Life in LADA land

Living Philippians 1:6 with type 1.5 diabetes

Learning the language of diabetes, part 2

on April 28, 2012

So this time around, I thought I would talk about what is involved in managing type 1 diabetes.  I can only speak to that, since that’s basically what I am, and I don’t really know what it takes to manage type 2. I might get a guest blogger to write about type 2 for me.  I saw a picture recently on the Type 1 Diabetes Memes facebook page, here, that adds a bit of humor to the situation, but is also pretty much how it feels to manage this disease.

A typical day for me starts with waking up and checking my blood glucose (BG) and figuring out how much insulin I will need for breakfast – which depends on what I’m going to eat, whether or not I am going to swim after breakfast, or if it’s a Sunday or some another non-exercise day. My insulin is delivered by an Animas Ping insulin pump, which delivers small amounts of insulin all day long (basal insulin), and then bigger doses that I program in for meals (called boluses).  I write down all these numbers on my BG log, and also enter it into my Dexcom continuous glucose monitor (GCM) to calibrate it.  At breakfast and every other meal, I have to make sure I don’t eat more or less carbohydrate than I gave myself insulin for so that I don’t go low or high later.  On swim days (5 days a week most of the time), I check my CGM just before I get in the pool. If it shows that my BG is borderline low, I do a fingerstick BG test and if necessary, I’ll eat a snack before getting in the pool.  Swim, shower,  then I’m off to start the day.  I usually check my BG before driving, since driving while your BG is low is a really bad idea.  And I need to keep track of my BG after swimming anyway, because it can tend to drop quickly, which can make the morning a bit rough. If it does start dropping, it’s time for a snack or a drop in my basal rate.  If it’s a good day, I don’t have to think about diabetes again until lunch.

A low BG is scary and incredibly inconvenient – I get shaky, sweaty, my head is really fuzzy and I can’t think straight, and oddly, I often get a burst of energy that causes me to do everything EXCEPT deal with the low by  eating something.  It’s not just me either, other type 1’s have shared this same experience.  It’s just weird. The worst is going low in the middle of the night. Nothing worse than feeling this way in the dark, and when you are already groggy and not thinking very rationally. It takes me about an hour to fully recover from a low, so I really try to avoid them.

Lunch and dinner are a repeat of breakfast – test BG, dose with insulin after figuring out how many grams of carbohydrates I’ll be eating, write it all down and enter it into my CGM.  The beauty of the Dexcom is that I no longer have to test my BG after eating, unless it’s really low or high, because it tracks my glucose every five minutes and shows me what it is, as well as a graph of the previous 3, 6, 12 or 24 hours of BGs.  It warns me if I’m headed high or low at a fast rate, or if I get too high or low because I ignored the warnings.  It’s pretty insistent if I drop below 50 – buzzing 4 times and beeping loudly until I shut it off. It’s telling me to DO SOMETHING!  I love this tool, and am grateful to have it clipped at my side all the time. Though I would appreciate it if Dexcom worked on making it look a bit more fashionable…..

I also keep a small notebook to record things like how I dose for certain foods, how I manage on Sunday mornings (a work day for me at church, and my BG tends to go really high, so I am working on a strategy to prevent that), and how exercise affects my BG.  I can upload the data from  my pump and CGM too, to track longer term patterns and make adjustments to keep better control. I generally upload about once a week and spend some time reviewing the data.

We tend to eat dinner on the late side, so I often have to eat something to keep my BG normal in the late afternoon.  That means testing, dosing and recording all that data, even for a snack.  Because I don’t produce any of my own insulin, I can’t eat anything with carbohydrate in it without taking insulin.  And all through the day, I keep an eye on the Dexcom, to see if I’m headed high or low, and can nip it in the bud before it gets to be a problem.

Both my pump and the Dexcom require their own maintenance.  My pump must be refilled with insulin about every 3-4 days and that takes about 10-15 minutes, and involves a needle (‘nuf said) to insert the cannula under my skin. Doesn’t really hurt, though no-one with a pump looks forward to inserting a new infusion site. However, it sure beats 6 shots a day!  Most of the time, I don’t have to worry about the settings on my pump, but every once in a while, I need to adjust a basal  rate during some part of the day, or some other setting.   The Dexcom sensor supposedly lasts 7 days, though most times I can make is last longer (that’s a secret, by the way). That also involves a needle – and hurts a little more than inserting a new infusion site. Worst case scenario is when both things need to be changed on the same day, which just happened the other day. Bummer.

All of this takes time, attention and energy.  Why all the trouble? The goal is to keep my BG as close to my target (120 mg/dl) as possible.  The motivation factor is high- the consequences of uncontrolled BG are serious – kidney failure, vision loss, neuropathy – and so I keep writing things down, poking myself, tweaking doses and figuring out what things cause me to go low or high.  Most of the time I am content to live with all of this added to my life.  But, there are times when I whine and grumble.  That’s when prayer and the reminder that I CAN control this disease becomes important.  I won’t let diabetes control me, or defeat me.  My God is bigger than that.

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