Living Out Loud: : Black and White with Shades of Gray

Diabetics R Us

Sep 15, 2004 at 2:06 pm

I put out an overall of my upbringing on diabetes last week, concluding with me hitting in on my backward positioning in regard to diabetes. I'm turned around in a better direction these days but am still learning and re-learning that acceptance runs on an assorted continuum (see "Diabetics R Us," issue of Sept. 8-14).

I remember sitting at a table against the left wall in Mullane's with Larry smoking across from me. My first day at CityBeat. Two Diet Coke cans before us, my new boss is teaching me the basics: who's who and what we all do.

My vegetable sauté and his Garfield salad arrive and it's time for me to do the deed. So I tell Larry I'm a diabetic and have to take insulin — and that I refer to as "shooting up".

He stands up hollering, "WHAT? You're a WHAT? You can't work for me — you're a diabetic!"

Okay, so those might have not been his exact words or sentiment.

His exact response was to say he has diabetes, too.

However random and weird this was, it's been cool and comforting to have another person to "talk shots" with during the past year and a half.

Sometime following that December lunch, I made an appointment to see an endocrinologist (diabetes doc). It had been a few solid years after all, and I was "outta shape." No, I wasn't skipping insulin or failing to test my blood sugar levels. Yes, I was exercising and eating a relatively decent diet. But my diabetes wasn't "in control," as we like to say. That, my friends, is the key to this disease.

Keeping blood sugar levels within range is what diabetes is all about. Too much glucose or too little insulin in the bloodstream results in a high blood sugar level, while too much insulin or not enough glucose drops it low. When things are out of whack, it increases your vulnerability to illness and future complications, along with draining your mind, body, and spirit.

It's almost a black and white deal, but the catching shades of gray are in there and come in many different shapes and sizes. I look at the black and white as the facts of maintaining control: the insulin keeps me going; the different blood and urine tests advise me on past, present and future decisions; eating healthfully and exercising; outings to the diabetes doc, dietician, nurse educator, eye doc, foot doc, hand doc, female fun doc, dental doc, skin doc and hip doc — the newest edition.

Hypochondriac much? Yeah, a definite "team" of docs goes with the territory. Best to get whatever's illing you checked out first thing, as we diabetics get sicker quicker and heal on the slow side.

I suppose the gray is a part of these regular appointments with numerous docs ­ track patterns, gauge progress, detect early complication signs and change things when necessary. All for better control, minimizing and eliminating any negatories that are neither black nor white.

So after a year of establishing a relationship and working with my endo, I made the decision to go on an insulin pump in March. It had been about eight years since I had made any big adjustments and I was actually "pumped" for some change.

The pump provides for better control through a continuous insulin flow known as the basal (background) rate, while dosing a bolus administered by the user when eating to cover carbohydrates. Whereas I shot up a long-lasting basal insulin that ran its course every 24 hours, I can now adjust that rate throughout the day according to changes in my body's metabolism, whether it be a natural occurrence, during exercise or when I'm sick.

In addition to modifying the basal rate, the pump enables me to enter my blood sugar level, as well as any carbohydrates to be eaten, and will recommend a bolus estimate — given the settings I pre-set for my own body-carb ratio and insulin-sensitivity factor. So if I'm running high at 200 and will be eating a granola bar with 15 grams of carbs, my pump suggests I take two correction units and one carb unit of insulin to get me to my target blood sugar.

The thought of not having to stick a needle in my stomach five or six or seven times a day when eating or to correct a high blood sugar was and is all too delicious. But being connected to this thing 24/7, all day, all night is not so appealing.

Insulin travels from a small reservoir stored in the pump through tubing that extends to a clip where I'm able to attach or detach from the insertion site. The site houses a 7cm canula inserted (with a needle that's immediately removed) into subQ, or fat, where insulin is absorbed. I favor my stomach over my legs and hips, as I've faced some challenging bumps as I've been pumping down the road.

My first month had me tripping to the ER twice. Two more visits came a few months later, unrelated to another three narrowly averted incidents.

This is when the frustration pours on like thick-stick molasses. These bumps are part of the gray. Take out that gray, those bumps, and my blood sugars hadn't been in such a tight range in 20 years. So what do you do? Stay on and hope for a smooth, gray-less pumping path? Or revert back to what wasn't working?

I woke up on a Tuesday morning in August with my blood sugar at 74. That's a little low, but not bad. Typical fasting puts blood sugar around 80-100, the range of a non-diabetic's readings after three-plus hours without food or exertion, i.e. overnight. The shock value of my low 52s and 38s had worn off long ago. So 74 was golden. I ate my usual banana and dosed out some insulin to prevent going high. Cleaned up, I caught a bus downtown and I was ready for coffee with Larry.

By the time I got to work, I wasn't feeling right. My stomach was bugging, mouth was mucky, eyes were dry, head was aching. I tested my blood sugar and I was over 300. The nausea kicked in, meaning I was on my way to diabetic ketoacidosis — ketones in urine. Bad news.

On that sunny, cloudless Tuesday in August, it happened not once, but twice. Holding down fluids that morning, I'd managed to avoid the ER. I recouped from the morning high, ate some bread and tested 127 a few hours later. Maybe I would be able to make the Bela, Keller and Yonder show that evening. No, not so much. A two-hour "betic" break from pricking my fingers for readings had me over 300 by 5p.m.

Who's ass you kickin at this point? Because that's the sanity left at this point in the day. Out of nowhere in the morning, followed by an afternoon sequel. Whether it's me or the machine, an answer is an answer and allows for learning. No such luck on that beautiful day. At least not anything concrete.

Where to go from here? I'm still sifting through the shades of gray. At some point I'll hit it or let it go. Either way, I'm rolling in the grass — and to be rolling in the grass at all, well, that's rolling in the good grass.