Relearning "Normal"

I am Kim’s Diabetes Paradigm Shift.

A large part of getting my A1C into range has been changing the way I think about, and react to, lows. The physiological and psychological effects of hypoglycemia are quite uncomfortable, if not a bit terrifying, to experience. This leads many of us to do whatever we can to avoid the feeling. As Henry Stewart put it in his series Insulin is Not a Cure, “hypoglycemia feels like a slow descent into death”.

Here's the best I can do at describing what severe hypoglycemia feels like to me.

  1. Imagine yourself at your most hungry state. You haven’t eaten all day, and it’s now 9 p.m. You are ravenous, and feel like you could a horse. And then maybe the barn he was in, too. Your brain and stomach are both in Full And Complete Panic Mode.
  2. Think about a rollercoaster ride. The particular moment I want you to envision is the moment when you’ve reached the top of the first incline, and you start to see how far down you’re about to go. Think about the rush of adrenaline, how your body starts to shake a bit, and how you feel a little bit scared about what’s in store for you. Now, take out the fun part.
  3. Now, for those of legal drinking age (because you’re all good boys and girls, right?), think about how you feel when you've overdone it. You lose a good deal of your motor skills, balance, and rational thinking. Also, again, take the fun part out.
  4. Now, I want you to add in heart palpitations, a really bad case of the shakes, and a general feeling of helplessness. You can also add in “taste buds going numb”, or “feeling like you’re vibrating”.
So, to recap: You’re eating a horse, on a rollercoaster, while drunk.

Here’s the issue. Blood glucose has a very large range – you’re probably dead at 0 mg/dL, and you’re probably in DKA at 600 or so. The target area resides within a very small fraction of that range – 80 to 120, if I'm being strict. If I fall outside of that, I’m taking some sort of action: more or less insulin, or more food. That’s a very small range to shoot for, and when so many factors out of your control can influence the results, you can start to see how this disease can be a frustrating monster. You can also see how scary it can be to try to aim for 80, when a mere 30 points less than that has you wanting to crawl out of your own skin.

In the past, I was always trying to avoid going low, at whatever cost. If I ran a little too high, that was okay with me, because it was better than the alternative in the short term. But, priorities have shifted. I’ve got something I’ve been working towards being ready for, and this has required me to re-evaluate what my goals are.

Using a CGM has made all the difference for me. I talk a lot about why I love it, but I really can’t ever stress enough the difference it’s made in my life, diabetically speaking. To put it simply, my CGM is a safety net I can rely on while I walk the tightrope of glucose control.

I don’t have to fear a lot of things anymore. Going low while sleeping is less of a concern, as Jim will do his best beeping and vibrating in order to wake me up. While I may never have taken corrective insulin for a reading of 130 in the past, I feel comfortable doing that now, for the sole reason that I can see in almost-real time what will happen. And I can feel confident when I walk to the other side of our neighborhood, because Jim will let me know if the exercise has caused me to bottom out. I don't have to wait until I feel the lows anymore. I can take pre-emptive measures.

A reading of 80 mg/dL doesn't seem "low" to me anymore, and it turns out that, for me, a fasting blood sugar of 65 doesn't need to be treated. If I can force myself to just wait it out (which I usually can, lately), I have learned that the mere act of waking up will cause my glucose level to rise about 20 points - which puts me right back in range.

This is a whole new world for me. Trying to change two decades' worth of viewpoint is hard, and anything but easy. I'm retraining my diabetes brain. I'm still not "perfect", but I tend to question anyone with diabetes who claims to have "perfect" control. Diabetes is a fickle monster, but it's not the whole picture of your health. I'll do what I've always done, which is to do the best I can. It's all any of us can do.