Scott's Diabetes Blog

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Location: Minneapolis, Minnesota, United States

Diagnosed with Type 1 diabetes in April of 1980. I recognize the incredible mental struggle of living with diabetes. I hope to share my struggles, my successes, and everything in between.

Friday, August 26, 2005

How has basketball been going?

I'm sure you're all curious about how basketball has been going! Overall I'd have to say it's been going pretty good. I'd like to share a story about last week that I think is pretty funny, then I'll get into the diabetes related stuff.

I usually get to the gym on Tuesdays & Thursdays for a couple hours during the lunch period. On Tuesday of last week I got stuck in a meeting at noon (who in their right mind schedules a meeting at NOON?) and wasn't able to go.

On Thursday I was a bit late leaving the office, but was still able to go. I stopped at the store between there and the YMCA to get some gatorade, then headed to the Y. Still a bit late, but not doing too bad. On my way to the locker room I peeked into the gym. The guys had started playing and I was anxious to join them. I go into the locker room to start changing, only to find that I had not grabbed a pair of my shorts, but rather my some of wife's sweat pants!!!

After some initial swearing and cursing, I found myself looking down at her sweats considering if there was any way I could make it work. I decided against the highwater spandex look and was so upset that I headed to Perkins for a high calorie fat filled lunch. Oh well - that'll teach me! Nothing like planning to burn a couple thousand calories but ending up consuming a bunch instead.

Okay - on to the diabetes stuff!!

I'm still experimenting with all of this, but the last couple times out I have done REALLY well. I'm able to get my bloodsugars right around 120 or so before starting (that in itself is a miracle!). An hour before playing I start a temporary basal rate of 25% for two hours. The thought behind this is after some time playing I will have exhausted my stores of glucose and will start burning fat at an aggressive rate, spilling ketones and raising my resistance to insulin. So having my basal rate jump back to my regular rate, which would normally be MUCH higher than what I need for exercise, will be enough to balance that insulin resistance from the ketones.

Before playing I also eat/drink something with decent protein and carbs, not bolusing for the carbs. I've tried a slim fast shake (about 24g carbs and 10g protein) as well as some type of protein bar (17g carbs and 15g protein). All three times I've started right around 120, and after 45 minutes or so I'm very close to that number (give or take 10 points - amazing!).

As I play I've also been drinking gatorade, trying to take in some calories and carbs to avoid the ketones. All three times I've kept my blood sugar incredibly stable. That in itself is so amazing to me! I'm playing intensive full court basketball for a little more than two hours, and am able to keep my numbers in target. It's almost inconceivable.

After playing basketball my numbers start to rise. Two out of three times I've tested positive for ketones, once large and the other time small to moderate (it's always hard to match colors exactly - remember when we tested our sugar that way?!). The one time I did not show any ketones I was very confused because my blood sugars were on the rise and my muscles felt the same way they do when I'm spilling ketones. Maybe they were there and I couldn't catch them by testing urine. It would have been nice to have the meter that can test the blood for ketones.

Either way, it's a pretty clear sign that I had been burning fat at a high rate. It's a matter of fuel, and the body will convert the fat after it runs out of the regular (and usually available) sources. I wore my heart rate monitor once when playing, and over the course of those two hours I burned over 2000 calories. That is a crazy amount of calories to burn in such a short period. With that high calorie output it is almost impossible to provide that many calories beforehand - besides, if I did that I would not lose any weight! So, if ketones are a part of burning fat, and burning fat is the goal, I want to learn how to keep myself safe during that process. Both in terms of blood sugar control AND the bodies acid balance (or imbalance with ketones).

I have not noticed any lows later in the day/night or next morning, so that is good.

I'm very happy with how well it's been going, but am also a little frustrated that I have to do all this extra stuff & plan ahead so much. We have such a complex system that deals with intensive exercise like that, and people without diabetes don't have to deal with any of it - it just happens automatically! It's a lot of energy for me to plan and prepare for the fact that I have to manually adjust a couple pieces of the puzzle.

How in the heck did I survive my active high school years when I played basketball all the time? Although during those years I was still doing shots of regular and NPH - which is a very different scenario. Heck, I can hardly remember back that far.

I feel pretty good about this...

I feel pretty good about the latest upload of my data. It shows that I've been in target slightly more than 50%, with a pretty even distribution of highs (makes sense, when I'm high I test more often, so there are more numbers to measure), and a very comfortably low number of lows (probably leading to some of those highs - overtreating the lows!) .

So, I feel like I'm heading in the right direction. We'll see if I can keep it up without getting too overwhelmed and drained (I can tend to get a little "perfectionist" with these things, which leads pretty quickly to burnout for me...)

Thursday, August 11, 2005

Basketball & Learning!

I've been lucky enough to be allowed to split my workday twice a week and go play basketball for a couple hours over lunchtime. It's really great. Great exercise, a good group of guys, and just generally a good time.

I've been generally curious about how calories, exercise, blood sugar and the myriad of other hormones (adrenaline, etc.) all play into things. The body is such a fascinating machine with all the mechanisms that are in place to deal with intensive exercise and the bodies need for fuel. The biggest stumbling block for me is that some of those mechanisms are manual when diabetic, and me and my brain are in charge of the amount of insulin I get and the food I eat.

I had a wonderful time today. One of the difficult things about exercising and diabetes is trying to get your blood sugar to a specific point at a specific time. Yeah. I don't know about the rest of you, but I have trouble with that. I started a little high this morning, but by the time I hit the court I was at 133, I downed a slim fast drink to start, and after an hour of playing I was (are you ready for this - better sit down!) 133. Another half hour and I was at 138. Beautiful!! I felt good, my energy was good, everything was right. I played on for another hour, but didn't test again until I got back to work.

When I got back to work and tested, it was up to 168. Not too alarming, but I was a little confused about why it was going up. Another half hour later and it was up to 194. A half hour after that and it was up to 213. Now, I hadn't eaten a thing since before basketball. So what the heck is going on? Did I miss a low and am seeing a rebound? Did I run my temporary rate too low for too long?

On a hunch I grabbed a ketone test strip (yes, I actually keep some around) and headed to the bathroom. To my surprise, when the sample hit the strip it almost erupted into a deep dark purple color!!! Large ketones! Holy crap!!

Large ketones with diabetes is usually something you see with very high blood sugars, and after spending a significant period of time without insulin. However, in my case I was only 213 at the highest. Now, what do we know about ketones? That they are a byproduct that is created when the body burns fat for energy. What do we know about calories? That they are the bodies energy source. What do we know about basketball (and over two hours of it)? That I burned a TON of calories.

I don't think it's even possible for me to eat enough calories in the morning to have enough on board for noontime basketball. So naturally, the body engages one of those fantastic mechanisms for survival and starts using the fat for energy. That's a good thing.

However, the ketones that are created in the process cause me problems. Maybe I need to stop my temporary reduced basal rate earlier, and even kick off a temporary increased basal? I also need to drink a bunch of water to flush them out.

Is that the right thing to do? If I was able to manage my blood sugar just fine, do I still need to eat to prevent those ketones? How does a non-diabetic person's body deal with ketones, and why is it not such a dangerous issue for them? I understand that their bodies have the ability to automatically pump out additional insulin, is that what does it, or is there more to it? What's the mechanics behind it?

I'm going to see if I can add an exercise physiologist to the mix of people I visit to keep me in decent working order. First step? How does one find a good exercise physiologist in the area?

Tuesday, August 09, 2005

Report on Latest Endo Appointment

I had my endo appointment on Friday of last week.

As many of you are aware, I've been pretty frustrated lately with my control (or lack of). My A1C accurately reflected that, coming in at 9.0. My last one was 9.3, so I guess it's good that it's coming down a little.

My thyroid levels were a bit high, so he backed my synthroid down a little. That situation is getting frustrating too, because for the last year or so we've been bouncing back and forth between a couple doses, one making levels too high, the other making them too low. The doc said that high thyroid levels will tend to elevate blood sugars, so that offers a partial explanation for the highs.

All the other lab tests came back normal, so I am thankful for that.

He asked me if I thought that I needed any adjustments to my insulin, and I really don't think it's my doses that are causing my highs. It's more behavior related. I'm always eating.

I don't even give my blood sugar a chance to come down from my last meal before I'm back at it, shoveling something else into my mouth.

However, for me, these behavior issues are the hardest to change. We'll see how it goes...

I'm going to try eating at more consistent times, and to lay off the snacking. I think that in addition to weight control, this will also give me a better, clearer picture of my BG's and hopefully make any trends stand out a little more.

It's hard to spot trends when eating at inconsistent times. All the software out there lumps your readings into pre-defined time periods (5am-9am = pre-breakfast, 9am-11am = post-breakfast, etc.). Well, if some days I'm eating my breakfast in the time that's designated post-breakfast, that doesn't give an accurate display in the software. This whole issue is tough with flexible therapy, because you have the freedom to eat when you want, not on an insulin specific schedule.

Diabetes is such an all encompassing thing, it's sometimes tough to make sense of when you have the rest of life moving on around you, whether you are with it or not!

Thursday, August 04, 2005

Testing too often?

This would be normal...if it was where I poked myself! I actually poked the LEFT side of that finger, and as you can see I got a sample from a previous test on the right side.

Another time that this happened my finger actually bled from both places! I didn't have a camera then, or you'd be looking at that picture instead.

Another fun thing is when you get the "sprayer" - that's when you're squeezing and squeezing, and nothing happens, until you notice the spray of blood all over the place (the squirt is such a fine stream that you can't see if coming out of your finger!).

On that note - how often do people really change their lancets? Many long time diabetics have more boxes of lancets than you can count, but rarely change them. I know myself, I usually don't change my lancet until it is so dull that it feels like I'm driving a large nail into my finger AND it doesn't produce any blood.

I don't know why I never change it - I guess I never think about it until it inconveniences me during testing.

Monday, August 01, 2005

Today Seems Like a Good Day to Vent...

I've got my quarterly appointment with my endo near the end of this week. Along with that comes the need to get labs drawn and get them done in time enough for the results to be at the office when I go in for my appointment.

There are a couple of logistical challenges that come along with that, and maybe it's just the way my endo's office handles things. At my appointment I get a lab slip with details on what labs to draw. This is the slip I am supposed to present to the lab prior to my next appointment in three months.

I don't know about you, but the ability to hang on to a specific piece of paper for three whole months is just about impossible for me. The only way I've found manageable is to keep the darn thing in my wallet. Needless to say, by the time it comes back out, it is showing it's age!

I had last Wednesday off to help a friend move. I figured that would be a good time to get the labs drawn, so I went in. Everything went fine. Took me about 40 minutes, and that includes the drive time, the check in time, the lobby wait time, the lab time, and drive back home time. Piece of cake - except for the comments from the ladies handling the paperwork about how it looked like it had been on a journey to hell and back (in my wallet)!

The draw went pretty normal, except I noticed that after the first vial of blood, the lady removed the needle and taped a small piece of gauze onto my arm. I thought I caught a glimpse of a second vial in her hand that she had not collected anything in. It just "felt" weird to me, seemed like they usually collected at least two vials, and the fact she had a second one in her hand which was empty. I didn't think enough about it to make any comment. You know those experiences where something is just not right, but you can't put a finger on it?

It all made sense a couple days later after I retrieved a message from the answering machine. It was the lab tech telling me she forgot to get a particular sample and that I needed to come back so they could collect it.

I go to North Memorial Hospital to get my labs done. The endo is in an attached building right across the street, and so far it has all worked out pretty good. However, the thought of going to this big hospital armed with no paperwork and nothing but the lab tech's first name just made me shudder.

I parked in the ramp, and could not find any spots until I reached the top floor. I made my way to the registration desk and gave the lady the story about the tech calling and wanting me to come back. To my surprise she handled it just fine, printed out a couple forms, made copies of my insurance card and sent me up to the lab (which is on a different floor). Now, I don't know if it's due to construction or if this is the way it is, but at check in you are given a red folder with a number largely written and circled on it. Then you go up one floor and sit in a general lobby area and wait for the tech to come out and call your number.

I had number 24. As I sat down I noticed a guy with a red folder next to me, and he had 23. There was a gal who was being taken back to the lab, and I'll safely assume she had number 22. There were a couple more people that came up with their red folders after me, numbers 25 & 26. After a while I saw the gal who had 22 come out and leave.

Me and #23 (and 25 & 26) sat in that lobby for no less than 40 minutes before the lab tech came out and said "Number 26?". at that time me & Mr. 23 started waiving our folders around and calling her attention!! Apparently upon check in, the lady is supposed to send a page or message to the lab tech to let her know someone is out there waiting. That didn't happen for #'s 23, 24 & 25. How she remembered to inform her of #26 and NOT remember that she forgot about #'s 23, 24 & 25 I do not know.

Talk about putting this lab tech in a bad spot! She felt so bad! She was not the same lady that forgot about getting that second vial from me.

So she took care of Mr. 23, and got me back to the lab for my draw. I gave the lab tech my story about being in last week, other lady forgetting the second vial, blah blah blah. She made a couple phone calls and was able to track down what they needed from me today. The stick went great and they got what they needed. I think it's still in time for my endo appointment on Friday.

I'm just frustrated because I was trying to handle this on my lunch break from work, and it ended up being a two hour ordeal. I'll have to work late to make up my time and it's all because someone forgot to notify someone else.

I was kind of trapped there once I had the parking ticket (the lab tech is the one who gives you the voucher to park free). If I would have left when I realized I needed to, I would have been stuck with the crazy parking fee!

This is just one example of how handling/managing diabetes can complicate an otherwise "complicated enough" life. It does at times feel like too much, and I can really see how people give up on it.

Maybe I'm feeling a bit frustrated today to begin with, and in the big picture this little thing is really a little thing. I just felt the need to talk about it, because it is often times no one big thing that ticks you off with diabetes, it's the millions and millions of little things that team up on you! The purpose of this blog is to share the perspective of a person struggling (and succeeding) with those millions of things. This is a fine example of one such thing!

You Have Found The Definition of RollerCoaster

I have been riding the rollercoaster BIG TIME the last couple of weeks. High every morning, still fighting to control my eating urges after suppertime. Because of those urges I've been eating crappy snacks after supper, not counting as close as I need to, etc. Which means that I'm running high or low, rebounding & overtreating, waking up feeling like shyte in the mid 300's, spending half the day trying to get back down under 200.

In a recent post Amy T of commented that she finds it both comforting and a little unsettling to find someone at the 25-year mark still struggling with the same issues. That's perhaps part of why trying to manage diabetes is so damn difficult. You never get a break, and I'm darn tired of dealing with it all the time.

My biggest struggle is with my diet, and I guess recognizing that is a big step. It is a real struggle for me to measure everything, and to be honest with my serving sizes (funny how they just keep getting bigger and bigger unless you measure them all the time!).

I also resent the fact that I have to count everything. It pisses me off. When I sit down with a bag of doritos (yeah yeah, real healthy), I'd like to just eat them! I don't want to count every 12 chips. Besides, you still run into issues when you get to the bottom of the bag with all the "chip chips" - you know, all the little broken pieces...

How about having to weigh 1 ounce of potato chips? I hate pulling out the scale and measuring tools to eat something. I hate it.

But, if I don't do that, my "serving size" tends to be more what I WANT it to be, rather than what it really is.

Diet control and willpower is such a critical piece of diabetes management (and just general health overall). It's a problem that spans many more people than just those with diabetes, but I've got so much more numerical feedback than just my weight.

It also seems like such a vicious cycle. When I'm high I feel like crap, when I'm low I feel like crap. I also feel like of all the BG numbers I see (40 - 600) the target range is SO LITTLE (even with a broad range of 80 - 180) . Even if I didn't eat anything ever, it would be tough to stay in that range while participating in an active normal lifestyle.

I sometimes get into a "screw it" mode, where I really fly off the handle. I will end up snacking all day, often eating before my post meal BG's have a chance to get back down to target. I just keep adding fuel to the fire all day.

I really don't mean to bitch and moan so much today - I'm just tired of it all. I'm Ok though, it's just part of the cycle of diabetic life. I'm entitled to be in a bad mood sometimes, and expressing that is important.

I'll kick the next person who says "At least diabetes is manageable". Very true, but it sometimes seems like a lifetime of undeserved punishment and extra responsibility. It can sometimes be a real burden.

On a spiritual note, I do feel that there is (there has to be) some greater purpose behind this. I try to keep that in mind when I'm feeling frustrated.