Living With Diabetes: Bad Day

Yesterday I started crying on the subway.

Fortunately, I live in New York City, which meant that even though there were literally dozens of witnesses to my humiliation, no one asked if I was OK. I honestly would have had no idea what to answer except “fine”, which is so stupid – the most cliche answer to the most cliche scenario in the book – girl by herself, crying on the subway.

I wasn’t crying over a boy, though. I was crying over a 110 calorie, 14 g carbohydrate, 6g fat Skinny Cow Chocolate Bar. One of those “dieters can eat chocolate too” chocolate bar.

I’ve been craving chocolate for a few days. I’ve been thinking about it kind of a lot, and I decided to have some for a snack yesterday afternoon.

Unfortunately at the moment I’d arranged for my snack, my blood sugar came in at 207. There’s a few potential reasons for this. Perhaps because, as my MY PERIOD APP (yeah, no shame) confirmed for me yesterday, I am just within the 2-week window before I get my period, which unfortunately for me is all PMS, from a hormonal standpoint.

My blood sugar may also have been 207 because I took my insulin with lunch about 6 minutes before I ate. That was probably not long enough to wait between taking insulin and eating – it works best when it’s had time to “marinate” in the system – 20 minutes or so. Although when I’m PMS-ing I’ll wait longer – 45 minutes, an hour. However, the danger is that waiting too long can really backfire if the insulin is “too far gone” by the time you take in the carbs. Then, they won’t start to counter the insulin fast enough and you’ll get a nasty low that you have to treat with fast acting carbs, then the treatment carbs will usually kick in around when the original carbs finally kick in, and you’ll wind up way higher than you started. So, some days, waiting 45 minutes for me would be a disaster. Others it’s not even enough. It depends on a myriad of factors that, quite frankly, I’d never be able to know without a lab in my back pocket (basically boiling down to: what is the precise level of every hormone in my system at this exact moment.)

Yesterday, I certainly could have stood to wait longer than 6 minutes – probably by the time the insulin started to act on my system, the carbs had already run away with the thing, doing their dirty business.

My blood sugar may also have been high yesterday because I was pretty sedentary all morning – I’d been working at my computer. Then, when I did work out in the afternoon, I did strength training, which is one kind of exercise that can actually lead to blood sugar increases, at least in the short term.

There are, you can see, many reasons my blood sugar was high at that exact moment; any of the above, but it’s also possible there’s even more reasons that I don’t know about.  It doesn’t really matter. All that matters is that that moment, when I wanted to eat 110 stupid calories and 14 stupid grams of carbohydrate worth of whatever-the-heck, my blood sugar was WAY too high to do it. The thing about my diabetes is that if I take in carbs when I’m already high, I spike even higher, regardless of how much insulin I take with the carbs.

So, instead of eating the stupid 110 calories of fake chocolate that I’d been thinking about for three days, I waited.

Like a good little diabetic, I tested, I dosed insulin according to the 14 g of carb I hoped to soon eat and the correction I needed for my high blood sugar, and I waited. I set the timer on my phone for 20 minutes and I stared at that stupid fake chocolate bar while the seconds ticked down.

After 20 minutes, I checked my Dexcom. My blood sugar was starting to settle – yes, YES, YES, it was coming down — I was now sitting in the 180s.

“But you know what?” I thought to myself, “I’ve been running high today. I REALLY don’t want to spike to the 200s again; so I’ll let it go a bit longer.” God, I thought I was being so responsible. Waiting even longer for my stupid fake chocolate bar.

So I set my phone for 15 more minutes. I tried to do something else while the Skinny Cow bar sat there, looking insultingly insignificant given how much of my time and energy had already been devoted to it.

15 minutes later, my blood sugar had dropped another 10 points to the 170s. I had waited a full 35 minutes between dosing and eating, and since I was only eating 14 g of carbohydrate, I figured I could go for it.

I ate it.

Then I got dressed for my rehearsal, hopped on the subway, and was sitting on the train, with my Dexcom in its regular place in my pocket, when I felt that all-too-familiar buzz-buzz that means the Dexcom is alarming.

I took it out of my pocket.

200. HIGH it proclaimed in big yellow letters. (Dexcom uses yellow for “high”, red for “low”).

I tested. Eighteen minutes after eating the 110 calorie, 14 g carbohydrate, 6 g fat chocolate bar that I had thought about for 2 days and finally taken insulin the precise amount of insulin for, my blood sugar was 227.

And I started to cry.

I hate this.

I hate this. I hate this. I hate this.

I would like a day, an hour, a minute off. I would like not to have my mood completely determined by “how well” I do at this, especially since I am doing as good as I possibly, possibly, possibly can and I am still, objectively speaking, failing.

I say objectively because I literally have a 24/7 data feed that is providing me with unequivocal evidence of the fact that I am failing. I have not had a day in the last 2 weeks where my blood sugar didn’t spike to the 200s. That is failing.

And if one more person tells me to forgive myself, I am going to punch them.

Because this isn’t some kumbayah “be nice to yourself” bullshit – this is my life. Highs are bad, they are bad they are bad they are bad they are bad they lead to things like blindness and amputations and kidney failures. The stakes are too high for me to forgive myself. I don’t really care that it is not actually possible to do this perfectly: I need to do this perfectly. I feel I can afford nothing else.

When I start to feel like I’m getting better at managing this, at figuring this out, at getting to a place of acceptance or peace with this, I have a day like yesterday (or, frankly, today, which has not especially been any better), and everything grinds to a halt.

Reading over this post, I’m not exactly sure why I wrote it, except that it feels like the same impulse that I talked about in one of my first posts ever – that idea that I need to broadcast my failures to everyone before they start to get the wrong idea. In case you weren’t clear: I am not mastering diabetes. Diabetes is mastering me. I realize this probably came out as a big, whiny rant. Which I guess it is. I wish I were better at this – both at handling it and at writing about it in some way that would make me seem competent, beneficent. Or at least allow someone reading it to “get” something out of it. But I guess I’ll have to chalk this post up to “honesty” and call it a day, because that’s really the only valuable aspect of it, on reflection.

Let’s just assume the deep, brilliant, competent post will come next time, right?