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Regarding the Diabetes
July 17, 2008
This week marks one year since I started writing a weekly blog entry for DiabetesSelfManagement.com. That’s 51 articles (almost 40,000 words!), or blogs, or missives, or whatever you want to call them, about what it’s been like for me (for the most part) living with Type 1 diabetes. This week, I’d like to share some modified portions of an e-mail I sent to a friend a few days ago as a response to her asking how the diabetes was going.
To answer your question about the diabetes, I went to the endocrinologist yesterday for my three- month checkup, and everything was fine. My hemoglobin A1c (a three-month blood-glucose snapshot that’s one of the major ways of measuring diabetes control) was 6.0%, which is actually lower (better) than it was three months ago—although three months ago it was 6.7%, and thus still under 7.0%, which is what you want to be under to drastically limit your chances of diabetes complications. There’s no reason for me to try to get it under 6.0%, because the benefits from an even lower HbA1c are negligible, if any, while the chances of dangerous bouts with hypoglycemia if I try for tighter control increase dramatically.
The 6.0% yesterday, however, is slightly odd. But it isn’t odd. Not necessarily. It is a really good thing, actually, because I’ve let up a bit on my mental rigor in managing the diabetes, and yet it seems as if I set pretty good groundwork in year one. So, well, that’s comforting to know. There’s nothing out of the ordinary with anything, and all seems to be well. I’ve gained about 15 pounds in the past three months, but the doctor said that’s not a problem. The reason for the weight gain is simply because I haven’t gone to the gym nearly as much and instead choose to be out in the garden. I’m sort of the opposite of most people: Instead of losing weight in the summer, I put some on and take it back off with hours indoors at the gym in the winter.
Do you want more? The one thing the endocrinologist pointed to as something that I might work on if I wanted to (and he wasn’t advocating working on this; he was just saying) was that I bring up my daily percentage of basal (baseline) insulin rates relative to the percentage of insulin I bolus (take for meals). Right now, my daily basal dose is about 36% of my total daily dose of insulin. Ideally, I’d be getting about half of my insulin from basal (the steady trickle administered by the insulin pump) and half from the bolus for meals.
But, again, these numbers are not a huge deal.
But, me being me, I want to improve it. So I adjusted my rates by a measly .05 units per hour overnight, and at 3 AM I woke up with a low blood sugar. This is the first time—yes, the first time I’ve encountered a low enough blood glucose to rouse me from sleep. I woke, stared at the clock, then felt a bit of the symptoms of a low and convinced myself to go check and see what my blood glucose was. It was at 55 mg/dl.
Seventy mg/dl is the high end of a low range (I target 120). Once it starts to dip, it can drop fast, and as I was standing there checking, middle-of-the-night by the oven light, I began to get sweaty and clammy and start trembling. In those situations, however, I need only about 30 grams of carbohydrate—about one container of fruit-on-the-bottom yogurt.
I quickly ate the yogurt, getting to the compote berry mixture on the bottom by burying the spoon into the vanilla without mixing it up. The thing here is, however, that I’m supposed to wait 15 minutes or so after that carby-ness until I check my blood glucose again. It will take fast-acting carbs about that long to kick in. During that time, though, my brain, which needs glucose as its fuel (its only fuel) is telling my body that I’m starved. I’m ravenous. I want to eat any food that’s in the house.
It takes most everything I have to not eat what’s in the fridge, to down three or four large Gatorades, to eat a loaf of bread, to scoop out the entire contents of the extra-crunchy peanut butter. Because that would only send me spiking the other way, and then I’d enter into a blood-glucose roller coaster with numbers that aren’t healthy at all.
Instead, to keep myself munching, I ate half a bag of (mostly carbless) baby-cut carrots. I tell you what: I’ve never tasted the sugar in cold carrots before. But when your body is needing that, or thinks it’s needing that, there’s nothing to compare to how sweet a vegetable like a carrot can be. These helped me until I was able to make it back up to around 120 mg/dl, around 3:40 AM, at which point, for good measure, I ate a piece of whole-oat toast (slower-to-absorb carbs to get me through the night) and went back to bed.
Yep. You’d think a disease would be easy. Sheesh.
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