Friday, April 4, 2008

The Numbers Game

Okay, so here’s the big explanation in case you need the info, the deets, the 411 (I’m down with it, just like my 15-year-old niece who would be mortified at my usage of this language). How about we make it easy for both of us and I do a mini-glossary to begin with? And please keep in mind I am in no way a medical professional or qualified to give medical information or advice. This is just what I know and how I know it.

Type 1 vs. Type 2: If you have Type 2 diabetes, that means your pancreas produces some insulin, but not enough, or your body doesn’t know how to process it properly. If you have Type 1 diabetes, that means your pancreas doesn’t produce any insulin at all. I have big, giant, humongous issues with people confusing the two (as always, more later). I am a Type 1 diabetic; everything from here on out, through eternity or the life of this blog, will always reference Type 1. If you’re Type 2, sorry—get your own blog.

Insulin: What I need to stay alive. Since my body doesn’t produce it naturally, I have to inject it myself. Please note that insulin is not a cure for diabetes, it’s a way to help control the disease so it doesn’t get out of whack. There is no cure for diabetes, although I keep reading that scientists are working on it. And while insulin keeps me alive, it can also kill me. (See Low Blood Sugar below).

Lantus: This is the type of insulin I use. I take an injection once a day, at night before I go to bed. While there are some people who use Lantus insulin in conjunction with other types of insulin, I only use Lantus. My doctors are amazed that I’m able to stick with just this, but it’s not a fluke—it’s me, doing a heck of a lot of mathematical wizardry. (You’ll see what I mean if you keep reading.)

Blood Sugar Measurements: The way I know how my diabetes is in check or not is by checking my blood sugar. I do this with a meter. First, I prick my arm with a lancet (a needle on a spring-loaded device) and get a drop of blood. Yes, I do my arm; I have a meter that can measure my blood sugar based on the blood in my arm (Freestyle—can’t live without it). The traditional way is to prick your fingers, but this hurts much worse and I can’t handle doing it. The blood goes onto a flat stick that’s already been put into my meter, and the meter whirs for a few seconds and gives me a number. That’s the number that dictates everything on a day-to-day basis. I check my blood sugar levels first thing in the morning, before I exercise, after I exercise, about four other times during the day, and right before I go to bed. I should point out, though, that the finger-prick, as opposed to the arm prick, gives you a more accurate, up-to-the-second reading; I do do the finger-prick when I'm low and need to know a real, true, undiluted number (although the difference is usually only a number or two for me, ie: 68 as opposed to 70). The number is either too high, too low or just right…

High Blood Sugar: If my blood sugar is too high, that means I’ve eaten too much, I’m stressed out, I’m sick or about to be or I’m about to get my period. If it stays too high for too many days, it means I’m not giving myself enough insulin. If my numbers are always high, and they never go low, and they’re high for years, it can cause complications—nerve damage that leads to amputations, blindness, death (yes, I truncated here, but isn’t the word “death” enough to get my point across?).

Low Blood Sugar: If my blood sugar is too low, that means I haven’t eaten enough, I’ve exercised or been excessively active without checking my sugar before I did it or I’ve given myself too much insulin. If I go a little too low, I get grumpy and irritable. if I go a little more too low, I get spacey and a little jittery and have to drink juice immediately to bring my blood sugar back up as quickly as possible. If I go lower than that, I can go into a coma and die. (Die, just a nasty a word as death.) That’s why my insulin can also kill me (see Insulin above).

Just Right Blood Sugar: Like I said, I like to take tight control and just right for me is between 110-120 two hours after a meal (I prefer closer to 110), and 70-85 before a meal (I try not to go too far below 75). All the other times of the day it’s either working toward the 110 or coming down from it.

Carbohydrates: My blood sugar levels are for the most part based on the carbohydrates I consume. Since I only take Lantus and it’s a once-a-day thing, I’m stuck with the numbers I get on my blood sugar meter—there is no opportunity for me to give myself a little more insulin if I want to eat more carbohydrates. To make sure that my carbohydrate intake and my insulin are matching up properly, and that my blood sugar levels remain in the “just right” category, I do what’s called “carb counting.” For every 15 grams of carbohydrates I consume, that’s considered one carb unit. After much trial and error, I know how many carb units I can eat for breakfast, lunch and dinner to make sure my blood sugar levels stay sane.

The Numbers Game…
Here’s where the balancing act comes in.
Insulin: Now, if I’ve been running consistently high for a few days, I up my insulin dosage by a fraction and wait a couple days. If my blood sugar lowers back to an acceptable number, I keep the insulin at that. If it’s still high, I up my insulin dosage by another fraction and wait a couple days. Same goes for if I’m consistently running too low—I keep lowering my dosage by a fraction until my numbers are back to normal.

Carbohydrates: If I check my blood and it’s supposed to be higher, I eat something with a carb unit value (ie: a container of yogurt, a glass of milk, half a Nutrigrain bar, a small banana, about 10 mini pretzels). If I’m hungry and I want to eat something when it’s not time for me to eat, I check my sugar. If it’s low enough, I eat. If it’s not, I either skip eating, or I eat something without carbohydrates (low-fat cheese, pickles, mushrooms, salad—the pickings are slim).

Sounds simple, right? But then, you have to take in effect that different foods affect different people different ways. For example, if my sugar is low and I eat grapes, they’ll give me a higher sugar level about an hour later. One hour after that, though, and my sugar will be right back where it started. I know other people who don’t have this same effect with grapes at all. The whole thing is trial and error. I eat something new, I take my blood sugar to see how it affected me; I do this a couple of times with the same food and come to some kind of conclusion about it.

I also have to take in account the time of day. My sugar tends to run lower in the morning, around 11am. It also tends to run higher at night, around 10pm. I also figured this out by trial and error, and lots of blood sugar testing.

I also have to take in account my physical activity. Riding my stationary bicycle barely registers a blip on my sugar level radar, but walking on the treadmill for 15 minutes can lower it instantly. I’ve also been gardening in the back yard when all of a sudden I felt pale and jittery and had to drink juice, then eat. The only way to work this one is to check my sugar right before I do the physical activity; if it’s under 100, I eat something before I go, go, go. I also check right after to see if I need to eat again because I’ve gone too low. And if I feel “funny” during the activity, I stop and check to see if it’s my sugar levels.

Then there’s all the other things: stress can make my sugar high; headaches can make my sugar high; if I’m about to get a cold, my sugar will go high before I even have my first sniffle. And there’s the unseen things: for no known reason, my sugar will spike high, or dive-bomb low, even though I’ve done everything right. And I don’t know what caused it and most likely never will. (And trust me, I spend hours analyzing what I've done that day, what I've eaten, how much, and every other possible factor with the exception of the tide and the moon, although now that I'm writing that, I wonder...)

And all of this, all of the above, I think about and calculate at least four to five times a day. It’s not that it consumes me, it’s just part of my life. It’s re-tying my shoe automatically when it comes undone. It’s picking dog hair off my sweater absent-mindedly while having a conversation. It’s testing my blood sugar at a stoplight while driving. It’s a conscious effort and it’s a non-aware measure. I’m always thinking about it and doing the math, but not often stopping to acknowledge that that’s what I’ve just done. It just is.

As always, more to come…

1 comment:

Anonymous said...

Out of curiosity, how long have you had diabetes? It seems really unlikely to me that you can get by on Lantus alone without adding Humalog or Novolog for meals. Unless you pretty much never eat carbohydrates at all, which is possible I suppose.

I have heard of people who have LADA or MODY or "Type 1.5" that just use a long-acting insulin, so maybe you fall in that category...

Sorry if I sound harsh or ignorant, but I'm just a little confused.