Life in LADA land

Living Philippians 1:6 with type 1.5 diabetes

“Settling” for 6.5

I saw my doc this week and it was, as usual, an enjoyable time.  My A1C was up .3, but we are all happy about that (me, my doc and my CDE).  Why would we be happy about A1C going UP?  Because to keep it lower (which it has been for the past 9 months or so) means I have too many episodes of low BG that have been really interfering with my life.  A1C is a measure of average blood sugar levels for a 3 month period.  The recommendation for diabetics is to keep it under 7%.  When I started with this whole escapade called LADA, my A1C was 11.7 (I think).  So I’m pretty happy with where I am now.

I’ve come to the radical conclusion that I really don’t need to put up with all of these low blood sugar episodes that come with trying to control my BG too strictly.  There is a way around them.  But it means setting aside my desire to control my BG too tightly. I have to let it go up and stay a bit higher than I want, settling for 130 or 150, instead of 110 or 100.  There’s not much room for error when you’re sitting at 100 – slight exertion, stress, and any kind of random event will put me in the danger zone all too quickly.  I was talking with my CDE a couple of weeks ago about this very thing, letting go of some of my rigid desire for control. She said that one of the doctors in the practice, a type 1 himself, came back from a conference saying that other docs with type 1 are content with a higher A1C than previously because it puts them at less risk of going low. I commented that that made sense for a doctor since they really wouldn’t want to go low and not be able to work at their full capacity at any time. She just looked at me as if I was nuts. I wasn’t sure exactly why at first, but then I realized that my life matters too, and that I shouldn’t be forced to settle for less than those doctors.

The good news about this relaxed control is that I have already found that I have more energy most of the time.  Lows take their toll longer than just while I’m low. I don’t think I realized that until now.  It’s good to feel good again, especially after the rocky weeks that I’ve had recently.

It’s hard to admit that I might have to let go a bit. I want to do this well.  And for me, doing something well means coloring in the lines, or playing by the rules.  Problem is, diabetes doesn’t play by any rules than anyone can predict, and sometimes, I just have to live with BG levels that go outside the lines.  It’s hard.  But then, what isn’t hard about living with LADA?

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Getting all the details right….or not.

Now that I have a new pump that I can rely on (thank you Animas!), I can get back to the diabetic routine.  Except that of course, there is no such thing, since everyday is a new blood sugar adventure.  But at least I can be relatively assured that I can keep things mostly within normal range.  MOSTLY.

This has been an emotional week. Four days with four different ceremonies celebrating our son’s high school graduation in two weeks.  Baccalaureate, Academic Signing, last Orchestra Fe stival and Senior Awards. Each has its sweetness and sadness.  Trying to keep my blood sugar on a relatively even keel has been a challenge, to say the least. A challenge I haven’t been completely successful with.

Tuesday evening was the Orchestra Festival, a concert that features all of our school district’s strings students from 4th through 12th grade.  Our son has played since 4th grade, so we have a long history with this event. Add to that the fact that the Orchestra director is not going to be directing strings anymore but instead teaching general music at one of our elementary schools, and you have the emotional forecast for that evening.  Teary with a chance of sudden bursts of joy.  The bursts of joy were when our son won two very meaningful awards.  The teary part was hearing him play for one last time in high school (he will be playing in college which is great news!) and being part of the delegation who prepared and delivered the farewell for our director.

My blood sugar tends to go high when I get emotional.  But on Tuesday night, I also knew that I would be involved in preparations for the concert since I had to supervise some students and was a general girl Friday for the director and so would probably be pretty active before I could sit down to enjoy part of the concert.  So, I dosed conservatively for dinner, thinking that it would be better to go a bit high during the evening than to crash and burn with a bad low.  So I was completely unprepared when about halfway through the evening, I finally sat down with my husband to listen to some of the performances and realized I was feeling like a low was headed my way. I pulled out my CGM and sure enough, it said 72 with an arrow pointing straight down. Not good. I reached down for my purse where I have plenty of sources of carbs and realized I had left it backstage.  Really not good.  Fortunately my type 1 buddy Jane had sat down with us and when I showed her my CGM (after she realized it was not an iPod) she reached in her purse and pulled out a baggie of glucose tabs. Rescued!  I chomped away and eventually felt good enough to finish out my responsibilities for the evening.  But all that night and the next day I was stuck with lows.  No matter what or how often I ate, I was stuck in the 75-90 range most of the time with a brief excursion to 110 before it returned to the red zone (the lines on the graph of the CGM are red if your BG is below 80).

So once again, I am humbled by diabetes.  I cannot account for every detail of my life in advance so that I can administer the perfect dose of insulin.  Even if I could, I suspect something would interfere somewhere along the line so that my plans would go awry.  I cannot predict what my emotions are going to do to my BG. I cannot anticipate how active I am going to be at all times.  I think that is the hardest thing about diabetes – you have to think about what will happen when you do something spontaneously.  Do I need to eat something since I just made 3 trips back and forth – quickly – looking for the high school orchestra students?  Will I go high at an awards ceremony when my kid receives an unexpected honor?  If I decide to start doing some of the big cleaning projects to get ready for visiting family on the spur of the moment, do I need to stop and have a snack first?  The fact is, I don’t always think that way, and so diabetes hits me over the head occasionally with a sudden high or low.

I also realized, when my purse was AWOL, that I need other people. Sometimes I need people to rescue me when I am not prepared.  If Jane had not been there on Tuesday night, I would have had to make an awkward exit and figured out a way to get backstage without being obvious about it to get some carbs. Not impossible, but inconvenient.  I need people to listen to my rants and to encourage me to keep on trying, even when diabetes seems impossible to deal with.  And I need people to remind me that I’m really not the one in control here, and I’m never really alone.  So thank you to all of you who are there for me, either with a glucose tablet, a cookie, a sympathetic and encouraging word or a hand on the shoulder and a prayer for strength and relief.  I’d be a real basket case without you.

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Roller coaster ride

At the Baccalaureate service at our church tonight, the charge to our students was from Joshua 24:15-16.  As Isaac talked to our seniors (one of whom was my son), he mentioned that the Israelites often prayed to other gods in addition to God, since they often adopted the customs of the people around them.  Though we don’t carry around wooden statues in our pockets to pull out and worship, we too have idols that we cater to – academic success, popularity, career advancement.  This means we are always trying to live up to some standard imposed by someone else, and depending on the success of that endeavor, or lack thereof, it can lead to a roller coaster life of riding up the hill of effort and down the slide of dissatisfaction or disillusionment when the hoped-for reward from that idol does not fulfill our desires.  Hopefully you get the idea, since I’m doing a pretty lousy job of summarizing.  You have to cut me a little slack – during this entire charge to our graduates, I was trying really hard not to cry.

But even with the emotional state I was in, I was able to see a parallel to diabetes (yes, really).  I ride a roller coaster of blood sugar almost every day.  The ups and downs from exercise, meals and just life in general often look like a roller coaster on my CGM.  The trick is not to let my emotions ride that roller coaster.  Do I feel like a success when my BG number is in range and a failure when it isn’t?  When my BG goes up and up and up after pizza (yes, that happened today) despite what I thought was an adequate dose of insulin (really, a ridiculously high dose of insulin, which still didn’t work), does my sense of self-worth or confidence plummet?  Unfortunately, the answer to those questions all too often is yes. Anger, impatience, frustration – these emotions are right there, ready to jump out and sabotage my day.  My emotions ride a roller coaster based on my self-imposed standards of success, and when I ‘fail’, I am quick to beat myself up.

So, just as Joshua charged the Israelites to look around at the other gods of the nations around them and then to choose who they would serve, I have a choice as well.  Will I choose my own idol of ‘success’, based on how well I manage diabetes, or will I choose to worship the God who created me, faulty pancreas and all?  I, like Joshua, will choose the Lord.  All the other options are miserable and hopeless by comparison.  He is faithful. His mercies are new every morning.  His love NEVER fails.  And He can even out those dreaded hills and valleys of the roller coaster that I cannot control.  I just need to trust and rest. In Him.  He can even out my emotions far better than any diabetes management program (if there was such a thing) ever could.

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