Diabetes Self-Management Blog

Many mornings over the past few months, I’ve conveniently forgotten to check my blood glucose when I wake up. I bolus for breakfast—a bowl of cereal or a couple of chewy granola bars—but I’m unable to correct for my blood glucose with the insulin pump because I don’t know what my blood glucose level is. It wants me to correct if I need to correct. I lie to my pump. I don’t know my numbers.

I tell it “Yes” when the screen defaults to “yes” for a correction bolus and enter my target of 120 mg/dl. I must be close to that. I mean, come on: my morning blood glucose is usually within 20 points of where it should be. It has been for most of the mornings these past 10 or 11 months. Why would this particular morning be any different?

Then I think the same thing the next morning, and the morning after that the same rationalization plays out in my head. Pretty soon…

Many evenings over the past few months when my insulin pump’s alarm buzzes to remind me it’s time to change the infusion site and reservoir, I’ll set the snooze for a few hours because I tell myself I’ll change it when the alarm sounds again. But I don’t. I’ll push it through the next day. Maybe even into a fifth day. I don’t see any sores where the sites are. I don’t have any hard spots near the infusion sites. The insulin looks fine.

And I tell myself I will only do it this one time; next time I’ll change the site and pump when the three days are up. On the nose. Next time I’ll move the site a little farther from the previous site. The problem is, I have my favorite infusion-site locations and I tend to overuse them a bit.

And then the next time rolls around, three days from the previous site change. Snooze. Snooze. Cancel. The next day, or two days later. “Next time,” I tell myself…

Many weekend afternoons I’ve been working in the yard and started to feel those warning signs that everything I’ve read tells me I can’t rely on. Low-blood glucose warning signs: I feel them. Most of the time.

But yeah, right: That’s not healthy. I’m deceiving myself. I can probably only be close to right in predicting where I’m in my blood glucose numbers about 50% of the time. At best. Not a good way to play it. A bit unsafe long-haul. But should I run inside and get my test strips and lancet? Should I stop what I’m doing when I feel fine (just a bit into the feeling of slightly low blood glucose—a feeling I could describe but which most of you know anyway)? Do I go inside? Do I check? Nope. I slug some Gatorade, or some orange juice, pay attention to how I feel, shrug my shoulders, and keep on going…

Many times at work lately, I’ve been struggling with a problem and tried to figure out how to solve it—staring at a computer screen, running through different ways of approaching the dilemma at hand—when my pump buzzes to remind me it’s been two hours since my last bolus. Eight buzzes. Annoying buzzes. The first set quits and a minute or so later the second round.

And then the third. And the fourth.

And then I hit “OK” and cycle back to the home screen. Without checking my blood glucose. Without knowing where I’m at…

Why am I doing this? Am I getting lazy? Has the newness of Type 1 run its course? Maybe. Maybe this is the beginning of a long-drawn-out nosedive into self-management neglect. Complicationsville.

It could be. Some of you might say, “I told you so.”

I sit here tonight typing away (and backspacing, deleting, rewriting a bit). I have only the sound of the refrigerator kicking on and the trickle of water from the fish tank in the next room to keep me company. It’s a quiet night, and I can hear the tune “What if?” all around me.

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Comments
  1. It could be a degree of “diabetes burnout”, but it could also be a normal psychological response to the sort of obsessive-compulsive behavior that tight control of diabetes (Type 1 OR Type 2) demands.

    Posted by tmana |
  2. I have you tell you, it’s a relief to see that I’m not the only one who feels this way. After 15 years of diabetes, I feel like a sort of apathy has set in. Then I look at my near-blank glucose monitoring book and a rush of guilt and panic sets in when I think about the long-term consequences of not monitoring my sugars closing or not rotating my pump site enough.

    It’s hard to do all this when all you want is to retain a sense of normalcy. Poking your fingers, sides, dosing up insulin, counting carbs: all reminders of how far away from normalcy I really am.

    I appreciate your post and understand just how you feel.

    Posted by raerae7133 |
  3. Dear Eric. Everyone likes to be let out of jail on occaision. I have not been logging all the food I eat, BG readings and exersice since 3 April 08. As a result I have gained back 5 pounds of the very difficult to loose 10 pounds that took many months of very determined i.e. compulsive behaviour. Diabetes is like total war any slaking off and you will loose quickly. Maybe the memoirs of Ho Chi Min(if there is such a thing)would be worth reading to see how to take so many bombs and keep on smiling. It is uplifting to read that most diabetics have this problem and that it is not just one individual that has: “lack of moral fiber”(a Canadian air force WW2 misdiagnosis of shell shock in aircrews that could not take it anymore).

    Posted by CalgaryDiabetic |
  4. Man, Eric… isn’t it amazing how we fall in that trap. I’m there, too. I haven’t tested but maybe 3 or four times in the past several weeks. Not to mention the same pattern for even longer. I am supposed to test 4 times a day. I am supposed to (according to my calendat) mail in the re-order card on my strips. I get 8 boxes. I still have 6 unopened ones left. Not good.

    I feel guilty. But for some reason that doesn’t get me to test again. I feel like I just don’t care that much because I still eat the same stuff I’ve been eating since day one. I don’t know how to break the bad pattern of apathy.

    Posted by Ephrenia |
  5. Eric, I think it’s pretty common, though obviously not something that any of us should be doing. I think part of it is that unlike a lot of diseases where the doctor is the last and final say as to how to treat the problem, diabetes is one of those diseases where it really is all up to you.

    We are supposed to “control the blood sugars” but if we were really able to do that physically, we would–by definition–not have diabetes. That said, we can do what we can to make ourselves feel better. Not necessarily control the diabetes, per se, but feel healthier.

    Too many people I’ve known when they first get diabetes go into an obsessive/compulsive mode as far as their behavior is concerned. It’s like they’re playing “Let’s make a deal” with diabetes; they agree to do EVERYTHING right ALL OF THE TIME, and they think that diabetes has agreed to basically leave them alone. It doesn’t work like that, regretably.

    To me, regardless of whether I am obsessively “controlling” diabetes or taking an ill-advised day off, diabetes is still in control because my behavior is affected by it either way.

    My advice to those newly diagnosed is to make a different “deal”. I suggest that we agree to do the very best we can (not necessarily do everything perfectly, since a person’s 100% varies day to day) and our bodies agree to feel the best way they can as a result.

    If I have a really healthy day, I feel better. If I string enough healthy days together in a row, maybe I develop a set of healthy behaviors that in turn become habits. When healthy behaviors become habits, I don’t have to think about them anymore. When I feel healthy without having to think about diabetes constantly, I don’t feel like a diabetic, and to me, that’s the real goal. “Controlling the blood sugars”, to me, can feel like an almost impossible task; but doing what I can, every day, to feel better, that’s more manageable.

    Posted by jasher |
  6. I can empathise with all of the comments made before. All the don’t do this, and don’t do that, along with test test test is a real pain. no pun intended maybe. I need some positive input. I am a cookie jar , cake baking grandma, that has just had about enough spank for one year. Something to perk up our spirits. No more of what we can’t have. What about what we can have! And how to make the best of it.

    Posted by J. P. |
  7. Eric, I have been playing the same game since being on the pump. I am too complacent to take the time to test. So, I bolus up with enough insulin to cover my carb intake. The problem is I have no idea what my BG is. Without fail, I usually end up with a low level - sometimes so dangerously low I am close to going unconscious, or I do. I can’t tell you how many times my husband has found me sprawled out on the floor somewhere, gives me a glucagon injection, sometimes two, and waits for me to regain conciousness. I know what the consequences of this behavior is, including dying, damaging brain cells that cause memory loss, and being a safety risk at work. I am a teacher and being a risk has been clearly explained to me that if I continue with these “episodes” I will be deemed unfit for duty and that will result in just one outcome. Now, is there anyone that has become an ill-fated diabetic as I have? I have been afflicted with this disease for over thirty years and I am over fifty years old. I caution anyone who has evolved into this frame of mind. Don’t let it progress to this level. It is dangerous, but so preventable. I have been blessed with the power to change, however. I have reformed. I do check my BGs
    frequently, every time I get the 2 hour reminder, sometimes more often. If you do anything, stop treating yourself as unimportant and not worthy of taking care of yourself. YOU ARE and you can control your diabetes and not let it control you.

    Posted by scasillas |
  8. I am a 52yr old female (married for 30 yrs, no kids)
    with type 1 diabetes for 49 years. I also am obsessive about my control and always have been. I
    was also born with polycystic liver disease and due
    to this had a kidney transplant 18 years ago thanks
    to my sister. I have never had any problems with
    my eyesight (no laser), and have no neuropathy in
    my hands or feet. This is thanks to good parenting
    years ago, but has also made me obsessive about my
    control. I test at least6 to 8 times a day and
    why the meter reads above 8 or 9 mmol I have to resist the urge to take a extra unit. This has been
    a constant in my life and the lives of all the people I love who have been with me through years of
    hypoglycemic reations which have had to alot of the
    time had to be resolved with glucagon injections.
    Yes I am human, and binge every once in a while, but
    I don’t do that too often. At 52 I had my first
    reaction while driving and no my licence has been suspended. This was my wake up call and since then I have been able to ease up on my control and
    have actually started after all this time to relax
    somewhat. How many others are out there like me?
    Feeling really stupid and embarassed! Why did it
    take something like this to make me realize how
    much time I have wasted?

    Posted by Janie |

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