Camping with Diabetes

I camp.  At least once a year in the fall, and sometimes a spring trip as well, with a very large group of friends.  In fact, we have our Spring camping trip coming up next month.  I thought I did a post about my first experience camping with diabetes last year but see it nowhere.  Suffice to say, I ate a lot of candy to keep from going low from the added activity (despite using temporary basal rates), but everything went really well... especially since I have a camping buddy with T1 who told me ahead of time to bring more stuff to treat lows than I thought I'd actually need.  Best. Advice. Ever.

But one of the tougher aspects of camping with diabetes is that I love to cook while camping, and I also love to sample the stuff my foodie friends create over the campfire.  I bring a cast iron skillet and a heavy dutch oven and get creative...  But last year, most of my creativity had to happen at home before heading out to the wilderness.  I ended up taking a lot of stuff that was already portioned in baggies with the carbs written on the outside.  I also made sure to know exactly how much my bowls and mugs held to aid in carb counting.  Like I always make an awesome vegetarian chili, so I counted up the carbs for the entire pot as I put cans and seasoning packets into a container, then divided to find out the carbs in one cup of that chili... and found out which of my tin mugs held about a cup, so I could easily portion myself a serving of chili without breaking out the measuring cups.  (Knowing exactly how much fit in our various sized mugs was also completely invaluable for sampling other people's goodies and making an educated guess at the carbs.)

The plastic baggies are an awesome camp cooking tool actually, especially since I usually only have the motivation to make one really fancy camping meal per trip.  I like to relax while I camp, too.  Though I will usually sizzle up some turkey sausage and other goodies on the skillet once Chad is awake too, I like to have something simple and tasty to eat when I first get up.  My solution is to bring plastic baggies of interesting home-mixed oatmeal in a plastic baggie, usually a recipe from Lipsmackin' Vegetarian Backpackin'.  All you have to do is pour in some hot water and let it sit for a few minutes.  These are already portioned for one (though some of the recipes in the book need to be cut in half), so I just wrote the carbs on the outside of the baggies last year.  There are lots of other variations on this, including instant rice, mixing batter for breads or skillet cookies, etc. (I know there might be health concerns when eating out of hot plastic, so the baggie could also just be used to transport the portioned dry ingredients before mixing it with hot water in a bowl.)

One thing I miss is the ease of campfire pancakes, though.  For a couple trips before my diagnosis, the perfect solution for easy pancakes was Batter Blaster, pancake batter that's dispensed out of a whip cream style can.  (These also make for great entertainment, as someone always wonders why you're putting "whip cream" on a skillet!)  But it's been impossible to find the whole wheat version, plus the carb counting based on the diameter a pancake is spotty at best (as I proved to myself a couple weekends ago with diner pancakes and a blood sugar of over 220).  I also don't like mixing batter in a bowl while camping because it's just too messy, so I didn't consider making my perfectly portioned whole wheat recipe last year.  This year, my plan is inspired by the Bisquick Shake n Pour canister.  I'm saving and washing one or two squeeze dispensers like the ones my usual reduced sugar jelly comes in.  I'll put the dry ingredients for two portions into the bottles at home, add the wet ingredients at the campsite, shake the hell out of it, squeeze the batter onto the skillet, then divvy half to Chad and half to me.  Tada!  Perfectly portioned whole wheat pancakes without a bunch of hassle and carb counting at the campsite.  I think it's going to be awesome.

You've Got to Move It, Move It!

Over all, I'm not a big exerciser. I did, however, manage to get into a good exercising habit for a while before I was diagnosed... which stopped when I caught a cold that turned into a cough (which was typical for me, but I hope it won't be now that I'm healthier), and the rest I took for healing time broke my good habit. Then I found out I was diabetic, and was told not to exercise, then to only do light exercise on a regular basis instead of the twice-a-week-average that had been my good habit... and I was both out of the habit and scared of lows.

But now that I know I generally feel a low pretty quickly and have my trusty Dexcom, I don't think I have any more excuses when it comes to going low. And that every-other-day-light-exercise-only rule is probably the ideal plan, but you know, I'm not the ideal person.... Despite my GP declaring I'm the ideal patient. Getting my butt moving, even if it's only one or two times a week and whatever exercise appeals to me at the time, may just be the best I can do at this point. In the grand scheme of things, despite the fact that sporadic exercise habits can make for sporadic insulin needs, some exercise is better than no exercise.

I hereby give myself permission to be a less-than-ideal exerciser. And if I get into the groove and become a more regular exerciser, hey, all the better! But I need to start where I need to start.

Bonus: I've discovered an awesome little park near where I work, which will be perfect for brown-bag lunch and a short hike. I'm so glad I found this place, because I learned long ago that staying at work during lunch, even if I'm not working, does not give me the proper mental break I need to stay sane... and a nice, quiet walk through a shady wooded area is very good for my sanity... while also helping me get a little extra exercise.

Dexcom, Weddings, and Alcohol

I absolutely love this thing.

It's a Dexcom reciever. Part of a Continuous Glucose Monitoring System. The sensor and transmitter are pretty small, and currently attached to my abdomen. Every 5 minutes, the Dexcom gives me my glucose levels.

These are not yet accurate enough to totally replace traditional glucose meters. Before you ever give yourself insulin based on your current BG, you have to stick your finger. But the number on the screen isn't what's so awesome about this device. What's so awesome is that you can see where your blood glucose is going!

Three examples of when I loved this thing this week:

Wednesday: I was driving to an appointment when Dexcom buzzed to tell me my BG was dropping fast. I knew (and it showed) that my numbers weren't high enough to stand such a quick drop for long, so I chowed down on some glucose tabs. 5 minutes later, I could feel that my BG was getting low... but very shortly after that, the glucose tabs kicked in and I felt better, and Dexcom showed my BG starting to slowly rise to safer levels.

Friday: At my birthday party, I decided to have some wine. I rarely do this for fear of what it'd do to my blood glucose levels, but I had Dexcom to tell me about any sudden drops... which I did not have. Dexcom gave me a view of my BG trends all evening, and I kept it where it would wake me if I went low during the night. I didn't have to stress.

Saturday (last night): I went to my cousin's wedding with an already elevated blood glucose due to eating fast food for lunch. At the reception, I gave myself insulin and made myself wait until Dexcom showed my BG starting to lower before beginning to eat my dinner (thus avoiding an even worse spike). This meant that, when it came time for cake, I didn't feel horrible about eating sugar. Again, I took my insulin a few minutes before eating the cake and saw that my numbers were starting to come down slightly before I ever put the first bite in my mouth. In fact, after that cake, I finally saw my numbers begin to return to a healthy range. Then, about three and a half hours after the cake, Dexcom buzzed me and showed a sharp drop in BG. What?! I tested to confirm and yes, I'd had a sharp drop. Aided by Dexcom (and the occasional finger stick to confirm whenever I was shocked to not see a rise in BG), I started consuming carbs. A small cookie... nothing. Another cookie... nothing. A 10-carb box of apple-carrot juice... A slight drop?! Glucose tabs... a slight rise, so wait and see.... no change? Finger-stick shows a BG of 88, which is too low for bedtime with such a downward trend and the knowledge that I'd had alcohol two nights in a row! I ate a 16-carb South Beach bar and sleepily watched Dexcom's numbers rise to almost 100 (with a slightly-upward trend arrow) before nestling it next to me and going to sleep. Dexcom shows I reached the 190 range in the night (which, I've discovered, means I was probably closer to 170 or 180), but the glucose meter showed me a 112 (Dexcom showed 130) when I got up late in the morning. I'd rather not go that high, but I think two evenings of alcohol threw my system through a loop, and it was necessary.

I've found the Dexcom numbers off by 20 points pretty often, but it's been an invaluable tool already. This was just a "trial" week, required by my insurance before they'll actually cover Dexcom, and I'm now more convinced than ever that I want one. It's helped me learn more about the timing of my insulin (I'm now trying to take it 15 minutes before I eat, when I can, to avoid spikes) and has helped me live a slightly more normal life (normal for me!) without worrying that I'd have a middle-of-the-night emergency. (I also learned that something last night didn't work for me. Was it two nights of wine in a row? Or did I guess horribly wrong about the carb content of cake? Or did even that small amount of dancing bring my BG down? I'll now have a much more watchful eye on all of those elements until I figure out what the problem was.)

Dexcom, you rock.

The Other Side of 30

So today is my 31st birthday, and last night was a celebratory game night with close friends (which wound up feeling more like a party than I expected, which was cool!). I opted against the rather large parties we tend to have partly because I still occasionally feel frustrated when faced with some food and drink situations, but also partly just because I wanted a smaller get-together.

Food and drink awesomeness:

1. I made low carb peanut butter balls, which took a little modifying (1 oz of chocolate was not enough!) and recalculating but turned out great and made 35 small balls at 1.3 carbs each (mmmm!).
2. Two desserts arrived with me in mind! Jenn brought cupcakes (with sugar-free penutbutter cups in them, FTW!) and told me upfront how many carbs were in them, and Jess (quite a famous chef in our group!) brought a low carb plumb tart with an almond crust. Yum!
3. I had three glasses of red wine and, while I let myself run slightly on the higher side for the evening, I wasn't afraid of dropping too low since I have a trial Dexcom unit this week (what great timing!).
4. No one brought anything super hard to "count," and I didn't feel pressured to eat out of courtesy.

Rock!

Other awesomeness:

1. GAMES! We played Ultimate Werewolf and Quelf, both of which make for goofiness and fun!
2. Friends! I felt really loved.
3. Fun and thoughtful gifts! One of the things Jenn and Bonnie gave me was a set of Russian nesting dolls that double as measuring cups!!! As Bonnie is also type 1, they probably knew how handy it is for me to have plenty of measuring cups around (and these are so cute!!!). Liz and Matt also gave me some cool vintage fabric with the thought that I could use it for making purses or meter cases to carry all my stuff, and Melissa and Jade gave me a copy of Quelf!
4. A really awesome husband! It was Chad that arranged all of this, and it turned out to be perfect. He's so sweet. :)

It was an awesome birthday celebration. I have to admit that, a couple months ago, I worried my birthday would be depressing. But surrounding myself with just my closest friends and not facing down a giant, sugary cake (and happening to have a Dexcom to help make drinking safer!) worked out beautifully. I felt normal, and yet not pressured to be normal.

Chad has commented a couple times that, after this diagnosis and some other less than pleasant issues this past year, we should be glad to say goodbye to 30. I think I agree with that, but I also think I've come out the other side of 30 in better shape than I went in. I suspect I went into it with this disease already in development, and now I've finished it with it under pretty good control and... overall happiness.

This was not the most pleasant year for me, but I think I'm better off for having gone through it.

Smoothing Out the Seams

I think I’m beginning to incorporate diabetes treatment into my life more smoothly. Even with the pump being so new, and even with other new things (CGM) on the way, it’s all starting to blend in. All of the actions are inspiring less, “Let me stop my life for 5 minutes to test my blood sugar and take an injection,” and more, “I hope I don’t look too inattentive while I test my blood sugar and listen to this person talk at the same time.”

The most invasive daily activity at this point is counting carbs, even though the pump takes care of some of that for me. Even if the database were easier to browse, some foods are just always a mystery unless you make them yourself. There could be sugar in your sweet corn, flour in your omelet, or (on the flip side) far more fiber in that dinner roll than is typical. And what is the tuna-to-pasta ratio in that tuna casserole??? It helps, when dining out someplace without a nutritional guide, to stick to simple foods. I’ve been eating a lot of poultry and seafood with rice and veggies or salad lately... The meat has little to no carbs (as long as it's not battered, and depending on sauces and glazes!), I can pile rice or veggies into a mound and judge which of my measuring cups it would likely fill, and side-salads with creamy dressings (ranch or Caesar), a few croutons, and no fruit have pretty reliably acted like about 10 or 15 carbs (depending on size). I’ll probably branch out into more combination foods as I get a better feel for carb content, but simple and familiar foods make life a little easier when there are no hard numbers to rely on.

Making food at home is easy. Meals for just myself are usually packaged and frozen (I love Kashi meals for lunch!) or routine enough that I know exactly how many carbs are in the final product as I always make it (my usual PB&J sandwiches are 34 carbs). If it’s a more complex meal for my husband and I, I usually try to cook exactly enough for both of us. I jot down carbs on a scrap of paper as I choose ingredients, total it up, then divide by two to determine the carbs in my half of the meal. (Or, more likely, I take a look at the carbs for one serving of a frozen “meal for two” I’ve just sauteed!) I test my blood sugar while the food is in the last couple of minutes of cooking, then punch the carbs into my meter-remote for my bolus calculation as soon as we sit down to eat. I’m already eating the first bite before the pump has finished its bolus. (So much faster than taking a shot!)

So it’s all falling into a rhythm. I’ve had to make some adjustments to my routine to more seamlessly incorporate treatment (eating simple foods at restaurants without nutrition guides, taking a few extra minutes every third day to put insulin in my pump and insert an infusion site so I don’t have to take a shot 5+ times a day, buying a more organized purse to easily carry and find my gear, buying some 1-cup tupperware bowls so I know exactly how much cereal I’m eating without breaking out the measuring cup...), but the treatment itself is also becoming easier to adjust (the pump means less time and mess before meals, I can use my glucose monitoring kit more quickly and without taking every little thing out of the case now that I’m used to it, and I don’t have to do as much math to give myself insulin anymore).

I still have these surreal moments when I realize, “I’m diabetic. I have a chronic disease. I have to take medicine multiple times a day to stay healthy and alive.” This strikes me especially hard when I wrestle with the tube of my pump while changing clothes, but then the pump disappears quite effectively under the front of my bra, and I only occasionally talk to it for the rest of the day through what looks pretty much like a fat little PDA... and it talks back to me from beneath my shirt through the quietest whisper of a *click* when it gives me a basal dose of insulin, and through a rhythmic vibration that translates into, “Bolus insulin for 41 carbs coming right up!!!” And I can hear the quiet twist-and-deliver as I enjoy the first bite of my meal... and then I think about other things.

Every now and then, I’m amazed by the things I do automatically. The seams are smoothing out...

A Need to Return to Normalcy

Long time no post, but I've been a wee bit busy.  I'm sitting in a new house full of cardboard boxes.

Also, I went through a dark patch there.  I was very, very down about life, including diabetes.  Not that I'm totally over that, but I feel a little more in control again.  And I want to get back to blogging, but I feel bogged down by everything I want to say when I do...  So, I'll just type.

Moving plus my period did a number on my blood sugars.  I had a lows four days in a row, including a 40!!!  So today begins a slightly new routine with the Lantus ("basal" or long-acting insulin):  A smaller shot every 12 hours, instead of a larger one every 24 hours.  My educator thinks it'll help prevent my evening numbers from going so low.

The honest truth is that this has been trickier than I thought.  I wasn't going to have crazy lows like all those other diabetes bloggers!  I wasn't going to have mystery blood sugar numbers that logically shouldn't have occurred!  But alas, I am no VIP to diabetes.

I think one of the most important things I can do for myself right now is take control of my life.  I may not have perfect control of my diabetes yet (it'll improve, though it will probably never be "perfect"), but maybe I can take control of other areas.  For various reasons, I've felt like a passenger in the process of finding, moving into, and buying this new house.  I need to make it mine.  My job is not where I want to be.  I need to make the best of it for the moment while taking steps toward where I do want to be.

Some other areas aren't as easy.  Diabetes has its claws in my diet and, to some extent, my physical activity.  This is necessary, at least in these early stages when we're still "figuring it out."  But I have to say that the psychological effect that has on me is very negative.  The first month, no problem, I was surviving.  Now, I need to start living.  I need to reclaim these areas to the extent that I can.  I'm eating more fruit again, for example, which I avoided at the beginning simply because I wanted labels and things I could measure.  But now I'm branching out and letting myself use my best judgment on portions/carbs.  Exercise?  Well, moving certainly was exercise.  Unpacking is too, as far as my blood sugar numbers are concerned.  After all this is winds down, I'm going to go do the exercise I always enjoyed most, damn it!!!  If I have to do shorter or lighter sessions, so be it, but I'm tired of being scared to walk-run on the treadmill or go to my favorite yoga class.  I'll be extra cautious, but I need to return to a little normalcy.

Phew!  There's my lunchtime post.  Back to work!

Party Pooper

I have to admit that this learning phase is starting to bug me.

First of all, I'm a little impatient, and a lot independent, so I want to be in control of managing my own diabetes now.

Second, I'm sick of my records dictating some if my actions. I could eat that giant cookie (and take insulin with it) at 4 in the afternoon, but then my before-dinner numbers would be useless to my diabetes educators when they review my records to decide on any changes to my insulin treatment. I could drink at a friend's birthday club-hop tonight, but that'll throw my numbers out of wack for at least a day and, again, make them useless to my educators.

I'm not a drunk and I don't "need to drink to have a good time," and other such cliches... But I do drink, and it is a part of my social life.  I've only briefly mentioned my social anxiety, but it's affects my life a great deal.  I'm no recluse and I don't start hyperventilating the second someone talks to me, but socialization (except with certain people I'm very comfortable with) often brings about more stress than enjoyment for me.  So when I'm in any sort of "party" environment, the relaxation and uninhibition (is that a word!?) that comes along with a couple drinks helps a lot.

Plus... it's fun.

Because I'll Never Completely Abandon My Vices...

Had my first alcohol since diagnosis, tonight: One decent-sized glass of Pinot noir.  I'm keeping a very close eye on my blood sugars with my sexy little red (cheap cheap CHEAP) back-up meter.  So far, a consistent drop that seems a little faster than I'd otherwise expect.  But since I started with a slightly high number, it's in more-than-safe levels.  I'll test again for my bedtime snack/shot... then once more before sleep, just to be safe.  I just hope that one glass doesn't make things plummet overnight!

Most alcohol causes blood sugar to drop (though it might cause an initial spike), despite the sugars in it.  My initial reaction to reading this was that, hmmmm, Intensive Alcohol Management might be slightly more fun than Intensive Insulin Management.  But... I don't think I'll be bringing that up to my diabetes educator anytime soon!