I confess…

I’ve been cheating on the DOC with Reddit.  Does anyone else read the Diabetes sub-reddit?  I really enjoy it.  Check it out!

After my awesome A1c results last week I, of course, had to share with my Reddit friends.  One person asked me to list 10 changes I’ve made to make such an improvement in my A1c (I went from 7.9 in April to 6.8 now, however a year ago, I was 8.7!)  Of course the first thing I thought when this person asked was: “Blog Post!”  I love to make lists.  If you ask the hubs, I make them for him pretty frequently – 10 Reasons why I miss him while he’s away (there’s no one around to kill spiders!), 10 reasons why I am excited for the weekend (Sitting on my butt is better than working, duh!), etc.  The lists.  I make them.

So, without further ado, here are 10 changes I made to improve my A1c:

1. I switched to sugar-free flavored creamer. When I first got my CGM I noticed that I was spiking big time after breakfast, even if I was bolusing to cover the carbs. Not willing to give up coffee, I switched to SF creamer and that has helped a lot.

2. I also gave up cereal. I eat a bagel and cream cheese for breakfast most mornings. I should have more protein but so far I’m doing OK, blood sugar-wise.

3. Getting the CGM period. It’s been amazing to know what my BG is doing at any given moment. I’ve been very attentive to it and adjusting my insulin when needed to keep me in range.

4. Baby-stepping my high alert on the CGM down. It started at 200 and I’ve gradually gotten it down to 160.  I think if I started with a high alert of 160 right out of the gate, I would have gotten frustrated with all the beeping.  If Bob can do it, so can I.

5. Communicating with my CDE a lot! I’m lucky in that she is very receptive to emails. I send her my reports every couple of weeks and she makes small tweaks. She’s noticed patterns I never would have noticed before.  She has quickly become my diabetes care BFF.

6. Getting back on the pump, in general.  For me, it’s much easier to correct those pesky high numbers with a couple mini boluses or temp basal.  A little more difficult and time-consuming to do on MDI.

7. Pre-bolusing for meals. It takes me about 30 minutes to get ready in the morning and halfway through I bolus for breakfast. Since I eat the same thing every day, it makes it easy.  I also pre-bolus for lunch and dinner too and I think it really helps prevent those after meal spikes.

8. Using combo boluses when I eat high fat meals.  I will master you, pizza.  I will.

9. Trying (although not always successful) to cut back on processed foods.

10. Really paying attention to the 15-15-15 rule when I’m low. Although this doesn’t always work (especially over night!).

It honestly hasn’t been a huge lifestyle adjustment or anything. I’ve just made diabetes a priority.  I know that I feel better physically and emotionally when I’m in better control of my blood sugars.

The weight of it all: One down, many more to go!

WooHoo!  Lost a pound this week.  I’ll be honest, I didn’t get back on the calorie counting wagon as much as I had hoped this past week.  BUT, even though it took me a few extra days, I am now back on track and hopefully will see another pound (or more) gone this coming week.  It may be a semi-challenging week with the 4th and going to a baseball game on Friday (hot dog and beer anyone?) but I think I’ll be OK.  If I want to indulge, I will just make adjustments elsewhere.

On the recommendations of my CDE, a nurse during my yearly health assessment at work, and fellow blogger Allison :o), I’ve upped my calories to 1550/day.  Seems totally do-able and hopefully I’ll see better results by eating a little more.  We’ll see how it goes.  On the Diabetes Front, I’m aiming to eat less than 60g of carbs per meal to prevent those big after meal spikes.

Exercise is, well…there.  I’m struggling with it for a variety of reasons.  The main one is that my blood sugar seems to react differently to it on different days and I really am working hard to keep my CGM graphs as smooth as possible.  I need to figure out a solution though because I know how important exercise is to not only losing weight, but maintaining a healthy D-Life.  I don’t know if this means choosing a different form of exercise or just being more aggressive with trying new things as far as basal rates when I go to boxing.

My goal for this week is to not let the holiday and baseball game derail me.  And to be more focused on what I am eating over the weekend!

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The trouble with exercise is…

I love to box and kickbox.  Back when we lived on the Outer Banks I worked with an amazing trainer and really fell in love with the sport.  Back then, since I didn’t have a CGM, my routine was as follows:

-Test BG 15-30 minutes before leaving work.
-Test BG 1/2 hour into commute (my commute was 60 minutes long)
-If BG had dropped, eat snack – banana or rice krispie treat (I know, I know).
-Test BG as arriving to gym.  I usually would get there around 6, and class didn’t start until 6:30.  If BG was lower after eating snack, skip class or eat another snack (all this snack eating kinda defeated the purpose of working out!).  If higher, yay, enjoy class!

Not the most scientific of approaches, but it worked.  Some days after class I’d be high, in the 200-300 range, but most days I would be below 200.  I only had a bad low once – was in the 30s once after class.  No passing out and after a few glucose tabs and waiting a bit, I was fine and able to drive home.  Maybe I was more confident at my previous gym because I had friends there as well as my trainer who knew I have type 1 diabetes?  I don’t know.  All I know is that it did not stress me out nearly as much as it does now.

At this point in my life I was pretty blasé about my diabetes care and my outlook was more “one day at a time”, rather than seeing the whole picture (I had an A1c of close to 9.0 to prove it!).  Blood sugar high?  Bolus and move on.  Low?  Snack time!  Now that I’m trying to get baby-ready I am really working hard at keeping my BG steady with as few drastic BG swings as possible.  My CDE told me all about the deviation smart numbers stuff and how it shows how dramatic my BG swings are.  The way she explained it that if  my deviation is larger, this is no bueno.  She said that I want to be able to multiply my deviation by 3 and have the resulting number be less than my average BG.  If I can multiply it by 4, she said that’s awesome.  So guess what my goal is?  Multiples of 4, baby.

But, with the plethora of information that my CGM provides, I have almost a fear when it comes to working out.  See, the pretty graphs on my CGM tell me that my BG has no real pattern when it comes to exercise.  Some days it will go up.  Some it will go down.  I haven’t noticed if this is dependent on if I eat before class, as well as when and what I eat.  It just seems so random and without patterns.  This annoys me.  I do much better in life with diabetes when I can at least get an idea of what to expect.

This also stresses me out because I’m trying to keep my blood sugars as steady as possible with as few swings in either direction.  It’s easy to say, “Well, Laura, use the awesome tool of the CGM during your class and make adjustments as needed”, which I have been doing.  However, it’s a lot easier said than done.  Sometimes when I notice I’m rising, it’s almost like it’s too late.  I can set a temp basal to +50-100% and I’ll still creep up and remain high for hours after exercise.  It’s like a freight train you can’t stop.  Setting a temp basal to much higher than that while I’m participating in such a physically challenging activity makes me nervous, but maybe this is what I need to do?  Also, I’ve noticed that when I get really, really high I’ll crash and burn.  Maybe too much correcting?  I don’t know.  All I know is that it’s not so good for my innards and certainly doesn’t feel great while it’s happening.

I am not sure what the solution is.  I think that the first step is to keep better records of what I eat before workouts and when.  I don’t know if I should take a step back from boxing and maybe try something that is less intense like walking on the treadmill or yoga or weight training or something?  Something that is a more steady pace that may help prevent those nasty random spikes?  What say you, DOC?

A love letter for my Endo’s office…

I am currently on a pump-cation.  (Got hitched, sick of being a cyborg, it’s ‘spensive).  I’ve been enjoying this pump-cation for about 8 months now.  However, since the Hubs and I want to create a small human, it’s time to get back on the pump.  I’ve decided to make the switch from Minimed to Animas as I’m a new Dexcom user and Dexcom and Animas are BFFs.

BFFs

Well, my Ping (I say this in my head like “BING!!” from “Friends”.  Oh how I miss that show.) is due to arrive today!  Yay!

However, my appointment to see the Certified Diabetes Educator to train me on my new pump is not until June 28th.  That’s, like, a million years from now.

So what does any pushy patient do?  I emailed my Endo and her PA asking for my last basal rates so I could get started pumping right away as I don’t want to wait 8 weeks to resume pump therapy.  I am so excited to see what results the Dexcom/Animas Best Friends Forever-ship brings me.

But, as well all know with diabetes, nothing is ever easy.  Doc responds to my email and does not give me my basal rates and says she wants me to wait until my appointment in June.

grumpy cat

I don’t think so.  So I call and complain and some how, magically, they are able to offer me not one, but TWO options for appointments this Monday.  Imagine that?!  So my homework for the weekend is to read over the manual and get intimate with my new Ping so I am fully prepared for my appointment on monday.  I’m mostly excited, with a teeny, tiny amount of sadness that I’ll now be attached to a pump again.  But, a wanna-be Mommy’s gotta do what a wanna-be Mommy’s gotta do.  Right?

However, I do wonder if the Endo’s office had these two appointments all along and it took me being a squeaky diabetic to get in sooner.  Squeaky D gets the new Pump?  Just goes to show that it can’t hurt to ask and those of us with chronic illnesses have to be our own advocates for our healthcare.

Also, side note.  I still need to figure out what to do for a pump case for working out.  I used to have a nice case that had a clip and zipped around the pump to wear while I worked out.  It was great because it didn’t bounce around (I wear compression capris so it holds firmly when clipped towards the inside), didn’t annoy me by riding up as I imagine one of the waist pouches/spi belt things would, and the fabric zipped around the entire pump protected it from moisture (I killed 2 pumps by sweating on them.  D’oops).  Of course, my awesome case is lost and it doesn’t appear to still be offered by Minimed.  Le Sighe.  What do you use for working out?