Every Day is the Same...but Different

Spending an evening with an old friend a couple of weeks ago, I realized how little people know about what goes into living with Type 1 diabetes (T1).  We ordered pizza, and when I thought I had about 15 minutes left until dinner I injected insulin #1 to cover the bread I was about to eat.  My body, the insulin and the pizza guy weren’t all on the same timeline, so my sugar dropped before the food arrived.  With falling sugar, I worked to balance the insulin with some M&Ms and glucose tablets to get my number up before dinner.  When I injected insulin #2 not long after that, my friend’s reaction was basically “wait, now what?”  That’s on me, not on her or anyone else — I’ve never told her about the details of what goes into T1.  How could anyone know about the constant battle if they haven’t watched in person or heard about it directly?  T1 can be a roller coaster or a calm drive through the countryside depending on the day.  This is my attempt to fill in some of those gaps.  It’s on the long side, so bear with me!

The first and last thing I do every day is manually check my sugar (a.k.a. my “digit”) on a glucose meter.  Before I got my Dexcom CGM last month, I typically poked my fingers somewhere between 8 and 12 times a day.  Now that I have the CGM I still have to use finger sticks to calibrate it at least twice a day.  Right now I’m doing that to start and end the day and somewhere else in the afternoon or evening.  If I go to the gym, I check right before I work out.  Because my sugar can drop pretty significantly during cardio activity, that’s the time of day I’m most worried about knowing exactly what’s happening and want to make sure my CGM is accurately reading my level.  The rest of the day, I’m able to check in with my CGM to see where I am, before and after meals, before and during meetings, and any other time I want to know how I’m doing.  I need to know where I am to know what I need to do to keep my sugar as close as possible to where I want it to be.

Where do I want my sugar to be?  In a perfect world it wouldn’t be any different than a person without diabetes.  For those who like numbers, that’s below 100 when I wake up, under 110 before I eat, and no higher than 140 after meals.  In practice that’s not always easy, especially that digit after meals.  That's because anything I eat raises my sugar.  That doesn’t just apply to sugary foods or high carb things that digest into sugar, like french fries.  It’s just about everything, including proteins like beef and chicken even in the absence of any carby stuff.  So for nearly every meal and snack, I need to take insulin before and/or after eating to keep my sugar from blowing up to 200 or beyond.  That’s insulin #1 in this story, the fast acting shots I take to adjust for food.  In a non-diabetic person, the pancreas works before, during and after meals to keep glucose in a healthy range.  In my world, I play that role with insulin pens and needles.  In diabetic terminology, those are called insulin boluses.  In my vernacular I’m either dosing or shooting up.  Eat food, dose.  Go high, dose again.  Go low and need to get back up to a healthy number?  Depending on the time and place, my solutions range from glucose tabs that are chewable sugar bombs in (not so) fabulous fruit flavors, to choosing a beer instead of a glass of dry (low sugar) wine during a night out.  The choices are many!  I will say there’s nothing quite like chewing raspberry flavored sugar at 4 AM…except the resulting taste left in your mouth when the alarm goes off 2 hours later.  However, I’ve yet to work up the motivation to get up and brush my teeth after a late night low!

Insulin #2 is my basal medication, or what I call my “nightly.”  This is a long acting insulin that is designed to keep my sugar fairly consistent in between meals, including overnight.  Its long duration of action means I only need one dose a day, compared to the original long acting insulin I took that was injected every 12 hours.  There are a lot of things that impact blood glucose other than food, including the release of hormones that happen naturally 24/7.  #2 is to keep me at a healthy base sugar level, and my dosage is independent of what I’ve eaten.  One guaranteed impact on that dose in my life is exercise.  If I walk on a treadmill at least every other day or so, my dose is lower than if I don’t exercise.  Cardio increases my sensitivity to insulin, so I take a little bit less when I’m working out consistently. 

Every day with T1 is a balance.  It’s a balance between food, insulin, exercise and all the other unseen factors in life and inside my body that can impact my sugar.  No two days are the same, even if all of my inputs to the process like food and exercise are identical.  That balancing act that my friend saw not so long ago happens every day, but I don’t tend to discuss it with many people.  It’s my routine now, even though there’s no such thing as a routine day.  Wake up, check sugar and dose if needed.  Eat, work, keep monitoring sugar via finger poke or CGM.  Dose for food, dose for unexplained highs, throw back some M&Ms or a bite of brownie to correct random lows.  Go to the gym to help manage sugar levels, but be careful to make sure my sugar is high enough going in that I don’t have a dangerous low that could cause me to pass out and fly off the back end of a treadmill.  Eat, socialize, sleep and keep checking sugar to adjust for anything known or unknown that’s causing the CGM trend line to deviate from a happy path.  Wake up tomorrow and start the cycle over again, wondering what tricks my body may have in store for the day.  And if you think I was joking when I said “bite of brownie,” I really mean that and I pulled it off recently at work.  It doesn’t take much, so willpower is important!  I eat M&Ms in increments of 1 at a time now.  Who knew that was possible?!

I don’t talk about any of this in detail very often.  It’s my grind, not yours.  At the same time, the longer I fight T1 the more I see the need to improve awareness.  I want my family, friends and the people around me to know about this disease and my experience as much as they can without living in my shoes.  I don’t want sympathy; I’m fighting T1 and enjoying my life at the same time.  But I do want to open a window, even to the extent that it’s possible with a blog post, into what T1 looks like.  There is rarely an hour that goes by without me thinking about my sugar, or the impact and timing of my last and next meal, or whether I need another insulin shot, or whether I could wind up with low blood sugar and have my brain let me down mid-sentence in a meeting.  This is Type 1, and until researchers come up with a cure, this is my life.  It’s all day, every day, but as I’ve often told another friend about fighting T1, “I got this!” 

On a not so side note, my sugar the last several days has been amazing, running most of the time between 80 and 120.  I posted a 24 hour graph of my CGM readings on the Beyond Type 1 app the other day and another Type 1 responded with “holy cow, what are you doing?”  Pretty cool validation of a really nice week.  Here's my last 24 hours as of tonight, I'm heading into the weekend in a great place.