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.

Thursday, September 28, 2006

Why do I want to eat when I'm high?

Due to some bad decisions and poor timing, my blood sugar is at 337 mg/dl. The bad decisions have to do with a co-worker bringing in some more goodies, and me deciding to eat some!

The poor timing has to do with the fact that the bolus I took for said goodies is/was not nearly fast enough to take the edge off the spike in blood sugar.

My question is this. My blood sugar is really high, and my stomach is full of goodies - why do I have this urge to eat more of something? I'm not hungry, but all I can think about is what I want to eat! Some salty high carb food. Crackers, chips, stuff like that.

I believe that it has to do with the "feel good" chemicals that our brains produce. I feel crappy because I'm high, so my brain is trying to convince me to eat more carbs to make me feel good! To get that temporary endorphin high that comes along with eating something good (and for me that usually does not mean good for me).

I have mentioned before, and I'll say it again here - it is cruel and unusual punishment to make me want to eat when my BG is high.

Monday, September 25, 2006

Mr. Fixit Man

I was thinking about all of the work it takes to troubleshoot and evaluate where your diabetes management is just not working for you.

The thought struck me:
I don't want to fix it - I just want it fixed!

That may be where something such as diabetes really is so much different than other conditions. For the most part, it is up to us to "make it happen".

It's not a matter of catching it early and having it treated - it's a lifetime of counting and calculating, lows and highs (blood sugars and emotions) and the threat of scary complications if you don't do your job well enough.

Diabetes is unique in the fact that we are said to have the ability to "manage" the condition. For that, to some degree, I am thankful. But on the other hand, would it be so hard if it were completely out of my control? My prescribed treatment either works or doesn't.

It would be more acceptable if the demands of living with diabetes weren't so unreasonable, so interwoven into EVERYTHING!

What other condition do you know of where there is so much intensive training to better understand the disease - DONE BY THE PATIENT!!??

And what of this is driven by the fear of feeling guilty? If you do develop some complication, is it your fault? Have you somehow not tried hard enough?

Maybe its not even the fear of the complication itself - but the guilt that goes with it? While I'm sure the complications do suck very much, we are taught that we can prevent them if we manage our bg's well enough! That fact alone almost automatically straps a big load of guilt along for the ride.

To say it is up to me to "make it happen" also sounds like it is an "event". Something that can be worked for, happens, and is over. Something like that might be achievable. But those with diabetes have to "make it happen" all the time. Every minute of every day.

And who wouldn't get worn out "making it happen" ALL THE TIME? No mortal human!! Who would not get tired, having their guard up non-stop, forever? Even sleep is something we have to calculate and plan for!

The difference between "fixing it" versus "having it fixed". The thought just kind of struck A cord with me.

Wednesday, September 20, 2006

Conflict of Interest?

I am often frustrated by the absorption times of the insulins we use these days.

Don't get me wrong! They are much faster than what we had back when Regular was the best tool for the job.

Back then we were told to take our insulin something like 30 - 40 minutes before we started eating. Talk about impossible!! I don't know about you - but I simply could not follow that rule, and accepted settling for just getting it into my system as soon as possible.

Now that I'm using Humalog, the "lead time" is much, much easier to follow. But it's still something like 10 - 15 minutes right?

There are many times that I dish up a meal, carefully counting all of the carbohydrates, and punching the information into my pump and allowing it to calculate my insulin delivery down to 0.01 units accuracy.

I'll do my best to get the bolus in my system and working ahead of my meal - but I'm still not very good at it. When I start splitting things up (bolus, wait, eat), I'm just begging to screw something up (getting sidetracked after taking my insulin or something like that).

Once I start delivering my insulin, I have a five minute window for which I can stop the delivery (assuming I am using a standard bolus, rather than an extended or combination).

But what do you do when you have reached the point of being content with what you have eaten, and you still have a bunch of food on your plate?

What do you do when you've bolused for 65g carbs, but have only eaten 25 or 30?

You have kind of put yourself in a shitty spot - but you were only trying to do what you've been told you are supposed to do!

There are a few approaches you can take to this scenario, but none of them are really ideal.

1. You can bolus for your food as you eat it, or shortly after eating it. The problem with this approach is the timing of the absorption. The carbs you are eating will spike your BG faster than the insulin you are taking can counter that spike.

2. You can stuff your content stomach to the point of being uncomfortably full, because you bolused for more carbs than it took to satisfy you. This just plain sucks. Having to eat when you don't want to is just crappy.

3. Work to balance meals to satisfy you, but with a much lower total number of carbs. Hmmm. Now this one has a lot of potential - but I'm not there yet. The idea behind this is that designing a meal to satisfy you with fewer carbs, your potential risk is not very great. It's much easier to cover 20g of carb bolus than it is to cover 40g or 60g of carb bolus. Even if you don't want to, you can pretty easily find something you can get down that has 20g of carbs.

The point I'm after here, is that to stop eating when you are no longer hungry, and to pre-bolus in time for the insulin absorption and digestion curve to match up, is a conflict of interest.

I don't much like conflicts of interest. They make life a little too confusing and complicated. I'm a simple guy - I don't do confusing and complicated well.

I manage to pull it off somehow, most of the time, but that doesn't mean I like it, and that doesn't mean I do it well. There's a lot of room for improvement with this one for me.

Tuesday, September 19, 2006

Do you bolus for caffeine?

I was running a basal test Friday morning. Starting at 6am, and testing every hour until noon. No food, no bolus, no variables (or were there?).

6:00 - 94 mg/dl - wow! I'm actually near my target! Good job Scott!
7:00 - 96 mg/dl
8:00 - 101 mg/dl
9:00 - 141 mg/dl - start of drinking diet coke
10:00 - 163 mg/dl - some more diet coke
11:00 - 176 mg/dl - yes, more diet coke
12:00 - 177 mg/dl - end of test, correction bolus taken

I got a few interesting things out of this test.

1) I woke up at around 7:00. Was at work by 8:00. I was under the impression that my bg rises significantly just from getting up and preparing for my day. But, you can see that my bg went up only 4 mg/dl - which is pretty close to exactly the same, considering the variability between tests (different meters, different samples, etc).

2) between 8:00 and 9:00 by bg rose by 40 mg/dl - which is significant enough to test for again. If I can nail that increase down to that particular time, I will adjust my basal rates to prevent it. This will take at least a couple more tests to figure out (never make changes on a single experiment). And if the pattern is not clear (ie, the increase is due to something other than the time of day), it will take many more tests to figure out what is to blame.

3) 9:00 is when I had my first sip of diet coke. I had two 20 ounce bottles between 9:00 and 12:00, and was watching my bg steadily rise.

Was it the caffeine or do I rise like that all the time? Only time, more testing, and trying to avoid the caffeine will tell.

I have heard conflicting stories about whether or not to bolus for caffeine. One very credible source, Gary Scheiner, in his book Think Like a Pancreas, even has a table with suggestions on how much certain levels of caffeine will raise blood sugars! Gary is awesome, and I highly recommend the book.

Some people I know will bolus for their AM coffee, others can drink 4 or 5 cans of diet dew before 9 bells and not see their bg increase at all.

So - do you bolus for caffeine? What is your formula? Is it a calculation, or a SWAG bolus?

Friday, September 15, 2006

Fighting the Facts

There is a simple fact facing me.

This fact is, I believe, the root cause of many of the things I struggle with around my diabetes control.

I am fighting this fact tooth and nail. Even though I can clearly see this fact, I have, so far, not been able to change my behavior.

And my mind is really fighting hard to come up with some other answer, some other reason that is easier to deal with.

But it can't find anything that fits the puzzle so clearly.

So it turns up the volume on the depression. Because when I am depressed, it is harder to buck up and do the work.

Depression makes you want to stay stuck in the present - it makes you WANT to feel helpless against whatever may be bothering you.

What I am wrestling with is the fact that I eat way too many carbs.

Reading some of Dr. Bernstein's materials, which makes perfect logical sense, but seems very extreme (in the degree to which carbs are limited), scares the crap out of me.

So I reject it - saying things like "it's too extreme!!" and "who can live like that?!" But the man is living proof that his theories work wonders!

Then moving on to my latest series of books - which to my dismay, ventures into the lower carb lifestyle (although much more balanced) too! I found myself very disappointed! Why does everything that makes logical sense to me have to tell me to lower my carb intake?!

To see my favorite things, my staple meal items, to be blacklisted - forbidden , is hard for me to reconcile. And for the staple items in these "solutions" to be things that are so utterly gross and yucky to me - things I would never even consider eating, or for that matter even heard of before!

How does one with such incomplete nutritional information (me) come up with reasonable alternatives for all of this stuff?

My average daily carb intake tends to fall around 300 or 400 grams per day, unless I have a nighttime low when I can quickly add another 200 grams (in a heartbeat). Yes, I know - scary isn't it?

Is it any wonder why my A1C's aren't where they need to be?

I am addicted to carbs.

It's how I've always eaten, and don't know any different. I like the way I eat - except that I know it wreaks havoc on my body - which I cannot continue to endorse.

My parents tried their best to straighten me out when I was younger - but I didn't budge.

I have hope though - as I learn more about how to balance my meals and food choices, I know that I will be more satisfied with less food - that's one of the things balance does for you.

But it feels like such a big change - to work towards that goal. Partly because I'm terrible at taking things slow, and try to change it all overnight. Going from total carbohydratoholic to moderately low carbs all at once. No gradual change here.

My knowledge level of foods that comply with my wishes also seems so inadequate. I've never learned about such things - and to be my age feeling that almost complete lack of knowledge is very intimidating to me.

I feel completely stupefied when trying to find things I like when I'm out and about. Or even at the frickin' grocery store!! What am I even looking for?

Some of the recent posts from folks like Sarah and Beth help tremendously - giving me some concrete things to shop for and try. Brand names and things to ask for if I can't find them.

My mental side is not giving up easily though - throwing up tricks and traps at every turn.

It's very hard to (near impossible) to fight some of these physiological signals with willpower alone. The signals that our brains send coursing through every fiber, demanding that high carb rush to stimulate the endorphins and other "feel good" chemicals, they are almost unstoppable!

What can I use to combat such complex self destruction mechanism? What do I have that can possibly outmatch and outwit the minds drive for carby satisfaction?

Willpower is a good start - but it's not strong enough or consistent enough. Willpower is susceptible to sabotage. Willpower, while it can be so strong at times, is can also be manipulated like a kid being tempted with candy. Why else do you think they put on those crazy costumes on Halloween?

I also get frustrated when I make choices that better align with my wishes, and can't get my blood sugar figured out. When I have a low carb meal, but run super high hours later from all of the protein and fat - it's frustrating! To run so high after making what I thought were good decisions. It pisses me off, and makes me want to just forget it!

But I try to take a step back, and tell myself that it is a new thing - and new things take us time, experimentation, trial and error, and a good deal of perseverance to work through and figure out.

Some days though, the carbs win out, and I'll be programming a bolus for 180 grams of carbs in a single meal. I can't even believe I just typed that.

I'm working up the courage to do a series on Full Disclosure - where I document every minute of every day for a week or so, what I eat, what I drink, what I test and bolus, what I'm thinking, how I slept, any other thing that may influence things. And open that up to all of you - drawing on the vast collective knowledge and experience that the OC has.

I'm just not ready for that yet - as it scares the shit out of me. I am open and honest in my posts, but you really have no idea just how "out of whack" my dietary habits and resulting wild blood sugar swings really are.

It will take a lot for me to come clean and spill it all - but I almost feel that it's necessary. I will ask for compassion and gentle constructive solutions - and I'm not at all worried about that part of it.

The part I am worried about is being honest with myself, which is easier said than done.

Thursday, September 14, 2006

So much reading!

Ok, I have been busy ALL week - not even having time to read all my favorite D-blogs.

I've spent the last couple hours trying to catch up with everyone's lives, and I'm making progress. I think I've only got something like 58 unread posts to read (oy!). For every minute I leave the computer unattended, that number grows.

You guys are just too good! I can't stop the reading to do any writing!!! Maybe by the end of the month I can get caught up and post something...

I'm loving every minute of it!

Monday, September 04, 2006

The Crystal Ball (or Planning Ahead)

This post was inspired by a comment that Bernard made on a post I did back in July. He commented about having to plan ahead:

"For me, the only thing that really bites is having to sort of plan in advance if I want to play with my children. Otherwise I know that even a half-hour with them cycling or kicking a ball around can send my readings down to the 50s. Now that does stink!"

It does stink - and ever since then it's been rolling around my head. The need to always plan ahead, and not always being able to spontaneously do something without running low.

According to the "Pumping Insulin" book (I only have the 3rd edition), the basal rate should be lowered 60 to 90 minutes ahead of the activity for Humalog insulin. I have had good results if I can start it even earlier than that, more like 120 minutes before the activity.

When things come up that are physically demanding, and I didn't have two hours notice OR have a significant amount of insulin on board from a previous meal, I risk running low. This is not the end of the world, and there are a few approaches I can take that involve eating extra stuff and starting the temp rate as soon as I can.

BUT - I would like to point out that doing so is officially a major PITA (Pain In The Ass).

The Time: 5:56pm, Monday
The Place: Front yard
The Scenario: Arriving home from work about an hour before the rest of the family gets home, I decided, spur of the moment, to do something productive and mow the weeds.
The Problem: Low Blood Sugar, again - even though I started a temporary rate when I decided to do yard work.

Frustrated, sweaty, covered in grass weed clippings and "blown about" dirt (that gives you a pretty good picture of the condition of my yard, yes?), and trying to figure out what I can grab quickly to treat my low and get back out to finish the yard - and without tracking a bunch of dirt and outside stuff all through the house.

It feels that I run low every time I mow the yard. Every stinking time! Why? Because I stubbornly try to avoid eating to boost my blood sugar high enough, and two hours ago I didn't know I would be mowing the yard. The temp rate I started has not yet had time to have an impact on my blood sugar level.

The Time: 2:43pm, Saturday
The Place: Sunset Park
The Scenario: The kids wanted to walk up to the park and play. The park is a little less than a mile away, and it's a great day to be outside.
The Problem: We've been playing for about 30 minutes, and I can feel my blood sugar dropping too low - even though I started a temporary rate before leaving the house.

I almost always have a tube of about 10 glucose tabs in my pocket, give or take a few depending on whether or not I've used any that day, or neglected to refill it - which does happen from time to time.

In this situation I have plenty of tabs with me, and can treat the low - but that's not exactly the point. It is the interruption. The having to stop what I'm doing to take care of things (test, cram some tabs, wait for them to digest). The feeling of the low, and the exhaustion afterwards.

The Time: 8:10pm, Wednesday
The Place: Halfway down the basement stairs at my in-laws house. Working to steady the top half of a big, heavy, made of much glass & mirror, china cabinet.
The Scenario: On my way home from work. My mother-in-law called because she needed some help moving a couple of big pieces of furniture out of my sister-in-law's house, to make way for some new furniture being delivered bright and early tomorrow morning. My wife's family is the best, and I would not trade them for anything - but they are masters of the last minute arrangement. And I am the only one in the immediate and local family that drives a pile of rust & holes, on wheels pickup truck.
The Problem: We're halfway down the basements stairs, moving the second of three big heavy pieces of furniture. I'm on the bottom side. I'm working with my nephew-in-law, who is strong, but he's young. I'm bracing the cabinet, bearing 70% or 80% of the weight, as he works from the top to navigate and make sure we don't break any of the glass or mirrors.

And I'm feeling low - even though I started a temp rate after getting the call. Muscles shaking, partly from the low, partly from the heavy ass piece of furniture. Sweat dripping everywhere, partly from the low, partly from the heavy ass piece of furniture. Feeling the feeling that I need to take a break, partly from the low, partly from the heavy ass piece of furniture. Hoping I can make my body do what I need it to do to get this piece safely down the rest of the stairs so I can deal with this low. Have I mentioned how frickin' heavy this thing is?! OMG.

(Have you ever thought about what happens to the guy at the bottom if a big piece of furniture slips out of controlling hands and starts to descend down the staircase? Not. Pretty. I don't know that from experience - I'm just using my imagination to picture how that series of events might play out. )

Most of the lows I have are not immediately severe. I can recognize that I need to treat the low, thankfully far ahead of when it would require help to do so. Meaning I usually have a little time to figure out what to do before it gets out of hand. HOWEVER, that fact did little to comfort me as I'm trying my best to a) avoid being crushed to death (or seriously injured) and b) keep from shattering glass and/or mirror all over the place.

We manage to get the cabinet down the stairs without any serious injuries or damage. I let them know I need a break, and chow down all 10 of the glucose tabs in my pocket. Take some time to recover, then it's on to pick up the last piece of furniture. And yes, I'm weak and exhausted from the low (and that heavy ass piece of furniture).

For all of these situations I should have better anticipated the need to do something to avoid the low. Being that I didn't have time to start the temporary rate far enough ahead of the activity, I should have had a little something to give me a boost. I know that.

The point of this post is that with the absorbtion times of the insulins we use, and the amount of time they are actively lowering blood sugars in our system, it is still a very crude system that requires constant diligence and and almost uncanny ability to see into the near future.

Life just doesn't always work that way.