Just Call Me a Super Hero

How’s that for an attention grabbing title?

I feel like a super hero after the night we had. Chad was set up on his pump yesterday! YAY. We went with the Tandem T:slim. It seemed to be operator friendly. He isn’t a techy guy and it’s the one he felt most comfortable with. It’s amazing that he can dose whenever. He doesn’t have to dread the shot. he doesn’t have to “catch it up later”, because he dreads the shot. WE LOVE THAT PART!

However, it was a bit of a rough night. I told him I would get up several times to check his blood sugar, since it was the first night on the pump. He was 125 at bedtime and more than 3 hours after dinner, which is an amazing blood sugar for him. For the first time ever, he didn’t eat a snack or anything. That trust and confidence was so hard! When I woke up at midnight, his blood sugar was 50. I gave him about 40 carbs of chocolate milk. I woke up at 3 to check and his blood sugar was 70. Another 40 carbs! When he woke up at 5, took forever in the bathroom,  was stumbling a bit, I got up and checked him. 36!!!!

I told him it was okay to go into work late. Usually he doesn’t. He gets back on the saddle and makes it into work on time, but I wanted to make sure he was okay first. I quickly googled “How long does Lantus stay in the system?” He was taking it twice a day, half a day’s dose at 8am and the other half at 8pm. His trainer set his pump up so his basal (this is the background insulin that runs continuously all day) didn’t start until after 8pm last night, but we are pretty sure he still had the Lantus from yesterday morning in his system as well, since it can last 18-26 hours! He conferred with his trainer this morning and she agreed that it was likely. Just to be safe she walked him through lowering the basal rate just a bit. (from 2.0 per hour to 1.8 per hour)

As far as the first day on the pump, he is loving it. He really likes not having to take shots. He loves that he can input his blood sugar and carbs and it will figure out his insulin dose. This is a new thing for us and we are fumbling around a bit, but in a week it should be second nature. He has done one infusion set. He will be doing a cartridge change and infusion change tomorrow morning with the trainer.

He has been approved for a CGM (continuous glucose monitor). This will be his next step.

I am hopeful that today will be a better day. He did end up going to work and got there just a little late. He is an excellent family provider and he hates missing time from work. Sometimes diabetes comes first!

ETA: I guess I should explain the super hero comment. I feel like a super hero after saving his life three times last night. :p I’m tired, it makes ME feel better.

Diabetes is so easy to manage!

I think that anyone who has actually dealt with diabetes can hear the sarcasm dripping from that title. Or they were shocked and wondered what kind of snake oil I was going to sell. No snake oil here!

We are back to the insurance company only wanting to cover 1 test strip per day. “102 every 90 days”. Part of having any semblance of control is knowing where you are at. How can anyone do that on ONE test strip per day? I shouldn’t have done this, but I gave up. I said I would just pay out of pocket for them. I know that this gives the insurance  company what they want, which is more money in their pocket, but come on!

To break it down again, my husband has double insurance coverage. Generally the secondary picks up any co-pays or costs that the primary did not pay for. So, 3 test strips a day, leaves a $50 co-pay for us, which the secondary was picking up. They refused to pick up the $50 co-pay for 4-6 strips per day. It didn’t cost them any more, but they still denied it. Now they are back to saying that they will only cover the 102 every 90  days. We tried to explain that he is type 1, because the 102/90 is what they pay for type 2, while they do 102/30 for type 1, but somehow it’s not getting through. I just need the darn test strips, ok?

We have started the process to get an insulin pump for my husband. This should be helpful in managing his diabetes, if the stress of the process doesn’t kill him first. We met with the doctor, who sent  the information to the pump supply, who contacted insurance. Insurance will not consider paying for the device until he does a blood test that shows the level of c-peptides in his body. A Type 1 diabetic has low or no c-peptides, while a type 2 could have normal peptides. From my research, it seems that they would require a person with normal or high peptides to control their diabetes through diet and exercise. Since my husband is type 1, this is  not going to happen. 45 years of medical records seem to make little difference.

There are two requirements for the test:

  • fasting after midnight
  • blood sugar below 150

The first night, I woke up shortly before midnight and checked his blood sugar. It was 82, so I had him drink some chocolate milk. I woke up again at 3, and it was 62, so he had more chocolate milk. He could not do the test because he was no longer “fasting after midnight”. Last night, I checked him at midnight and he was a little on the high side, so I woke him up and had him take a shot. He was still too high this morning for the test, so we will have another go at it tonight.

It’s really frustrating that I know other diabetics who have taken this test, but they were not required to have a blood sugar under 150. Generally, he is under 180 in the morning, but it is rare that he is under 150. Even if he was under 150, there is no guarantee that it won’t go up between  here and the doctor’s office and waiting to be called in for the lab. Or, it could go the opposite way, he could be under 150, but drop rapidly because he has been fasting since midnight.

We will do this. WE WILL. I am flabbergasted at the amount of frustration that a insurance company is willing to cause a diabetic. He wants a pump to have better control over his diabetes. He wants a pump to have more normal blood sugars. Making my husband meet a list of requirements, although short, makes him feel like a failure when he doesn’t meet them.

We would love your prayers for better results tonight. If he could get this part out of the way, I know he will feel victorious.

Hi, Hi, Hi

Or high, high, high, Whatever the case may be.

Chad had a doctor appointment yesterday. He got a cortisone shot in his hip, because he had what presented itself to be bursitis. His blood sugars have been pretty good, but after the appointment, he had a tough time keeping it below 300. It was fine at lunch, then skyrocketed after that. We could say it might be what he had for lunch, but it was left over dinner, so who knows. He was thinking it might be the cortisone shot.

Last night he took about 20 units of insulin to compensate for the high blood sugar and the birthday cupcakes we had for our 10 year old. This is way more than he usually takes, so I got up at 2AM to test his blood sugar. It had dropped a little, but it sky rocketed again this morning, and was still high near lunch time. He called his doctor and they said “Don’t eat carbs and go for a walk”. He texted me along with a “WTF” for emphasis and I said “Well,  that sounds like a pretty good plan, actually”. So he ditched the left over lasagna from his lunch, but ate everything else. He texted a bit ago and said his blood sugar was 160-something. So that stinky old doctor’s advice must’ve worked.

I told him to be patient and ride it out, because panicking creates the yo-yo affect, Sky rocket, plummet, over compensate, repeat steps, which is just frustrating. You really do have to be patient  with diabetes (when it’s not an emergency, OMG get the Glucagon situation). It’s hard to ride it out though, because we’re human and we want things to be better five minutes ago.

The good news is that his A1C is down to 6.8%! His doctor was impressed with his A1C and cholesterol numbers. His kidney function has declined a bit in the past year. I really wish they would give more information than just “kidney function is declining”. WHAT DOES THAT MEAN? I’m assuming that if it was  an emergency, they would say more?

And the pump lady called to set up an appointment. We are one step closer to pumping that man up. 🙂

How Low Can He Go?

The right amount of carbs + the right amount of insulin = Diabetes Bliss

The right amount of carbs + too much insulin = Diabetes Hell aka a low blood sugar

My least favorite thing about diabetes is the low blood sugar.

This is my husband

IMG_0313

This is my husband with a low blood sugar

Chad blood sugar beachThe difference may be so subtle that many people wouldn’t even notice. I don’t like this picture. It is a reminder of the time that I was so focused on something else that I didn’t notice he was not “right”. Usually I can look at him and tell by his stance, the look on his face, the way he holds his hands, and the way he talks to me. On this day, I completely missed it, and he had to bring it to my attention. A few days later I was looking through the pictures I had taken and it was as clear as day.

According to WebMD, symptoms of a low blood sugar include:

I normally have a sixth sense when it comes to my husband and his blood sugars. I called him from work a few years ago and knew he had a low blood sugar. I was too far away to help in a reasonable amount of time, so I called the paramedics.

Low blood sugars can be caused by too much insulin, too little carbs, and exercise. It happens when the body does not have enough glucose in its blood stream.

I asked my husband what it is like to have a low blood sugar. He said that for him, low blood sugar leads to confusion, exhaustion, and feeling like it is extremely difficult to move. I looked at him and smiled. “That explains the time you kept telling us your feet were glued to the floor”. He said that is exactly what it feels like, as if he is slogging through mud and it takes all of his strength and effort to lift his feet one more time. I asked if he knows that he is having a low blood sugar. He said “Sometimes, but it’s like I am in an alternate world. I know that’s what it is, but I can’t figure out what to do to take care of it.” He also said that diabetes likes to trick the brain. His body feels off, but his brain keeps telling him he is okay.

My daughter says that the scariest time for her was a day we were at Goodwill. My husband was shopping with the kids elsewhere in the store. I hadn’t seen him for a while. My daughter came up and said “Something is wrong with daddy”. It was very crowded and I had a hard time finding him. When I did, he was staggering like a drunk. I found a chair and sat him down. We had been at Target prior to Goodwill and I just happened to buy an orange juice. I had taken a sip of it, then put it back in my purse. His blood sugar was so low that the bottle didn’t help much. I grabbed a bottle out of their cooler and gave that to him. We’ve had to do this a few times over the years, and I do it knowing that I could risk making an employee angry. I don’t care. 🙂 Sometimes, like that day, a low blood sugar comes on so quick that he doesn’t have time to react to it.

Night time is the worst, because it is generally 8 hours of untreated diabetes. If you are resting, you are not testing your blood sugar. Lucky for my husband, I don’t sleep. Okay, I’m kidding. I do wake up several times a night to check on him though. I don’t always check his blood sugar, but I make sure he is breathing and not sweating. When he is sleeping, I can predict a blood sugar by the way he breathes and if he is sweating. A low blood sugar sweat does not present itself in the same way as “this room is way too hot” sweat.

I wish that people who know he has diabetes understood better the signs and symptoms of a low blood sugar. Last week, I made a spur of the moment decision to visit him at work. I didn’t tell him I was coming, I showed up. When I walked in, he was glad to see me, then he said “I’m not doing well”. He sat down and tested his blood sugar. It was 32. (anything less than 70 is considered low, although he is much more functional at 67 than he is 32) Even while he was treating his low blood sugar, his co-workers were talking to him, asking him questions, and trying to push him out the door for lunch.

If my husband has calculated his carbs and his insulin amount, he can’t decide halfway through that he just isn’t hungry anymore and skip eating the rest of his meal. Since he has already dosed for the entire meal, he’s kind of stuck eating the entire meal. It’s pretty inconvenient.

A low blood sugar can be relatively easy to counteract, you just have to catch it. One of the challenges we face is his insurance company only wants to cover 3 test strips per day. One for breakfast, one for lunch, and one for dinner. Without insurance coverage, test strips are very expensive. He needs to test, at a minimum 4 times per day. (He needs to test before bedtime) If he feels off, he needs to test. If his blood sugar is low, he needs to treat it and retest in 15 minutes. It is very hard to get by on just 3 strips per day.

Have you ever seen someone with a low blood sugar? Do you know how to treat it? The general consensus is 15 grams of fast acting carbs and retest in 15 minutes. I’m official. I have glucose tablets in my purse at all times. 

What is a Carb and Why Does it Matter?

I Googled “What is a carb?”

Google said “Short for carburetor”.

Close. It wasn’t quite what I was looking for.

Carbohydrates, what they are, and how they affect the body are as important to a diabetic as insulin.

Let’s start with what a carbohydrate is. A carbohydrate is defined as: any of a large group of organic compounds occurring in foods and living tissues and including sugars, starch, and cellulose. They contain hydrogen and oxygen in the same ratio as water (2:1) and typically can be broken down to release energy in the animal body.

Um. What?

Foods with carbs are typically pastas, rice, bread, potatoes, sweets, sugars, etc. Carbs! Glorious carbs. I love carbs. 

That sounds simple enough, but it gets tricky when you learn that there are simple carbohydrates and complex carbohydrates. Simple carbs are sweets, white breads, potatoes, sugar, sodas, donuts, etc. Fruits and vegetables also consist of simple sugars, but the body processes them like a complex carb.

Complex carbs are carbs that take the body longer to break down and process. This gives a more steady release of sugars throughout the day and is better than the spike and dip of simple carbs. Complex carbs are whole wheat (rice, pasta, bread). Complex carbs are better for everyone.

Just to complicate things, one carb doesn’t always equal another. 15g of carbs from a bowl of cream of wheat affects my husband differently than 15g of carbs from a potato. If only one equaled another. He has to keep track of how many units of insulin he needs based on carbs and also has to remember that sometimes he needs to take more or less for one food than another.

The body uses carbohydrates for energy. The moment you put it in your mouth and swallow, your body starts processing it. Carbs cause your blood sugar to rise, then your pancreas produces insulin to absorb blood sugar for energy or storage.

Unless you’re diabetic, because your pancreas is broken and not producing insulin. A non-diabetic person’s body automatically calculates how much insulin you need and distributes it.  A diabetic has to do this calculation themselves, taking into account current blood sugar and carbs to be consumed. Then they administer the insulin (synthetic) their body doesn’t produce. Without insulin, your body doesn’t know to level off. A normal blood sugar is under 140. Kycie was admitted to the hospital and diagnosed with T1D. She had a blood sugar of 1,148. This is what diabetes does!

I imagine that for a typical person, the amount of carbs in a food is not particularly important. It seems most people know there are good carbs and bad carbs, even if they like to indulge in the bad. A diabetic needs to be aware of the carbs in any and all foods and drinks that they consume. It’s not as simple as it sounds. Some food doesn’t come in labeled packaging and if it’s a vegetable, you might not think there are carbs in it. Carrots have carbs. My husband loves carrots, so he needs to be careful to either dose for the carbs, or not to over indulge.

I don’t know why anyone would willfully over indulge on a carrot, but hey, that’s me. He sings his own songs. 

Fortunately, these days, information is practically at our finger tips. It is very easy to search “How many carbs are in a carrot?”. 6g for one carrot, in case you were wondering. With this information, a diabetic can calculate their insulin dose, inject and eat. My husband would not dose for one carrot, but if he was eating 3 of them, he would need to do so.  (There’s a calculation and it’s not a one size fits all formula and if you figure out YOUR formula, it can change. Because it wants to. Diabetes is its own boss, it doesn’t need a reason.)

My husband has to be aware, all the time, of all the carbs. If he thinks he doesn’t need to count a carb, he is usually wrong. On Saturdays, we like to grab a coffee. He always gets a sugar free Double Torture. He used to never dose, but then we found out there are 16 carbs in the milk they use. He started injecting two units of insulin prior to drinking it, and hasn’t had wild blood sugars like in the past. “But I only had that sugar free drink!”. Sugar free does not equal carb free and it matters!

Sometime we’ll talk about that time that the waitress served him a regular drink, instead of diet. Fortunately he noticed. We can’t imagine what 38 extra carbs not accounted for, would have done to his blood sugar! By “noticed”, I mean after he drank practically the whole glass, he pushed it across the table and said “I don’t think that’s diet”. I tasted it, confirmed it was not. So he recalculated his dosage, with the extra carbs included.

Carbs. They matter.

Please don’t take anything I say as gospel or fact. Do your own research, talk to your own doctor. If you see a mistake I’ve made, please bring it to my attention. I wrote this based on personal experience, reading, dietitian appointments, and internet searching. I am not a professional, just experienced. I’m going to get to some fun stories some time. I’m starting with the basics. Ha. None of this sounds basic though. Even writing it down makes my head spin and I am not sure how we do it.  

Sources:

http://www.diabetesforecast.org/2011/mar/how-the-body-uses-carbohydrates-proteins-and-fats.html

http://www.everydayhealth.com/diet-nutrition/101/nutrition-basics/good-carbs-bad-carbs.aspx

http://www.hsph.harvard.edu/nutritionsource/carbohydrates/carbohydrates-and-blood-sugar/

http://www.webmd.com/diabetes/how-sugar-affects-diabetes