When I want to eat…

So DeTickles adds a bunch of steps to everyday things regardless of what method of management is used. I’ve talked about food some and mentioned how sometimes I hate food.

But even with eating, it’s not just carbs, haha, nooo, not that easy. Let’s add in a few more steps.

When I’m hungry, it’s mealtime, or I want a snack, dessert, or whatever — any time there will be food — here’s what I currently do using pump and continuous glucose monitor (cgm) therapies.

With the Dexcom cgm I can usually get an accurate idea of what my blood glucose levels are. This can affect my food choices (or I might not care, or I might have very limited or no other options).

Once the food is decided and carbs figured out, by measuring, looking up online, checking the nutrition label, or flat out guessing, at mealtime I need a finger check — nice way of saying my insulin pump requires a blood sacrifice. (And I better make sure my hands are washed clean or disinfected clean with sanitizer first. I don’t want a false reading from sugary or just dirty fingers.)

First juggling pump, finger poker (more officially given the horrid name of lancing device), test strips bottle, individual test strip I need to use, and often my Dexcom receiver (either the app on my phone or the little special receiver that looks like an mp3 player) to make sure its still accurate. Then I’ll poke my finger, the blood drop goes in the test strip, and the pump will give me my blood glucose number. Once it has that it kindly asks me if I’m going to eat and if so how many carbs. Based on that, my current insulin-to-carb ratio settings, and how much insulin is active in my body (insulin on board or iob), it will suggest an insulin dose, which I usually accept as is….

20171014_230649195384811.jpg

First this, then food.

And then I get to eat.

After I put everything back away, that is.

If I’m going to have a snack or dessert and I’m confident my Dexcom is accurate, I’m medically permitted to use it to manually inform my pump of my blood glucose number, thus saving my poor fingers (and a text strip, the really expensive part of DeTickles, ha), and then follow the steps to dose from the pump and nom.

It’s a lot written out, and sometimes it feels like a big interruption when I’m hungry or want to get to eating and watching a show or chatting with friends. It’s usually quick steps (if I’ve already figured out my carb count…and if nothing goes wrong) but it’s still adding about five more things between me and my food and fun times.

And when I was using insulin pens instead of pump therapy…whooo boy. For now I’ll just say I admire those who use pens. For me it was too many needles. But, you do what you gotta do when the choice is needle poke or get sick and ruin your health and slowly starve to death. Yaaay, the lighthearted fun of DeTickles. Anyway, some folks aren’t as bothered by them as I was (or they’re waiting for insurance coverage for a pump). I tip my hat to those diabadasses and remain ever grateful for my insulin pump and cgm.

Advertisements

Food that should be “free” foods

Here’s something I’m learning about DeTickles. There are rules for carbs and foods and exercise and getting sick and low blood sugar and high blood sugar and water and….everything, and there are variables that acknowledge  that each person is different, and then there’s also seems like at least one thing that will break each and every “rule.”

Here’s just one example. “Free” food.

I don’t mean a snack someone gives you because they want to share, and I don’t mean something stolen, haaaa, please don’t steal. I mean food that can be eaten without dosing insulin.

Some foods go without saying they have carbs. Potatoes, baked goods, uhh sugar, bread, etc. However much they have, they have some. (Fun fact, carbs in bread depends entirely on the kind of bread and can vary from nine grams per slice to oh say fifty grams for a bun. Yeah.) But some foods don’t have any carbs or are low enough to skip counting. (The rule of thumb I’ve heard on this is 5g or less in whatever the serving you have, and this only goes for a total of 5g from all the food in food in front of you. Eat six servings of various 4g foods and you better total up 20-24g or have problems later.)

For example, black coffee, diet soda, cheese, un-or-less-processed meat, raw leafy greens like spinach, cauliflower, snap peas, some tree nuts, coconut oil, eggs, and so forth.

The basic idea is food is primarily one of three: carb, protein, or fat. If it’s not a carb, it’s free.

But here’s the rub. Some Type 1 Diabadasses need insulin for their black coffee because of the caffeine.  Same thing for caffeine in diet soda. The caffeine can raise blood glucose, which means insulin is needed to keep it even or bring it down.  Some meat is processed in a way that adds countable carbs. Some have to dose for a pure protein like eggs or steak if the serving is large enough. Cauliflower is low-carb but still has carbs — so do nuts, snap peas, and more — and if one is sensitive to small changes, they better count each carb.

Here, have a favorite meme.

Every meal or every snack can be a guessing game. Without the right count and the right dose for carbs and other factors, blood glucose numbers are harder to manage and balance into that sweet spot where the diabadass can feel good, function well, and thrive.

So, even free food isn’t always free.

Nachos

Another quick and easy go-to, nachos at my house is basically ground turkey (my sweetie likes it better than ground beef and when I finally tried it, I was convinced of its deliciousness), Tostitos Scoops chips (for carb count, fun factor, and ease of eating the toppings), and whatever we feel like.

20170918_1816041734411241.jpg

Tomatoes, guac, sour cream, greens (I usually use salad spinach or salad mixed greens–then I don’t have to buy anything extra when I want a salad), shredded cheese, black olives, mushrooms….

20170918_1816081325940828.jpg

Recently my brilliant spouse suggested pineapple nachos and I looked it up and it’s been done repeatedly! I was so excited, I stopped at the grocery store on the way home from work and we tried it that night. Barbecue chicken that night, then we had it again with ground turkey. Tasty both times!

20170919_152821310862063.jpg

Nachos are a surprisingly easy go-to and always a crowd pleaser.

20170918_1826071529717778.jpg

DeTickles Fashion

Let’s talk pockets.

I love pockets all the time and any time and on just about anything ever (I once saw a movie where a character has a beanie hat with a pocket on the front, and after several years I still want a hat just like hers). 

Now, interestingly enough, most women’s clothing here in the States, especially the less casual and more professional or dressy clothes, either don’t have real pockets or don’t have functional pockets. Fortunately for me, I tend toward a more sporty look, but even then it can be hard to find pockets in clothing that fit both my preferences and my needs.

Before DeTickles, most of the time I didn’t necessarly have to have pockets, though I always preferred the availiability. Now, with DeTickles, I have to carry several things with me at all times, and when I’m walking from one department to another at work, up or down the stairs at home, checking the mail or mowing the lawn, or going to a nice evening out and don’t want to lug my casual and cute, butterfly-covered backpack purse with me everywhere, I need somewhere to put my dia-things without filling up my hands.

Currently I need to keep my phone and my insulin pump controller with me at all times. My phone has an app for my continuous glucose monitor (CGM) and is also a safety measure in case I need to call for help like my sweetheart or 911. I need my pump controller with me in case I have a problem and need to make immediate changes to my insulin, like completely shutting it off so I don’t have a dangerous low blood sugar and pass out.

To be honest, I don’t always carry these two things with me absolutely everywhere…but I really should.

So, that’t two medium pockets I need to have all the time. Then I have other things that are very, very, very good to keep within arms reach, like fast sugars–again safety in case of that dreaded and often unexpected low blood sugar, or my glucagon kit (emergency kit for the same thing), or my testing supplies, or backup supplies in case something fails. And if I wasn’t using pump technology, I’d need pockets for my insulin pens (or needles and insulin vials).

So, of late, I’ve been wearing mostly two pair of pants that have enough pockets and switching out my mostly casual tops with them. All fine and good, but wearing the same pants for probably a month without breaking the monotony with flowy skirts that I like a lot (which never have any pockets), I’ve started to not feel like myself. DeTickles has taken over my clothings choices rather than me picking what suits my preferences and expression on a given day.

It becomes an emotionally draining thing.

Funny how even fashion and clothings choices are affected by that darn DeTickles.

More pockets, please.

Carbs, sugar… It’s all the same, right?

As I have been learning about my own body and the disease I dub DeTickles, I have noticed there is a lot of confusion when it comes to the language used to explain and understand what is involved in the daily life endeavors of a Type 1 Diabadass.

With all the talk about sugar this and sugar that, low sugar, sugar free, and even “blood sugar” (same thing as “blood glucose” but seemingly easier to understand the concept?) the focus for people who don’t know better and haven’t been taught better goes to sugar.

Buuuut, it’s not quite that simple. I could get a sugar-free bread like Ezekiel bread, but it still has carbohydrates. I could buy sugar-free Jello, but I still need to check the label to see if it has any or no carbohydrates. I can indulge in a sweet, but even if it’s a zero sugar candy, I need to know how many carbohydrates it has (because it does still have them, not fair, I know).

I found this in my local Target’s tiny diabetes shelf in the pharmacy section. I can’t eat that without dosing insulin unless I’m having a problem. I’ll pass.

Carbs are why I need to be careful about and get some sort of (carb) count for everything I eat. Did you know that foods like peanuts, broccoli, snap peas, carrots, and tomato have carbohydrates? It’s not usually a whole lot of carbs, but they’re there.

Crazy, right? They’re not even sweet. Unfortunately it’s not as simple as what’s sweet and what’s not. (Just think about alternative and artificial sweeteners for tea and coffee and water flavorings and diet sodas, which can be very sweet but boast of no calories and often…almost no carbs.)

See? It’s confusing, right? Sugar is the key word everyone knows. But it’s not about sugar — though sugar is an undeniably important factor to consider — and it’s not just about how sweet something tastes.

The all-important thing to know about with DeTickles is: Carbs.

Carbs can be present when there is no sugar. And they will always be present when there is sugar.

Another way to put it is: All sugars are carbs but not all carbs are sugars.

And I need to be aware and careful about all carbs.

Tuna egg salad sandwich 

One of the easiest go-to meals I have picked out was inspired by a recipe from eMeals which I immediately modified to my personal preferences. The powerful tuna and egg salad sandwich.

I’d heard of and had egg salad sandwiches before, but they were often fairly bland. Add some lettuce or spinach leaves, that’s pretty good. Slices of cheese make it even better. But add in that tuna and it becomes something rich and varied and powerful. And that I had never thought of adding before.

When I can, I’ll add in some chives, paprika, and if my plants are doing well, some fresh chopped basil leaves.

Deliciousness. And it hardly seems like “just a sandwich.”

I could possibly make it lower carb if I followed the directions from the eMeals recipe and boiled my own eggs and made my own mayonnaise, but I’m quite content with my methods. If I have medium-hard-boiled eggs on hand, which I sometimes do as an easy, high-protein freebie for breakfast or snack, I will definitely cut up one or two to the mix, but I like to buy little tubs of pre-made egg salad. They are delicious, not particularly high carb (a 1/3 of a tub [or less even] scoop goes a long way to cover a lot of bread and fill my tummy, especially when adding the tuna and spices), it’s so fast to fix, and it makes a good dinner or a packed lunch (or not and relax at home on the weekend!). The biggest downsides are they can be a bit messy to eat (that’s not much of a concern with a napkin and a fork) and my carb information becomes an educated guess (also not unusual, though, so it’s a tradeoff I’ll make).

It works with any kind of bread, so I can use my lower-carb sandwich bread, a toasted burger bun, or enjoy something fancier with more complicated flavor. I bet it’d even be great as a wrap.

Add a couple sweet pickles on the side and that is a great go-to meal!

Low Blood Sugar

I asked friends and strangers alike to finish a statement for me, and I’d like your thoughts in the comments, too. (It will help me with a personal DeTickles project.)

Finish the sentence: “Low blood sugar means…”

When I asked on Facebook and Twitter I got an interesting mix of responses though granted from a very limited selection of people. Answers ranged from, “Huh, guess I should eat something,” to “I’m about to need to go to the hospital so I don’t die.”

This leads me to think that context is key and there could probably be better awareness raised for people with hypoglycemia (fancy technical word for low blood sugar in general and for frequent low blood sugar, also called lows) and for people with diabetes (who are more susceptible to low blood sugar, especially those who take insulin as a medicine).

When I think about low blood sugar, I try not to freak out, but the reality is, I have to take immediate, measured action to make sure it doesn’t stay low and doesn’t drop lower.

For a lot of people, and for me when I was going through growth spurts, low blood sugar meant I was hangry, weak, and couldn’t do anything else until I got some food.

Meat was usually the food of choice, maybe a sandwich, so there was bread (carbs) involved too, but I find it fascinating that some protein was enough then but today, with DeTickles, I have to have carbs and a specific kind of carbs at that: fast-acting carbs. Candy; regular soda; a baked goodie should work; every Type 1 Diabadass’ favorite, the glucose tablet (chalky, flavored, special sugar, if you will); juice (oh yes please); or something along those lines. A lot of things we may normally veer away from become essential life savers. (The candy does live up to it’s name!) And I have to measure how much of what kind of carb I’m eating and time it, waiting while I feel shaky and sick and try to be aware of every little symptom and change so I can prevent my body from shutting down. For me personally it usually takes a half hour before I’m okay again and can get back to my normal living.

So if the majority population thinks “low blood sugar” means a minor inconvenience that can be handled with a little snack, pretty much whatever it is, the phrase doesn’t hold much weight, especially for daily living when you need to get help from somebody.

Which is one reason why I like to try using “my blood is too thin.” It sounds less catchy maybe, but iuueghh, it gives an immediate, visceral impression of a definite problem, right? (I’ll talk more on this phrase in a future post.)

But while we wait for that phrase to catch on, try to think of low blood sugar as your body’s cells starving. If the cells starve, so do you. So yes, please eat something that will feed those cells.

And keep in mind, it might just mean an ER visit for someone you know.

I remember Mama

The last year and a half have been a non-stop whirling of good and hard and painful things.

In 2016 I adopted the Old Man, was diagnosed with DeTickles, and became engaged to my best friend. This past spring we had our wedding, and this summer I experienced something harder than my diagnosis day.

A month ago my mother slipped away from this world quietly and when loved ones were near but not paying close attention. It’s just like her to be happy to leave us to it when the room is filled with laughter and reminiscing.

I was holding her hand.

I miss her greatly.

What else can be said? It’s a loss I can’t fully explain or understand, though I will speak in favor of counseling. It helps.

I spoke at her service. I knew I would always regret it if I didn’t stand up to say something about who my Mama is, how she treated everyone, and how she raised me and my brothers. She loved well and fiercely.

I loved cuddle time sitting in her lap for long stretches. I loved the conversations we had about serious things and silly things. I loved sitting next to her on the couch as we colored together during one of my last visits.

I loved seeing her bright and joyful at my wedding.

At her service I took the podium to honor my mommy. Here is what I said:

My name is Dorathea Chaplin; I am Mary Lou’s daughter, and growing up, most of you probably knew me better as Dotty.

The essence of my mama is complicated and beautiful, and therefore hard to capture, but as I was thinking over her life and who she is a few things stood out to me.

First and most, my mama is the most caring person. She wanted to make everyone she met feel like the most special person in the room, and she was good at it. All my life I watched her do that with cashiers, bank tellers, strangers anywhere around town, on trips, meeting my mother-in-law, and really anywhere and everywhere she was.

Mama made sure everyone had what they needed, and especially if it was food…
Which was always delicious…

She was gentle but she was also fierce, and that never contradicted her loving heart. She had a protective sense and counseled many people, including myself, and she would do anything to give those who needed it a safe space to take rest in.

And my mama was one of the smartest people I knew. She was inventive, creative, educated, and an absolute wiz at logic puzzles which she loved spending time on.

She had the fortitude to homeschool her not-always-willing children while taking care of her parents. And with determination and strength I could never comprehend she would drive me to my classes when I needed rides even while in the process of undergoing chemotherapy and radiation treatments. I remember she said she loved that little extra time she and I had to spend together… and I did too.

She was proud of what she had done and had every right to be, but also never cared to take center stage. Her biggest delight was in seeing others taken care of and surrounding her with their happiness.

I’ll never be able to say enough, and she probably wouldn’t want all the fuss. But I will say I am so happy she’s paving the way home for us. I bet when the time comes she’ll be part of the feast preparations when we all join her. And in the meantime…

…Mama,

I saw you smile.
wp-image-558551664.

When Every Conversation Turns to Diabetes

For me and I suspect for many others with DeTickles, there is no switch to turn off thinking about the disease. It’s like background software in the mind, always running and taking up some memory or necessary pathways for other functions and thought processes. My mind is already non-stop whether I want it to be or not, and the constant awareness and management needed for DeTickles just added to that busyness and chaos of thought.

So, it isn’t surprising to me that, especially in the first year of diagnosis when I was on the fastest learning curve and one-way lifestyle change I’ve ever experienced, every conversation made me think of something DeTickles related.

A friend could say, “I am so hungry!” and I will immediately think, Food, yeah that’s a good thing, important. You should eat. If I were to eat a snack like yours, I’d have to count up those chips, check my blood sugar, make sure chips is an okay choice for me right now, then get my insulin, and then I have to make sure I eat all of the food even if I decide I don’t want it.

Or I might hear how cool a concert was and think about if I had gone or if I wanted to go to a different concert how often I would have to check my CGM to make sure my blood sugar was stable because I wouldn’t likely be able to hear any warning alerts.

Or if I were invited to go to the beach later in the week, I’d be thinking about where I want to wear my insulin pump and CGM and which swim suit to wear–do I feel like hiding the pump and monitor and feeling more “normal” or proudly wearing them visibly and being an advocate–and also prepare for questions. I’d think about carrying emergency carbs with me, preventing dehydration (which sends blood sugar numbers up) and sunburn (which can also weaken the body and send sugars up), and trying not to feel like an idiot when I carry a huge, awkward tote of everything I could possibly need (or skipping some of it and taking a risk).

For me, everything comes back to DeTickles management; DeTickles affects everything.

Eventually I noticed how often the word “diabetes” came out of my mouth. I didn’t count, but I was beginning to annoy myself, so I figured maybe it was getting old for others, too. Now, I have a lot of amazing friends who engage and ask honest questions and want to learn about it. That’s great! But for my own sake as well as maybe theirs, I didn’t want absolutely everything I ever talked about to be diabetes this diabetes that, diabetes up the wall and in the bathroom and at the vet’s and on vacation.

There is still a very real element where I do need to talk about it, and often if I have an alarm sound or feel off or whatever, DeTickles will and has to enter the conversation. But I get to choose the other times how much I want it to take over and be the only thing I talk about.

Nah, man. I’m far too interested in a bajillion other things to want that.

Making this blog was in part so I could have a place to regularly pipe up about it without noisly taking it to every restaurant or hangout with friends or shopping trip. And I’m still learning, but I have been a little more proactive in not chiming in with DeTickles fact #1203 or DeTickles complaint #1701, and I’m not sure if anyone else has noticed, but I’m happier for not letting it consume every single time I talk to a friend or family member or share something on social media.

Sometimes I really do even forget I have it. And that’s pretty nice actually.