My exercise-induced sugar levels

First post-run BG
When I started self-monitoring my blood glucose, I was a zealous tester, testing up to ten times a day. But I tested only for food and not for exercise. Testing for other things meant using more strips, which were not cheap, and pricking more times than my fingers could handle. In addition, I did not consider it necessary because exercise is crucial to controlling diabetes and lowering high post-meal BG level, which I thought meant that exercise automatically gobbled up my BG. But one blood test laid bare my ignorance.

Frustrations

Confusion in blue

Can you actually say that you completely understand diabetes? If you can, then I envy you because I can’t. I understand some of it, but not all of it. And I’m just talking about my own, not anyone else’s.

I can eat the exact same meal several times, but I can never be completely sure what my BG is going to be. They usually are within a reasonably close range, but there are days when I get an inexplicably high BG number, or the other way around – meaning, I get an unbelievably normal or low number.

I can sometimes feel a hypo, but when I check my BG, it’s normal. I’ve had highs without feeling any differently. Sometimes, I do a random test, and the number is completely way off my expectation. I sometimes check my BG twice in a row on the same finger and get numbers that are so far apart you’d think that, depending on the number, I either dipped my finger in honey or I injected insulin before the second test. I can feel great one moment, and then suddenly go low for no reason at all.

Those are just a few examples. I’m certain that others have additional far more frustrating stories to share. Diabetes can drive anyone crazy. So, how does one keep one’s sanity? I wish I can tell you with certainty, but I can only share with you some of the things that I do to cope.

1. I try to not be a slave to BG numbers and to look beyond them. It is so easy to go mad if one’s BG number is even just 1 point above one’s target number (whatever that is). It helps to remember that our meters and test strips are not accurate (there is a 20% margin of error). It also helps to remember that the number is not fated, and that we can always positively influence our next test even by just walking around the block.
2. I have learned to take things in stride. This is easier said than done, though, and it took me a while to relax. When I have difficulty calming down, it usually helps to remind myself that getting all stressed out is more likely to drive my BG up than down.
3. I focus on trends, not single episodes. I note an unusually high or unusually low number, jot down factors that may have influenced it, and check whether it is becoming a trend. If these anomalies are not a common occurrence, and I can’t find the reason for the spike or dip, I don’t lose sleep over it.
4. I accept that I’m not perfect. Some people may be able to perfect their BG numbers and eat the right foods, all the time, while living an actual life. I can’t. I try, and that’s all I can expect from myself.
5. I look at the bigger picture, instead of getting bogged down by one or two details. Instead of focusing on a bad number, I focus on my other really good numbers that outnumber the bad ones.
6. I just keep at it. The worse that can happen is failing, and the best thing is succeeding. But if I give in to frustration and give up, then I can only fail.
7. I don’t obsess about testing, and do not test 8-10 times a day, everyday. I test regularly and often, but I am not obsessed with it. Obsession with testing and BG numbers interferes with my ability to make better and well-informed decisions.

I’m sure you all have your own little tricks and secrets of coping with the inconsistencies and frustrations that diabetes often causes. Would you care to share?

Six Years of Living with T2D

I had my regular check-up with my endocrinologist this morning. Last week, I had a fasting blood test, and today we met to talk about the results. Before talking about the results, however, I tried to convince my endo to minimize fasting blood tests (I don’t like skipping breakfast, even if it’s just once every three months), but he likes to check my cholesterol level and other conditions that require a fasting blood test. I tried before but he gave in only one time, with the excuse that he wanted to know what my two-hour post-breakfast BG level and non-fasting cholesterol level were like. Just once. Today, I don’t think I convinced him to do away with fasting tests.

Anyway, my appointment with him was uneventful as everything was absolutely fine. How exciting is that? But, to my endo’s credit, what could have ended in five minutes was extended to more than half an hour, as he spent time to explain one of the tests, my fasting insulin level. He was pleased that my fasting insulin, my fasting BG (mind you, after showering, dressing up and going to the doctor’s office) and A1c were within the normal range (some, on the low end). If it weren’t for the fact that my previous tests consistently showed that I’m T2D, I could have been diagnosed with another type of diabetes.

My endo again brought up the possibility of reducing my metformin. I’m on 1,000 mg of metformin and he wants to reduce it to 750 mg. I had to remind him that we tried that before and I was not very happy as it required me to reduce my carb intake and live in what for me was absolute misery. I have no desire to be medication-free if it means a poor lifestyle for me. So, he agreed to keep my metformin level as is since (a) my A1c is at the low end of 5%, (b) my fasting insulin level is low, (c) my fasting BG is in the non-diabetic range, (d) I haven’t gained weight since 3 months ago, and other factors (he listed them down as if to convince himself that I really did not need to reduce my metformin dosage).

After we discussed my medication and my next tests (I’m due for annual checks), he inquired about how I was dealing with the weather, eating challenges and other difficulties I may have faced in the last 3 months since we saw each other. And I knew he was listening because he was taking down notes and asking questions. Before I left, he reminded me of some of the things I must watch out for vis a vis metformin (such as stop taking it if I’m having very high fever and the chill, or if I’m vomitting, or if I’m suffering from food poisoning), and to keep hydrating myself as it’s still hot and humid in Tokyo.

When I filed away my copy of my recent tests tonight, I noticed that this month marks my 6th year diagnosis as a T2 diabetic. After consulting my journal, I can confidently tell you that I’ve come a long way. In September 2007, my A1c was 6.8% (that, together with an FBG of 161 and a previous random BG test that yielded 218, sealed my diagnosis as a T2 diabetic). Six years later, my A1c is 5.3% and everything else is within a normal person’s range (in fact my doctor told me that I’m healthier than most of his non-diabetic patients).

I wish I can say that the past 6 years went by in a breeze but I’d be lying. The first 12-18 months was a period of discovery, not just how to live with T2 diabetes but a discovery of myself. The most important thing I discovered was that the secret to living with diabetes is not just to find the right diet (which most newly diagnosed diabetic and even long-time diabetic focus on), but to figure out how one wants to live. I experimented a lot to figure this out. If we don’t know how we want to live, we can’t settle on a lifestyle that we will be satisfied with, which only leads to a miserable existence.

Another lesson I learned is that while we can learn from other diabetics’ experiences, what works for them may not work for us and vice versa. Your Mileage May Vary (YMMV). Your Diabetes May Vary (YDMV).

The third lesson, which I find to be one of the most difficult, is to learn to respect other diabetics’ choice, to not preach, and to not judge others simply because their choice is different from mine.

The fourth lesson I learned is that while it’s not good to preach, it is also important for diabetics, especially T2 diabetics (there are not enough bloggers and DOC participants), to share their experiences and difficulties, to let their voices be heard, and to fight the perception that we deserve our diabetes and that we brought diabetes unto ourselves.

Another important lesson I’ve learned is to not be cynical and to give everyone the benefit of the doubt.

I must say that even after six years, I still have a lot to learn. I’m learning from the DOC, whether it’s through someone’s blog, or through a diabetic board, or twitter, or advocacy sites. I’m glad of the advancement in technology that enable people from different parts of the world to interact and exchange information. I’d be so lost without the Internet.

Today, I look forward to the challenges and humbling lessons that this chronic condition will bring in the coming years. But wherever diabetes takes me, I have no doubt that I’ll conquer it and be on the winning side.