Two.

Today is my two-year anniversary with Type 1 Diabetes. 

Did I celebrate? Cook a special sugar-free treat? Have a party? 

Well, no... today was just like any other day.

But as I checked my blood sugar, gave insulin, counted the carbs, went through the motions that over the last two years have become second thought to me...

One part of me silently mourned for the life that I lost two years ago,

And the other celebrated the woman I have grown to become. 

Here's to another two years, Type 1, and many more years living in spite of you. 

4.3.2011.

I Wear My Insulin Bruises Like Battle Scars

Ouch. The insulin has struck back again, and this time with a vengeance. I know I've already blogged about my colorful, rainbow-riffic insulin bruises before, but this morning as I was getting ready, I just got to thinking about all of the things Diabetes would be like in a perfect world. (Granted if, in a perfect world, Diabetes did exist, which in mine it wouldn't).

1. In a perfect world, insulin injections wouldn't leave bruises. Or, for that matter, it wouldn't leave tiny microscopic holes in my skin, either. My stomach, my arms, my.... legs, would be perfectly bruise-free. Some people fear bikini season because of too many Holiday cookies - I fear bikini season because of my bruises. Nothing like having a great swimsuit to wear and a great bruise to match the color of that swimsuit right on the side of your stomach. In that elusive, perfect world with perfect Diabetes, bikini season would be worry-free for me, and people wouldn't have to wonder about whether my apartment-mate, Crystal, is beating me up. (ha-ha).

2. In a perfect world, the lancet would work on my finger the first time. Not the second, not the third, not the fourth... the first.I wouldn't have to keep upping the lancet depth from 2, to 3, to 4 and now, finally, to 5. My callused, though once-delicate fingers would not be as tough as a man's now. I wouldn't get ugly calluses on my fingertips, or tiny shallow depressions from where the lancet has pricked (the red marks have finally gone away) that just plain don't look good.
It's a good thing I'm not a fingertip model.

3. In a perfect world, I would NEVER, EVER not notice my insulin pen is nearly empty and either a.) run out of Novolog right in the middle of dinner (at a friend's house, out to eat --- never at home, it seems) or b.) run out of Lantus right as I'm about to go to bed, and am spending the night somewhere that is not my typical abode. This typically ruins my entire day, evening or outing and forces me to have to go back and get my insulin, or eat nothing. This has happened on Christmas... at a dinner out with friends... out with the family... nothing is sacred to Diabetes.

4. In a perfect world, I would never have to forgo eating lunch in the car when on the way to work. When I'm in full costume, driving and have no access to arms, legs or my stomach (such as a long-sleeved, full length gown), there's really just no way to give an insulin shot. Sometimes, I am able to stab myself with an insulin pen through my clothing, while driving (can you say impressive?), but most times I simply have to forgo eating. Which... is lame.
While we are on the topic of parties, I would never get random lows in the middle of parties. Doing a fashion show, painting 30 children and trying to act cheerful while doing so are all extremely difficult things to do, and they suddenly become about 5x more difficult when you're feeling low.

In a perfect world...... oh, forget it.

Chinese For Lunch.

"What do you want for lunch?" Joshua asked, as he climbed into my truck. I had just gotten out of my class at Mercer and had stopped by Josh's work on the way back to Wesleyan so that we could have lunch together. I take a class at Mercer, one of the other colleges in Macon during the week, because they offer several classes that Wesleyan doesn't and it gives me a good chance to get off campus. I told Joshua that I was still debating, and he suggested Zaxby's or Chinese. I eat Zaxby's about every other day it seems (I'm a big fan), so I decided to go with Chinese, and we found a place in the shopping center not far from his workplace.

We walked inside, the bell above the door clinging as we entered. I stared at the menu for a brief moment, saw that they offered chicken and vegetables sans-rice, and approached the man behind the counter. To this day there has only been one time that I have eaten a dish of rice since becoming Diabetic, and I found that I didn't like the direction rice pushed my glucose levels in. Rice and I just didn't agree with each other very well.

"I'd like the chicken and vegetables, please," I said, pointing at the menu.

The man stared at me quizzically.

"Erm..." I said, trying to figure out which would be the best way to convey to him my menu choice.
"I don't want the lunch with rice." I told him.

At this point, another man on his lunch break had gotten in line behind us.

Despite my best efforts he grabbed a plastic white lunch crate and started loading rice into it.
"Wait, no," I said quickly. "No, I don't want the rice."

The man starts shoveling more rice into the box. I wave my hands frantically. The man behind Joshua and I snickers a little.
"I just want chicken and vegetables! I'm Diabetic. I don't eat rice," I told him, trying to make him understand. The effort seemed futile as he hesitated for a moment, but then he dumped the rice back into the metal dish and called a woman who I assumed was his manager. He told me to wait.

The man behind us gets his lunch as we wait. As Joshua and I are waiting to get my correct order and the man is waiting to pay, he turns to me.

"My wife is Type 1 Diabetic," he says. "She doesn't eat Chinese often."
I look at him, realizing his laughing earlier suddenly made a great deal more sense.
"I don't either," I said. "But sometimes, I like to spoil myself," I said with a hint of a smile. "...minus the rice, anyways!"
I turned to Joshua. "What a small world, isn't it?" I was amazed at the random people I seemed to meet, who had connections to Diabetes,

The other woman finally came out. It took a good 5 minutes to explain to her what I wanted. "Chicken and vegetables," I said again, pointing to the lunch dish which was on the menu... "No rice, please", I said, almost pleadingly. After a few quizzical glances, the woman disappeared in the back for about 10 minutes. When she came out I had my box of chicken and vegetables... and at long last, NO RICE!

Joshua and I walked back out to the car, and he opens the door for me. The other man comes out as I shut the door, sees my and smiles. He mouths,

"That woman is crazy!," And I laugh.

Not only do I have Chinese for lunch, but, at least for a few short minutes, I have met someone else who I know understands what I'm going through. It makes me feel a little bit less alone.

One of the Only Roller Coasters I Can Honestly Say I Don't Want to Ride...

*Note to reader: I've been meaning to publish this for a while, but this post was started in February, and my blood glucose levels have evened out considerably since then.

My forehead began to sweat and I watched as my hand, covered in a latex glove, trembled erratically. My breath caught in my mouth and my heart sunk down low, picking up force and rapidity steadily. I swallowed and walked to the trashcan, pulling the gloves off of my hands, balling them up and tossing them away in disgust. I walked into the coat room, already knowing exactly what it is I was going to find:

52, staring at me on the screen, the tenth low over a 3-day period. I closed my eyes, trying to clear my head, and then throwing my meter down stormed into the dining hall. I grabbed an apple from the fruit basket on my way to the floor, sinking down in an utter state of mental and physical exhaustion. I bit into the apple, tasting salty tears as I did so. I fought the tears back, but it was like trying to hold back water behind a dam riddled from top to bottom with cracks. Tears began to roll down my face.

Oh, how I cried. This was the first time I had gone to any type of camp since being diagnosed with Diabetes. I've experienced a great deal of things with Diabetes, but this was all new to me. The physical work that we did for a good deal of the day with little break was very tiring. My friends and I were on Work Crew for Northland Church's Christmas camp. But as an ex-competitive gymnast, hard work was something that could be easily dealt with. I was able and strong enough. In fact, camp so far had been a wonderful experience. When it came to the work, my mind wasn't the problem, and neither was my stamina. It was my compromised body that was ultimately failing me, as my glucose levels just couldn't catch up and level out to adjust with the sudden increase in physical activity. Despite the lower amounts of insulin I had been giving myself, I had had 5 lows consecutively on Day 1, 3 on Day 2 and now, on Day 3, I was on the 2nd of the day, and it was only 11:15 AM.

My friend Trent walked over, saw me, and sat down next to me silently. His presence comforted me, reminding me that I wasn't alone, reminding me that my friends and the people close to me made this struggle to live with my disease worth it. But still, coping with the frustration of not being able to control my body was so frustrating. I was used to telling myself to do something, and then doing it - always. To find that now I couldn't always do that was a difficult pill to swallow, and I resented the fact.

Two months later, I stared at the meter screen. The meter at 9:00 AM had read 232, and it now read 545 after bolusing for breakfast and giving myself a correction dosage (to bring my levels down).

Two days later, my meter read 182 after going out to eat at my favourite pizza place 4 hours earlier. 3 hours later, the meter read 447. My mouth was so parched I could hardly swallow, and my body felt physically immovable. I suffered through the night with a bottle of water by my side.

My sugars have been doing exactly what they are not supposed to do; "roller-coasting".

High.

Low.

High.

High.

High.

Just right.

Low.

High.

Low.
... Wow, am I really 92? *Re-checks* Really? Seriously??

Low.

Acceptable.

High.

I'm so over this. It seems as though every time I get my levels just right, and my insulin dosages spot-on... something causes them to change. Activity levels, insulin-to-carb ratio... the weather in Greece... someone sneezing across campus... I swear, my insulin ratios are as finicky as a 3 year old.

From December all the way until February, I just couldn't seem to get my levels in check. Sometimes they will be perfect, but most days my sugars won't miss a chance to read either something way too low, or something ridiculously high. I have no clue why all of the insulin changes are happening. Before Winter Break my insulin ratio was one level (12 to 1), then it changed and it took me a good 3 weeks to figure out that it was 6:1. Then, right after my endocrinologist visit in December it changed to about 9:1...and then after Christmas camp to 12:1... back to 8:1 again in February. These changes seem very small and infinitesimal to the healthy non-Diabetic, but in actuality they can make an enormous difference. Picture it this way:

If you think your insulin ratio is 10:1 and you eat 45 grams of carbs, you'll round up and give yourself 5 units of insulin. But if your ratio is 6:1, suddenly you need about 8 units. If each unit of insulin lowers your blood sugar by 50 mg/dL, your sugar will end up being about 150 milligrams per deciliters too high... which could be the difference between an "80" and a "230". That's an enormous difference, especially if you decide to have a slice of cake one evening. It works the opposite way too - if you think your insulin ratio is lower than it actually is, you will bolus too much and end up low every single time you eat.

This is the extreme frustration that I've lived through for 3 straight months. After a while it makes you fearful to eat carbs at all - I just can't pin my numbers down quite right and have resorted to living off of protein shakes and salads, mostly. It also changes your perception - 200 doesn't seem too bad when your levels have read 400 for the last 8 hours. But I have been so disappointed in myself, because 1. I tend to be hard on myself and 2. Once again I feel like a failure and feel as though people would look down upon me for not being able to properly control my blood sugars. After all, perception or no this is a very bad thing, because any way you look at it, your sugars simply shouldn't be at 200, especially when you're aiming for a target of 130.
In fact, it's this roller coaster of sugars that is so bad for those with Diabetes, and to my understanding is what causes a good deal of the future complications like Diabetic retinopathy and neuropathy, not to mention slower healing.

Great, huh?

Diabetes, can I please get off of this roller coaster now?

Contagious Diabetes?

Last week, my apartment-mate Crystal turned to me and stated,

"You know, since we started living together, I've just about stopped eating carbs."

I thought this truly funny, because lately I've noticed a trend that people close to me will start mimicking my low-carb diet, as though being around me makes it contagious. It might be for a short period of time - maybe over a couple of days at camp, or, like Crystal, over the school year, or for others, simply because they're curious as to what it's like.

I don't expect people to do this - I don't even encourage it (I think?) But it makes me oddly...happy. Granted, I don't feel as though I need others to emulate what I choose to go through for the sake of my happiness. I am happy in and of itself because of the fact that eating healthy helps me control my glucose levels better. It's nice to know that what I choose to put into my body is healthy and healthier for me. I am confident that at least for now, the way I choose to approach my diet is the right choice for me. I've stopped eating cereal, pasta is on my "banned" list, and my soda drinking days are a thing of the past.
And I've noticed how great it makes me feel! I eat lots of natural foods - fruits, vegetables, slow-acting carbs such as oatmeal - and try to avoid highly processed foods and foods with a great deal of sugar, such as candy bars and cookies.

Most of the time, I do not feel as though I am missing out because of this decision. I think that the benefits outweigh the costs. But of course, that's not to say there aren't times when I get sad about having to turn down the big bowl of chicken alfredo, or being guilted by my inner Diabetes-police into not eating the chocolate chip pie. I do. Sometimes, it's not even the fact that I passed up the delicious unhealthy food - it's feeling as though since I know it won't have a good effect on my sugar, passing it up the only option I have a justifiable right to choose, and choosing otherwise would be an irresponsible fault on my part. The guilt is what gets to me - and the feeling as though Diabetes is what makes the choices, not me.
And yeah, I'll say it: feeling like this it has its sucky, downright depressing points.
I'm not perfect at this - I eat unhealthy sometimes, too. I'll have a third slice of pizza, a piece of candy, or a slice of birthday cake. Sometimes I bolus successfully for these foods, and I feel triumphant, accomplished, a master of Diabetes. Sometimes, it turns out to be a huge disaster, and my blood sugars will soar. I'll then take my blood glucose meter to a corner, test, and look around to see if anyone saw the number on the meter, hoping they haven't. I'll pull the test strip out, turning off the meter, and hide it quickly as I grab my insulin pen and subtly give myself an insulin injection. Then I feel shame - disappointment in myself - frustration, and anger at Diabetes. Anger at not only what Diabetes does to my body, but what it does to my mind. How wrong is it that I should feel guilt for doing something as simple as eating dessert every once in a while? That I should feel too bad about myself to eat when my sugar is higher than it should be? That I have to answer to other's accusations about that number on the meter screen when, were they to wake up one morning at 2 a.m. in a hospital bed faced with the same fate, they themselves would make the same mistakes I have made?

How can I make them understand? I never want my sugars to be high. I don't want my mouth to feel parched, to feel as though I've taken a beating from a bus, to feel my eyelids grow heavy with sugar-induced sleepiness. But sometimes it's torment, to never be congratulated for my choice to eat healthy, but rather feel held up to some stereotyped expectation by others that that's how I should be acting. To be made to feel as though eating properly all of the time is the good thing, the right thing, the diabetic thing to do. Good diabetics eat healthy all the time - good diabetics never eat dessert - good diabetics accept it without any feeling at all...
I'm only human, and while I love to eat healthy, sometimes I want to make those "bad" choices sometimes, too.

And so, the fact that my diet with Diabetes is sometimes "contagious" to others makes me feel not quite so alone, both when it comes to my choice to eat healthy, and when I am feeling particularly down about it.
I'm glad that Crystal supports me, and that I've encouraged her (whether purposely or unwittingly) to eat healthy and relatively low-carb. Crystal makes me feel as though I have a true friend - we support each other eating healthy and hold each other accountable.
It's a touching gesture when a friend who sits next to me me will refuse a tempting, delicious, homemade brownie sundae... because I can't eat it either.
I feel as though there is a purpose to my choice when someone else decides to try to eat low carb, just to gain a better understanding of what eating with Diabetes is like.

And yes, at the end of the day, I know that my war on Diabetes is my fight alone.
But it's good to know that there are people that help to make fighting the battles easier.

Confessions of a Burnt-Out Diabetic

Man, do I feel bad for not blogging in a while. It's been on my mind - it's just, life is so full of many other colorful, exciting things that it's easy to forget about writing down all my experiences online. :)

Here I am, though. It's hard to pick something to write about - so instead of taking things from the present right away, I want to touch a little on December and Winter Break before writing about things right now.

When I left off, I was describing my pseudo science experiment in minimizing my Blood Sugar testing each day. I have to say that overall, the experiment was a failure. Originally, the minimal testing inspired me to make healthier eating choices overall. However, it soon became a case of my simply being lazy. Tired. Uninspired.

Burnt out.

"Out of sight, out of mind." If I didn't check my BG, I didn't have to face the consequences of not managing my sugars as well as I should have been, right?

I wish it worked like that, but of course, things in life are rarely easy - we all know that I am wrong.

On top of that, my insulin levels changed from a ratio of 1 unit to every 8 carbs to about 1:5. This doesn't seem like a big difference, but look at it this way: If I have oatmeal that is 30 carbs for breakfast, calculating my insulin ratio using the 1:8, I would give myself 4 units of insulin to cover myself (32 carbs). However, counting carbs using the 1:5 ratio, I would need 6 units - this difference can mean a difference in my blood sugar of almost 100 mg/dL (the difference between a BG of 120 and one of 220).

Long story short, my BG levels for the month of December were, erm, ... a disaster. I was dreading visiting my endocrinologist in Florida over Winter Break because I just knew they would be disappointed, especially after my summer A1C had been so great. I felt a sense of shame, really, because I knew that I was better than this - but I was slacking, and I wasn't putting in the effort that I should have in order to care for myself right.

I could use the excuse that my old insulin meter broke, leaving my hundreds of stocked up test strips lying useless in their box, and that I only had about 100 One Touch test strips left (the new prescription for which CVS has STILL not filled... but that's a different blog). But ultimately, I know that the problem was me. If you don't put in the effort, you won't get the numbers you want. it's frustrating, really - I just hate how time consuming and effort-demanding this disease can be. Even if I don't have time for it, Diabetes makes itself impossible to be ignored. If I let down my guard for even a few hours, it seems, my sugars creep up...and up... and up...

So after my failure of an endocrinologist appointment in mid-December (which was a shameful experience indeed), I resolved to do better. My endocrinologist made me feel pretty stupid for even considering testing only a few times a day, but I suppose it had started out as a valiant effort, right?

After my appointment, I knew I needed to shape up. I more carefully monitored the food that I intook - going back to very low carb, and very precise carb counting. My endo also was able to give me about 100 more One Touch test strips, so that I could test a little more often as I waited for CVS to sort my prescriptions out. In about a week, my sugars weren't perfect, but were markedly better.

I'm not proud of my high levels, but I did learn from the experience. I realized just how much I was willing to work hard to get to the numbers I need to be at. And while I think that I was experiencing a little bit of a burn out, I understand that it happens and that while I'm still learning the ins and out of this disease, that I'm going to make mistakes and, yes, lapses of judgement. Now, at least, I feel a renewed sense of ambition towards getting my A1C even better than ever before.

As of January, my levels are still high occasionally, but my average lies at around 155 for the month, which is pretty darn awesome (and below 180!). My goal is to get my average to about 130, as my new target BG is 130 (a "big girl" goal, as my endocrinologist told me), and things are looking positive. On top of that, I've begun working out again, and am on my third straight week. While I've noticed a spike in my glucose levels short-term after exercising, my overall basal insulin needs have gone down from 20 units of Lantus to 17 units, so my overall insulin needs have lowered.

Hopefully, I will make better progress - and realize that I need to put in more effort - in the future.

Diabetes burn-out, be gone!

Full-Time Diabetic, Part-Time Mad Scientist.

It's been a stressful last few weeks. November brought on an onslaught of new barriers to my tiny Diabetes-world bubble. With the welcoming of my 19th birthday in October I found myself suddenly thrust into the mysterious-pseudo-medicaid twilight zone. It was a grey zone filled with odd, confusing and scary terms such as "cost of share" in which I found myself utterly unprepared.
When I heard the news, I glanced with a nervous swallow at my minifridge, which had essentially become the home base of my day-to-day "let's not let Diabetes kill me" operation. My internal calculator did up the math in my head to try and count just how long my insulin could last me in the event that I could not get more for a while. And test strips - what about test strips? I thought of the 5 times I day I liked to test, now seemingly more like a luxury and less like a necessity. Could I cut back? Inwardly, I challenged myself and thought that maybe I could be a successful, saavy and test strip-thrifty Diabetic, too.

I'm not saying it's permanent, but believe it or not, it's been a blazing success. I've essentially reduced my testing to 1-2 times a day just to see how good I am at controlling my sugar by sense and hyper carb-awareness alone. The last week has gone a bit like this:

I wake up in the morning, courageously assume that both because I tested my sugar before bed last night and it read normal and because I am, in fact, not dead or going into seizures or ketosis that I'm hovering reasonably normal, and then have breakfast. I usually eat oatmeal or cream of wheat, which typically breaks down nice and slow and doesn't cause a sharp spike like my now sworn-off Recees Puffs did. After bolusing I go to class, go to work, grab a piece of Candy from Amy's desk (bolus 1-2 units), go to lunch, give myself 3-4 units for my salad and any extra depending on what kind of candy I snagged or if I feel I overdid it a little too much on the carbs that morning, stay hydrated, then go back to class. I have a snack after my last class of the day at 2:30, then go to dinner and give myself about 6 units to cover both dinner and any residual slight-high I might have had from my snack that afternoon. Then I have a snack in the evening, bolus for it but undershoot just a little to avoid nighttime lows, and test before bed. Just to show you, here's a complete list of my sparse readings from the last few days:

11/11 8:21 PM: 121 mg/dL

11/10 7:47 PM: 184 (A work day, so consequential little monitoring of sugar).

11/9 9:32 AM: 151

11/9 1:14 AM: 282 (Ok, I was a little high here, so I bolused to bring myself back in range, then checked in the AM - this was because of the cookies we baked at the apartment).

11/8 12:44 PM: 81

11/8 9:19 AM: 237 (Too high - just beginning this experiment and, a few days in, it's a work in progress).

11/6 8:29 PM: 119

11/5 6:40 PM: 169

11/5 12:52 AM: 172

11/4 12:10 AM: 133

My seven day average is 168.

BAM. I feel like a regular mad scientist. Or maybe the nerdy side of my Biology major is just now starting to swallow me whole. Or maybe I'm just a saavy, test strip-thrifty Diabetic.
It's not perfect, and there is of course the worry that I may just be missing the high readings by simply not testing them. That's true. But I'm definitely pleased with myself - I feel like even if I don't continue this "experiment" of testing my blood sugar sparcely that I've learned a lot just over the span of this week alone. I've learned to be more in-tune with my body, recognizing the signs of an oncoming high as it starts (dry mouth and I know almost immediately that  my sugars are going up) and experience very, very few lows. I've also learned to keep careful track of what I eat and hold myself accountable for all of it. When I think clearly about it and remember it, I always bolus for it, and in theory that in itself should keep my sugars normal. I've also encouraged myself to make the healthy choices that I know are better for me (i.e. NO RECEES PUFFS) to avoid surprise highs. For the most part, I feel great, my sugars are showing steady readings and things are going well, so that's what I figure is important. Therefore, we'll see where this goes.

I would like to note, however, that for Thanksgiving all bets are off - that's going to require practically 24 hours of constant monitoring if I'm going to successfully pull off the biggest nightmare of every Diabetic's year. Am I ready for it? Yes. It won't be a repeat of last year. Armed with better sense of my body and what it's telling me about my sugars, I'm confident that I can succeed this time!