A Soul Crushing Low

It wasn’t 1.8 or 2.5. In fact, maybe in regard to numbers it wasn’t even that bad. But for me  3.3 was absolutely soul crushing.

I’ve had Diabetes for 12 years. In that time, I’ve had lows that freaked me out, inspired determination or forced me to face habits that weren’t serving me. This low, however, was different.

I felt numb, not just numb in my extremities, but numb to everything. My sole focus was watching the minutes tick over on my timer waiting for the sugar to kick in. When it didn’t it was hard to stay calm. Downing even more glucose gummies, resetting the 15-minute alarm and watching my breath were my only allies. My husband held me tightly from behind promising me my blood sugar would come up. “It always does,” he reminded me. “You got this.”

I kept thinking, “Why don’t I have a hypo kit? Why are we so far from town? What if I lose consciousness? What will my husband do? How fast will an ambulance come in lockdown?

I don’t think we talk about our lows enough. Sure, we post pictures on Instagram, express our frustration, tell each other to feel better or commiserate. In the short term it helps. It’s the aftermath that gets me. Like how today not even 24 hours later I’m feeling a subtle anxiety after eating my breakfast or how that rebound high took hours to resolve. Or my feelings about the interaction with my husband during the height of the hypo and shortly after; how hard it was to explain the feeling of being held underwater for 20 minutes, starved of glucose, mind slowing to lead and then how just like that I’m up for air, without really feeling like I’ve stopped drowning.

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Photo by Taylor Leopold on Unsplash

Being determined to get it right next time doesn’t always work with so many factors at play. Are my ratios correct? Is my basal set? Was there more fat, less carbs, did the carbs spike or didn’t they? Did I wipe down the mirrors in the bathroom for a little longer than I’d planned? Did I wait too long to eat after pre-bolusing? Did I weigh that last meal correctly? Is my correction factor too low or high? Did my yoga practice make me more sensitive to Insulin today?

Even when I do everything right, it’s like dancing on a tight rope. Turning, extending one leg, teetering, lifting and falling only to land back on the same foot again. I love dancing, but not like this.

After a hypo I usually cry. This time was no different, except maybe wailing was my way of expressing my pent-up frustration in general at being quarantined. I miss my family, I miss the beach, I miss the feelings of certainty and safety.  It’s awful thinking that grocery shopping is potentially life threatening or that breathing, laughing and hugging in close proximity is no longer ‘normal’. I’m heartbroken at how many people just five minutes down the road from us have no food, nor adequate shelter in which to ‘social distance’. With all these personal and not so personal things going on most days I feel at a complete loss for anything to say when everyone ‘out there’ is saying it anyway. I know I’m not alone in this.

And it’s hard not to push down feelings of guilt that I am in a beautiful place even while challenged with having a chronic illness.

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Photo by Liv Bruce on Unsplash

I often mention in this blog how yoga is my lifeline. Yesterday was no different. Having gone super high after treating my hypo I decided to do a vigorous practice to kick start my metabolism. It wasn’t long before I felt energised, calm and rejuvenated. No matter how bad I feel physically, no matter what goes on emotionally, a simple balanced practice of posture and breathing sets me up for a good night’s sleep and a healthy mental attitude.

In particular it also helped me to put my soul crushing low into perspective. I caught it, handled it and recovered well. It’s all anyone can do.

If you’d like to join me for livestream yoga classes during isolation I’m teaching on Tuesdays and Wednesdays. Entry is by donation with 50% of the proceeds going to our local village for masks, food and medical supplies. Donations can be made via www.paypal.me/yoga4diabetes

Tuesdays at 8.30 am South Africa Standard Time/ Zurich Time  which is 4.30 pm Australian East Coast time

Wednesdays at 11 am US East Coast time and 5 pm South Africa Standard Time/Zurich time

With great respect…

rachel

 

 

 

 

 

Preparation, practicality and cautious expectation

Yesterday was the start of my holiday. Piercing blue sky, slight breeze, the swell of the ocean and a day planned walking through the forest to a remote and pristine river. I was excited and frickin scared. I packed my backpack to overflowing with glucose tabs, insulin, lunch, phone fully charged, an extra and accurate blood testing meter and rescue remedy. My husband would have to carry my bathing suit, sarong and water bottle.

I love walking and I do it every day. 20 minutes hits the spot and lowers my levels just enough so that I cruise into dinner steady and in range. If I go beyond my 20 minute cruise I often end up high. Seems like the liver kicks in and releases more glycogen aka sugar into the blood stream.

Honestly, I am not a fan of long hikes. The last time I did one was before I started short acting insulin in 2018. That’s why I was scared. How would it work to walk for more than 3 hours, on a sunny hot day? Would my insulin stay cool? How would I dose for lunch when I knew I’d have to hike up a hill after our planned picnic at the river mouth. So many questions, so many unknowns. While my friends and husband were excited to walk I felt like I was jumping off a cliff.

As much as I use yoga to keep me balanced, it’s these normal everyday things that get me. I can’t take a vacation from diabetes. EVER!

In spite of my trepidation we went. The first hour was awesome. The forest was alive with wild flowers, trees dripping in moss, singing birds and dappled sunlight. I felt connected and alive. Our forest is 50 million years old.

IMG_0491By the end of the 2nd hour we had reached the lookout. My blood sugar was a steady 6.0 mmol. I started the walk with a 1/4 of an apple and didn’t take any insulin to cover.  Things were going well. We had to cross the river to get to our picnic spot. On went the bathing suit. With my backpack and shoes held above my waist we waded across. The water was brrr cold. Here in Africa the water is clean and crisp, full of prana, amazing!

As everyone else munched on snacks I pulled out my prepared lunch, enjoying every bite, it was crunch time. Would my usual two units be best considering that in an hour I’d  be climbing a steep hill followed by an even steeper descent? I opted for just under 2 units and an extra 1/4 of an apple. Then threw myself in the river, cold refreshing water. So good!

I started the next part of the walk around 5.7 mmol. It took 30 minutes to hit the dreaded low. 3.9 mmol with a downward pointing arrow. I took two and half glucose tabs, while gazing at the most beautiful view in the world. We waited for 15 long drawn out minutes.  My friends asked me what would happen if it didn’t come up. I’d take more tabs and wait some more. Waiting is the worst. On the plus side I was so tired from the walk I couldn’t feel the low or my fear. I was peaceful, relaxed and grateful. Grateful for my husbands arm around me, the patience of my friends, and the beauty of our surroundings. My levels returned to normal and we completed the walk. Topping it off with a dip in the wild ocean. It couldn’t have been a better day.

IMG_0505Back at home my husband reminded me, holidays are all about dropping the every day stresses. Time to take a break from normality, hang out with friends, talk about whatever, spend time in nature. I get it, I used to have that freedom, even took it for granted. Since diagnosis I’m a work in progress. I take each day as it comes. I work with what I have without expectation. Rather than define my ‘vacation’ by what everyone else does. I do relaxing my way.

Preparation, practicality and cautious expectation.

Have a wonderful holiday season

with great respect…

rachel

 

 

Sick with Diabetes

Usually I can fly 30,000 miles without a hitch but not this time. I’ve been hit by some sort of bug. Could be an allergy, could be my body trying to eliminate all the toxicity from breathing in smoke from the Australian bushfires or could be I actually picked up a bug. One thing I’ve consistently noticed about myself since diagnosis is that I hardly ever get sick. I know others have mentioned this too. It’s like diabetes gives us some sort of immune super power, where we are chronically ill but never sick. Weird!

I try to avoid exposure to bugs as much as I can. It can make me antisocial.  I won’t go to hangout with someone when they have the flu. Getting sick can wreak havoc on blood sugars. Fighting off a bug can raise levels, and having to take extra herbs or medications can lower levels. Even something supportive like Vitamin C can affect the accuracy of the readings on a continuous glucose monitor. Basically a cold or flu is a minefield I’d rather avoid.

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When I travel I wear a mask. It’s not pretty and I’m often the only one on the plane who wears one, but it seems to help. If nothing else it gives me a feeling of security.  Insecurity rears its ugly head when I am tired, sick and feeling irrational. Same as one of those out of control hypo moments. Brain offline, body shaking, must get glucose now kind of stuff.

Obviously this time the mask was no match for the super bug. Now I’m in that lovely cycle of watching and waiting. Watching how it progresses from excruciating pain at back of nose, to yellow phlegm, to sore throat, waking up every hour during the night, to loss of  voice. Where to next? No idea… Such fun!

Meanwhile my blood sugar seems to be staying in range for once. Go figureIMG_7258

And it’s a beautiful day in Africa! Nature is in full force in spite of my gluggy head. A little bird is building its nest in the rafters, the lion down the road is roaring, the natural bush around us is filled with cheeps and chirps and there is a presence and stillness in the surrounding forest and mountain scape that can’t really be described.

Yep, it’s definitely annoying to get sick when you live with diabetes, but it’s also a good opportunity to rest, reflect and appreciate one’s health.

Happy Thanksgiving!

See you tomorrow #NDAM #DiabetesAwarenessMonth

with great respect…

rachel

The number of tests?

“How many times do you test per day?” this was the question put to me this morning by the Accuchek Guide rep while I was trying to replace my meter. “About twenty,” I replied adding that my blood sugar can tend to be volatile. The rep murmured a sympathetic sound. But I wondered what she really thought.

I know what my Endo thinks. He’s mentioned to me on more than one occasion that I am obsessed with checking.  Do I really need to wake up throughout the night to check? Ummm…YES!  It’s not like I set an alarm or anything, I seem to naturally wake up between 1-3 times per night anyway so why not check?

Overnight lows are the worst. In the days before I had the whole diet thing mastered I’d wake up and have to eat at 2 am. Nothing worse than sitting by myself in the kitchen watching the clock tick over while I wait for my blood sugar to rise.

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And what about in the day? Do I really need to check every hour? I actually don’t check every hour, it depends on whether I’m insulin resistant or have had some sort of injection blunder. Most mornings I can go from breakfast to lunch without even checking. I know my liver is doing its thing, dumping some extra glycogen into my system so it’s rare for me to drop. It’s usually between 12-5 pm that I like to be vigilant. I can never seem to get my lunchtime bolus right, and then there might be some extra exercise thrown in the mix around 4 pm.

Checking vigilantly when you live with Type 1 Diabetes is a make or break situation. Especially if you can’t tell when your low. Its called hypo unawareness, it happens when you have too many lows and the body stops recognising the feeling of being low. Like my horrible hypo two weeks ago, before I knew it I’d dropped to 3.2 mmol. Scary!

It was also after that horrible hypo and sharing it here that some friends encouraged me to use a CGM (continuous glucose monitor). This is something I would love to have but sadly here in Australia there is no subsidy for someone like me. To be eligible for the Dexcom or Medtronic CGM you have to be hypo unaware and admitted to hospital more than once or under the age of 21.

The Freestyle libre flash glucose system is also on offer here, but this has no subsidy at all. I have written before on the blog about how much I love this product. Sleek, discreet and accurate using it has increased my peace of mind and saved my finger tips. I’ve attended  product launches and #dx2Melbourne and can honestly share the company, its ethos and care are palpable. I’ve even lobbied the government to make access affordable for people like me and had a small feature in the Noosa News. In spite of my passion and efforts, I still can’t justify spending $100 every fortnight.

But wait ho… my wonderful parents, after reading my blog, gave me the best early christmas gift ever! A 6 months supply of the freestyle libre. I am touched and grateful.

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Here I am ready to launch. So excited to have some time off from the drudgery of test strips and the ability to see whats actually happening minute by minute with the food I am eating, the insulin I am taking and the sleep I’m sleeping. I’ll probably put one in starting next week so stay tuned…

See you tomorrow #NDAM #DiabetesAwarenessMonth

with great respect…

rachel

The humble test strip

Something that bears the brunt of many jokes in the diabetes community is the test strip. If you haven’t a clue what that is. No worries, I’ll explain.

The test strip is a very small yet essential item for anyone living with diabetes. In order to keep blood glucose levels in check you have to take regular measurements with a blood sugar measuring device called a glucometer.  Even if I wear a CGM (continuous blood glucose monitor) which measures blood sugar through an implanted device, I still need to calibrate my CGM or double check that the reading I’m getting is accurate. Especially in an emergency. Nothing worse than getting a false reading on my CGM and treating it with either insulin or glucose and then having either a low or high. Sound complicated? Not even the half of it.

Anyway I digress…

The test strip is inserted into the Glucometer, I prick my finger with a lancing device, place a minute amount of blood on the test strip and within 5 seconds I see the reading on a screen. Then I take the test strip out and supposedly dispose of it. The big question is where? One lone strip usually lands in the side pocket of my meter case, eventually 1 becomes 50 or 100 and before I know it little tiny test strips covered in droplets of red blood are literally falling out of my meter every time I open it. Too lazy to throw them in the rubbish I put them back in the side pocket only for them to fall out again the next time I go to test my blood sugar.


Stray test strips end up in car seat crevices, on the floor, in the bed, in the toilet, on the pavement, in my hair. I’ve even found a test strip in my soup. Yuk!

Getting the test strip out of the little round container in the middle of the night in the dark is also a total drag. It’s bad enough having to get up to test my blood sugar but then when I waste a strip putting it in upside down and back to front… total headache! Plus if I don’t get enough blood on the strip the machine tells me I have to test again. That’s another waste of a strip.

Strips are made of plastic and as far as I know non recyclable. In fact most of what we  use to manage diabetes is non recyclable. Talk about feeling guilty every time I test or inject. I just wish someone could invent a recyclable paper, bamboo or hemp test strip. In fact why not invent insulin pens, needle cases, devices out of hemp plastic or some other compostable equivalent. Anyone want to start a movement ?

The test strip is also a conversation piece. ” What’s that? My aunt has diabetes. How many times do you test? Does it hurt?”

The test strip is certainly not something to be undervalued or ignored. Before the test strip made its appearance on the world stage, the only way to know what your blood sugar reading was was to use a special solution mixed with urine then boiled to get a rough sense of the levels. Eventually  a urine test strip was used and by the 80’s there were home test kits like the one pictured below, but it took 5 minutes to get a reading.

Screen Shot 2019-11-08 at 5.13.53 PMThink about it, before the invention of insulin and diabetes technology we didn’t know what we had. how to manage it or even how to stay alive. The humble test strip for all its foibles, annoyances and character flaws is an absolute life saver.

I for one will never leave home without it!

See you tomorrow for #NDAM #DiabetesAwarenessMonth

With great respect…

rachel

P.S. Check out the amazing Miss Diabetes and her latest cartoon about how to test your blood sugar here

6 tips to bounce back from a rebound high

The first time it happened I was clueless. People living with diabetes often talk about blood sugar roller coasters but I thought that just meant highs and lows in a short period of time. What I didn’t understand was that when I go low I also go high and not just right after correcting a low blood sugar. The high lasts for days. My body starts resisting the insulin I’m injecting and I need more insulin to manage the highs which means more risk of lows. When I was a kid I hated rollercoasters and for good reason. They made me feel sick, scared the begeezus out of me and I’d come off the dang thing with a sore throat from screaming my lungs out.

It took quite a few hypo’s for me to work out that the high’s that followed were to do with the lows. At first I just thought there was something wrong with the insulin, or maybe I hadn’t dosed enough. I even speculated that maybe my pancreas had finally hit the dirt and I really didn’t have an ounce of beta cell function left. Because I live with LADA ( latent autoimmune diabetes in adults) I still produce a minute amount of  insulin, this means that sometimes my body squirts out a tiny amount when I first start eating. It also means that if I am already low when I start eating I could go even lower and have a hypo. Not having the recipe as to what my pancreas will do when means there’s a lot of guessing going on. So when I’m high for days on end and doing everything exactly as I did it the days, weeks and months before it feels like I’m in the middle of a crap shoot. Lucky me!

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When people meet someone living with diabetes, the decision making and daily micromanagement is largely invisible. You might see a CGM or an insulin pump, but on the whole it seems as though the whole process runs smoothly.

Here’s what actually goes on most days for me. I wake up, inject. I eat, inject. Go a little below range, take a glucose tab. Go high, take some insulin.  I check my blood sugar every hour to be on the safe side except for at night where I place my faith in morpheus, the god of sleep trusting that the amount I take for my long acting insulin will keep me in range all night. 20 fingerpricks and up to 6 shots a day of insulin is not easy or seamless no matter how doable it is.

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What do I do to deal with the physical and mental blood sugar challenges during a rebound high? Here’s 6 things that have really helped me.

  1. Do some physical exercise which I know increases insulin sensitivity, like a walk with some hills,
  2. Do a yoga practice which works with the larger muscles of the body and includes standing hip openers and balancing postures
  3. Talk to myself in a positive and supportive way when I see a high number on my meter. I.e. This too shall pass, this is a normal response to a low blood sugar, everybody goes through this
  4. Do things in my day that give me joy, like writing, yoga, connecting with a friend or have some hang out time with my husband
  5. Go to bed early, there’s nothing more healing then a good nights sleep
  6. Reach out in the #DOC ( diabetes online community) to find out how my diabuddies deal with the same situation

And if you live with diabetes I’d love to know… How do you deal with a rebound high? Lets start a conversation in the comments below!

See you tomorrow #NDAM #DiabetesAwarenessMonth

with great respect…

rachel

A horrible hypo

I titled this post at 2 am this morning after a sudden hypo around dinner time. At 2 am I was thinking clearly, taking time to make a note on my phone so I wouldn’t forget. At 7.15 pm things were a whole lot more chaotic. Well not at first….

I was cruising nicely through my evening yoga practice after taking my basal shot (long acting insulin which keeps my blood sugar level over night) about 30 minutes prior. I’ve been playing around with where to take the shot to avoid insulin absorption issues, and decided to inject in the soft fleshy area in the top part of my bum. There was a sting on entry and when I pulled the needle out quite a bit of bleeding so I knew I hit a capillary. I wasn’t concerned. Usually this means the insulin won’t absorb as well and I’ll sustain a higher level overnight.

I hopped on my mat, forgetting all about the shot. It was towards the end of my practice that I noticed some itchy sensations around my waist. This is usually a sign that I am going low but sometimes that itch comes when I’m high. I actually find the itch super annoying. It’s not at all useful in helping me determine whether I should check my level or not. Luckily I checked.

3.4 mmol flashed large on my blood glucose meter. This is NOT a good result. This is a scary result. The last time I had checked I was 5.4 and usually it would stay that number until dinner. This sudden and fast drop could only mean one thing. My long acting insulin had hit my blood stream and was absorbing all at once. If I’d been wearing a CGM ( continuous glucose monitor) I could have seen the trend. Arrow pointing down on an angle means I can treat it with around 8 grams of fast acting carbs and it would come up in 20 minutes. Arrow pointing straight down would mean taking 15 grams and still having to wait 20 minutes.

Sadly I cannot afford a CGM. I had to fly blind.

After cramming two tabs in my mouth at once I sat back down on my mat. By now the itch had turned into a crawl which went from head to toe. My husband who was sitting next to me and in the middle of his own yoga practice reminded me to breathe.

I engaged whats called Ujayii breath a slow whispering breath, which sounds almost like a snore and tried to focus on lengthening my exhalation. It worked and I stayed calm but it did little to budge the numbers on my meter. I took another tab and a half and started raving and ranting This is the point where someone telling me to calm down doesn’t  work.  Me telling me to calm down doesn’t work.

Telling myself, “don’t react, don’t eat more tabs, just be here, it will pass, your blood sugar will come up” is like that feeling on the edge of orgasm when the thought comes “don’t do it… hold off… keep enjoying…” and then you go for it anyway.

Not the best analogy, because sex feels good while hypos are horrible, a total brain melt. 

It took 30 minutes and three and half glucose tabs to come out of the tail spin. The graph on the app which measures my data went straight up. When I pulled out my syringe to take some fast acting insulin for dinner my husband was confused. Why are you taking insulin when insulin just caused the problem? How to explain that if I don’t take some insulin to cover the meal I’ll rebound even higher.

Living with diabetes is a fine and tenuous balancing act between the horror of lows and the haunting of highs. No matter which way you look at it you can’t win. Best not to try. Thankfully I rarely have these testing moments. I chalk this up to a consistent and daily yoga routine. More of which I’ll share with you here during #diabetesawarenessmonth.

Want to learn the ujayii breathing technique I use to calm myself during a low? Watch this short video below and join in.

See you tomorrow

with great respect…

rachel