I met a good friend for coffee at Panera Bread.  I got a caramel latte (holy crap – it was amazing) and a breakfast sandwich of ham, egg, and cheese on an asiago cheese bagel (yum!). I bolused for the carbs in both and went on with my day.

After breakfast, I went by Walmart to pick up a few household things and found a nice case for my new iPhone 4 (love it!).  I also picked up some Midol because, for reasons unknown, I’m annoyingly bloated.  Seriously, I have cankles.  I asked my endo about it when I last saw him, and he wasn’t concerned.  So, knowing that Midol has a diuretic, I decided to give it a whirl. 

Finally, around noon, I was back home and feeling sleepy, so I decided a nap would hit the spot.  First, I grabbed the Midol, noticing that the pain reliever is Acetaminophen.  Crap. 

As all Dexcom users know, Acetaminophen is like kryptonite for the sensor.  But, I decided that the water retention was a more pressing issue and that I could go a few hours without Dex’s security.  Besides, I’d eaten a ton of carbs at breakfast, and though I bolused correctly for them, I’m so insulin resistant in the mornings that I usually have to correct.  It was unlikely that I’d go low.  So, I got settled in bed with my dog curled up against my leg.  Within a few minutes, I was out.

And here’s where Murphy’s Law comes in. 

The dream was my first clue.  In my dream, I was low.  And hungry.  I don’t ever dream about being low unless I’m actually low, so my brain decided to wake me up.  It took a few minutes, though.  I just laid there for a while thinking about how hungry I was.  It was then that I noticed the sweat.  I was drenched.

Sufficiently freaked out, I grabbed a liquid glucose thingy and downed it in one gulp. I don’t know if I fell back to sleep or if I passed out, but when I was aware of my surroundings, I checked my BG.  44 mg/dl.  After the glucose!

You guys know how I get when low.  I overtreat.  Over the next 30 minutes, I consumed one juicebox, half a sleeve of crackers, several spoonfuls of peanut butter, and a very healthy serving of Baja Fresh chips and salsa.  Happily, the shaking and sweating stopped.  Unhappily, you know what happened next.

My BG shot up to 297 mg/dl.  And so went the rest of my day:  rage bolusing for all the carbs I’d ingested.  

Damn, I hate lows.  But, I don’t have cankles anymore

When I made the appointment with a general practitioner, I suspected that I had diabetes. I had all the classic symptoms: extreme thirst, weight loss without trying, insatiable hunger, etc.  I was also getting recurring yeast infections and my fingernails were doing weird things.

When the doctor told me he suspected I was diabetic, I wasn’t surprised.  What did surprise me was his “treatment” idea.  The appointment was on a Friday afternoon.  The doctor (I can’t even remember his name) told me to fast all weekend.  NO FOOD FOR TWO DAYS.  He said that sometimes, doing this can “jump start” a person’s body and stop diabetes.  He made a follow-up appointment for Monday morning.

Knowing what I do now, I know that this was complete and total bullshit.  But back then, I didn’t know much about diabetes; I only knew the symptoms. 

So, I did what I was told.  I didn’t eat anything all weekend.  I drank gallons of water because my thirst didn’t go away, and I struggled with headaches, nausea, and dizziness the entire time.

When I got back to his office on Monday morning, he tested by BG.  I don’t remember the exact number, but it was somewhere around 400 mg/dl – even higher than it had been on Friday.

Instead of reaching the logical disgnosis of Type 1 diabetes, he accused me of cheating.  When I made it clear that I hadn’t had anything except water, he didn’t attempt to hide his doubt.  He declared me a Type 2 diabetic and gave me a prescription for Glyburide. 

For two weeks, I took the pills, and had significant success.  However, I had some horrible lows, as well.  Looking back, I know I was very insulin sensitive at that time, and the Glyburide just made my pancreas work harder while it was dying.  I’m convinced that those few short weeks I was on the drug hastened the near complete destruction of my beta cells.

I stopped taking the pills because the extreme highs and lows were impossible to manage.  I made an appointment with a new PCP, who prescribed Metformin.  I started off in small doses, but with each follow-up appointment, and no improvements, he increased my dose.  Met made me very, very sick.  I think I vomited at least three times per week while taking it.  And my BG stayed high.

After being hospitalized several times for near DKA (I never actually got to the critical point), I was referred to an endo. 

The rest of the story starts here.

But then you start to feel funny.  Sounds don’t sound right. The world doesn’t look right. And your brain is just not working right.

That’s when you finally decide to test.  And not long after seeing that 41 mg/dl, do the real symptoms arrive in earnest.  Sweating, shaking, dizziness, extreme hunger.  Do you get these symptoms because you finally know you’re low, or were they coming anyway? 

Damn, I hate lows.

Maybe I’m boring.  Maybe I’m disciplined.  Or maybe I’m just a big chicken shit.  Whatever the reason, the only thing I like to use to treat a low is juice.  It’s fast, predictable, and easy.  It doesn’t require me to chew, and they make them in these really nice little boxes that I can carry around everywhere.

As a backup, I carry glucose tabs.  I LOVED the BD brand, but they don’t make ‘em anymore.  So, I’ve converted to Dex 4′s Watermelon flavor.  They’re not bad.

I NEVER treat a low with any dessert item.  Desserts usually have lots of fat, which delays carb absorption.  When I’m low, the only thing I care about is getting back to normal, so anything that will make the process slower is out of the question. 

I have been known to inhale an entire bag of Sun Chips after drinking a juice box, though.

So, I decided to participate in Karen’s brilliant idea:  The First Annual Diabetes Blog Week .  All week, I’ll be blogging about the different aspects of my life with diabetes.  When I last checked, there were a TON of bloggers who are also participating, so when you’re done here, check them out.

Today’s topic is: A Day in the Life … With Diabetes

12:01am – 5:29am:  Sleep.

5:30am: Alarm.  Ugh.  I want to go back to sleep.  I decide to let Dexcom decide.  If my BG is in range, I’ll get up; if it’s not, I’ll correct and go back to sleep.  Dex shows a nice flat line with a BG of 87 mg/dl.  I decide that the agreement wasn’t in writing and, therefore, is not binding.  I roll over and go back to sleep.

6:08am:  Brian brings me a cup of coffee because he’s the greatest husband ever.  I slowly come to life.  I check my BG and confirm Dex’s assessment with a PDM reading of 92 mg/dl.  Thankful that my nighttime basals are spot on, I check my iPhone for email and Twitter updates.

6:18am:  I finally get up and stumble into the bathroom.  I brush my teeth, shower (thankful that I no longer have to suspend and disconnect a pump to do so), and get ready for work.  I peek at Dex a few times just to confirm that I’m not rising or dropping unexpectedly.

7:10am:  I do a quick finger test to confirm that it’s safe to drive – 102 mg/dl.  I hop (well, not really– it is still morning, after all) into the car and brave the Baltimore traffic.

7:45am: I arrive at work and unload my various d-tools that I’ll use throughout the day:  PDM, Dex, glucose tabs, iPhone, etc.

7:50am – 9:00am: I work. At staying awake.

9:00am: Prepare a bowl of oatmeal.  BG check is 100 mg/dl, so I inject 60mcg of Symlin and eat. 

9:10am: Finished eating, I bolus for the meal.

9:10 – 11:30am: Work.  Meetings.  More work. Bathroom break.

11:35am:  Dex shows that my breakfast bolus didn’t do its job.  I confirm with a finger stick and take 1.5U to correct.

12:30pm:  Lunch time!  Since I keep a mini fridge at work, I often have lunch stuff available.  Today, I decide to make a turkey and cheese sandwich with mustard.  Dex shows the correction dose finally dropping me to normal range. 

12:35pm:  I do a finger stick to check my BG: 112 mg/dl.  I dial up 60mcg of Symlin and eat my sandwich.  When I’m done, I program an extended bolus and get back to work.

1:10pm:  Feeling weird.  I hear Dex’s low alarm and, after a quick peek, I see that I’m dropping.  FAST.  Looks like the Symlin is working faster than the carbs are being absorbed.  SHIT!  I do a finger stick and look with almost disbelief at the 52 mg/dl staring back at me.  I have no idea what to do.  The Symlin will delay any fast acting glucose I take, so I won’t rebound quickly, AND I’ll be high later.  I decide to wait it out.

1:15pm:  WTF is taking so long?  I’m still hovering at 50 mg/dl.

1:20pm:  Sweating now?  Really? 

1:21pm:  Screw it.  I drink some juice and hope that it helps.

1:30pm:  Finally beginning to rise, I feel well enough to get back to work. 

2:38pm:  Dex HIGH alarm.  Son of a …!!!  Sure enough, finger stick shows 185 mg/dl.  Dex has one arrow straight up, so I know it’s not over.  I correct the 185 and continue working.

3:15pm:  Bathroom break.  Wash hands and test BG – 174 mg/dl.  Damnit!  Correct again.

3:45pm:  Pack up, test BG, and drive home.  Correction dose still not working, but I don’t want to rage bolus only to crash later.

4:15pm:  Home.  Aaaaaah.  I change clothes, go to the bathroom, pet animals, and clean up the kitchen.  I don’t even look at Dex because I’m tired and I just don’t care.

5:00pm:  Waiting for Brian to get home, I begin thinking about dinner.  I check Dex to see if carbs are even an option tonight.  Sure enough, I’m dropping again.  At least this time, it’s a gradual drop and not a jumping-off-a-cliff drop.  More like coasting, really. 

5:30pm:  Brian comes home.  We try to come up with a dinner plan.  “What do you want?”  “I don’t know.  What do YOU want?”  “I don’t know.”  This can go on for hours.

6:02pm:  Dex’s low alarm makes the dinner debate more important.  We decide to go out.  I grab a juice box, and we head out to the restaurant.

6:28pm:  We are seated.  The waitress brings bread (bitch!) and our drink order (iced tea, unsweetened).  After a few minutes, our salads arrive.  I test my BG with a finger stick – still too low for Symlin.  I begin eating the salad, which is soooo good.  I LOVE Carrabba’s Caesar salad. 

6:50pm:  Dinner arrives.  I ordered the Salmon with a pasta side, which I calculate to be about 45g carbs (for ½ of the serving).  I program a 30/70 dual-wave bolus for 2 hours – lots of fat in that lemon butter sauce – and dig in.

7:25pm:  Waitress clears plates and offers us dessert (bitch, again!).  We decline, pay the check, and go home.

7:56pm:  Home.  Again.  Aaaaah.  Dex shows two arrows straight up, so I know that the carbs are hitting me faster than I anticipated.  What to do?  If I attempt to head it off, I WILL go low later.  If not, I’m going to be spiking well above 250 mg/dl before it’s over.  I still don’t know what to do in these situations.  I wait.  I feed the cats and watch some TV with Bri.

9:30pm:  Dex has been bitching at me since we got home.  Since my extended bolus only finished a few minutes ago, I decide to wait a little longer.

10:00pm:  Bed time.  I wash my face, brush and Waterpik my teeth, apply zit cream (don’t even get me started on *that*), and put on PJs.  I grab a juice box from the fridge and put it next to the rest of my diabetes arsenal on my nightstand.  I check my BG with a finger stick – 213 mg/dl.  FUCK!  I take a correction bolus, turn off the lights, and go to sleep.

11:37pm:  Dex alarm – falling faster than 3mg/dl per minute.  Well duh!  I drink the juice box and hope that tomorrow is a better day.  But, I accept the knowledge that today was just another typical day in my diabetes life, and tomorrow is probably going to be similar.

I’ve written about my sister before, and she’s a common commenter on my posts.  Her latest scans and bloodwork did not yield good news.  Her cancer is growing.  FAST.  I’m angry and scared about what this means, and I fear that I’m going to have to step out of my denial bubble soon.  I like my denial bubble – it’s safe there.  I’m traveling to Florida to see her in a month or so, and I’m hopeful that her new treatment won’t leave her feeling sick, weak, or anything else bad.  I know she doesn’t want that.

You all know what’s going on with the fertility stuff.  I got more blood test results today, which indicate that I need more blood tests.  WTF?  My arms are already bruised from the last two blood draws on Tuesday.  Now, I have to go for more (they’re going to have to take a gallon or so for all of these tests!).  I HATE having my blood drawn – mostly because I have to deal with morons. 

The big D is a big B lately.  Almost every day, I’m going low right after I eat lunch, which causes me to treat and then skyrocket a few hours later (damned Symlin).  Today, I’m not eating until I bottom out.  I know that Apidra is a fast insulin, but I seem to have a much longer response time in the morning.  Not to mention my I:C ratio and basals in the morning are so much higher than the rest of the day.  I need an advanced math degree just to figure all of this nonsense out.  I really need a diabetes vacation.

So, that’s why I’ve been scarce lately.  My subconscious is desperately working on sorting all of this out, hence some very weird dreams lately, which have left me completely exhausted when I wake up.

On a happier note, I believe that by now, little BSparl has made her way into the world.  I want to offer Kerri and Chris my most heartfelt congratulations.  I’m very happy for you all.

1.  Some people were “put off” by the way I responded when they offered me candy during said low.  Evidently, I was too stern in my insistence that I drink juice to treat.

2.  People are getting offended when I do not want to try their homemade cakes, cookies, Indian dishes, or other carb mysteries.  As you guys know, I can SWAG, but I’d rather not have to – especially when I’m desperately trying to get my A1c down.

So, here’s what I wrote:

Team,

I know that some of you already know this, but for those who don’t, please be aware that I have Type 1 diabetes.  Due to this, I sometimes experience episodes of extreme high or low Blood Glucose (BG), which can affect me in odd ways.  I work very hard to keep my BG steady, but it is a 24-hour-per-day job, and sometimes, I fail.  I use an insulin pump, which provides me with a constant supply of insulin.  I also use a Continuous Glucose Monitoring System (CGMS), which will sound an alarm if my BG goes too high or too low (everyone who sits near me will hear this beeping from time-to-time).

If you see me, and I appear to be drunk (i.e., slurred speech, stumbling, passed out, etc.), I am most likely having a very low BG reaction (i.e., too much insulin in my body).  I keep a supply of fruit juice in the small refrigerator under my desk – this is what I use to treat low BG.  If I’m low, please help me to drink some juice.  If I’m unconscious, I keep an emergency GlucaGen Kit in my purse (in a bright orange plastic container).  Inside the container, there are instructions on how to mix and administer the injection.  I understand if some people are squeamish around needles, so if you are, please find someone who isn’t ASAP (you could save my life).  In all of my years of having diabetes, I have NEVER had to use the emergency kit.  I don’t intend to start now, but sometimes crazy things happen.

For the most part, I try to avoid foods with unknown carbohydrate values.  This makes pot lucks and other food-sharing activities difficult.  Please do not be offended if I am unwilling to try a particular dish – it has nothing to do with the cooking or the cook.  It’s just about my need to keep my BG as steady as possible.  Keep in mind that I *can* eat anything, so if you see me munching on birthday cake with everyone else, don’t scold me.  As long as I know the carbohydrate count in any food, I can program my insulin pump to accommodate it.

Finally, please do not be offended if I seem short-tempered or overly emotional when I have low BG.  This is not something that I can control, and a short temper is usually my first sign that my BG is dropping.  But other times, I may look and sound perfectly normal – that’s why they call it an “invisible illness.”  Usually, the one symptom of low BG that I always have is an inability to speak.  When I’m low, I just can’t make my brain connect with my mouth.  Again, please don’t be offended if I don’t respond to you right away.  FYI – other visible symptoms of a low BG are sweating, shaking, pale color, and rapid breathing.

So, if you have any questions about diabetes (the most common questions are about the difference between type 1 and type 2), please feel free to ask.  I’m an open book about this aspect of my life.

Thanks in advance for your help and understanding.

Shannon

I wrote that I was afraid to say it out loud, but it looks like the Symlin is working.  I can’t remember the last time I went for 24 hours without a single high or low alarm (which are set for 180 and 70, respectively).  I usually spike up to the mid-200s after meals, even when I bolus early.

But, since using Symlin, I’ve managed to avoid those spikes, I’m taking less insulin, and I’ve lost three pounds.  I’m eating less food because it takes very little to fill me up, and what I do eat is better for me.

I know that there is probably a huge psychological element to this – I think I should be full, so I feel full, etc., but I can’t discount the physical stuff, either.  I can’t ignore the nausea that I feel after every meal – believe me, I’ve tried.  And I can’t deny what my eyes are seeing – fewer BG spikes after meals.

I’m up to 60mcg of Symlin before every meal, and my plan is to go all the way to 120mcg.  I even had Dr. S. call in the Rx for the 60/120 pens.  I figure that if I can’t tolerate 120mcg, at least I can still use the 60mcg setting (and get 2x the meds at the same copay).

So, if anyone out there is desperately trying to lower his or her A1c, experiences high BG spikes after meals, is becoming insulin resistant, or just wants to reduce the TDD of insulin, think about giving Symlin a try.  Yes, the side effect sucks.  I hate nausea more than most people, I think, but it’s worth it.

********UPDATE*********

Not long after writing this post, I was cursed with an inexplicable 237 mg/dl.  WTF?

Symlin works by replacing the natural Amylin that, in non-Type 1 diabetics, is secreted by the beta cells of the pancreas.  It works by delaying stomach emptying, which helps you digest slower.  It’s also that little voice in your head that tells you when you’re full.  Since I am beta cell challenged, my body doesn’t make Amylin, which is why I often feel hungry even after a satisfying meal (= weight gain).  It’s also why my BG can easily spike to 300+ after I eat, which = more insulin, which = weight gain, which = insulin resistance, which = weight gain, which = well . . . you get the point. 

As it happened, George (a.k.a. Ninjabetic) also decided to start Symlin again.  He and I had very similar beginnings with Symlin, and we were both reluctant to try it again.  So, it’s really nice to be doing this with someone else who knows what it’s like. 

As you know, I started on Tuesday night at just 15mcg (the absolute minimum for a Type 1).  Yesterday morning, I skipped breakfast, so no Symlin.  Truthfully, I was feeling a little nauseated, and I wasn’t sure if it was from the Symlin or just general morning crappiness.  I was super-busy at work, which meant that lunch was upon me pretty quickly.  Knowing that I had a meeting at 1pm, and feeling the desperate need to get a home pregnancy test because my period is still MIA, I quickly ran to the drugstore for the test and Chick-fil-A for a salad. 

Back at the office, I peed on the stick.  Negative, which was no big surprise, considering . . .  Even still, I was disappointed and relieved at the same time.  After all, I’m taking meds that are not pregnancy safe (Lisinopril and now Symlin).  Still, it sucks to see that one lonely line on a pregnancy test time after time. 

Anyway, back at my desk, I dialed up 15mcg of Symlin and ate my lunch.  I programmed a 60-minute square wave bolus on the pod and watched Dex like a hawk.  Sadly, my BG began to spike within 30 minutes, and it went high (like mid-200s high).  Then the nausea hit.  I felt like complete shit.  It was weird because it was more severe than the night before.  As George, Scott, and I were discussing last night on Twitter, it feels like you’ve got food stuck at the very bottom of your throat.  I don’t know how else to explain it.  Whatever.  I wasn’t going to let this nausea screw with the potential benefits of using Symlin.

So, last night before dinner, I decided to up the ante.  I dialed up 30mcg on the pen and bravely took the shot (it stung, too!).  I ate my dinner (about ½ of my typical portion size) and waited for the nausea.

It didn’t come.  As soon as I finished eating, I got up and started cleaning.  Keeping busy really seemed to help.  My BG remained steady and under 150 mg/dl before dropping slightly.  I tested before going to bed and was 145 mg/dl.  Hearing Dr. S.’s voice in my head (he wants me under 100 mg/dl in the morning), I did a small correction bolus and went to sleep.

Sometime around 11pm, I heard a low BG alarm.  I grabbed Dex from my nightstand and saw that I had dipped just below 70 mg/dl.  However, a finger stick showed me at 75 mg/dl, so I didn’t treat and went back to sleep.

At 1:30am, Brian’s stupid on-call phone for work rang.  I woke up instantly.  A quick peek at Dex showed me still hovering in the low 60s.  A finger stick confirmed, so I decided to drink a very small glass of milk.  This was definitely the right thing to do.  I woke up this morning at 99 mg/dl (hey, it’s under 100, right?), and Dex showed a nice flat line all night.  I felt pretty good, although tired because of the phone call. 

I got to work, dialed a 30mcg dose of Symlin for my modest breakfast (45g of carbs).  I programmed a 30-minute square wave bolus this time to prevent any spikes. 

That was an hour and a half ago.  My current BG is 157 mg/dl, but it looks like I’m rising fast.  I’m going to keep trying different ways to get the most out of Symlin.  I am anxious to get up to the 60mcg dose, which has more weight-loss benefits.  But, as it is, I’m eating much less than I was, so that’s good.  I’ve read that some Type 1s are able to tolerate the 120mcg dose, which offers the highest weight loss benefits.  I’m going to shoot for that, but I’m prepared to stick with 60mcg if necessary.

Overall, this experience with Symlin has been significantly more positive than my last attempt.  It’s something I’m determined to stick with, so I’m not going to let a little nausea derail me.  I’m committed to losing this weight, dammit!

I admit that I rebelled a bit.  I also got lazy.  I was just so tired of the tight control and limitations.  I went a little nuts.  I have the weight gain and lousy A1c to show for it. 

All other tests were good.  BP was “excellent” according to Dr. S.  He also said that I’d *lost* two pounds since my last appointment.  This just doesn’t seem right, but I wasn’t about to argue.  He gave me a list of group meetings and events (read: support groups) for Type 1s and encourage me to attend.  I don’t know if I will – I admit that it would be nice to meet some other Type 1s in person, though. 

As I mentioned yesterday, I wanted to talk to Dr. S. about Symlin.  After looking at my A1c, Dex graphs, and logbook, his initial feeling was to further increase my basals.  Since I had decided that I was not going to let that happen, I needed to find an alternative.  See, *I* think my basals are too high as it is.  The highs I’m experiencing aren’t the result of too-low basal settings; it’s because I’ve been eating like shit for months and, more often than not, SWAG bolusing.  So, I’m high because I didn’t count carbs correctly.  Sure, I correct, but once I’m high, it’s so hard to get back down. 

Which, once again, led me to the Symlin talk.  I’d tried it once before and gave up after a few days.  I was told that it is not indicated for pregnant women, and since we were actively trying at that point (and blissfully unaware of our fertility issues), I decided that it was best to stop.  To be honest, I was not heartbroken to lose the awful nausea that accompanied it.  But, the thing is, I never really gave it a chance. 

In preparation for my appointment, I did a bunch of research.  I learned that the nausea goes away pretty quickly and that the key is to stick with it.  I learned that some people have lost huge amounts of weight thanks to it.  I learned that most decrease their boluses by at least half.  All of these facts solidified my resolve to give it another shot.

So, just before dinner last night, I dialed up the minimum 15mcg and gave myself the shot.  I ate my meal slowly (I did notice that I got fuller faster) and waited.  I carefully calculated the carbs in what I ate (49 grams total), and programmed a 60-minute extended bolus.  And I waited. 

Sure, I felt a little nauseated, but nothing too extreme (I definitely didn’t feel like I was going to puke or anything).  I wasn’t hungry either, which was nice.  I often feel hungry even after eating a decent meal.  Dex showed almost no movement in my BG for over an hour.  Since I was super exhausted yesterday, I went to bed early. 

At 11:53pm, Dex beeped.  The dreaded low alarm.  I looked at the screen: 68 mg/dl.  Not too bad, but I did a finger stick to confirm:  66 mg/dl.  Since Dex indicated a downward trend, I decided to drink a juice box.  Then, I did something really stupid.  I programmed a temp basal of 50%.  I was spooked; I admit it.  I didn’t want to have a horrible low that would be difficult to treat because of the Symlin (I’d read that this happens).  I wanted to play it safe. 

Just as any sane person would expect, a few hours later, my BG started to climb.  Nothing drastic – I was sitting at 150ish.  Then my usual Dawn Phenomenon kicked in (I have a basal rate that is more than two times greater during the hours of 5am-8am).  A temp basal of 50% was not going to make a dent in that train wreck.  After my shower, I was sitting at 180 mg/dl and climbing. 

Since the pod was due for a change, I swapped it out and canceled that stupid temp basal.  Now, as I write this at 9:16am, I am at 189 mg/dl.  This is despite two decent correction boluses.  I know the crash is coming, and I’m ready for it.  I’m just pissed off at myself for giving in to the fear.  It’s the fear of lows that gives me a 7.5% A1c.  It’s unacceptable.

Ugh, diabetes, I hate you.

**UPDATE**

As I wrote this post, I got a call from the fertility doc’s office.  They wanted to tell me that they’d received a copy of my A1c (which the nurse described as “elevated”), and that for conception, they want it to be under 6%.  As if I didn’t already feel shitty enough.