Fifty-One On, One Off (Kinda) :: Diabetes Self-Management

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Apr 17, 2008

Fifty-One On, One Off (Kinda)

Eric Lagergren

Diabetes Self-Management. Sure, it’s the name of the Web site and the magazine, but, more importantly, it’s what we do. We, us—those of you reading, those of you with diabetes, those of you living with and helping care for people with diabetes.

Let me be immodest here and say that over the past year my diabetes self-management has been quite stellar—a claim corroborated this month by both a thorough physical exam by my primary care physician and a visit to my endocrinologist. Good self-management—if I can state the obvious—is really important. Tight blood glucose control, consistent exercise, a healthy diet, and on and on. There's no end to the articles about how good self-management of our diabetes can help us live a long and mostly complication-free life.

So when my wife and I went on vacation a couple of weeks ago, to another country, I fully intended to do my best at continuing my good self-management practices. I was soon to discover, however, that the best-laid schemes for tight control while traveling can often go awry.

The food. The irregular sleep habits. The change in exercise routine (or lack of exercise altogether). Adjusting my basal rate slightly and bolusing somewhat less often to avoid low blood sugar on the flight or in an unfamiliar place. Did I mention the food? And, oh yeah, we were in the Caribbean, so, um, there was rum punch, too.

These and other factors helped contribute to quite a few blood glucose readings well over 200 mg/dl. Two hours after a meal I'd see 237, or 249, or 213. I'd issue a correction bolus with my insulin pump to try and bring it back down to around 120 mg/dl. Yet two hours after that, it would still be around 200 mg/dl.

What to do?

Panic, right? Fret and worry and think that all of my hard-fought self-management practices were going up in smoke. Assume that my carbohydrate ratio was off or that I wasn't being diligent enough in counting the carbs in the restaurant food I'd been eating. Or, better yet, berate myself and feel overwhelming guilt because I was enjoying myself on vacation in the tropics. Yeah, let me stop with the delicious food. I'm going to refrain from the glass or two of rum punch. (And by the way, there's some serious proof in Antiguan rum!)

No. No panic. Instead—surprisingly—after a year with Type 1 diabetes, I knew enough to realize that this was a snapshot moment of the rest of my life with the condition, that one week does not living with diabetes make.

I quickly put aside my worries, cast off the inclination I had to stress out about this week of anomalous numbers, and vowed to enjoy myself. I'd spent the past year achieving some pretty great diabetes numbers, and here was an occasion where, while not abandoning my self-management entirely, I could allow myself some slack for seven or eight days. When I returned to the states, then I'd pick back up where I left off. And I figured that I wouldn't suffer any ill effects from this practice, either.

My endocrinologist confirmed that the approach I took was just fine. I visited him on Monday and explained what had been going on with my self-management during my vacation. He told me this was actually a great way to approach living with diabetes, and he used the analogy that I'd been banking all of those good self-management practices, so there was no harm in withdrawing some of it for a week or so.

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One of my first dietitians suggested that I read recipes of dishes common to where I will be visiting. It doesn't work perfectly, but does give me a general idea of what is in the food I'm eating so I can "guesstimate" how much insulin to take.

Jan Chait

Posted by: Jan Chait | Apr 18, 2008 03:26 PM

I think it is SO cute that you think that you have aced diabetes after only a year. That is so sweet! Let me know how you are doing in 10 or 15 years or so when the new wears off and the numbers are not quite so good every day. Let's see how it is when you are older and tired of being so vigilant and you just want to live your life. Then we'll talk.

Posted by: Cathym | Apr 23, 2008 04:12 PM

Goodmorning Cathym,

I'am sorry that your life is not as you want. I have a friend who has three children, & a husband that she will soon leave behind ,unless she gets new eye cells.

Even though her oldest is only 16, she has never wasted a minut,with selfpity,and or bubble busting of others. Your still here,think positive -- IF YOU CAN'T SPEAK POSSITIVE THEN DON't SPEAK. LEE

Posted by: Lee | Apr 24, 2008 07:02 AM

Dear Lee - I am with Cathryn - and I don't think she's being negative at all. I've had Type I diabetes for 31+ years and I certainly don't think I know it all like our friend Eric does after a year. Cathryn is right, even the most positive person runs into "down time" when you have diabetes! And don't lie because we've all been there! Tired of the highs, the lows, the watching what you eat and when you eat. It doesn't mean you're a negative person, just sometimes it would be nice to have a break from the routine! I consider myself one of the most positive people around when dealing with my diabetes - every day I can see and hear and have my kidney function and all my limbs is a good day, and there are people much worse off than me, but sometimes it gets to be a lot to handle. I admire Cathryn for saying like it is. It's easy to be "perfect" when you've only been dealing with diabetes for a year. After a while "perfection" is harder to achieve - just by the nature of the disease itself and if you don't admit that you've had a down day or two I have to say you're a liar because we've ALL had a time when we wish we didn't have to deal with this disease!

Posted by: dyll | Apr 24, 2008 11:54 AM

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