Diabetes Self-Management Blog

This past week my wife, our dog Ellie, and I were a couple hours west of home doing some much-needed and very anticipated absolutely nothing at a cabin on a lake. OK, there was hiking, some kayaking, campfires, lots of reading, and good grilling… but for the most part, absolutely nothing.

We’re back home now, returned only a few hours ago after a unanimous decision this morning to come home early.

“Early!” you say. “You left a vacation and went home early?”

Well, technically we’re still on vacation, but now I get a few extra days to work in the garden, hang out in the comfort of my own home (which is decidedly not a rented-out cabin, although the cabin was nice enough), and be able to go outside somewhere where, while it may have its share of mosquitoes at this time of year, has nowhere near the massive numbers of the biting buggers we experienced at the cabin. (It’s no exaggeration to say we went through two cans of Deep Woods Off! in five days.)

Being back home means that we’ll quickly settle back into our routines, and while that may sound boring, I think routines are nice. I enjoy my day-to-day, even when I’m not on vacation, and so to fall back into whatever it is you want to call it — the mundane, the quotidian, the grind, the boring — is for me such a welcoming, comforting prospect that I really don’t care what you want to call it. This morning when I could choose two more days in the woods or two extra days hanging around the house, I chose the latter.

For that decision, I think my blood glucose numbers — or rather, my organs — will thank me, because back here at home the blood glucose numbers will no doubt reflect this slipping back to normalcy. You will probably recall that last week I asked you to share any tips or warnings about traveling while under the influence of diabetes, and many of you did just that. I prepared well for our travels, and I had more than enough supplies. That wasn’t the problem. In fact, there weren’t any real problems, but several situations came up, all of which involved blood glucose readings.

The only really frustrating incident happened the second night we were at the cabin. We’d gone out for a drive, and on the way back stopped by a little pizza joint and ordered a pie. Now, first of all, let me say that I don’t adhere to any strict diet while at home. I do try to eat as healthy as possible, and for the most part I’m quite successful at it.

But on vacation? Kathryn and I both kind of threw caution — or rationality, or our good sense — to the wind and decided that potato chips, dips, pizza pie, raspberry–rhubarb pie (wife’s early birthday dessert), tortilla chips, salsa, beer, and other various snacks wouldn’t be prohibited. Now of course nothing’s prohibited in my at-home life, but apart from good microbrews, all of the above-mentioned items never make it into our house, except for on special occasions. For good reason: “Out of sight, out of mind” works well for both Kathryn and me. “In sight, on the plate,” is the dilemma we face otherwise. It was the dilemma we faced with the aforementioned snacks for the past five days.

Why’d we do it? Come on, you know what I’m going to say next. “But we’re on vacation.” It was a phrase we used to the fullest extent of its powers.

And let me tell you, that phrase held quite some power.

Back to the pepperoni pizza…

The rule of thumb I follow is roughly 25 grams of carbohydrate per normal-looking slice. These slices seemed normal enough, and so I had three around 9 PM, bolused accordingly, and then a few hours later checked my blood glucose. Around 180 mg/dl. High(er), sure. But I was on vacation. But… But! This pizza wasn’t made by a pizza house where I normally get pizza.

An hour later my blood glucose was at 250 mg/dl. It’s now midnight, I’m tired, and I want to go to sleep. Yet I don’t want issue a correction bolus and fall asleep when I’m not sure why my numbers are up there. I check the insulin pump and everything’s working fine. I change my infusion site, in case there are any problems with the insertion point. Then I issue the correction bolus.

Then I read. Watch TV. Drink some Diet Coke.

An hour later, about 230 mg/dl. At 2 AM, still around 230 mg/dl.

I finally see it start to go down around 3 in the morning.

The next day I relayed my long night’s blood glucose travail to Kathryn, speculating that maybe that pizza sauce was made with pure sugar. She laughed, but she said she did find it awfully sweet.

That’s what I’m going to attribute my blood glucose frustration to. Super-sweet pizza sauce. I’d bet there was extra sugar in the dough, too.

If I were to comment on my own blog from last week, that’s the story I’d share. Never assume that some food you’re used to eating will be made the same way and always have the same amount of carbohydrate.

Oh sure, I could say that I should never enjoy those kinds of foods, never deviate from a diabetic-friendly diet (tell me what, exactly, that would be?), because see where straying from righteousness got me.

But that’s not what this is about. The types of foods I mentioned aren’t great for anyone, let alone people with diabetes. However, they can be had (that’s me saying that, not some diabetes educator or doctor or anyone affiliated with Diabetes Self-Management!). It just can’t be with wild abandon. See, I’ve learned how to compensate for most of any kind of junk food I eat during my normal day-to-day life, how to bolus, how my body reacts, etc. Yet in a different place, with different foods…

I know my mistake seems like a “duh” kind of error, and so my advice seems rather elementary. But hey, I forgot to heed it. I assumed — or just didn’t think! — and I lost many hours of much-needed sleep.

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Comments
  1. I understand where you’re coming from. Pizza is one of the worst things I can eat as a diabetic no matter where it comes from. Did you try using the Dual Wave feature on the pump? This will compensate for the carbohydrates that are being processed hours after you are done eating a fatty meal. When I eat pizza I try not to have more than 2 slices, otherwise it’s to hard to bring my bloods sugars down.

    Posted by Wayne Z |
  2. Duh, is right sir. I am retired and travel alot on occasions. Recently from East Coast to West coast in 14 different airport and 7 or 8 States. I find that when on vacation you should NOT drop your guard and say “oh, well I am on vacation and I can do anything I want.” That is a “duh” idea. Story about similar situation like you are doing. I have a friend that is a diabetic. He takes pills for control. Kept drinking his beer, eating his pies and all the no-no’s. Well so far he has lost some fingers, he has a stump for a right leg, has had several strokes and one heart attach. So my friend think about what you are doing. As a diabetic I have not had a drink of alcohol for years. I use to drink alot. No more. Not even on vacation. DUH.

    Posted by Mitchell |
  3. Next time try a cruise. I went on my first this year. I did some research about the food, and read some tips about how to adapt. What I found was heathy food prepared with few hidden calories or ingredients and smaller portions. Sure you could order two entrees, but one was enough. When I saw that every night there was a sugar free dessert on the menu I was set. It was easy to order egg whites, turkey sausage, and hand made salads. At every meal there were healthy options.

    I even lost weight while on the cruise. My friends couldn’t beleive it. There are so many health concience people in the world that the cruise line had to change the menus.

    Posted by thepang |
  4. Reading the blog and comments has brought up a totally separate issue but in the ballpark. I am a Type II diabetic and treat it with exercise and pills. Now, however, for the next two years I will be injecting myself daily with a medication to treat osteoporosis. This must be kept refrigerated. How on earth do I travel on airplanes and keep my medicine cold? Has anyone dealt with this problem with keeping your insulin refrigerated? I’m sure there is some simple solution, right?

    Posted by Merriel |
  5. Merriel,

    You may want to ask your pharmacist or doctor (or go and read online about the specific medicine you’re taking), because I know that insulin can be kept unrefrigerated for a day or more without “going bad.” (It’s not recommended all the time, but it won’t lose its effectiveness.) So when I travel, I’ll often just have it out for the day-of traveling, and then stick it in a fridge at night.

    There are companies that make refrigerated packs for insulin, however, and an internet search for “diabetes kits” should point you in the right direction. But more inexpensive are probably the refrigerated lunch packs (the “cold bags”) that you can buy at big box stores.

    Good luck,
    Eric

    Posted by Eric L. |
  6. Merriel,

    I travel a great deal for work, charity activities and personal travel. I currently inject Byetta twice a day, and it needs to be kept to refrigeration tolerances that are tighter than insulin.

    The best solution for traveling is to use a small (briefcase size) stainless steel thermos - it can keep a pen injector cool for up to 24 hours. It can also be the cheapest solution, with a 1/2 liter stainless steel thermos available at Walmart for about $12. Directions for setting up a thermos solution can be found at this link:
    http://www.diabetesmonitor.com/m77.htm

    For short term travel something as simple as a Frio Wallet might be the solution. This relies on water evaporation for cooling, so it is a little limited in use in really cold weather, and hot weather can shorten the cooling timeframe. But it is a simple and cheap solution.

    As an alternative, there are many commercial refrigerated packs available, including the Medio-Fridge Micro Cooler, the Medi-Cool Pack and the Polar-Bear Medical Cooler - each is different in size and application, you will have to review them on a vendor website to see which one fits your needs, cost, etc. - you can find all these at the Insulin Case Shop (I am not affiliated with them in any way, just know they have all 3 units). or you can Google the names and you will find many other vendors.

    However, hands down, then thermos solution is the most durable and holds the cool temps for the longest period of time.

    Hope this helps. Have fun traveling,

    Posted by Mark_in_MO |
  7. By the way - when you are traveling, always plan to keep your meds cool for a longer period of time than you planned trip.

    In the past year I have been stuck on planes for many, many hours sitting on a runway. I have also had a vehicle breakdown on a very hot summer day.

    So you need to be prepared for any kind of extended delay in your travel, from a flat tire, to an overnight when your plane is diverted due to bad weather.

    Thus a solution that does not require special freezer packs is often the best way to go. With a Frio Wallet is just takes adding some water to refresh the evaporation process. With the Stainless Steel thermos setup, all you need is a little bit of ice (you can ask a plane stewardess for some, or buy a soft drink and dump the soda and use the ice).

    Personally, when I travel (multiple times a year) I always carry a thermos for my refrigerated meds.

    Good luck!

    Posted by Mark_in_MO |
  8. Noticed the comments about self pity. One of the sort of sidewise blessings of being diabetic is that i have been sick enough that I can truly appreciate how healthy I feel most of the time. Can’t really notice how good we feel if one has not felt bad. Sort of like the best part of having a cold is getting over it. Colds aren’t as bad as acidocisis. Thank god.

    Posted by fred matusky |

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