When you live with T1 diabetes for a number of decades, some things just become habit and so integrated into daily routine, that it’s easy to overlook them. Carb count, test, bolus, test, adjust basal rate before exercise, site change, test, treat, test, correct. Repeat. As part of my normal routine, these things are so natural I barely think about them. But our lives are not consistent from one day to the next. We don’t wake up at the same time every day and work responsibilities vary.
I did a little day trip yesterday for work. Nothing too strenuous; I’ve certainly done crazier. But it was a long day that started at 4:30 AM and didn’t end until late at night. It consisted of 2 restaurant meals containing unknown carbs, irregular meal times, lots of sitting, being stuck in meetings where I couldn’t just stop and test, temp basal rates, and overtreating lows.
Here are the highlights:
4:30 AM: Wake-up. BG 133.
6:00 AM: BG 201. Argh. Temp basal of 0.9 for 2 hours. I was driving, so didn’t increase the basal as much as I normally would.
7:45 AM: Stopped to get coffee and breakfast. BG 192. Got my usual Dunkin Donuts egg-and-cheese wrap. Bolused (with correction) and did another temp basal rate of 1.0 for an hour. Switched off driving with a coworker.
9:00 AM: Arrive at our destination. Hit the Starbucks. BG is 212. Getting ready to go into a meeting, and don’t want to risk a low. Conservatively increase basal rate to 0.70 (normal basal rate at this time of day is 0.45).
10:00 – 12:00: During the meeting, I can feel my BG dropping, so I cancel my temp basal. But I’m in a meeting and have no idea what my BG actually is, so I just cross my fingers and make sure I know where the juice is in my bag.
12:00 PM: My BG is 108. Yeah, seriously. Have no idea how I made this happen, but whatever. We head to lunch and I stick to a meal that contains a minimal amount of carbs (salad and egg frittatta). I only bolus to cover 18 carbs. The salad dressing doesn’t taste sweet, so my bolus should be more than enough.
1:30 PM: Back in afternoon meetings. I test before heading into the meeting and see I’m 275. Seriously WTF? I correct because that’s just way too high, and set a temp basal rate.
3:00 PM: Crash. I have no idea what my BG is, but I am looking at something on a computer and the screen seems to be floating away from me. I am thankful I catch this. Thankfully, we’re not talking with people at the moment and just reviewing stuff, so I sneak 5 glucotabs (blech) and a fruit bar. I slowly regain my vision and composure. Meetings all conclude around 4:00. I test before I leave the building and am at a nice 112. Happy with that number, but a little concerned about how low I was before I treated.
4:00 PM: We walk several blocks back to our car. Feels good to stretch my legs and move. The walk is not brisk or anything, but when we get to the car, I am worried I’m going low so have a small snack, as I’m the one driving (and killing your coworkers with a bad hypo probably isn’t the best career move). But then I realize we’ll be sitting in a car for several hours, so I also set a temp basal. It all feels very schizo.
5:00 PM: Now I know I’m going low. And I’m driving. Shit. Thankfully, this happens as we approach a rest stop, so we stop and I switch off with my coworker. Gotta pee too, and test while in the bathroom. A heart-stopping 41 pops up. Three glucotabs in the bathroom, followed by a juice box and snack in the car. I feel normal again rather quickly.
6:00 PM: Arrive to restaurant. BG upon arrival is 220. Clearly, I overtreated. By this point, I am exhausted, hungry, and getting a little irritable. There was a long wait at the restaurant, but this actually works to my advantage, because I want to try and get my BG down before eating. I do a small correction, not knowing how long we will have to wait. We finally get a table about 30 minutes after arriving, and the food is amazing. It’s Greek and the fish and salad is PHENOMENAL. I bolus as best I can and even have a little spanikopita and a small piece of the best pita bread I’ve had in quite some time. The grouper is like butter, it melts in my mouth, and is served with perfectly-seasoned vegetables and a rice (which I don’t eat too much of for fear of rocking the diabetes boat).
8:40 PM: I drop off my coworkers at the Metro station. BG is 82. I have a small juice box to be safe. Basal is 0.5 and I leave that alone.
10:00 PM: Finally home and showered and in bed. BG is 83. I have already brushed my teeth and can’t stomach anymore juice, so I do a temp basal rate of 0.35 and go to sleep. I know, I know…
7:30 (next day): Wake up to a BG of 176. Argh
- Like a job, T1D requires constant multitasking, the ability to think quickly on your feet, and foresight. But the pay is non-existent and the benefits suck. They don’t even give vacation time!
- I do all this while actually doing a job too. As people are talking and I’m trying to process what they are saying, I am trying to do all this crap in the background to stay alive. It can be exhausting. No wonder I sleep so well.
- Diabetes can really be invisible. It’s not something I like discussing in the context of work (that’s just me, I don’t have any opinion of what others do in this regard). And I doubt that anyone notices what’s going on. Sometimes that makes it easy, because I don’t feel singled out, but it also sometimes leaves me feeling very frustrated because I don’t feel like I can say, “Hey, I don’t understand a word you’re saying right now because my blood sugar is 45. Can you give me a minute?” At the same time, there are situations in which I have to ask for help. I can’t operate a car if I’m low. That’s just reality. And sometimes it sucks and frustrates me, and sometimes it just makes me grateful and appreciative for the coworker who happily steps in and doesn’t say a word.
- Days doesn’t just affect me, but also the people around me. Whether it’s driving a car, doing my job, whatever, others around me are affected, even if I think diabetes is “invisible.”
- The above experience highlights all the variables that affect the management of T1D – food, activity level, stress, sleep (or lack thereof), schedule changes.
- Doing anything with T1D requires a lot of preparation & planning. Other than the things I had to prepare for work to do this simple day trip, I also had to prepare lots of stuff with diabetes in mind – extra infusion sets, test strips, extra insulin, snacks, juice, glucotabs, glucagon. I had to think about our schedule not just in terms of getting something accomplished for work, but also in terms of T1D. Will I have time to test? Grab a snack? Eat a decent lunch at a place where I can get something that will not cause my BG to skyrocket? Even when walking into a meeting room, I consider things like how my bag is positioned relative to me, just in case I have to grab a snack. Glucotabs are always on top so that I can quickly grab one if needed. Water is available to prevent dehydration (which leads to those pesky ketones). I’m constantly thinking one step ahead.
I don’t know how I feel about all of the above. On one hand, I feel like I’m complaining and that makes me feel guilty because, despite all this work, I am alive and healthy. I have access to cutting-edge medical technology, the internet, and many other things that mean diabetes is not the death sentence it was for me years ago. I am not disabled, I am productive. I am active. On the other hand, there’s a part of me that is frustrated that I’m still doing all this crap, because wasn’t there supposed to be a cure?
But life it what it is. I could be frustrated and wallow is self-pity, but I would miss out on so much. I’d miss out on the amazing things around me, the people I love, and the things I love to do. I’d also miss out on laughing, which is one of the best things life has to offer, even if that laughter is at the ironic bitch that is T1D:
My blood sugar at the conclusion of writing this post.