Hey, colleagues!
Have you ever considered giving back by being on the board of a professional organization? Now’s your chance! The American Diabetes Association is currently taking applications for their national Board of Directors.
Here’s the link…take a look!
This morning I had fasting blood labs drawn. Fasting can be a challenge for people who take insulin. In the perfect world, our basal (background) insulin would keep us steady in our target range if we don’t eat. However – newsflash! – diabetes is not a perfect science. People who wear insulin pumps may have a slightly easier time managing during a fast (you can increase or decrease your basal rate as needed). People who wear continuous glucose monitors have it even better: you can tell by the trending arrows and patterns where your blood glucose is likely to go and dose insulin accordingly. Those who wear a hybrid closed loop pump probably have it best of all, because the pump determines the basal rate moment by moment.
For reasons I’ve written about in the past, I use a vial and syringe, so I’m old school when it comes to fasting. I take my usual basal dose and run myself slightly higher the night before the blood draw. This morning I woke up 177 and took 2 units of rapid-acting insulin to bring that down. When I left the house I was 127. After lab draw and before breakfast I was 103. Of course it doesn’t always work that well. One time many years ago I was low before a fasting blood draw. I took glucose tablets to treat the low and was later told that was not a problem for the blood draw.
Here are some suggestions: 1) ask if fasting is necessary for the blood draw (maybe it’s not!), 2) find out how you can treat a low if you need to do so overnight or in the morning (or if you’d have to reschedule), 3) get your blood drawn first thing if at all possible, 4) if you don’t check your blood glucose often, or if your overnight blood glucose is unpredictable, ask your health care provider about lowering your basal dose overnight, 5) treating a low is more important than fasting!
So this happened to me (and my daughter). I don’t know whether to feel embarrassed, upset, or just shocked. Because this is what I talk to patients and students about all the time – advocating for ourselves (and our patients).
I took my daughter to a routine appointment and had a conversation with the nurse about an upcoming vaccine. We agreed to wait until next year. When I joined my daughter in the exam room, the provider said, “I’m a big fan of getting that vaccine today, so let’s go ahead and do that, ok?”
Sure, I could have asked her to slow down and explain the rush. I also could have said “no, I already discussed this with the nurse and we’re going to wait.” But it happened so fast, and with such authority, that I simply said, “Ok.”
Then I looked at my daughter and she was angry! I realized that I had an opportunity to teach my daughter by example how to advocate for herself. So when the nurse came in with the vaccine, I asked her about it. She admitted she was confused because she thought we were waiting, so when the provider came out and said we were ready, she thought we’d changed our minds. I explained that I felt strong-armed and that we really did want to wait.
Later I explained to my daughter that in situations like that we have to slow down and process what’s going on. Then we can take the opportunity to advocate for ourselves if we don’t feel comfortable with what’s happening. I told her emphatically that I did not say no to the vaccine to get her out of a “shot” – she will have it next year. I said no to the vaccine to show her how to advocate for herself in an intimidating (health care or any other) situation.
I am constantly saying that what we know about diabetes changes all the time; there’s something new to learn every day. While that may be true, there are certainly days when it seems like same old, same old.
I’ve had nothing new to add for over a month. Writer’s block? Diabetes block? There are just going to be times when there is nothing new. And then again there is so much new stuff that it’s overwhelming and easier to stay where we are.
I don’t have the answer; I just listen to my body and hope for the best. I read a lot and remember some. We don’t have to try something new every day; when we get in a rut, though, trying something new could be life-changing.
Oh wait! This sounds like balance (thanks, D). There’s an old concept. Let’s balance the old and the new and live as well as we possibly can with that thing we call diabetes.
My kids are attached to their cell phones like some people are to oxygen. So I sometimes give them a hard time if they are away from their phones by asking, “Are you OK? Can you breathe?”
What about diabetes technology? How dependent are we on insulin pumps, continuous glucose monitoring, and the rest of it? Could we survive without it if we had to?
As much as technology has changed lives and diabetes care (and it most definitely has!), there are still many people who don’t have access to it. These tools are also not yet perfect and they do malfunction from time to time. This is a good reminder of how important it is to continue teaching/learning the basics, at least for now.
I have no doubt there will come a day when people are diagnosed with diabetes and immediately connected to technological gadgets, and there might even come a day when those gadgets are fool-proof. While they will do all the math for us, we still have to do the thinking.
So let’s not cut off our oxygen supply yet, and let’s not ever stop thinking. After all, diabetes is the thinking person’s disease.
Yikes! Who would write a blog post about menopause?? Who would read it??
As I quickly approach that time in life, I am thinking about things like cardio (heart) protection, blood glucose swings, sleep, bone health – all the things that menopause (and diabetes) affects.
I once had a patient call me and say that her blood glucose levels were all over the place and she thought it was menopause. That was my first exposure and now I’m experiencing it first hand. So the thing I tell parents of newly diagnosed children with type 1 diabetes – you’ll get it down, then it will change; then you’ll get it down again and it will change again – is true! Welcome to menopause where it can change every week (day? minute?). And I really had it down!
Anyway, in addition to blood glucose swings, with menopause come difficulty sleeping, which can certainly be exacerbated by pump and CGM alarms; loss of bone protection – people with diabetes already have a higher risk of bone loss; and loss of cardio-protection.
So where’s the good news in all this? Well, women at this age are wiser, have more experience, have more perspective… blah, blah, blah. Exercise. The good news is that we can still exercise and if we do, we will be doing our part to protect our bones, get better sleep, and protect our heart. In fact, this article says that one workout could protect the heart for hours or even days!
Despite the hot flashes, mood swings, glucose swings, lack of sleep, we are strong and intelligent and we can figure this thing out. It definitely takes patience and a sense of humor…and those of us with diabetes already have those qualities, so we’re all set. Bring it on!
I recently heard someone say that there are different kinds of hope. She talked about lazy hope and authentic hope. She shared that we’re displaying lazy hope when we say things like, “I hope you do well.” On the other hand, authentic hope is hope with action. That’s when we actually help make something happen.
I have long questioned whether it’s even possible to live without hope, yet I had never thought about the possibility that there are different kinds of hope.
Immediately I started thinking about how this applies to life with diabetes (because everything does). Lazy hope could be thought of as sitting around hoping for a “happy” blood glucose level, or a cure for diabetes, while authentic hope could be doing the tasks that lead to “happy” blood glucose levels.
Authentic hope could be helping those with diabetes in disaster zones or providing support to a loved one or stranger who’s struggling with the daily frustrations of diabetes. Authentic hope could be supporting work toward a cure – financially or in other ways. Authentic hope could be finding ways to stay strong, healthy and motivated until there is a cure.
I once heard about parents who threw away all their child’s diabetes supplies when they heard about a “cure,” only to call the diabetes center in a panic when they realized they still needed that stuff to help their child live until they had access to the “cure” (which, by the way, wasn’t actually a cure). What kind of hope is that?
In the hope department, I still have more questions than answers. I believe in hope, and I believe in working hard to get the best possible results. Maybe that’s hope in action.
It’s a good day to think about thanks. All the other days I’m so busy getting life done. I’m checking blood glucose levels, taking insulin, counting carbs, making appointments, going to appointments, working, working, working, driving kids, teaching kids to drive, walking the dog, going for walks, preparing meals, eating meals, working some more…
Days, weeks, months and years go by faster and faster all the time. They weren’t kidding when they said time flies. It’s all good, and fun, and challenging, and it flies by. So fast that I forget to slow down and think about thanks.
I like to call today CarbFest. I am thankful for insulin, because without it my body couldn’t metabolize (break down and use for energy) carbohydrates. Thankfully, on this day I can figure out how many carbs I’m about to eat (thank you to whoever invented carb counting) and take the appropriate amount of insulin (thank you, Banting, Best, Collip, and Macleod). I can also take a long walk to burn off at least some of those calories (thank you, all the diabetes educators and other health care professionals who have taught me about healthy choices over the years).
It’s good that Thanksgiving falls within Diabetes Awareness Month, because it gives us a designated time to both be aware and give thanks. Happy Thanksgiving – enjoy your carbs!!
