Pre-Bolus?

One (more) thing I can't seem to do very well is to time my meal bolus to be a few minutes ahead of the actual meal.

I think in the ideal situation I would like to get my meal bolus in and started somewhere around 15 minutes before I start eating. This is assuming I'm not low (or heading low), not dealing with any delayed digestion (don't think I am yet), or any other weird situation.

This has been recommended as long as I can remember - back in the days of bolusing with Regular insulin, and now using the faster acting insulins. The time was different though. Back with Regular insulin we were told to bolus 45 minutes before eating.

Getting this timing down has always been near impossible for me, and since the consequences of not getting that meal are pretty heavy - such as a sever low blood sugar, I have always bolused when the food is either a certainty or is actually right in front of me.

But the times where I can get that insulin in my system and working ahead of the food by a few minutes, I have very nicely matched curves - closely matching the digestion with the peaking insulin, resulting in spikes that are very tolerable and that are quickly back to normal.

But again - the potential for disaster is HUGE if for any reason that meal is delayed or drastically different than what you planned for. So that part of it scares me off most often.

Another approach that I've seen, but not tried, is to take a partial bolus up front, then finish it off at mealtime. I guess that way if something changes you are trying to catch up to a much smaller bolus rather than the entire boatload.

I think the primary reason I've not been very successful at this is that most days I can hardly get my act together enough to know what will happen 15 minutes from now.

Not to mention, I think it adds yet another level of complexity to the already painstaking tasks of doing all the diabetic stuff that surrounds mealtime. And that kind of ticks me off.

This is practically impossible for parents of young D'ers - where you don't know what they will eat until it's down the chute!

But what about you adult OC'ers? How many of you pre-bolus? Do you do the entire meal bolus beforehand, or just a portion? How far in advance do you do it? Does it matter for you what type of food you are eating, and do you adjust the lead time accordingly? Does it make a big difference for you?

And lastly - how the HELL do you keep track of it all?!! Do you pull a modified "flava-flav" and wear a kitchen timer medallion on your gold chain? "Ding! - time to eat!"

Fifth thing I hate about low blood sugars

The rebound.

There are a number of things that happen when you experience a low blood sugar. These are things that your body does to defend itself from the low. This includes dumping a couple fast acting hormones (glucagon and epinephrine (adrenaline)) and a couple of slow acting hormones (growth hormone and cortisol).

According to Medscape, the primary defense is the epinephrine because our glucagon secretion systems don't work like they should. The article gives many more "medspeakly" correct details, if you are interested. The adrenaline comes and goes pretty quick (relatively speaking).

The growth hormone and cortisol responses are really tough because they can wreak havoc on any attempts to keep blood sugars in range later in the day.

So, not only do you have this "late to the party" glucagon and "first to arive" adrenaline, which can spike you up after dealing with a low, you've also got these "missed the party altogether" double whammy of growth hormone & cortisol which mess with you hours later.

I once heard a doctor at a meeting say that the goal of diabetes is to keep blood sugars in range as much of the time as you can, AND AVOID LOWS. It was these "delayed response" hormones that he said cause so many problems later in the day.

I'm not exactly clear on whether these hormones are all released every time you have a low, or if the lows have to be of a certain severity or a certain duration. Based on my personal experience, I don't think it happens every time.

I think this just about wraps up my mini-series of things I hate about lows. Tomorrow? Back to your regularly scheduled blogging.

Fourth thing I hate about low blood sugars

Interruption.

I don't care what it is you are doing, but if you have to stop to deal with a low blood sugar, you have been interrupted.

Even if I'm happily doing nothing, and get interrupted, it bothers me. What was I doing? Nothing!! But it still bothers me.

Worse though, is when I am doing something, or planning to do something.

Ellen commented on the second thing I hate about low blood sugars about how her son planned to go to karate class at 6:30. He planned early, tested his bg, ate, took less insulin all in preparation to be strong for class. Moments before they left, his bg was in the 60's and all the plans came to a crashing halt. No way to get the BG up to where it needed to be in time for the rigorous exercise he planned for. So, he treated the low and stayed home. Once again disappointed by diabetes.

This too has happened to me. I've talked before about how far in advance I need to start planning and preparing for basketball - only to have to skip it because my blood sugar is too low shortly after starting. Situations like that, there is almost no way to get ahead of the curve - to get the bg rising and still have enough energy on board to sustain the bg during the hard workout of basketball. That really bummed me out, so I was very in touch with Ellen's comment.

How about those of you who have had low blood sugars during important meetings or even interviews? I can remember posts about lows while on important phone calls as well. Or what about acting "strange" while out in public?

Yes, yes, yes and yes. I would definitely count those in the "interruptions" column.

Then there's the whole fatigue thing afterwards.

Yes, interruptions are certainly another thing I hate about low blood sugars.

Third thing I hate about low blood sugars

The stubborn low.

For whatever reason (insulin on board, delayed digestion, etc.) you treat a low that just keeps going lower.

You know how you feel when you're low, and you treat it, then wait a bit.

But waitasecond - I still feel low... you test, and you're LOWER than before you treated!!!! You have a minor "Oh Shit" moment, and slam some more glucose down the old pie hole.

A few more minutes go by, and you're STILL dealing with the symptoms. You check again. And you are still dropping. This is when you have a major, full blown "HOLY SHIT I'M GONNA PASS OUT" moment. Then you just panic, and overtreat like never before. You worry that you can't get ahead of the steadily dropping BG. You worry that you'll need help to pull out of it. You are confused about why you are still dropping after all that you've eaten. You are trying to figure out what the heck you did to cause it.

A little while passes, and you are starting to feel a bit better. You've made a conservative attempt to add up all the carbs you shoveled down - conservative because you've just been scared half to death by the experience. You inevitably are skyrocketing up to 300 or 400 as all the carbs you ate are finally starting to hit the bloodstream. And the fatigue sets in.

If you are lucky, you are able to figure out what happened - some type of strange timing issue, or a massive miscalculation of some sort. Sometimes though, it's a "WTF?!"(What The Fuck?!) thing. You can't for the life of you understand why this happened.

If I've learned one thing over the past 26 years of diabetes, it is that diabetes does not always follow the "rules".

Second thing I hate about low blood sugars

After it's done, and I've either completely blown it out of the water with a panic driven overeating session, or I've been able to stand my ground and treat with only as much carbs needed to get back to target, I feel downright tired. I mean, literally run over. Like, Mack Truck style.

The adrenaline flow has been cut off - the emergency is over. Time to slow things down, back to normal.

There is a literal wave of exhaustion that rushes over me. I can feel it as it envelopes me in tiredness. Crashing back down to the "non-adrenalined" state of normalcy. I just want to curl up and go to sleep. Or at least not be pressed into doing anything.

To a certain point, the degree to which I feel wiped out is proportionate to how bad the low was. When I say that though, I don't mean what the number was, or the test result, but rather the symptoms of the low. Have you ever noticed that even though the actual blood sugar value is not that low, the symptoms just kick your ass? Like a 64 might feel worse than a 46? It's not consistent though - it must depend on the scenario somehow. Maybe it has to do with how fast you are dropping.

Anyway - that's the second thing I hate about low blood sugars.

First thing I hate about low blood sugars

"Hi, my name is Scott and I'm a compulsive overtreater"

This is where you say "Hi Scott, welcome"...

This topic has been darn near beat to death over the course of my lifetime, but I still have trouble with it.

See, our bodies have these intricate systems that drive us, instinctual urges for survival that fight to keep us alive and unharmed. These are the same systems that make us pull back when we touch something hot or when we experience pain, the same systems that make us thirsty when our bodies need water, or hungry when our bodies need food...

What happens to us when our blood sugar is lower than it should be? There are alarm bells ringing like mad, screaming at us to get some form of sugar into our system!! I am often overpowered by these urges. I find it terribly difficult to eat only what I need to raise my blood sugar back to normal.

These urges have driven me to do things like drink maple syrup, eat sugar (white or brown) by the spoonful, eat 4 or 5 bowls of cereal in record time, devour a stack of oreos taller than what my hand can hold, try to eat a napkin (?!) and just generally lose all rational thought processes I might claim to have under normal blood sugars.

Usually I know enough to know that I shouldn't eat everything I can get my hands on, but that logical part of my brain is just not speaking loud enough to beat back those primal survival instincts. That is why it frustrates me so. I know better!

How do you do it though? How do you spend those 10-15 minutes it takes for you to start feeling "less low"? Every cell in your body is screaming bloody murder, and yet you are supposed to wait - to stop eating?!

I find that during the day this is manageable. If I am in a safe & stable environment, such as work, I am able to find something to pull my brain off the complete and total panic that my body is screaming about. The most troublesome time for me is when I wake up low at night. Is it because I'm tired and anxious to get back to bed? So I just shovel it in so I can go back to sleep? Is it because I'm lower than I would be had I been awake to feel the symptoms? Is it because I'm scared, and don't want to go low again after I go back to sleep? Could it be all of the above?

In part, I am thankful that I am able to feel symptoms when I go low. There are many people that fight with hypoglycemic unawareness - they have no symptoms of low blood sugars. That is pretty scary considering what happens if you don't treat a low blood sugar.

However on the other side of that coin, if they have reliable and consistent tools that help them to catch those lows (such as Wil and his CGMS), they do not fight the urges to overtreat. Does that make it easier to eat only what is needed?

Both scenarios are no good - but I sometimes wonder which is worse? The unawareness is clearly more dangerous, but that doesn't make me like being able to feel the symptoms any more.

Don't get me wrong - to a certain degree I appreciate that I can feel my symptoms. I'm just saying that I hate the fight to not overtreat. It's a fight I often don't win.

Real life experiences with the Dexcom

No, I'm not the lucky one with this - but I wish I was!

Take a look at www.insulinfactor.com for Matt's blog on using the Dexcom STS continuous sensor.

Very interesting and very informative.

What to do for lunch?

So here's the scenario.

You've had a decent breakfast, and a somewhat healthy mid-morning snack. But, you have failed (again) to plan for lunch.

What do you do?

There are all the "regular" fast food places within reach, as well as some sit-down types of places. You are also 3 minutes away from a Cub Foods (local grocery chain). You are also within 20 minutes from home, meaning you can drive home, have 15-20 minutes to cook & eat, then drive back to work.

What are some fairly healthy things that you can grab on the run, or at least within your lunch hour?

What to do for lunch?

That is the question.

It's a double edged sword

Being charged with managing diabetes is a double edged sword.

On one hand it's very fortunate that we are able to take measures into our own hands rather than being completely at the mercy of a doctor or clinic.

But on the other hand, that's a lot of responsibility to deal with. And what if I don't feel like taking care of diabetes in addition to the "regular people" stuff that is always going on. You know, raising kids, paying bills, working to pay bills, dealing with the little daily emergencies that pop up, etc.

It sometimes seems like a lot to be working on. Overwhelming. Intimidating. Frustrating.

And with it being up to you - who is to blame when things go wrong? Yep, you got it. At least that's what the perception is. Self perceived or otherwise.

Don't you ever just want to not be in charge? To take a break from all the responsibility? I know I do.

There are days that I feel very fortunate that I (am supposed to) have the ability to "control" or "manage" my diabetes. There are days where it is easier than others, and there are days where nothing is working right, despite my best efforts.

There are also days where I just don't give a shit. Where I'm just downright tired of it all, and do just enough to avoid a disaster - but even that seems like more than what I want to do.

But who is to blame when those "screw it" days inflict some lasting damage? Myself. You can't cheat mother nature, no matter how much you want to stick your head in the sand and wish it all away.

Coming to terms with things is a big task. Figuring out how to keep marching on through the frustrations, inconveniences and obstacles that get in your way. How to manage it all without getting burned out or wore down.

When even doing things that are good for us, like exercise, wreak havoc on our blood sugars.

I don't have the answers yet, and this month marks 26 years of (not?) dealing with it. Will I ever figure it out? Can it be "figured out"? This makes me think of the discussion around Sandra's post that brought up "mastering diabetes", and the great discussion on the same topic over at Caro's "Diabetes Wise" site. I really got a lot out of both posts and the great discussions that ensued. I think the consensus was that diabetes can't ever be completely "figured out" or "mastered", but the key is to find that balance where you are doing the best you can without having diabetes completely control your life. The place where you are happy.

And maybe that is why it sometimes frustrates me so much - because you can't just get it handled or figured out once and for all, then cross it off your "to do" list like a weekly chore or project. It keeps demanding attention. All the time.

Will I find that balance that seems so elusive? Who knows. But I know I have to at least keep looking - keep working towards that balance. I may not ever get to where I want to be, but every step closer to it, is a step in the right direction.

I also want to acknowledge that it was a year ago today that my mom passed. I celebrated my 31st birthday yesterday and this month also marks 26 years of diabetes. I was an emotional wreck yesterday, and my birthday was tough to deal with. But I also know that my mom would want me to have a happy day, and that is why she fought to hang on until the day had officially passed.

I called my dad to talk with him and it made me feel better. I wanted to share with him how much I love him and how much I appreciate him being who he is and the positive influence he has had on my life. When I tried to talk about it I got all choked up and couldn't spit it out right. And when I got some of it out we both got all choked up.

I know he reads this so - "Dad - I love you very much, and I appreciate everything you have done for Laurie and I, and the sacrifices you and mom made for us. You have had a very positive influence on me. I feel that you and mom did (and continue to do) a very excellent job raising the two of us. We are as proud of you and mom as you are of us. You and mom did such a good job of helping me learn to be responsible of my diabetes, making sure I never felt limited in life due to it, and helping me to develop a positive outlook. It continues to make a difference to me. Thank you."

I could have never gotten all that out without breaking down a bit. I know it's not the same as saying it in person, but I hope it's enough for now.

Test Strip Contest - Prizes Update

I wanted to let everyone know what the actual prizes were for our contest winners.

Our lucky winners were Caro from Diabetes Wise, and Kerri from Six Until Me.

Getting a prize to Caro was interesting, because she's overseas. I really wanted to get her a six pack of Diet Cherry Coke, in honor of her post about it and it's general lack of availability over there. Unfortunately I can't send pop (or soda) in the mail, so we had to come up with something else. To get around huge shipping costs and therefore getting Caro the most prize I could afford without eating most of it up with shipping, I got her a e-giftcard to Amazon.co.uk, which is a localized version of our Amazon.com. That way she is able to actually spend my gift to her on something besides shipping. :-) I sent her a total of 15 pounds no pennies. Works out to somewhere around $26 US dollars.

Can anyone guess what I got for Kerri?

Appropriate, don't you think?

Thanks again for everyone participating - I hope it was as fun for you all as it was for me! I'm working on another contest, but I can't count that many strips in a single sitting - so it may take some time before I get it all added up and posted. :-)

Spring at Scott's House

Ahhh, the snow has melted, the temperatures are creeping up, we've had some rainstorms, I heard someone mowing their lawn already. Yes, spring is here.

You'll never guess what I found near the side door of my house the other day. See if you can pick it out of this picture:





What? You can't see it? C'mon now - you mean your eyes can't pick these things out from a mile away? Here's a close up:




Yes folks, that would be a Another Used Test Strip.

I really can't explain how this got out here - but somehow, buried under the layers of snow & ice, mixed in among the twigs and dirt, magically avoiding the temptation to stick to the underside of one of the many shoes & boots that walk along this path, we have an authentic AUTS.

When I saw it the other day, after the confused looks of "how in the hell did that get out here", I just knew it was blogworthy and went to retrieve the camera. This time I spared you all the pain & suffering of using my famous cell phone camera, which I must admit was my first reaction.

Is there anywhere that is safe from the invasion of AUTS? I don't think so.

Have a happy Monday everyone!

I Wish I Had Taken A Picture...

I tried another new thing at lunch today!

When I get the thought in my head to try a new food, it's always a pretty risky maneuver. I mean, what if I buy this thing, and don't like it, and then am hungry for the rest of the afternoon?

That would be Bad. Not only wasting the money, but also leaving me hungry, and therefore susceptible to the temptations of the junk in the vending machine.

So, I try to buy one or two things I know I'll like, and experiment with the item in question.

This afternoon the new item was a bean, cheese & rice burrito. Not sure what to expect. I had worries about it being chock full of gross crunchy veggie chunks, or all spiced up with onions & stuff. Or maybe the cheese will be all stringy like. I know - that probably sounds good to most of you out there. Yes, I know I'm weird. Love me or leave me.

I followed the directions and nuked this thing in the microwave. I took it out and let it cool off a bit. Still wary of the contents, because I can't see what's inside the tortilla wrap. After a couple of minutes I took my knife and sliced one end off...

Hmmm, that doesn't look half bad! I see some beans and some melted creamy cheese. The label talks about rice, but I didn't notice any. I cut the end in half again, and stuck it in my mouth. I chewed a couple times, waited, let my tongue get a taste of things. While I didn't hate it, I didn't really love it either. But - I thought I could tolerate it, and might in fact like it.

I took a few more bites, and noticed that I didn't like the seasoning too much. It was very mild, but still a bit too spicy for what I would choose on my own. Then it happened.

I glanced down at the burrito on my plate... and what the hell is that in there - nestled up next to a bean??!! I probed a bit with my fork & knife, and it was a chunk of some green colored vegetable or spice! Eww! Aw man! Now why did they have to go and do that to me?

I wish you all could have seen this thing. It was absolutely minuscule. The average person would not have even noticed. But me, having a full blown phobia of onions or other colorful crunchy organic foodstuffs, picked it right out of the "where's waldo" picture of beans, rice, cheese & tortilla. Incredible. I wish I had taken a picture.

So, I scraped out the rest of the insides of the burrito, picked through the resulting mound of beans, rice & melted cheese, and got rid of most of the "chunkies" that I didn't like. I ate most of the surrounding tortilla, and mixed in a bit of the "bean mound" here and there. But, I admit, I was tainted by the experience, and didn't eat as much of the beans & stuff as I would have without those added goodies.

Maybe I should stop looking at the food I'm eating? I ask myself if I would have even noticed that little bit of whatever it was if I hadn't seen it.

Probably not.

And I LIKED it!

I actually tried hummus the other day.

And yes folks, better sit down. I actually liked it.

Here's another shocker. I had some real fruit for breakfast yesterday. I made a smoothie in the blender, with a real live banana, a big ole strawberry, a little bit of peanut butter and a cup of milk.

It was good.

Now, I'm sure you're all wondering. Well Scott, how was your blood sugar?

Wouldn't you know that I forgot my "Other Checkbook" at home! And instead of doing the rational thing and just writing my BG's and stuff on a different paper, I just didn't pay much attention at all. I still checked, and reacted when necessary (correction or food), but just didn't record anything. I don't know why I do weird things like that.

Just going on memory here, but I started the day high (mid 200's). After breakfast it was running a bit high too. I corrected and got things back down, but was a little frustrated that I had tried this new thing for breakfast and didn't get "good" results in terms of my BG.

But then I took a step back, and told myself to be a little more relaxed about it. I'm trying a lot of new foods that I'm not familiar with, and there will be a learning curve to work through with them. It all takes time.

I watched the movie "Super Size Me" over the weekend. Wow. What was most apparent to me was the changes in this guys mood and general change in behavior. He was just absolutely lethargic and pathetic after only a couple of weeks! Especially near the end! The scenes where they show him just sitting in a heap doing nothing - depressed and pitiful! Man - I'm probably like that ALL THE TIME!!!!

I wonder if I will feel so much better when I'm routinely eating a healthy diet and keeping my blood sugars under better control? Maybe I've been depressed, lethargic, pathetic and pitiful for so long that I don't know any different? I think about that, and I feel good about where I am headed. I feel good that I am working to make smarter choices about my overall health.

I just feel good about the future.

The Appointment...

I had my first appointment with a nutrition specialist on Friday of last week.

It was wonderful! She is a very neat lady who did not make me feel strange about the way I have been eating. She was very energetic and very encouraging.

We talked for a while about what had brought me to her. I explained that I feel my eating habits are the last frontier or barrier to good diabetic control, and I wanted to focus some attention on that area of management. I talked a bit about my strange likes and dislikes, and the frustrations that they cause with my blood sugars.

You know what? She was excited to help me! Wow! I was blown away. I could literally see the gears turning in her head.

We talked about the typical times of day that I ate. She threw out about a zillion ideas of foods, trying to get a better feel for things that I liked/disliked, or things I was or was not willing to try. There were a pretty large number of things that I thought I might like, or at least thought I could try.

One of the biggest things we came up with for why I like/don't like foods was the texture. She had a solution for that. "Blenderize it!!" she says! Make a smoothie. Puree the crap out of things where the texture bothers you! Try to learn the taste of it, and we can overcome the texture of it.

We came up with a schedule of times that would be best for me to eat, and estimated calories for each meal & snack.

We started a menu of sorts, where I have a handful of things that I can try for breakfast, lunch, & snacks. We ran out of time to build up anything for dinner, but she did lay out a calorie target and servings from the different nutritional groups.

Do you remember me talking about how the appointment was scheduled for 75 minutes? Well I met with her for the entire 75 minutes, and could have used another 75 minutes! Boy, the time just FLEW by!!

So I've got a very short menu of a few different things to try. She felt strongly about not trying to change the world in a day. She talked about trying different things and building up a menu of things to choose from.

For the past few days the appointment has been "digesting" in my head. And like much else in life, it seems that planning is the key. I have to wake up with a plan laid out for what I'm having to eat that day. If I can get that part done, I think the rest will be pretty easy.

SmittyWerbenJegarManJensen

Oh man. I've been dealing with a cold type of thing over the weekend, and I took some medicine for it this morning. I feel soooooooooooo disconnected. Like I can't get my brain and mouth/fingers to operate together. It's awful! I'm not sure which is worse - the cold symptoms or the side effects of this damn medication!

My words are all jumbled together and slurred. I swear, I think my boss will kick me out of work today because I'm acting intoxicated!

Plus my BG's are all over the place!

I've got both prizes underway for the Test Strip Contest. Caro has received hers, but Kerri's has yet to arrive. I can't spoil the fun by telling what it is until I know they've both been received. Then I'll post an update to let everyone know what they won. I'm waiting for Kerri's prize to arrive at my place, then I need to ship it to her. I would imagine it will be late next week before I can spill the beans.

I had my appointment with the dietician on Friday, and man, it was awesome! I'll dedicate a post to it when my head clears up a bit.

10 points to whomever can tell me where the title of this post came from.