I took a vacation to the beach a couple weeks ago. I decided to disconnect the pump for the week, just because I wanted to. I was expecting that I would come home and rave about how much I missed my pump and how thankful I am for it. Surprisingly, I waited a week thinking about what to write because I have mixed feelings.

Disclaimer: I love my pump. Really I do. I’m not ready to give it up. Take this whole post with a grain of salt.

Other disclaimer: I had really bad blood sugars this week. They influenced the tone of this post and they are sorry.

So during the vacation, I used a split dose of Lantus for basal insulin with Humalog (as usual). I ate at least one ice cream cone per day, we ate out some, and I left my food scale at home. So I was expecting wild swings in my blood sugar with 8-10 injections per day correcting all those crazy swings. BUT I woke up between 80-100 mg/dl and most of the times that I checked, my blood sugars were near perfect. I was doing everything wrong, but the numbers didn’t show it.

OK, I was definitely more active than usual, but I wasn’t experiencing frequent lows the way I usually would. I was constantly amazed by my great blood sugars.

I chalked it up to a GREAT vacation and reconnected to my pump on the last night. Right when we got home, I felt a cold coming on… and I’ve been sick most of the week. My blood sugars were everywhere- really horrible. Highs that linger and just refuse to come down. It seemed that NOTHING was going right.

So it’s hard for me to write about how I love my pump and how much I missed it during the vacation. BUT when I am thinking more rationally, I realize that there are reasons that I love the pump and reasons that I have better control with the pump. I will list them here, mostly to reassure myself that all the extra work with the pump is worth it. Feel free to add to my list (or disagree with it!):

  • I correct EVERY blood sugar, even when they are just slightly high. It is hard to correct just slightly high blood sugars with injections.
  • I exercise more with less lows because i can turn my basal rate down to 50% one hour before exercising– this is amazing!
  • I can live with more flexibility, because if I ate, checked my sugar, then want to eat more, my pump can process all that data telling me what to do without going high or low (it remembers how much insulin is active in my body– something that is hard to keep track of unless you write down your every move).
  • It’s easier for me to give boluses early. You should give your bolus 15-20 minutes before eating. I can often do this while walking to get lunch, while cooking, etc. I think that with injections I would often not bother to do this.
  • I have different basal needs through the day. In fact, most of us do. So the pump can give me more basal insulin in the late evening than in the early afternoon. You can replicate this by splitting your long- acting insulin dose, but with much less precision.
  • With the pump, if I have good blood sugars and do not eat or bolus, they will stay good all day. The basal really works as a background insulin. When I used injections, I could not go 12 hours with eating, which means sometimes I was feeding my long acting insulin.

I love Snickers, always have, probably always will.

After my diagnosis with diabetes, no one told me: “Don’t eat Snickers”, but it kind of seemed implied. When the doctors, diabetes educators, and books talked about carb counting, they always talked about whole wheat bread, fruit, and other healthy options. So I figured that my love for Snickers would need to be suppressed FOREVER…

… but I secretly wondered, what would happen to me if I DID eat a Snickers bar???

Everything was so new too me, I even thought that maybe if I ate a Snickers, I would just die. So I didn’t eat them.

Then I heard about a JDRF support group in my area. It was mostly families with younger children, but I was just so excited about meeting other real live people who live with diabetes!! I was asked to bring a snack to share. So I searched for a LOW CARB treat to bring. I decided on pudding drops (sugarfree pudding, made slightly thicker than usual, put on wax paper in the freezer). Carb count about 1g per drop.

I show up to the meeting and put my pudding drops on the table next to the apple pie, cake, ice cream, … and I wonder what all those things were doing there. Perhaps it was for the non-D parents??? But I noticed that the parents had written out the carb counts carefully next to each food.

So I watched. The kids went up to the table, picked out WHATEVER they wanted and bolused accordingly. I was shocked.

I had to ask. Was I allowed to eat this stuff?

The parents admitted that it was the exception rather than the rule, but sure if I counted carbs accurately and bolused properly I could even eat desserts!! BUT I should test and make sure my blood sugar did not spike too high afterwards.

So a Snickers bar wouldn’t kill me. I didn’t need to be afraid.

After almost a year with no Snickers, I bought one the next day, bolused and savored every bite. Wow, it tasted good.

Then I did the same the next day, and the day after that, and… I didn’t die.

That was the beginning of my “eat whatever I want and bolus and correct” phase. This was NOT the best form of diabetes control. I DO NOT RECOMMEND IT. But it was a step in the journey and part of getting to where I am now. During this phase, my saving grace was that I checked my blood sugar often and corrected the inevitable highs.

This phase gave less than perfect A1c’s and also caused huge swings in my blood sugar. It wasn’t until I gave it up recently that I realized how tiring that lifestyle was physically. Therefore I’m sure that it wasn’t good for me.

The upside is that I learned how to carb count well and that serves me well now when I want to integrate treats into my diet in MODERATION (i.e. Fun Size Snickers).

Dear Diabetes,

So today is the 5 year mark in our journey together. We sure have had some ups and downs.

On our special day today, I wanted to treat you really well. So I woke up with a great fasting blood sugar and ate an almost no carb breakfast (though it wasn’t all that tasty)– I just wanted to make sure that we would both be in the mood to celebrate. Then you decided to pull one of your usual tricks: the unexplainable high that just won’t come down. I’ve seen it before, but why today???

Recently, I started to feel that I can 100% accept and control you, that life with you is not so bad… and maybe it’s not.

But there are days where I do everything that I can to treat you right and you don’t seem to care– you decide that the insulin you got just wasn’t enough (despite accurate basal rates, carb ratios, corrections factors, and carb counting that I determined based on your earlier complaints). And I start to wonder if all the effort is worth it…

So we decided to go out to dinner tonight to celebrate our five years of life together. I decided that I would celebrate with a high carb meal and some genuine “carb guessing” and ad hoc bolusing. And I did.

How did you thank me? With a blood sugar of 101 🙂 You knew just what I needed to end the anniversary right. Thank you for giving me the “night off” and allowing me to enjoy a nice meal out while you stayed on your BEST behavior.

I wanted to write this letter on a purely positive note about the struggles that we overcame and how we are ready for whatever may come. But today didn’t feel that way. No, today was more real. Today was a day to recognize that our relationship for the past five years has been full of ups and downs, just like today was up and down. And the coming days, weeks, months, and years will be full of ups and downs.

But the point is that we keep on keeping on because that’s what we do.

Sometimes you don’t cooperate with me; sometimes I don’t take care of you. But then there’s always a new day, a new inspiration. So far there have been just enough– I hope that there will continue to always be enough new days, new inspirations, and new reasons to keep on…

Yours,

Kristin

At 3:21am, I woke up covered in sweat. The feeling was familiar; my blood sugar was low. I reached for my meter to confirm what I already knew. Yep, 48 mg/dl..

But my immediate thought was: I could have prevented this late night low… if I had followed my instincts.

Last night included an evening run, where I was proud to keep my blood sugar between 100 and 140. Afterwards dinner and a before bed reading of 77 mg/dl. Given that there was still some active insulin in me (insulin-on-board, I like that phrase), I knew that I needed to eat 12g of carb. And I did.

But a little voice told me:
“You don’t usually run in the evening… you’re probably going to go low during the night. Maybe you should eat a little extra.”

Since I am really trying to avoid all night highs, I ignored that voice. As I fell asleep, I was even thinking that I should check again– or set an alarm to go off in an hour and check then. But the thought of a full night’s sleep in the midst of our busy lives was too enticing. Second good instinct ignored.

I could have eaten a small snack and woken up during the night to check, but I didn’t want to wake up during the night. So here I sit at 4am very awake and blogging about my night time low… brought on by the fact that I didn’t want to wake up during the night.

I think that it’s time that I start listening to my instincts a little bit more, even when I don’t want to hear what they are telling me!

During college, I babysat for a family with one child who has type 1 diabetes and one child who does not. Immediately I saw how excited the child with diabetes was to be with someone else like him, someone who had to do all the shots and finger pokes and carb counting. When he first saw my syringe, he excitedly proclaimed, “HEY! I have the SAME one.” (As far as I know, I think all insulin syringes look about the same.) But the high point for me was when his non-D sister walked into the room while we were both checking our blood sugar. He took one look at her and said in a slightly bragging tone, “Your pancreas works, but OURS don’t!!” At that moment, I realized how much easier it was for him, for me, for all of us to face diabetes knowing that we ARE NOT ALONE.

At the age of six, this young man taught me a lesson that I have only recently come to fully appreciate, living with diabetes is much easier when you know that you are not alone.

After years of feeling the need to prove to myself and the outside world (and even my doctor) that I can do this ON MY OWN, I now accept and rejoice in the fact, that there is no need to. I handle my diabetes better from day-to-day knowing that people all around the world are living similar lifestyles, dealing with similar issues. Through the diabetes online community, and TuDiabetes in particular, I have found comfort and strength in knowing that there are people that understand.

We went to visit some friends this weekend and one of them was surprised to see me poking my finger to check my blood sugar. He said that he figured that those days were over now that I was on the pump.

It’s a common misconception– that that device that I wear attached to me 24 hours a day deals with my diabetes for me.

No way. The pump is a tool that helps many achieve better control and a more flexible lifestyle. But, if anything, the pump requires MORE work on my part than injections did.

So then came the next question: how hard can it be to ‘close the loop’? (a pump that immediately responds to blood sugar levels– like a fake pancreas)

The answer, I don’t know. I hear that we are always “five years away” from closing the loop. Perhaps it’s too difficult, too risky. Perhaps there are companies that prevent such a technology from becoming available.

This could be a great advancement in diabetes care– still not a cure– but a whole new level. We tend to think that we can accomplish ANYTHING with technology. So what’s the hold up on closing the loop??