind of help when their about to get on a boat.

Get on the boat and take off at 10. Check sugars again. Now I'm 361. That's pretty crappy. Correct again. (361-100)/50 gives me 5.2 units. Sitting on this boat motionless is going to add to the crappyness so I up my temporary basal to 155%. Try to sail.

I spent most of the morning trying to get my sugars down. Eventually I upped my basal again and corrected a lot. I managed to bring it down to the 200's by lunch, but it didn't get much better than that. We anchored that afternoon and, after a quick swim in the surprisingly warm water, we hiked across the island (only about a mile) to watch the sunset over the pacific side of the island.

That walk couldn't have been more welcome. A chance to stretch my legs and get my body a little more sensitive to the insulin. On that walk I got into the good zone, actually I kind of overshot it, but was brought quickly back in thanks to the PowerGels I always have in my pocket while sailing.

The rest of the days went just like the first, 300's in the morning, even with high basal rates and lots of correction, and afternoons that were good once I got on land. It was odd to see the immediate difference in my blood sugars on land and on sea. While on the boat my sugars were very obstinate, they dug in their heels and did not want to come down. Once on land they became perfect, that level line between 80 and 120.

As I start to plan my insulin regimen for my upcoming trip I start to wonder, was that a morning thing versus an afternoon thing (there are different hormones circulating around your body depending on the time of day that can make your body more resistant to insulin) or was it a land versus sea thing? Or maybe a little of both?

Looks like I will have to go back into the lab and do some experimenting, change some variables and then analyze the data. Maybe a morning sail and then an afternoon sail and then check the sugars? Will a run in the morning before I take off fix the problem? I can sit on the couch all day on Sunday watching football with perfect blood sugars as long as I've had a long run in the morning, this might be similar.

Maybe some sort of exercise on board? I thought about doing some squats while at the wheel last weekend but I didn't have the guts to start aerobicizing in front of everyone. I was already the weird one who had to draw blood on an hourly basis, and gladly swam half a mile to get to shore to buy a soda to get my caffeine fix . I didn't need to add to that impression by doing squats while on watch.

While I'm alone I would have no problem, but can you do squats safely while on a 25' boat as opposed to the 31' that we were on? Maybe some pushups wheile I anchor? Maybe some dancing wildly to loud music might do the trick.

Will my activity level change on a smaller boat, will it rock more, will I have to balance more? We had 5 people to manage the boat last weekend, sailing alone will certainly mean more work. Will the increased work load help with my blood sugars, and if so how much? Will stronger winds make a difference? We motored most of the way out and back so there was very little scurrying about the deck to adjust the sails. The stronger trade winds in the Keys will definitely change that.

While down below in the tight quarters I bumped into a corner and ripped out the sensor in my leg that measures my blood sugars every 5 minutes and then reports it to my pump. I yelled at Johnny for not holding on tighter to my leg (if boys can name their cars that just get them from Point A to Point B, I can certainly name the Continuous Glucose Monitor that has already added years to my life).

So next time I should probably move it to a safer spot, one that won't be as likely to hit a counter (not that I need to explain where exactly that might be) and probably bring an extra couple of sensors. I only brought one on this trip because I had no idea how I would shoot a 2-inch long, way-too-thick needle into my thigh on a rocking boat when I can hardly bring myself to do it while on land. In July, I can just go ashore, I suppose, and do it in a bathroom stall in some run-down Florida restaurant (note to self: bring lots of rubbing alcohol).

Things like this ran around my head during the whole weekend. My brain was wracked with math and strategies and analyzing every variable to make a sad attempt to keep my blood sugars stable, while the others simply enjoyed the sea and the sun and let their pancreas do all that hard work for them.

So next time you see your diabetic friend start to go to that place when they stop listening to you just for a brief moment, pause, just for a second, to give them a chance to zip through the math, and then go ahead and finish that story about that time when you were just 18 and could still stay out all night and not feel it in the morning. They'll appreciate the gesture.