Making Adjustments

I’ve had Type 1 diabetes for 21 years now. I’ve spent significantly more time in my life WITH diabetes than I have without it. For the most part, I’ve been able to maintain very good control, but we all know managing diabetes is not a one-and-done thing. We don’t just figure out carb ratios, insulin levels, and all the rest ONCE and then forget about them. I seem to be at one of those points in my journey through the Diabetian life. What has been working pretty well until recently isn’t working as well anymore. And it’s time for another adjustment.

Luckily, I’ve been able to line myself up with a very good diabetes center, and with their help and a LOT of blood sugar checking (somewhere in the neighborhood of 10–12 checks every day for the past week — seriously, I’m running out of fingers), I’m seeing a really clear pattern of what’s off. And it looks like the solution will be switching to an insulin pump rather than sticking with the daily injections I’ve used for the past 21 years.

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I’m not wild about the idea of the pump, though I know most people who use them will swear by them. I’m one of those people who feels a certain stigma about having something always attached to my body. At the same time, I can also see plenty of situations where a pump might make my life a whole lot EASIER and more convenient — not the least of which might be the fact that I don’t have to go find the public restroom at every restaurant for my shot and pray that it’s been cleaned sometime in the last six months (bathroom roulette, I used to call it).

In any event, the particular details of my adjustment aren’t that important for anyone reading this to know. But what I thought might be an interesting topic to write about is the way we handle the constant adjustments that diabetes throws at us. Because along with the logistical challenges we face, there come emotional challenges.

Data, data, data
I tend to be a pretty levelheaded guy. But that clear thinking can get thrown right out the window when my little meter beeps and I see the number “298.” Diabetes is a data-driven condition. We need to think like calculators, like scientists, like computers almost, when we deal with the patterns in our blood sugars. But that’s hard to do when the impact of those “bad” numbers is so deeply personal, human, and painful.

Separating the two can be such a challenge. I’ve struggled with that this week. One thing I’ve kept coming back to is this: There IS a pattern. With THIS many blood sugar checks each day, I’ve seen a very consistent, albeit frustrating, pattern. I don’t think it’s a pattern that can be fixed with my current daily-injection routine, but it’s one a pump will probably have no problem with (the short story is my daytime and nighttime basal insulin needs seem to be very different — if I raise my Lantus I’ll suffer severe hypoglycemia overnight, but it’s not at all sufficient for my daytime basal needs, causing me to use very high fast-acting carb ratios to counter the lack of basal insulin, which causes more instability. A pump can simply be adjusted down for overnight).

The hardest part is always the initial stage. For me, that was the first few days of intensive monitoring. I was seeing the high and low numbers, but I hadn’t yet done the two fasting checks to check for basal insulin, and all I had to work with was a stack of “bad” numbers. There was no pattern yet, and anyone with diabetes knows that the most frustrating thing you can have is out of control numbers with no clear reason WHY they happened.

Once the pattern started to become clear, things got a little easier. But there’s also a second stage that’s pretty aggravating — the waiting period before you correct the imbalance causing the pattern. For me, I don’t think that correction can really happen before I switch to a pump, and even then I’ll have some ups and downs as I get used to the new routine and get the settings right. So there’s an endurance and a letting go that becomes pretty crucial, too. I didn’t do to well with that the other day. I was tired, and I just wanted some normal numbers. But I already knew the pattern wasn’t one that could be addressed right away. And it got to me. I was sullen and angry most of the day.

Finally, there’s the self-defeating, self-blaming game we sometimes play. “Bad” numbers can make us think we’re “bad” Diabetians. I go through that. I start to paint a picture of myself as a careless, neglectful manager who’s not good enough to keep his blood sugars in the right range. It’s important to remember that sometimes this disease will throw us curveballs, and while we can usually adjust, it will take some time. Even the most diligent mangers of diabetes can’t be expected to be perfect. And when the condition changes the way mine has over the past year (Lantus worked pretty well for 20 years, but now the pattern has to shift — it happens), we don’t need to beat ourselves up for a period of erratic numbers. It’s not our fault, and all we can do is react with focus and dedication.

Diabetes won’t always behave itself. So when things change, when old routines stop working, be thoughtful, be analytical, and above all, be kind to yourself. You can adjust.