More Ice Cream

I was feeling good today, so I went for the ice cream again...Yarnell's Cookies and Cream this time.

I had forgotten how much I miss oreos.

Oh, on the equivalence meter - 1 pint of ice cream = 8 oreos,.

If you have to shoot for it anyway, the real sugar is totally worth it.  That is all.

Also, people started filtering back in to work today, so it wasn't nearly as empty as it has been.  I got to work on a couple of fascinating walk-ups today, which was also fun.

Post Holiday Post

Resting in the lull between Christmas and New Year's.

Christmas went well.  I've had some days where my averages are a bit higher than I like, but nothing earth-shattering.

I've snacked a lot less this year than I have in years past.  I can't say I don't miss grabbing a handful of cookies, whether homemade sugar cookies, oreos, or whatever else is handy.

One thing I've noticed is that I have gotten very cold sensitive, which is unusual for me.  I used to have incredible cold tolerance, even for a kid from Michigan.  (I once did a dorm fire drill in shorts and a t-shirt in the snow, and I was fine.)  Just before my diagnosis, I noticed a definite change in my ability to tolerate cold, and it seems to have gotten worse in November and December.  We don't get too much cold weather here, but it's affecting more than I think it should be.

Ramping up...

I'm getting ready to run another food gauntlet for Christmas.

I've been doing pretty well overall - my week of training being a minor exception.  My machine averages are running 130, which is bit higher than I want, but not dreadful.

Lately I've been undershooting a bit.    Today in particular I've had a couple of higher-than-I-like highs.
Even when I think I'm overestimating, I have gone high.  So my average for today is high.

Lunch for today was all-you-can eat Chinese buffet.  I bolused in a way I've never tried before - rather than try to guess the whole thing and shoot in one, I did a shot per plate.  I still got it wrong, but I like it as a strategy.

I was on the low side going to bed last night - and I'm pretty sure I went hypo overnight.  Woke up 175, which sure hurts the averages.  Waking up twice drenched in sweat should have been my first clue.  I had a fierce headache going to sleep so that may have masked some symptoms.  Next time I wake up at 03:00 I will have to test myself.

Oh, and before I forget...

Merry Christmas, everyone.

Kids Say the Darndest Things...

My four year old son has taken quite an interest in my treatment.

When I come home, sometimes he will point to his finger, which is his way of telling me it's time to do a blood test.  (He thinks the strips are cool.)

Last night, he wanted to help me take my Levemir.  He pulled up his shirt, pointed to his stomach and said, "Shot!"  (Sometimes he'll pinch up some skin, too.)

So he watched while I did my nightly levemir.  When I was done, he wanted to put the big cap back on the pen.

It was the cutest thing I've seen in a long time.  He obviously doesn't understand all the details, but he knows it's important and he's being supportive.  And cute, which it's hard not to be at his age.

What a day...

Today was quite a rollercoaster for me.  Normally, I like rollercoasters.  This one wasn't nearly as much fun.

I woke up 98 this morning.  I was stoked.  Maybe it's Monday, but it's gonna go well...

My next conscious act this morning by misjudging an apple-cinnamon muffin.  I need more insulin in the mornings, and figured the muffin for about 40 grams.  When I tested two hours later, I was 225.  Oops.

So I took a slightly aggressive corrective, 5 units.  Should have taken me to 80-90.  Instead, it took me to 48.  I noticed the tunnel vision and difficulty focusing.  I figured I was low, but not that low.  That was the scariest part for me - I should have been sweaty, or shaky, or something.

I carry Smarties for dealing with lows.  They are small, and they keep forever.  I used to love them in my pre-D days, and this gives me a good reason to enjoy them again.  I scarfed three rolls on the spot - about 22g of very nearly pure sucrose.  Took me right into the 120's and things were looking good again.

I was in class, and my test and subsequent treatment were fairly public.  So I had everyone asking me what they could do, where my sugars were, etc.  Everyone meant well, of course, but the thing people don't seem to understand is that when we lose control like that, we just want everyone to pretend it didn't happen, as much as possible.  Nothing to see here, people.  Please get on with your lives. :)

So things went well through lunch and afterwards.  Tonight, we had a party with some friends.  I wound up taking 10 and 8 to cover food, and I thought I was being aggressive.  I tested and...232.  Grr.  Still coming down from that one.  Though I only took 4 to correct from that one - I really don't want to hit 48 overnight.

So my average is going to be way up for the day.  Some days you win, some days you don't.  I have won many more than I've lost so far, but that still doesn't make it feel much better.

Bolusing

I've been meaning to do a post about the mental process I use to determine my insulin doses.  I thought it would be easy.  Heh.

See, there are two primary inputs to use when calculating your bolus size - the amount of carb you're going to eat in the next couple of hours and your current blood sugar.  If it's high, you need to take some extra insulin to bring it down again.  (This is often called a corrective.)

The first two factors are close to determinate, but there's still some variability, especially the exact carb count. There's a little fudge factor there, and there are times when your guesses are off a little.  So that will lead to extra Smarties/Lifesavers/juice (or whatever's handy) or corrections later.

But there's a third component that has to do with intuition more than anything else, and that's the hardest to quantify.  If I'm feeling like I'm trending low, I may hold off on a unit to let myself go up a little.  If I'm trending high, I may take an extra unit to come down.

It's not quite the same as basing the dose on the exact BG reading, it has to do with whether today's results have indicated a little extra resistance, or creeping up.

Historically, I've been very conservative about taking extra when I'm in the 80's or so.  Today marked a little bit of a change in that for me.  I've been worried about about going hypo due to too much insulin.  Sometimes I get low, but I have always had plenty of warning since I am very sensitive those situations still, and it's not hard to find appropriate sugar sources if something comes up.  (Or goes down; you know what I mean.)  Sometimes those highs seem very "sticky" in that they don't respond well to correctives, or a little extra carb has more impact than it seems like it should.

The difference between handling this third factor well or not can mean 10-20 points difference on the machine average in a given day.  (That's different from just blowing it and hitting 328 on the meter and fighting that.)  Time will tell how much difference that makes in the long run.  Of course, I'm looking forward to taking my first official post-diagnosis A1C, and we'll see how closely that correlates with the machine average.

I think this is what people mean when they talk about the "art" of bolusing and carb counting.

The Non-Diabetic Freak-Out: Musings on Etiquette

One of my co-workers (and friends) stopped by my desk yesterday just as I was taking my post-prandial.  He happened to get a good look at me just as I hit the trigger on my lancet device.  His response?

"Holy CRAP!!!!"  (Dodge behind the wall.)  10 seconds later..."Is it done bleeding yet?"

It was one of those moments when you realize how much you've changed in two months.  The daily grind of injections and fingersticks has become very routine for me in the last two months.  Most of the people closest to me (all of those at home, and most of those at work) accept the things that I have to do to manage my sugars as a normal fact of life.  I often get sympathetic comments about having to inject myself, but honestly, what are people expected to say?

And there are some people I see fairly often that are not as familiar with the daily necessities.  Some of them (like my hapless friend above) are totally at a loss when they encounter us doing our thing.

The important thing to remember, I think, is that most everyone means well.  Some people are genuinely curious about things, but most of them don't want to know too many details, for the same reason lots of people don't like to go to funerals:  it reminds them of things they'd rather not think about.

I don't see my friend's reaction as any kind of judgment on me, more as a confused reaction from someone who had no idea how to react to the situation he found himself in.  I mean, what's the right etiquette to use when someone is deliberately bleeding in front of you?  I don't think they ever covered that in grade school.

I have learned that many people have deep and abiding misconceptions about what diabetes is and does, and what we have to do to deal with it.  I was explaining protocol for what to do if I went unconscious to another of my friends, and I happened to have my Novolog pen out at the time.  He pointed to it, and said, "So, how much do I give you if you go out?"  (He is an ex-phlebotomist -- blood-donation taker -- and a current member of our in-house medical emergency response team.)

"None.  If you give me that when I'm out, I will very likely die."

So I explained a bit about hypoglycemia, and since the point of insulin is to bring blood sugar down, giving me any of that when I'm already low is not the best course of therapy.  And he got it immediately.

Many people have no idea about how fingersticks work, either.  A lot of people have been through the middle school exercise with the spear-sized el-cheapo lancets, where people lance their fingerpads and scream in pain, in hopes of getting blood.  (That's how I recall my experience, anyway.)

I show the outsides of my fingers, which always have some number of little dots, indicating recent test
sites.  I explain that the fingerpads have more nerves in them than just about anywhere else in the human body.  I use the outsides of the last three fingers on either hand, and I have no problem with typing or anything else (and I type quite a lot during the day).

One of my best friends, when I first told him of my condition, said, "So, no more salt for you then, huh?"

I'm still not sure where that came from.

My experience is that people may not know, but many are curious and willing to learn.  Most of those closest to me know a lot more than they did two months ago about what makes diabetes and what people have to do to treat it.  The ones who know me best of all know enough to not advise me on what I should or shouldn't eat.

There are those that will say, "Oh, you really shouldn't have any of this."  But even in those cases (yes, it bugs me, I think it ranks in the top-10 pet peeves of all diabetics, at least those who post on-line), most people are trying to be helpful.  Their hearts are in the right place, regardless of how it sounds to us.

The truth is that diabetes care has changed considerably in the last 10-15 years, and so a lot of the memories people have of grandparents, etc., may not be accurate anymore, but why would they stay current unless they had it or lived with someone who does?

So, I think it helps to be patient with people.  I think it helps to assume that they mean well.  After all, there are a lot more of them than there are of us, and I think we're all OK with that.  Meanwhile, we can take all the opportunities we can find to teach people about the way things are now.

Pizza Two Days in a row...

...and I'm still here! :)

Pizza is notoriously hard to bolus for, and I'm kind of old-school in that I'm using pens and a regular glucometer. (No pump, no CGMS.)

For me, it seems to be true that I can't overbolus for pizza.  I wound up taking 16 units for lunch (three pieces) and it worked out perfectly.

Still, my numbers have been consistently very good, and I've been very happy with what I've been doing and how it's been working for me.

Lots of people in the DOC seem to have been posting about their CGMS experiences.  The DexCom 7 seems to be a favorite.  I'll ask around locally about them; not sure what my insurance plan will and will not cover.  The opportunity to get readings every 5 minutes, and trending info, seems very important.

A Bit More on Ice Cream

I had some more ice cream tonight - normal ice cream, though for me, it was guilt free.  (Sorry, couldn't resist that one.)

I've done some research on ice cream, and consistently the lowest in carbs are plain chocolate flavors, which seem to run about 17g/half cup.  Other varieties may run as much as 25g/half cup for things with high-carb ingredients like Cookies and Cream.  Different flavors vary, so read your labels and dose accordingly.

I've seen other diabetic bloggers (and heard other diabetic friends) complain about ice cream and pizza frequently.  They seem to be relatively hard to bolus for.  (In my case, I went up 60 points after eating it - to 151.  A little higher than I'd like, but no reason to take drastic corrective action.  I took an extra unit and claimed victory.)  I think one of the things is that it's hard to get serving sizes precise with ice cream.  A scoop is close to a half cup, but sometimes the scoop wants to get more, or less.  Or maybe that's just me.

So we come back to the question of Sugar Free ice cream that was raised here a couple of weeks ago.  Is it worth it?

Most "sugar free" items feature about the same overall carb levels as regular ice cream - in the vicinity of 16g/serving.  Usually, a decent percentage of these are "sugar alcohols", a particularly unfortunate term since they are not truly sugar and not truly alcohol.  The reason these chemicals are used is that they are not completely absorbed by the intestines, which means they wind up passing through.  This leads to gas, bloating, and some other unpleasant consequences.  In the class I took from the CDE, we were told that you can subtract half the total "sugar alcohol" content from the net carbs.  So for most sugar free ice cream, that would be about 3g/serving, and most ice creams would net out around 13g/serving.

That may make a huge difference to someone on a very strict carb control diet, but I'm not in that situation.

I've illustrated for several people what it means for me to eat things like that, but showing how much insulin I'd have to take to cover it.  (You should see the way people's eyes pop when I show them what I'd have to take to cover a Sonic slushie.)  Most people, though, are still affected by the perceived horror of taking a shot every time they eat, and so they blow that aspect of it out of proportion.  The simple fact is that 3g more or less per serving is going to mean at most 1 unit of difference for me, and for smaller servings, could get lost as rounding error.

Let me put it another way - to eat anything more than a spoonful or two of ice cream, I would have to take *some* insulin.  So the big deal-maker or deal-breaker is not how much carb is in a given item, but whether or not I have to take insulin for it at all.  Since I'd have to take insulin for "reduced sugar" ice cream anyway, it's not compelling as an option.  Also considering that the most common way to get ice cream at most grocery stores is by the half-gallon (more or less), that would be a lot of servings to get through.  I've found that other members of my family will happily eat the lower-carb varieties of normal ice cream.

Does that make sense?  It seems to be a very hard thing for non-diabetics.  Mostly because a lot of them have a hard time getting past the idea that we inject ourselves a lot, so it's not the extra units that make a difference, it's whether we have to inject ourselves at all.  I'll happily eat something I don't have to stick myself for, so I eat a lot of almonds and peanuts, which net out about 2g carbs/ounce.

For Whom The Bell Tolls: The Strength of the Community

I've been trading some comments with Joanne at Death of a Pancreas.

I've been in technology for a fairly long time, and I spend a *lot* of time with computers.  One of my friends once described me as "the kind of nerd other nerds aspire to be", and he meant it as a compliment.

I have been reading and following a lot of blogs for a long time, and I toyed with the idea of starting one myself - I just wasn't sure I'd have anything useful to say day in, day out.  Then I was diagnosed with diabetes and I've got plenty to talk, think, and write about.

The big thing that pushed me over the edge, though, was reading several of the other DOC blogs - the standard stuff, like Six Until Me, some of the dLife blogs; Lee Ann's The Butter Compartment.  And several others.

They all have different, but very valuable voices, which come from different experiences.  Some have grown up with diabetes, some have children with it.  But the important thing is that we can all learn from each other, and we can all see that our hopes and fears and triumphs and frustrations are very similar, despite the particulars of each case.  And that's a very real strength in this community, and which makes me happy to participate in it.

I'm a big fan of Linux, the Free/Open Source operating system.  I originally picked it up because I was a novice computer science student, but it was Unix for a PC, and to a young CS student that sounded like magic.  The interesting thing about Linux, though, is that it is driven primarily by an online community, people who volunteer to improve it in various ways, and to help those who are new get accustomed to it and get the most out of it.

Of course, spending time with Linux has helped me immensely in my career, but I have also had the opportunity to give back to the Free/Open Source community.

My current favorite Linux distribution is Ubuntu, which is a Swahili word.  "Ubuntu" is one of those words that is very hard to translate directly into English (I'm told, I'm no Swahili scholar), but I'm told it approximately means "I am who I am because we are who we are."  It's part of the same mentality behind the expression "It takes a village to raise a child", and Donne's great "For Whom The Bell Tolls".  Linux is strong, and improving, because of its community.  And I really appreciate what I see from the Diabetes Online Community as well.

How can you not chuckle at the #Diabetesfacts, if you have it or live with someone who does?  How can you not love Shugasheen's "All The Diabetics" riff on Beyonce?  Different voices, but with a common cause.  I can relate to them, and I hope some of you can relate to what I'm writing here, too.