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Thursday, August 19, 2010

Following the "Rules"

When I left the hospital after I was diagnosed, I went to a certified diabetes educator (CDE) where I was presented to a list of rules to follow for good diabetes management.  I learned about carb counting, taking my insulin, testing my blood sugar.  For me, the rules were as follows: 

  • Eat less than 150 g carbs a day.  Splitting them up into 30 g for meals and 20 g for snacks.  
  • Test blood sugar when I wake up, before every meal and 2 hours afterward, and before going to bed.  Use a sliding scale of (BG-120)/60 for corrections.  
  • Take insulin at least 30 minutes before eating.  
  • For low blood sugar (< 70 mg/dL), eat 15 g fast-acting carbs and test again 15 minutes.  If still low, eat another 15 g and wait another 15 minutes.  Continue until blood sugar is normal and follow with a protein snack. 
  • Get at least 30 minutes of exercise every day.  
  • Take 7u of Humalog before each meal and 20u of Lantus at bedtime.  
  • If at any point I feel "off" whether it be I feel fatigued, heart racing, or get a twitch in my eye:  TEST!  This was probably the best advice I was given, because I didn't know what was a result of bad blood sugars or just normal weird stuff.  
For the first few months after diagnosis, I followed these rules to the letter.   I was able to bring my diagnosis A1c of 9.1% down to 5.8% within a month!  Looking back on it now, that's a crazy drop!  I think a lot of that was because I was still on MDI which plagued me with lows. 

When I went on the pump nearly a year later, I got a little lax on my "rules".  I felt released from the MDI chain and liberated to eat whatever I wanted with a simple push of a button on Arnold.  Sometimes it worked out for me, and other times I would soar to the 300s without a second thought.  "No problem." I thought.  "I can just correct using my bolus wizard."  Basically, the pump made me comfortable, too comfortable.  My first few A1c's on the pump were 6.0, 6.1, and 6.3%.  Soon after I landed at 6.5% and stayed there for a good year, nothing I did could bring me down.  I was still following the "rules" except for taking my insulin 30 minutes before eating because it made me afraid of lows. 

Then, I got married, which was the best thing that ever happened to me in my life, but not so great for my diabetes.  I got so caught up in my married life, and making scrumptious meals for me and my husband.  For a while, it was as if I forgot I was diabetic, and I didn't want it to be a main conversation piece with my new husband.  I was just going through the motions, not really thinking of any patterns I was developing.  It got to the point that I wouldn't blink at a fasting BG of 180 mg/dL or higher.  I got used to expecting to correct a post-prandial in the upper 200s after a meal.  Most of my boluses were SWAG bolusing.  I would go several hours without testing, even going to bed without a test!  I just wanted to be a wife and enjoy my new life, that along with finishing up my master's thesis made diabetes a faint background on my busy life.  All of this finally caught up with me when I had an A1c of 7.1% in February of this year. 

I know for some people this is a great number, they do the best they can and follow the "rules" and their body is comfortable at that number.  But for me, I wasn't following the "rules" and landing at this number.  In fact, it was a trend that I was ignoring because my A1c before that one was 6.9%, and I made all the promises to myself after leaving the endo's office.  "I've got to get back to measuring my meals."  "I need to exercise more."  "No more SWAG bolusing."  I didn't want this upward trend to continue, but I let it. 

Enter in twittering, blogging, and CGMing--everything that has happened since that appointment.  I learned that not everyone follows the "rules", but that's not the most important rule.  Yes, I have gotten back to measuring my food, counting carbs, exercising, and (thanks to Constance) have started taking my insulin 30 minutes before eating.  And things have been pretty smooth sailing, except for this week. 

I have no idea what's going on, but it seems no matter what I eat that I spike into the 200s with no rhyme or reason.  Also, I have been going low (like super low) with a meal that I've eaten everyday for the past week with no issues.  And yesterday I randomly hit my 180 mg/dL high threshold while eating nothing!  What the heck!  This isn't fair!  I'm following the "rules".  But I realized that this kind of attitude is what leads to getting lazy all over again. 

It makes sense, if you follow the "rules" you should get fair results.  But life (and diabetes) isn't fair.  Sometimes we get bent canulas or bubbles in our pump, and accuracy issues with meters can make a 120 mg/dL really an 80 mg/dL which leads to a 60 mg/dL and a "WTF?  I was just 120!" a few minutes later.  And stress and anxiety can cause our BG to go up out of nowhere.  And so many other variables that affect our BG that haven't even been discovered yet (I'm fully convinced the smell of bleach makes me go low, but I have no research to back it up). 

So what about the "rules"?  Throw them out!  Get rid of them and just remember this rule:  BE FLEXIBLE!  Diabetes is as predictable as the weather, it comes and goes with highs and lows, sunshine and rain.  Don't get frustrated with a single number, but correct it and move on.  Don't dwell on "what happend there?" or "what did I do wrong?".  Nothing.  Diabetes is an ugly monster inside us, it's not part of us or who we are.  It gets out of hand, just when we think we have it all under control.  I think the ultimate rule to living a good life with diabetes is learning to roll with the punches.  It's not fair, even when we follow the "rules".  But I think being successful is not being perfect all the time but rather learning to adjust to change. 

I'm saying this myself as much as I want everyone to hear it.  I feel like if I were a "good enough" diabetic, then I would never reach 200 mg/dL and I will prevent any lows from happening again.  But the truth is, I'm already a "good diabetic" (heck, a GREAT diabetic!) because I don't let my diabetes get out of hand.  It would be so easy to throw my hands up after every high, but that would be giving up.  It takes strength, perseverance, and patience to handle this disease. 

I hope this post helps someone out there.  If not, at least it might help me in 6 months or a year from now, when I'm ready to throw my hands up. 


  1. I'm right there with you, lately. I eat the same darn breakfast every day, bolus the same way, with great results before... and this week? I've had a post-prandial peak of at least 220 every GD morning! I hate to think that I have to up my breakfast I:C ratio once again - it's already pretty epic. I'm running out of ideas, aside from completely cutting carbs out of breakfast.

    A very well-written post, and great advice. I'll try to follow it. :)

  2. thank you Holly, this is fantastic. I like the rules, they sound genuinely helpful. As for the breakfast thing you guys, just stick it out. I'm willing to bet its just temporary diabetes shenanigans. Happens to me from time to time then goes back to normal.

    great read.

  3. Fantastic post! I especially needed this being pregnant. The constant changing of basal rates, IC ratios and everything hormonal going on in my body is a constant battle. I know I am doing great but it definitely takes a lot of perserverance and strength to keep it up (and to get the guilt out of my mind). It can be so easy to get down on yourself. Thanks Holly! :)

  4. Loved this post!! Especially after I was reviewing my logs earlier this week to fill out the Dexcom paperwork (and then didn't even need that page, which was annoying) and kept getting slapped in the face with the highs and lows. Ugh. On the bright side, it should help my insurance company approve my request. :)

  5. I appreciate this, too. As a d-mom, I get frustrated and then I feel guilty. It helps to know that sometimes we have no control no matter how hard my son & I try to get it "right."


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DISCLAIMER: I am not a doctor, nurse, certified diabetes educator (CDE) or any medical professional of any kind. (But I did stay at a Holiday Inn Express!) Therefore, please do not use any of my postings as medical fact. I am simply a blogger expressing my highs and lows (pun intended) with diabetes. For changes in your medication, exercise regiment, or diet please consult a qualified physician.

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My name is Holly and I live in north Alabama with my hubby, two cats, and a dog.