Unintended Consequences

Like many other people living with diabetes, I tend to struggle a bit with balance. It's pretty easy to swing to one end of the pendulum or another - you either eat, sleep, and breathe monitoring yourself and freaking out over every out-of-range number, or you resign yourself to the fact that you can't control it, and stop trying. I've swung out to both ends of that over the last 24 years of being diabetic, and I still struggle with where the "happy place" is. (I know it involves scampering puppies, abundant cheese snacks and limitless rounds of Skee-Ball, but where is it, exactly?)


Right now, I definitely know I'm more towards the compulsive side. As I've mentioned, I check my blood sugar a lot. There are days I'm putting up numbers in the twenties - as in, I'm doing over 20 finger-sticks in a 24-hour period. While this change in my behavior has brought me some happy results, I also must admit that it comes at a cost. A few costs, actually.


The first - and this is tough to admit - is that I haven't been working out, with few exceptions, in the last 3 months. Running, which I love doing (even though I'm not very good at it) always messes with my blood sugars. I know, I know, exercise is supposed to be good for you, right? In the sense of general health, yes. But, it involves some extra work for me to make it happen. How many carbs should I eat before my workout to avoid going low? How long of a workout do I plan to have? How far ahead of exercise should I eat? What combination of carbs and protein should I have? How much insulin is still active in my system? Did I remember to turn down my basal rate an hour before I start? Then, there's The After. Even though I burn through many of those calories and carbs during the workout, my blood sugar starts steadily rising after working out, no matter what combination of things I've tried in order to avoid it. So, let's recap: I have to eat something (which sort of cancels out the workout, right?), I have to time it exactly right so I don't have to quit mid-workout due to a low blood sugar, and then I need to take even more insulin after I'm done moving. When my goal became lowering my A1C (which determines an average of my blood sugars over the past 2-3 months), my first thought was those skyrocketing highs after workouts. So, unfortunately, I cut those out for the most part.


Secondly, trying to gain tighter blood sugar control means that, inevitably, you're going to have more lows - and aside from the general unpleasantness associated with hypoglycemia, it's darn inconvenient. Sometimes it means I'm eating half of my lunch early, because I need to eat the crackers I brought to treat a low. Sometimes it means I have to turn down an invitation to eat outside during my lunch break at work, because I didn't have enough lead time to prepare myself, health-wise, for the ten minute walk. Yes, ten minutes of walking makes me drop - by 50 to 60 points, if there's active insulin in my system. So, when my dear co-worker asks me at 11:24 if I want to eat outside with her (and I go to break at 11:30), and my blood sugar is in range, I have to turn her down. At that point, I've already bolused for lunch at 11:15, so the walk will make me drop dangerously low before I can even get a bite of lunch in. Having to turn down her invitations doesn't sit well with me - it makes me feel guilty, even though I've done nothing wrong.


And third - it's just darn exhausting. When I'm testing that often, and checking my Dexcom every five minutes to see what the new reading is (which, by the way, will drain the battery like you won't believe), and setting temporary basal rates in an attempt to correct every little thing, it's difficult to think about much else. Diabetes is always in my brain, somewhere. I'm looking at the clock to see if it's time to test again, checking to see how I feel and wondering if it's diabetes-related or not, and wondering if I bolused correctly for whatever I ate last. There are so many variables to consider when trying to figure out "what went wrong". Am I 200 because there were more carbs than I thought there would be? Do I need to re-evaluate my insulin-to-carb ratios for this time of day? Is my pump site clogged? Did my insulin get too warm, and start to deteriorate? Have leprachauns been messing with my basal rates while I sleep? (Really, really hoping the answer to that one is "no", because... um... creepy.)


So, now that I've proved to myself that an A1C below 7 is attainable for me, I need to work on better ways of maintaining that. I need to work regular exercise back into my routine, most importantly. I can't let the tough path to get there prevent me from even trying to walk it. I have to remember - an optimist sees stepping stones, where a pessimist sees stumbling blocks.

http://textingmypancreas.blogspot.com

Have you read Bernstein? He is “radical” but some of what he says is really useful. I will never get my son to eat the way he says to but I have made some changes that are helping. The think I think makes the most sense that he says is the “law of small numbers”… if you have to give a lot of insulin for a lot of carbs there is more room for errors. Seems like my son does better with smaller more frequent meals of lower carbs… this also helps when he is very active outside. Whenever he eats big…and doses big…he pays big in his numbers.
I also have found that Bernstein’s explanation of things makes sense to me more than anything else. Exercise makes you less insulin resistant…if you build into a regular part of your day it will become a constant and predictable… this is hard for me to do w/ a 16 yr. old boy though! LOL

Katsz - I have heard of him, but have not read anything of his. I agree with the theory that large amounts of insulin/food inherently have a larger amount of risk associated with them. And while the rational side of me knows that regular exercise will have the benefits you mentioned, my realistic side knows that isn’t always possible for me. :-/ The only one that can change that is me, I know.

Yes, yes, yes! You’ve encapsulated the whole complex nightmare, that I can’t even be bothered to explain to people who ask. “so how is your Diabetes?”. Throw in peri-menopause on top of what you’ve described and that’s me. Are there other women out there who spike high before their periods? My gp looks at me like i’m a freak when I mention that. I’m going to an endo. for the second time in the 13 years since I was diagnosed type 1 to try to get some insight into this new situation. As for Bernstein, I gobbled up his book when I was first diagnosed, until i got to the part where he said he hadn’t eaten a piece of fruit in 25 years and I threw it across the room in disgust! Honestly! Life’s too short.Balance isn’t just about your numbers, it;s about quality of life too. Rant off.

Kim,
I could have written the same post you just did. We must think alike!

The exercise thing is something I have struggled with. Around Christmas last year, I started going to the gym and walking on the treadmill. I turned down my pump 30 minutes before going to 25% basal rate and then worked out for 30 minutes. Stepped off the treadmill and my blood sugar was 23… Oh my gosh. Drank lots of OJ!

Next workout I turned the pump off before going to my workout and drank some juice… Got off the treadmill after working out and my blood sugar was 45…

Next time did the same thing and blood sugar was 75… Getting somewhere now…

Next time I turned off the pump, ate a banana and drank some orange juice before going to the workout, drank some OJ slowly while on the treadmill and finally my blood sugar was ok when I got off and then was high (200) and hour after the workout from all the carbs…

That is absolutely exhausting and in my opinion kind of stupid to have to drink/eat so many calories to get through a workout without going low… And my pump was off!

That’s the last time I was on the treadmill…

I still take walks, play soccer with my children, ride bikes with them… I always have juice or a soda with me just in case!

I work, have 2 children and a busy life. I don’t have the time to plan hours ahead of time before working out to make sure my blood sugar is ok when I am done.

Maybe you could work out in shorter time periods… A 15 minute walk at sometime in the day and then another 15 mintue walk at another time in the day…

Diabetes ruined my vacation recently. We went to Maine for a week and I was high before going to bed one night. I thought maybe I didn’t bolus enough for the dessert I ate that night. So I corrected and went to bed. Next morning I was high and thought maybe it was a left over delay from the dessert. Bolused again but I was not feeling well. Drowsy, tired and really thirsty. We went shopping and I stopped to take my blood sugar and it was 560! The highest I have ever been since being diagnosed. I panicked! My husband told me to go to the bathroom and see if I could figure out what was wrong and he stayed with the children in the store. I disconnected the pump, but did not have another infusion set with me (big mistake which i have since corrected). I bolused a lot and by lunch I was 300! Then it came down and I was low that night. Then the next day really high. Changed my infusion set twice that day

Anyways, I don’t know what caused it. We were in the ocean a lot and maybe salt water caused it. But I didn’t feel right for 3 days and it really ruined my vacation!

This is all exhausting - isn’t it! Combine type 1 diabetes with the rest of your life and it is just exhausting!

I hope you can find out a way to exercise!

Do you get highs/lows around the time of your period? This really throws me off as well. I got high a week before my period and then crash after it starts. I have 3 basal patterns that I switch between depending upon what time of the month it is!

Good Luck,
Rebecca

Kim, did you read my diary? I should be writing the same things, only as a T2…I have had the summer from “H” as far as medical things are concerned, and just taking readings, eating hopefully correctly, sometimes exercising and taking my meds has been enough for me to do. Sometimes all four get done, sometimes three, and you know the routine…Meds are a no brainer… I can do that… I have other meds to take. Exercise is a pain in the “A” as far as I am concerned…so I haven’t really done it. Eating and fixing meals is tough for me during the winter, I don’t feel like eating when I am hot and sticky, so I eat some fruit, try to get in two meals a day, but they aren’t the best, but they aren’t junk food either. My mood has been depressed and I don’t care as much as I think I should. I haven’t been drinking water…which is amazing, because I drank an ocean last summer.

I go through very good times, and then I go through very bad diabetic times. I am amazed my numbers are as good as they are…I’ve seen the dietican, because I lost mine with the reorganization of our clinic. I lost my CNP/CDR because of that reorganization also, and still haven’t found someone I feel works with me or I with them, yet.

To be shorter…I make an concerted effort to do what I am supposed to be doing, and make sure that this is what is important. I will bet back to 100% and life will be good, but I think the whole medical thing has me down and out…but we can’t let the world dictate how we feel, what we do to control our “D”…and how we feel about it.
We are strong people, and we need to keep plugging on…as if this were all normal behavior. Good luck to you…stick around here, we can support each other.

I pretty much always have candy in my pocket…fast acting, mostly sugar like smarties or jelly beans. It’s a pain to eat them when you aren’t neccesarily in the mood, but it allows some spontaneous extended activity. Can you sip on juice or pop sugar while you workout or walk to lunch?

Thanks for all of the positive feedback, everyone! Elaine - if I did that on the walk to lunch, I’d end up skyrocketing later from the extra carbs. Maybe that’s just how my body works; I don’t know if that happens for everyone. The timing never seems to work, no matter how I adjust the variables. (So, it becomes easier to just eliminate that activity.) The eating/drinking carbs for a workout thing bothers me because it’s extra calories. As I said in my post, I take in carbs pre-workout. If I tried to wait until during the workout, my BG would drop like a rock. During the week, I do have two 15-minute breaks at work that I walk during - so I’m at least getting a little bit in.

It is hard…

Constant battle huh?