Tag Archives: BGs

That Time of Day

I don’t know what it is about that time of day, but…

There’s something about 4:00 to 6:00 p.m.

It seems like every single day between 4 and 6, my blood sugar takes a nosedive. Doesn’t matter what I’m doing, doesn’t matter where I am. It’s a strange, strange thing.

This has been happening for years. It goes back over ten years, in fact. Some things have stayed the same during that time, but some have not.

I still work for the same company, though I’ve worked in my current office location for almost a decade. On the other hand, I don’t go to the office five days a week like I did back then. Now I work two days each week from home, and the lows happen on those days too.

On the days in the office, I have about a half mile walk from there to catch the train home. Typically, between the time I leave the office, walk to the subway, get on the train and come home, my blood sugar will drop 50 to 80 points. When I work from home, it will still drop 30 to 50 points during the same time of day.

I’m not as active as I was back when I first noticed this phenomenon. I’m still fairly active for someone my age, but let’s face it, I’m not as young as I used to be either. Who is? My blood sugar is still reacting to this time of day like I was on the spin bike for two hours straight.

Before you say it, I adjusted my pump settings long ago. Between 4:00 and 6:00, I’m getting half a unit of insulin per hour. That’s it. And most days, I could just suspend the damned thing for two hours and I’d be just fine.

One of the hardest things to explain to people who haven’t had diabetes in their lives is the constant changing nature of our endocrine systems. It’s like, they hear you when you say diabetes isn’t “set it and forget it”, but they really don’t understand that it means I need 1.6 units per hour in the morning, and less than a third of that (or less) during those two hours.

And truly, even the regular basal settings on the pump aren’t perfect for each moment of the day, because every day is different, right? Stress, no stress, exercise, diet, caffeine, alcohol, and any number of other things can affect my BGs from day to day, minute to minute.

But if I had to pick a time where my diabetes is most consistent, I’d have to say it’s during that magic time between 4:00 and 6:00 p.m.

Do People With Diabetes obsess too much? Or is it just me?

I was in the grocery store a few weeks back, in the aisle where the boxed juices sit on the shelf.

As I stood there looking at the flavors (because rule #1 for hypo supplies: taste good), I was also checking out the carb count of every single juice box in the aisle.

“Well, this one looks good, but it’s 22g of carbs per box. This one is 12g… how do I count/bolus for that? Each box of this juice is 15g, which I want. But the flavor is… not my favorite”.

After standing in front of these shelves for over five minutes, I asked myself (out loud—good thing I like to shop early in the morning) whether it really mattered if a juice box had exactly 15 grams of carbohydrates per box. I mean, if I’m in the middle of an overnight low, and I need to treat with a juice box, I don’t think an extra 7 grams is going to make a huge difference. So I wound up picking the juice with the flavor I liked (fruit punch), but 22 grams of carbs.
This is just my viewpoint on the subject… I completely understand if you are into exact measurements and precise management of your diabetes to get to, and remain in, a good glucose range all the time. In fact, I admire you for that level of dedication.

But you know, I just wonder if years of exchange diets, A1cs, and carb counting has made me obsessive about a gram of carbohydrate here and a couple of BG points there. It was brought into focus for me about a year or so back when I visited my endocrinologist, she relayed my lowest A1c result ever, and in the next breath wondered herself if I had been obsessing too much. Her very words were “You know, it’s not the end of the world if your meter reads 140 mg/dL before dinner once in a while”.

Plus, and I don’t think this happens to everyone, but it happened to me: As I experienced more success with my A1c results, I became more and more of a micromanager about my numbers. I mean, it’s great when you get good results from it, but I don’t think I can keep it up forever. And mostly, I need to remember that I don’t know everything, or even much, about day to day management of my diabetes. You may disagree with that, but there’s no denying that I could stand to learn a lot more.

The other side to this is what happens if something unexpected happens when your numbers are so tight. And something unexpected is bound to happen once in a while. I’m fond of reminding people that the better your numbers are, the closer you are to hypoglycemia all the time. It’s a lot scarier to go from 100 to 50 than it is to go from 200 to 150.

If I’m obsessing over anything right now, it’s probably my basal rates and my insulin to carb ratio. Over the past two years, I’ve also cut down a lot on my daily caloric intake. So if I can get the basal and insulin to carb ratio numbers right, I think I will be in a good place with my diabetes about 80 percent of the time. And if you told me six or seven years ago that I could be on top of my diabetes 80 percent of the time, I wouldn’t have believed you.

How about you? Are you a control freak about your diabetes? Or are you more of a rounded, but nice, edges Person With Diabetes?


What is it about diabetes that just knocks us off our game now and then?

Nothing about diabetes is wonderful, unless you count the people you meet who are dealing with the same things, either by living with diabetes themselves, or living with someone who lives with diabetes. The rest of it pretty much sucks.

Still, sometimes we put on airs of “I’m a tough hombre” because we deal with everything this disease throws at us, and yet we get through it… we’re strong enough to suffer the slings and arrows that diabetes sends in our direction, and often we emerge from the battle stronger than ever. How many people with completely healthy bodies do you know who can put up with what we put up with on a regular basis?

I can’t say that’s how I was feeling the other night when I went to bed. But it had been a long time since I’d experienced an overnight low, and nothing about that Thursday night was any different from a thousand Thursday nights before it.

Insert diabetes… begin chaos.

I woke up around 1:30 a.m., feeling sweaty, and a little irritable. If I’m sweaty at this point, it means my blood glucose level has already sunk pretty low. Normally, when this happens, I just need to get up, go downstairs, get the juice from the fridge… I’m good. This night, I didn’t, couldn’t, get to the fridge. Instead, I sucked down a juice box sitting next to the bed. Then another. Then a package of peanut butter crackers. Then some candy. Then some peanut butter. Another juice box. In all, it took around half an hour for me to actually feel like myself again. Like I could even stop to check my BG. Prior to that, it was all about feeling well enough to remain upright.

Therein lies the problem with feeling like you’ve nearly nailed your management of diabetes. You get surprised when you least expect it. It’s also the point where a lot of People With Diabetes feel a lot of guilt. I was a little guilty in this instance. I had a snack that evening that I probably over-bolused for. It happens. It happened Thursday night. But unless I make a habit of it, I’m not going to feel bad about it. That kind of thing doesn’t work for me. And while I don’t want to tell you what to do, I think you should consider what I’m saying here.

This might sound a bit harsh, but when it comes to diabetes, guilt is for suckers.

It’s not that we’re perfect… no way are we perfect. But what’s done is done, and feeling any guilt about anything that happens to you because of a disease that you did nothing to contract is like blaming your parents for your eyes being brown. Sure, your parents had a lot to do with it, but your eyes are still brown. After the moment passes, we still have diabetes.

So Friday came, I went to work (tired and hungover and a little afraid of my next bolus), and I continued living. That’s the final victory.

If you want, think of it this way: our imperfections are only a trivial botched play in the middle of an otherwise victorious game. If we live, we win. I want to improve my game so I’ll be successful more often. But I’m also going to realize that sometimes, a botched play is going to happen anyway, and the best way to deal with a botched play is to make it trivial by making the rest of the game spectacular.

I’d rather concentrate on the spectacular.

Somehow, diabetes is diabetes.

Edmund Burke once said, “People must be taken as they are, and we should never try to make them or ourselves better by quarreling with them“.

The same holds true for diabetes.

Regardless of what I’m involved in at the moment, good or bad, diabetes is there. Work, gym, party, driving, it doesn’t matter. Hey, I’m like everyone else… I like out of sight, out of mind thinking. But diabetes just won’t allow me to do that.

When my BGs were running low the other night, right at the end of work, I just wanted to power through it, finish up, walk to the train, and head home. But… as you can probably imagine, I wound up sucking back juice boxes, staying later, and getting home about an hour later than usual.

Part of the secret to managing diabetes, I think, is in realizing that the same diligence is required for those moments when we may not feel high or low. We might not always feel it, but we know it if we’re checking. And if we know it, and it seems like the numbers are consistently not what we need to live a healthy life, then we know we need to make changes.

And once we make the changes, then we have to deal with verifying that our changes are actually working. So that requires staying on top of the part of our diabetes management that wasn’t so perfect before the change. Maybe we need to make additional changes after the first one to get our BGs back where they need to be. That’s life, and that’s diabetes.

Burned out yet? I know, I know.

Listen, making changes is tough for me. Dealing with stress because my changes don’t seem to be working right away can make me very cranky. If there’s ever a time when I want to curse diabetes, this is it.

But… somehow, diabetes is diabetes. It doesn’t care if you’ve made changes, and it doesn’t account for how hard you’re trying. It’s really not doing anything at all. It’s requiring you to do everything. We can quarrel with this disease all we want, and then we wind up right where we were before the argument began.

Although he wasn’t speaking specifically about diabetes, Edmund Burke also said “Our patience will achieve more than our force“. I think that applies pretty well to diabetes too. It’s with us for the rest of our lives, probably. If we can make meaningful changes to our overall lives, and give it a little patience, we just might be okay after all. Doing what we can to work with our diabetes, rather than rage at our diabetes, makes us healthier. And it might just give us a chance to live longer too.

I’ll settle for that.

Diabetes ain’t no sissy game.

We’ve talked about this before…

Why is it that we are all so good at making life with diabetes look normal?

The reality is that life with diabetes is anything but. Diabetes is not for sissies.

– How many times have we worked hard, over a period of years, just to get our A1c down to a range that we and our endocrinologists can be happy with? How many times have we worked hard, over a period of years, to keep our A1c from growing higher?

– How many times have we voluntarily engaged in the tradeoff that includes using a sharp tool that causes us to bleed, just so we can help maintain our diabetes management?

– Pump users: How many infusion set changes have you completed over the course of living and pumping with diabetes?

– MDI users: How many injections have you had to endure over the course of living with diabetes?

– How many hypoglycemic moments has your diabetes included? Lows that knock us down… but often we get up and go on with our lives like nothing ever happened. And the people who we would most like to know, don’t have any idea at all what it’s like. Side note: I tell those people that I went through a near-death experience. Because I did. I want them to know how precarious the balance between high and low BGs really is.

– Show of hands: How many of us have had workouts that were cut short due to the fact that our bodies use insulin way better when exercising, and getting the basal/carb/exercise mix is difficult and ever-changing?

– Have you had an endocrinologist tell you that your A1c was high, and you’ve been trying so hard, and you just wonder if you should keep trying anymore? But you do, because, what’s the alternative?

– Did you get one of those unhappy A1c reports, or a high or low number on your meter, or a pump occlusion that causes you to do more than one set change in a day, or a low or high that just doesn’t seem to quit, but…

We forgive ourselves? That, my friends, is real bravery.

I haven’t even started on all the things that parents of kids with diabetes have to go through, much of which is even more out of control than what I go through.

There are many things that diabetes puts us through, on a daily, weekly, monthly, quarterly, year-by-year basis. Sometimes we can feel like a failure. Like we’re weak. Like we’re not as good as someone else. But nothing could be farther from the truth.

It’s easy to forget the fact that we’ve endured a lot, and come through it despite the tough moments (or weeks, or years) that come with living with a disease that is with us all the time, and is so volatile.

Fact: Diabetes ain’t no sissy game. If you’re living with diabetes, and you’re alive, you are a champion.

Have anything else you’d like to add? Feel free to tell me how you’ve endured through the months or years by leaving a comment below.

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