A day (or so) in the diabetic life
As part of National Diabetes Month (November is freakin' National EVERYTHING month), I'm going to attempt to illustrate a day in the life of a Type I diabetic using an insulin pump. I may not be the typical Type I diabetic, but perhaps this might help explain what I do every day. Before we start, I'll give you some background. The "normal" fasting blood sugar for a non-diabetic is supposed to be between 80-120 mg/dL. That number may go over 120 for non-diabetics after a heavy meal, but not usually and once your blood sugar if over 150 mg/dL, I've always been told that's the point when the excess sugar in your system is damaging your organs. No pressure or anything ... To regulate my blood sugar levels, I take Novolog brand fast-acting insulin. It's synthetic but is supposed to best replicate the insulin a human body produces. My insulin pump delivers me a basal rate of 1.1 units per hour as just part of walking around and being human. I also take a bolus of 1 unit for every 11 grams of carbohydrates, give or take (hooray math with prime numbers!). Calculating a bolus is not necessarily straight division by 11, as the amount of fiber in foods will reduce the amount of insulin I need and the amount of fat will increase the insulin I need as it slows and reduces my body's ability to process the insulin. Exercise will also lower my blood sugar and require reducing my basal rate, eating a snack, or both. Lastly, alcohol, despite its high sugar content (for mixed drinks etc.), inhibits my system from processing sugar so can actual make me have very low blood sugar. Basically, while alcohol isn't forbidden, it throws a monkey wrench in any math I might need to calculate.
I don't feel like there are any foods or drinks that are forbidden as a Type I diabetic. The key, just like for non-diabetics, is moderation. I can have that giant piece of cake, but I have to know how many carbs are in it, and there's nothing like clicking that into your insulin pump to make you aware of what you're putting in your body. My main frustration as a Type I diabetic is that I can do everything I'm supposed to do and still feel bad because of something I didn't think about or just the planets weren't aligned.
So as we drive to Richmond to eat one of two large holiday meals today, I'll try to explain how yesterday and this morning have gone for me.
7:24am 132 mg/dL I take 0.2units of insulin at the pumps suggestion (try doing that with a syringe) and then change out my tubing. This involves refilling the reservoir in the pump with ~160 units of insulin and changing my infusion site to a new location. I have to prime the pump so that there is no air in the line and that the infusion site is full. That all done (the whole process takes about 7 minutes), I head to work.
9:30am 176 mg/dL I check my blood because I want some candy that Bossman had brought to the office and wondered how the tubing change had gone. Apparently I lost a bit of insulin during the change. So I have three small pieces of candy (Hershey kisses sized) and take 2.5 units of insulin to bring my sugar back in range. At the time I wonder if I should have been more conservative in my insulin (homemade candy is a guess as to carb content) but figure I'll play it by ear.
11:36am 175 mg/dL So much for being too conservative. I take another unit of insulin.
12:37pm 128 mg/dL Ah, that's more like it. My sugar is still on its way down but it's lunchtime anyways. It's been decided that we're going to Don Pablos (hooray tortillas and cheese for high carbs and high fat!). I have 4 tortilla chips with salsa (yes, I count them) and the lunch steak fajita with a corn cake instead of rice. I only use one tortilla and only use a spoonful of refried beans. The corn cake is my dessert. Since I don't really eat all the parts, I guess that I had about 128g of carbs. 128 as a guess sounds more like guessing the number of jelly beans in a jar more than guessing how many carbs I ate, but it's sort of a zen thing. My pump tells me I should take 11.6 units of insulin and I cross my fingers that we're both right.
1:55pm 120 mg/dL Woohoo! The pump and I were right! Take that, corn cake!
3:40pm 80 mg/dL Still going down, but I should be at the end of my insulin's curve soon. I feel fine and not hungry, so I leave it be.
5:13pm 67 mg/dL I feel a little shaky, but not falling apart, so I have a fun size Butterfinger and another random piece of candy.
6:33pm 101 mg/dL Look at that! Thats right! Who's the diabetic?! I rock. We're home now and I'm tired and cranky (having just discovered my massacred tomatoes) so I have 6 triscuits and 3 slices of cheddar cheese. The triscuits are 19g and the cheese is negligible so the pump and I agree on 1.7 units.
8:15pm 161 mg/dL WTF? Guess that cheese was sneaky sugar cheese. Sigh. I'm still angry about the tomatoes and not quite hungry yet, so I just have a few bagel chips and the last of the hummus. The bagel chips say they're 17g and the hummus says it's 5g. I don't trust that I had a full serving of either, so I take 2.5 units (2 units for the food and half a unit to try to fix my sugar).
9:37pm 119 mg/dL That's more like it. But I know my sugar is 119 on it's way to being low. I'm finally inspired to eat something for dinner, so I have a peanut butter and banana sandwich. That's 24g for two slices of bread, 5g for my tiny amount of peanut butter, 31g for my large banana (thank you Calorie King software on my phone!). Top that off with 8oz. of milk (11g) and I total up 71g of carbs. My pump suggests 6.4 units and that sounds fine to me.
At this point, I'm tired and cranky and Rich is killing bad guys on the computer, so I decide to just do a bit of knitting and go to bed. Some might find this cavalier to take a chunk of insulin after eating and then just go to bed, but I like to tempt fate that way.
8:36am 66 mg/dL When I woke up this morning, I knew I was low. I didn't feel 40 sweetie-get-me-OJ-because-I-might-fall-down-the-stairs low. I just felt I-should-get-some-OJ kind of low. I drink about 8 oz. of OJ (26g of straight up sugar) and two bites of a banana because Rich and I plan on going for a fast-paced walk.
9:19am 120 mg/dL We're back from our walk and I'm feeling fine. Looks like the OJ and walk did it's job. I plan on bustling around the house cleaning for dinner tonight, so that's a good sugar level to start out my bustle.
11:09am 201 mg/dL Sigh. Guess I didn't bustle enough this morning. Man, shit like that gets old. I take 1.6 units (per the insulin pumps suggestion) and we shower and change for dinner in Richmond.
And that brings us to now (12:58pm) and my blood sugar is 94. I would be excited about that number, but I have a sneaking suspicion in another hour I'll be at 64. Oh, well. Dinner #1 is at 2:30pm and I'm sure they'll have a snack at the house. Since yesterday morning, I've checked my sugar 14 times. My insurance will only pay for 6 test strips per day, so see if you can find the 4 testings I did yesterday that were extravagant. Test strips cost between 75 cents and $1 a piece, so it adds up fast.
As we get close to Rich's parents' house, I am mindful that today is a holiday that we're supposed to enjoy with our families. While I worry that I'll eat too much or the wrong mixture of food, I'm still happy that my insulin pump allows me to eat when I want to as opposed to when I have to. I'm also thankful that insulin pumps exist at all and I'm not trying to do this with syringes that barely measure units accurately. And I'm hopeful that eventually there will be affordable solutions to make all this easier on everyone.
Have a good holiday and try not to stuff yourselves! And remember, turkeys can't fly!