Testing…Testing…

I’m embarrassed to admit it but, until a few months ago, I was not monitoring my blood sugar properly.  I’m not talking about the physical act of poking my finger and placing blood on a test strip — that I have down pat.  No, I’m talking about watching trends in my blood glucose levels and learning how different foods (or different combinations of foods) affect my blood sugar.  It wasn’t until this past March, when Amy Tenderich (of DiabetesMine) posted an piece called “Glucose Testing in Pairs,” that I realized I fell into that category of people who “…were never given a good explanation of when to test or why.”

When I read Amy’s words, I was surprised to discover that I identified with this description.  In fact, I was a little bit shocked.  I mean, I’ve always been a good patient.  I get my bloodwork done regularly, I see my endocrinologist at least once every four months, I get a yearly physical, I see the ophthalmologist once a year and I’ve started going to the dentist on a regular basis.  I always listen to what my doctors have to say and I always try my hardest. I do blood tests, I count carbohydrates, I take my insulin and I exercise.  Despite all of this, it wasn’t until recently — in my 16th year of living with diabetes — that I realized the importance of pre and post meal testing.

After coming to the realization that I’d been testing ‘wrong’ for over a decade, I started to feel angry.  For years, I had been struggling to achieve good blood sugar control without much success.  I couldn’t help feeling that, if I’d been taught to test in pairs earlier in my D life, some of those unexplainable highs and lows that had plagued me throughout high school and university might not have been quite so mysterious.  Why had I never been told that testing your blood sugar after a meal is just as important as testing beforehand?

I soon realized that the answer to this question is not important.  Dwelling upon what I was or was not aware of in the past is futile.  So, anger quickly turned to determination as I resolved to embrace my new found knowledge and test and test, test and test, test and test…in pairs.

So, I remodelled my blood glucose monitoring routine.  And, in the eight months since making the change, it’s amazing how much I’ve learned!  It’s as though a key has turned, a curtain has lifted and I’m suddenly seeing a bigger picture; I’m suddenly getting a behind-the-scenes tour of my own personal insulin/carbohydrate/blood sugar show.

As I strive toward optimal control, there’s something comforting in knowing that — even after more than a decade and a half with this disease — there are always new things to learn and new things to try on this roller coaster that is diabetes.

My Favourite Number? Less Than or Equal to Seven.

Yesterday, something happened that has never happened before.  Yesterday, something happened that made me smile.  Yesterday, I had an appointment with my endocrinologist and, yesterday, I was greeted at his office door with a high five and an exclamation of, “You did it!  You broke the A1c 7 barrier!”

I am proud to share that my most recent A1c clocked in at 6.9%.  Only once before have I had an A1c less than or equal to seven… but, unfortunately, it didn’t count.  At that time, I was 17 or 18 years old and my sugars were wild, swinging with reckless abandon from 17.4 to 3.2, from 14.1 to 2.4.  All this Tarzan-like swinging, while not particularly healthy, did result in an okay average blood glucose and, therefore, a deceiving A1c.

But, this time, it’s different.  This time, it counts.  This time, my A1c is a reflection of my hard work and diligence.  Reaching this level of control has been a major undertaking for me and something I’ve been working very hard to achieve since the new year.  And finally seeing my hard work pay off feels pretty hecky-darn good.  Over the past year, my A1c values have hovered in the mid-seven range (7.8, 7.6, 7.4) but, with abstract plans for a potential baby in the not-so-distant future (was that vague enough for you?), I have been seriously striving to get this number to that seemingly mythical “less than or equal to seven” range.

It is why I decided to switch to an insulin pump (I struggled for years on multiple daily injections.  For me, no matter how much effort I put into my diabetes management, I never saw results on MDI).

It is why I make such a concerted effort to precisely count each carbohydrate I consume.  It is why I started keeping a kitchen scale, a copy of Calorie King and a calculator on my kitchen counter, within easy reach and in plain view (as opposed to stashed away in a rarely-used cupboard that I had no intention of ever opening).

It is why I make an effort to regularly exercise.  See, for example, mountain climbing, kayaking, cycling or walking.

It is why I test my blood sugar 8, 10, 12 or 15 times a day.  And it’s why I’ve finally started keeping my meter on my bedside table over night.  No more stumbling around the house at 3am, with low blood sugar, overturning cushions and digging through backpacks and purses searching for my meter for me (and no more run on sentences either)!

And it’s why I decided to become an active contributor to the Diabetes Online Community.  I take so much of my inspiration and motivation from individuals, scattered across the globe, whom I have never even met.  I’m fairly confident that today’s favourite number would not be 6.9 if it wasn’t for the D-OC.  Thank you Kerri, Amy, Chloe, Scott, George, Tim & Alison, Chris, Karen, (and so many more!) for telling your day-to-day stories, for sharing your hopes, your frustrations, your disappointments, your goals and your joys.  Reading your stories makes me healthier.  And I hope, in my own little way, I can inspire this same positive change in others.

Here’s to reaching our diabetes goals!

That Lovely (and Sometimes Illusive) Window of Control or: How to Pass the Time When Your Sugar’s on the Fritz

9 o’clock pm.  My sugar’s 6.1mmol/L and, having eaten supper about three hours ago, I’m feeling pretty good.  Not too low and not too high but right in that lovely (and sometimes illusive) window of control – that window known as “in range.”  Feeling good and not knowing what to do with the evening, I suggest to Daniel that we embark on a mission to spend some of his recent birthday money on our not-so-recent Catan obsession; brick, ore, lumber, sheep and wheat…oh how we love to settle Catan.  With Daniel driving, I absentmindedly scratch the skin around the gauzy sticker of my infusion set.  “My site’s really itchy tonight” I idly mention, more to make conversation (I’m a winning conversationalist) than out of any sort of concern…

We arrive at our destination, peruse the vast array of Klaus Teuber’s ingenuity and decide upon Catan Dice…portable, inexpensive, fun and playable with only two participants!  An all-around winner.

Two hours pass.  Slightly cranky and mildly thirsty, I do a blood test and am startled to see my sugar at 14.2mmol/L.  Of course, I immediately remember the itchiness.

“I don’t think my site’s working.” I unenthusiastically proclaim.

“What?  Why?”

“My sugar’s been climbing at a fairly good pace for the last couple hours…This might be a long night.  I want to make sure my site’s working before I go to bed.”

Daniel, ever-supportive in times diabetes duress, happily reminded me, “At least we have two-player Catan to pass the time!”

I smile and decide to give my infusion site the benefit of the doubt, bolusing to correct for the high.  One hour (and three games of Catan Dice) later my sugar’s at 16.3mmol/L.  And so, at midnight, bleary-eyed and pajamaed, I filled a new reservoir with insulin, rewound and primed my pump, cocked my Inset II and inserted a new infusion set on the other side of my abdomen.  I bolused again and settled in for some more waiting.

“You up for another round?” I asked, shaking the dice in my hands.  “I want to wait at least an hour to make sure this one’s gonna work.”

And boy, did it work.  After heading to bed at 1am with a sugar of 10.9, I woke, three hours later, to an aggressive low that kept me up, testing and eating, for almost an hour.  No Catan Dice to fill in the waiting this time.  Just juice *poke* toast and peanut butter *poke* more juice *poke*.

* * * * *

With five hours of sleep under my belt (and two nice bags under my eyes), my morning sugar is, once again, around the 14mmol/L mark.  But, with my infusion site working and with my ever-supportive husband by my side (and with Catan Dice to pass the time if necessary), I’m ready to battle my blood glucose back into submission, back into that lovely and sometimes illusive (I know from experience) window of control – that window known as “in range.”

One of Those Weeks

While I’m usually chipper about living with two autoimmune diseases (what other way is there to be?), it doesn’t mean I like living with two autoimmune diseases.  It’s true, there are days when celiac is hardly a consideration and my blood sugar cooperates by staying right where it should -  in that lovely window between 5 and 10mmol/L.  But there are also the days when this is definitely not the case.  Despite my to-the-gram carb counting and 12+ finger pokes a day, there are times when, no matter how much effort I seem to put forth, I get bounced around like a human yo-yo.  The soundtrack to these days plays in the background like the audio to some sort of bizarro workout video:

“And Plummet to 3.8.  And up to 14.7.  And plunge to 3.4.  And breathe.  And breathe.  And up to 15.8.  Do you feel the burn?”

No, I do not feel the burn!  But I do feel exhausted and cranky!

Frustration and discouragement often come hand-in-hand with diabetes.  I know we’re often told that, “numbers are just numbers” and I try to take this to heart but those silly numbers really can (and do) make me angry sometimes.  There are those days – weeks even – when, no matter how hard I try, my numbers just won’t reflect the effort or time or thought or care that I put into daily living with diabetes.  I find it so hard to not feel annoyed and defeated when I work so hard at something but fail to see positive results.

This has been one of those weeks…

Name That Blood Sugar!

When I was younger, I would often play a game with my family called “Name That Blood Sugar.”  Placing a lancet in my lancing device and sliding a test strip into my blood glucose monitor, I would shout from the kitchen, “I’m ready to do my blood test!”  This was my family’s cue to call out a flurry of numbers and guess my forthcoming blood sugar result.  I’d poke my finger and we’d watch as my glucometer (yes, they called them glucometers back then) counted down 59 seconds (holy eternity, Batman!) before displaying my result.  The winner never received a prize but, as a newly diagnosed diabetic, this little guessing game did add a bit of fun and suspense to my otherwise unpleasant pre-meal routine.

What's it gonna be??

I’ve recently learned that I’m not the only type 1 who has enjoyed this blood sugar guessing game.  Nial Giacomelli, a 21 year old web developer from the UK, shares a similar interest.  In fact, he has created a website called Diabetting to help people, “settle decisions using the blood sugar level of a type 1 diabetic [Giacomelli himself].”  How hilariously fun is that?!  You guess Nial’s most recent blood glucose, your friend guesses Nial’s most recent blood glucose and whoever is closest gets dibs on…well…you decide!  That last scoop of ice cream?  Full control of the tv remote?  The restaurant choice for Thursday’s dinner?  The movie for your Friday night date?

I love it.  Way more fun than flipping a coin, no?  Plus, if you want to infuse your guess with some strategy, you can hunt for blood sugar trends on the graph of Giacomelli’s 30 most recent results.

Giacomelli created Diabetting as, “a fun way of making sure I keep on top of checking my blood sugar regularly and eating responsibly.”  Sounds great to me.  Being aware of trends and anomolies in blood glucose is a critical element of good diabetes management.  If this sort of creativity is what it takes to get people testing, I’m all for it!  As I’ve said before, diabetes means dealing with lots of numbers so why not have a bit of fun with them?

Smart Charting

I keep running across the idea of “Smart Charting” as of late.  Multiple times this week, some complex graph/table for recording blood glucose has presented itself before my eyes.

source: http://www.diabetesnet.com/pdfs/smart_chart.pdf

So, for the next little while, I’ve decided to say, “Move over old school logbook, I’m trading you in for a Smart Chart!”  (Truth be told, I have never and will never actually say this.  In all my years of record keeping, I have never once talked to my logbook.  And, if I had, it definitely wouldn’t be with such boisterous enthusiasm).

The main challenge of this Smart Charting endeavour will be staying motivated to fill out all the required data on a daily basis.  In theory, Smart Charting is great.  A single page with a visual representation of blood glucose over time, overlayed with food intake, insulin dosages and activity levels.  That’s a lot of important information crammed onto a teeny tiny logbook page…and definitely more informative than my current logbook…

…with boxes and boxes of numbers (not all of them my favourites), scribbled notes in .03 size font and symbols and arrows to explain my highs and lows.  It proves confusing to me at times, let alone to my endocrinologist!

Of course I know most meters can be plugged into a computer, yielding handy-dandy graphs of blood sugar trends.  However, I rarely, if ever, actually get around to doing this.  By the time I download information from my meter and start noticing patterns, three months have passed – it’s a completely different season and my schedule/routine/exercise levels have changed.  Also, and this may just be me but, inputting data into my UltraSmart takes me ages!  What with the buttons and the menus and the scrolling through values until I find the one I want – I could write it down faster!

Enter, Smart Charting.