Burning Out

I don't know when it happened.  I think it was a process of one thing adding on top of another until, all of sudden, I feel buried by everything living with diabetes requires.  It is kind of strange, really.  My overall mood and general outlook has been improving thanks to the help of some medication adjustments.  Mentally I have been feeling better than I have anytime in recent memory.  But on the diabetes front things are going slightly awry.  Looking back I think the beginning was using the last Dexcom sensor from my stockpile accumulated after my deductible was met last year along with the realization that I would not be able to afford to buy more for a while.  Although the alarms could be annoying, the data could be overwhelming, and I would often make myself feel guilty whenever the graph ran into the red, the ability to see where my blood sugar was at a moments notice and react accordingly as well as not having to rely on my horrible memory to get blood sugar readings was invaluable.  A short break from the CGM is always welcome, but long term it leads to me being in the dark about the overall effectiveness of my diabetes management.  I first noticed that things had begun to slip around the 4th of July when we tool a small trip to the town where I grew up to see some family and friends.  Throughout the trip I found myself forgetting to bring my insulin places with me.  In the past I would either return to get it or eat something I knew wouldn't effect my blood sugars too much.  On this trip I usually just brushed it off and even usually forgot to check my blood sugar and take a correction bolus when I got home.  That started me thinking and last Thursday, my third diaversary, I took some time to really think about how I'm doing and evaluate where I am at with my management.  What I ultimately decided was that I have let things slide considerably.  It started with not checking my blood sugars post meal.  That has always been a struggle.  I get busy or I just plain forget.  That, in turn, led to not checking my blood sugar before meals and then to forgetting to check my blood sugars in the morning.  I realized that there have been stretches where I have gone 3 days without a single blood sugar check.  (This post from Kerri Sparling was unbelievably timely.)  In addition, I have found myself just using wild guesses for boluses instead of actually counting carbs.  This can be a dangerous thing, especially given that I usually don't feel my lows until it is at a scary level (like in the 30's).  But the thing I am most disappointed in myself over is putting off my insulin doses.  I am pretty vigilant about my basal injections.  If I forget it at bedtime I always get it the next morning.  However, I have been pretty hit and miss on my bolus injections.  Some of this is from having lots of little snacks here and there and not thinking about taking insulin for it.  Some is because I get pulled away right before I eat or often in the middle of my meal, or both while I'm at work.  And sometimes it is just silly things like not wanting to lift up my shirt and have to tuck it back in at work or just plain not wanting to deal with a painful injection, and those have been more frequent as of late.  I have a common thought when I check and find a high blood sugar; do I want to subject myself to the pain of another injection or wait until I eat again?  More often than not the answer is to wait.

Step one is admitting you have a problem.  I admit it, I'm burned out.  So now I need to find a solution.  I have tried using BG tracking apps, setting alarms, making promises to myself, and none of it has worked.  So my new goal is to find a way to get back on the CGM and eventually a pump.  The first step in that process?  Finally get in to see and Endo.  From there, who knows, but at least I am acknowledging the problem and starting on the path to a solution.  One step at a time.

Unaware

Two nights ago, just after crawling into bed, my blood sugar dropped from above 200 to under 70 over the course of an hour.  My CGM alarmed for a reading of 64 just after 11 pm.  Then again for a reading of less than 55 a few minutes later.  And I didn't feel a thing.  When it was still showing a reading of 40 a while later I decided I'd better do a finger stick check and was sure that my sensor was off because I didn't feel the slightest bit low.  CGM said 40, bg meter said 49.  Pretty close.  Then, last night around midnight, I was awakened by a low alarm.  I vaguely remember looking at the screen and seeing a red 63, silenced the alarm and went back to sleep.  I don't remember any more alarms, but there must have been more because looking at the graph this morning the low continued.  Until the graph disappears all together.  When I grabbed the Dexcom this morning to check my levels as I do every morning it was turned off.  At some point in the night I tired mind must have thought the best way to get the alarms to stop was to turn off the receiver.  Genius move, Craig.  Not only do I not feel my lows, now I am turning off the one warning system I have in the middle of the night.  Why do I not feel low at all?  I read a lot about people feeling the effects of bg below 50 or 60 and not being able to function and yet I can fall to 40 and not even realize it if not for the CGM.  I don't know which is scarier, reacting in a way that shows some pretty frightening physical symptoms or not reacting at all.  What happens on the day I don't have my CGM on or if I can't afford it?  Am I going to drop low and not know it until I am unconscious?  Of notice too late to react?  Or even worse will I be driving and drop low with now warning and become a danger to others?  Will my kids be in the car?  Just one more thing that scares the shit out of me.  One more thing the haunt the recesses of my mind as go throughout the day and one more thing to think about before I go to sleep.  Am I going to wake up tomorrow?

DBlog Week Thursday: Mantra's and More

What brings me back up when diabetes brings me down?  This is a hard one for me.  Yesterday's post was easy because I've been fighting some demons lately.  Getting back up is something I've not done a particularly good job at.  The best I can do is remind myself that the feelings are temporary and that things will get better.  Or really that things are already better than I think.  It helps to do something different, spend some times with the kids or go for a run.  Sometimes I try to write and sometimes I just veg out and play some video games.  I think the biggest thing for me is to remember that I can get through it and to distract myself from the things that are stressing me out.

There are times however when the feelings are clingy, like that low you just can't get rid of.  Those are the times when I have to step back and let my numbers slide a little.  Sometimes I just turn on the Dexcom for a few hours or for the day, or if it's time to replace the sensor I'll leave it out for a couple of days.  Having the constant information is so useful 99% of the time.  But there is that 1% that it is just overwhelming, serving as a reminder that I will have to do this forever.  There isn't really a go to pick me up I guess.  It varies.  Sometimes it's as easy as escaping into the virtual world, and sometimes it requires a short vacation from the constant information flow and reminders.  However I do it, I think the most important thing is remembering that it will pass.

To bolus or not to bolus...

Had pizza for dinner even though I knew I shouldn't and I've somehow managed to stay under 160 since.  Now the question is, do I take a bolus before bedtime to insure I don't go high tonight or trust that my number will stay steady and come down?  Damn you pizza!  So delicious but so much trouble!

Broken

I love my Dexcom CGM.  There is no way around that.  There is just one problem.  That little sensor attached to my stomach has become another reminder.  Everytime I lift my shirt and look down I see the sensor, I see the bruises from the injections, and I remember that I will be in this same routine for the rest of my life.  And it is depressing.  I keep a pretty positive outlook most of the time.  I love the opportunities I get to educate others about the disease.  I few days ago I got to show of my CGM to some co-workers and excitedly tell them the ins and outs and how it is a great tool to spot trends and tweak insulin dosage.  I totally geeked out on them.  I also got to express my passion and some of the startling numbers about diabetes to a group of workers while I tried to rally support for this years Community Walk.  Times like that make me realize that this disease has had it's blessings come with it.  I feel hopeful and love that I have this part of me that fuels a passion to spread the word and help others.  And then I look down... 

Cyborg Glucose Monitoring!

A week ago I entered the world of CGM (continuous glucose monitoring not cyborg glucose monitoring as the title suggests).  For those who don't know how this works, I'll explain.

I attach a sensor to my body, either on my belly, butt, thigh, or arm, which has a filament that is deposited under my skin by a very small needle.  This filament determines blood glucose readings by monitoring sugar levels in interstitial fluid (the fluid I between cells).  This information is sent via a small grey transmitter to a receiver that displays a blood glucose reading every 5 minutes.  The sensor is calibrated by periodic checks with a finger prick from a standard glucose monitor.

In the last 6 days (I'm excluding the first day because apparently the pain killer I took confused the sensor which in turn confused me) this information has already proven invaluable.  I simple vibration from my pocket tells me "Hey Craig, you should probably take a break and eat something", or "Hey stupid, that handful of Snickers fun size you ate should have been accompanied by some insulin."  

But the information goes beyond a simple number and alert now and then.  While a finger stick will give me a number that tells me if I'm high or low, my CGM will tell me where I've been for the past 12 hours, if I'm headed up or down, and how fast. That is really good information when I'm deciding how to treat. If I know that I'm at 200 and falling I'll use less insulin than if I'm at 200 and rising.  Same goes for treating lows.

Yesterday reaffirmed my thoughts that this was a great choice for me.  I left work and took The Bug to the urgent care.  After dropping her off at daycare I stopped at the gas station to get a donut.  I injected what I thought was the correct amount for the donut and enough  to cover my planned breakfast after I got home.  Having worked a 12 hour shift on an hours sleep I was exhausted when I got home and collapsed on the couch, forgetting the breakfast and taken insulin to cover.  An hour or so later I snapped awake, not sure if the Dexcom was beeping or if something else woke me.  I was in a stupor and shaking badly.  My mind was in a fog and I took a second to remind myself where I was.  I reached for the receiver to my Dexcomand it simply read LOW.  Looking at the graph it appeared I was in the low 50's.  This was the worst low I had ever experienced.  Had I spent the time looking for my meter in my already confused state and then tried to pour myself some cereal which already ended up on the floor before reaching for a handful of gummy bears I very well may have been found in a crumpled heap on the floor.  But the Dexcom allowed me to act fast without searching for anything extra or taking extra steps.  

My experience so far has been full of positives and I've loved being able to explain to people that my new toy is not an MP3 player.  Hopefully it continues that way as I continue to pay more for this equipment than simple test strips but reap greater rewards.