Diabetes in daily life recounted

Above is the author’s Dexcom graph, with time on the x-axis and blood glucose on the y-axis. The grey area shows the target range, while red is low and yellow is high. Frankie Knuckles/The Miscellany News

On the morning of Nov. 1, 2018, I draft a Facebook post, proclaiming that we are now in Diabetes Awareness Month. I tell my friends to educate themselves about the disease with which I live every month. Last year around this time, I wrote an article for The Miscellany News detailing a day’s worth of diabetes routine. Not much has changed since, and that’s why I want to repeat the exercise; diabetes affects someone, relentlessly, every year. So, I am once again opening a window into the diabetes side of my brain.

I wake up at 8:24 a.m., minutes before my alarm, feeling weird. My Dexcom (a continuous glucose monitor that measures my blood sugar at five-minute intervals) displays an error message, so I use my old-school glucometer and, sure enough, my blood sugar is 54. A normal reading is between 70 and 150, so this is significantly low. I calibrate my Dex, then pop four glucose tablets and wait to feel better. When I do, I get dressed.

I don a blue-ribbon covered headband and head to breakfast. I get my usual: a scoop of potatoes, two cups of coffee and a piece of toast with Sunbutter. I take my normal bolus (a supplementary dose of insulin to counteract carbs eaten. Basal insulin, by contrast, is a constant drip).

I head to my first class. Beforehand, I tell one classmate that November is Diabetes Awareness Month. Another walks up in the middle of the conversation, just as I’m saying it’s nice to have a whole month dedicated to diabetes. “A month celebrating people who die from sugar?” the newcomer asks.

More calmly than I feel, I say, “That’s a good example of the type of thing you might not want to say to someone who has diabetes.”

My righteous outrage subsides, and we go into the classroom. People make light of my disease all the time, and frequently it’s from ignorance, which I don’t take personally. During class, my phone vibrates with a Dexcom notification: rise rate alert. I know the vibration pattern without having to look at my phone. I figure more insulin won’t make me drop. I subtly take out my pump and up my basal rate by 20 percent, hoping to head off hyperglycemia (high blood sugar).

My effort fails, and I end up having to go to the bathroom twice during class. A symptom of high blood sugar is frequent urination, which isn’t conducive to a classroom setting.

In my next class, it’s time for a mid-morning snack. Usually, I try to eat it before class starts, but in the kerfuffle of getting my academic materials ready, I sometimes forget. As class begins, I check my Dex. Still on the high side, at 158. I bolus for my snack and let the insulin deliver for a couple of minutes, then get the foilwrapped pastry out of my backpack. I wait for my professor to pause. He looks at me and says, “You can open it.” I do, quickly, to be as little distraction as possible.

Forty-five minutes later, my Dex vibrates in three long pulses. High blood glucose. It’s just that kind of day. I set a basal increase of 30 percent for the next 30 minutes. Class continues, and even though I have to go to the bathroom again, I don’t want to. It’s an excellent class. I wait and go between classes.

Despite my efforts, my blood sugar remains high an hour later. I don’t want to bolus because I’d risk crashing soon, and I’ve already eaten my snack, so I don’t. High blood sugar is soporific; I fidget with my pen to stay awake.

After my third class, I eat a 3 p.m. meal. My blood sugar is in range, so I bolus only for the carbs. I eat rice and broccoli, then wander the internet. My post has some shares, mostly from diabetes camp friends. I’m pulled from my internet reverie by another Dex alarm: a fall rate alert. I turn off my basal for a half hour, hoping that’ll balance things out. I decide to delay my afternoon walk before my four o’clock class. Fifteen minutes later, I’m holding steady, so I pack up and take a truncated turn about campus.

Clearly I shouldn’t have, because I start to dip down again just before my two-hour creative writing seminar starts. I turn off my basal again, for an hour this time, and take two glucose tabs, just to be safe. When I keep dropping, I add two more glucose tabs, making a full treatment. I feel foggy but hope it will dissipate. I wonder if I overestimated my portion of rice or overcorrected for my high.

A few minutes later, my Dex tells me I’ll be urgently low within 20 minutes. It even counts down the minutes. I waffle between taking more glucose tabs or not, and decide it’s safer to take another one.

Ten minutes later, the reading is still dropping, but I feel that indescribable ache behind my brow bone that means my blood sugar is rocketing up. I decide to check with my glucometer again. It says 150, so I calibrate. My Dex tells me to test again in 10 minutes and recalibrate. My sister (who also has type one) says that the discrepancy between my Dex and glucometer might be because I’m constantly dehydrated. I try to recalibrate, and it doesn’t take, again. I contemplate the metaphorical resonances of inaccurate measurements, especially ones on which my life depends.

We take our 10-minute break in the middle of class, and just before we resume, my pump beeps to tell me I have to change my infusion set soon. I huff. It’s a day of alarms.

At the next prompt, I calibrate my Dexcom again. I’m down to 111. I wonder if it predicted a low because I’m dropping. Just in case that’s happening, I decrease my basal rate by half for an hour. I’ll check again soon to make sure I’m trending the right direction.

Five minutes later, I’m 115 with an arrow up, so I put my basal back to normal. In another 20 minutes, I’m 152. High again. I’ll correct with dinner.

I get some rice, beans and jambalaya and bolus accordingly. I guess it’s about a cup of rice, which is 45 grams of carbs, and probably another 15 or so for the sauce. I know I usually dip low after starchy meals, so I lower the bolus a little bit.

Not enough. An hour after dinner, I’m going low again. I eat fruit snacks because I’m getting tired of chalky glucose tablets. I do some homework and chat with my friends, then get ready for bed. An hour after I fall asleep, my Dexcom loudly announces that my blood sugar is, once again, high.

Today has been a frustrating day for me, blood sugar wise, but it wasn’t peculiar. People think that insulin and technology make diabetes easy, but that’s not true. Insulin isn’t a cure, but it keeps me alive. Even with improved tools for diabetes management, I struggle every day to keep my numbers in an acceptable range. This November, try to remember that some of us have to be our own pancreas.

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