Wednesday, September 5, 2012

An Overwhelming Overview

One of the things I encounter are misconceptions about how T1D (Type 1 Diabetes) affects everyday life.

I knew nothing about diabetes before my diagnosis, except that my Grandma smelled like 'hospital' when she injected her insulin.  And when she died young, it was due to "diabetes complications".

Some people have asked me, "you just have to watch how much sugar you eat right?", as they get you a giant fruit salad because you can't have cake, or others, in the face of someone with "uncontrolled" diabetes say "why don't you just eat the same thing every day?"

As I said, before I was diagnosed, knew very little about the disease.  I learned (somehow) that "diabetics can't have sugar".  So when one of my T1D friends was passing out due to low blood sugar, I reached for the Diet pop. Not helpful, and in fact a dangerous misconception.

So in my desire to help others understand the magnitude and extensive reach of the invasive arms of diabetes, here is my list (by no means exhaustive, just exhausting) of what can affect blood sugar.

Food (let's get the obvious out of the way):

What you eat (not just sugar)
  • Carbs are found in every food to varying degrees that is not a fat (oils, butter, etc) or a protein (eggs, meat, etc).
  • Fat changes how your body absorbs sugar - I need to match how my insulin works with a fatty meal, which is different than a meal that is lower in fat.
  • Fiber and protein are very low in carbs (A hot dog won't budge my blood sugar, but the bun, sweet relish, and ketchup will!)
  • Fast acting carbs (simple sugars - white sugar, syrups, pop, etc) will raise my blood sugar quickly.
  • Along with carbs directly impacting blood sugar, PWD (People with Diabetes) are encouraged to limit their intake of fat and cholesterol.
When you eat
  • A regular schedule is encouraged for diabetics to reflect your body's natural ebb and flow (ever had a meal delayed by an unexpected appointment?)
  • Eating right before or after a workout? I need to know how the food will react with my insulin and stomach in both situations.
Medication (My drug of choice is Insulin via insulin pump):
Insulin works to lower the blood sugar. There are 2 reasons I take insulin - to cover carbs eaten (bolus) and as a continual background insulin (basal).  However, it's not that simple as there are many factors that impact my insulin needs.
  • Exercise - helps my body to use less insulin to cover the same amount of carby ground as a non-active day
  • Hormone changes - throughout the month my insulin needs change.
  • Weight changes - a loss or gain of even 5lbs can increase/decrease how much insulin I need.
  • Body's rhythm - throughout the day, the amount of insulin it takes to cover 45 grams of carb changes.  I use less insulin in the morning and mid afternoon than I do the rest of the day.
  • Site absorption - where I inject my insulin impacts my blood sugar levels.  My belly absorbs the most consistently, legs and arms are next however absorbency changes more rapidly with exercise, and my love handles are the lease reliable.  And though I would love to stick to the belly, scar tissue and other factors beckon me to rotate sites.
  • Age of site - by the fourth day of one injection site, my optimal insulin absorption wanes.
  • Age of insulin - insulin left in a hot car will render it useless, and insulin in a pump in a hot tub has the same results.
  • Timing - Insulin works best taken 15 minutes before I eat - but if I take it too soon and a delay happens, then it will lower my blood sugar too far.
  • Cardio - can lower my blood sugar rapidly, depending on how much insulin I have that is still active (IOB: Insulin on Board), unless my blood sugar is too high in which case no exercise is recommended.
  • Strength training (think weightlifting) also drops my blood sugar, but less quickly than cardio.
  • Daily chores and shopping are also included in this category as anything that involves physical exertion (*ahem* . . . any physical exertion) affects blood sugar levels.
Other Factors:
  • Stress - raises my blood sugar like you wouldn't believe.
  • Pain
  • Outside Temperature - on the hotter days my body uses insulin more effectively (it takes less insulin than usual to lower my blood sugar).
  • Hormone changes - everything from the once-a-month club (insulin needs may decrease but chocolate cravings increase!) to pregnancy.
  • Amount of sleep.
  • Illness and some medications (I have to take insulin if I want to take a dose of regular cough medicine due to the sugar content).  My blood sugar increases when my body is fighting an infection and is sometimes my first indication that I am getting sick.
  • Alcohol consumption.
To be able to comprehend how this practically plays out, imagine 2 scenarios:

Before a meal:  How many carbs am I eating (a SWAG (a Scientific Wild-@$$ed guess) is necessary if you are at a potluck or buffet)? How much fat? Will I be walking anywhere after this?  How far will I walk?  What about those 8 upcoming reports I have to get done this afternoon (stress)? I do still have IOB from my last bolus? When are we eating - how long will it take for the servers to bring our food out?

Before a walk outside:  What is my blood sugar now? Too high - can't exercise now; too low - need to drink a juice (my preferred vehicle for blood sugar raising - and btw, I can't think of the last time I drank juice just because it tasted good).  Do I have enough fast acting sugar for the duration of the walk if my blood sugar drops?  I do still have IOB from my last bolus? Too much IOB and my blood sugar will drop rapidly and often - taking more strength than the exercise would give me. Do I have my cell phone and i.d. in case of emergency? Do I have my tester and enough strips? Where's my Mp3 player?
A life with diabetes is far more complicated (excuse the term) than just managing what goes in my mouth.  It is broad and sometimes surprising.

This is not meant to overwhelm (contrary to what the title implies), just to inform.  Living with this disease for 9 years most of this feels second nature - but it is still a lot to consider day-to-day.

Any questions or comments, please post below!

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