Wednesday, February 24, 2010

Exercise shmeksercize A rainy winter day doesn't help. But overwork, undersleep, two travelling weekends in a row, and too many other worries and activities to count, on top of the usual strenuous schedule of work and childcare, add up to - too much! I've tried to keep some balance by sleeping as much as possible and exercising. I don't go to a gym. I don't like them much, my schedule isn't that conducive to going (even if they had childcare; daughter H is in childcare enough as it is), and I wouldn't be sure my blood sugar is at the right level (neither too low nor too high) at just the right time to fit it into my schedule. I also like to exercise pretty late at night.

Instead, I go for walks as often I as can. I can be pretty flexible about the timing, and eat as much as I need to right before heading out (in addition to using a lower temporary basal rate on my pump). This time of year, that's tough, so I follow a yoga video when I can't get outside. Years ago (before migraines set in for their 14-year visit), I used to run and do aerobics videos. I've gotten in the habit of doing lighter exercises (the heavier stuff would trigger migraines, when I was prone to them). I do occasionally do the aerobics workouts, now that I can, but I find that quick walking is strenuous enough to get my heart going, and it's so much easier to motivate for that. The yoga is great, too. I just did tonight, it at the point where I was tooo exhausted, and it actually gave me a little energy. It's a really easy program, which I think is key for any nighttime effort, especially at the end of a long day!

I also really do get a workout during my time with my daughter. I spend a lot more time standing, leaning over, getting up and down, carrying her (a not insignificant load!), etc. As I've mentioned (oh, maybe once or twice), I actually have to be careful not to go low when I make that sudden shift from sitting on my duff all day for work to my more active time with my daughter.

I've always been suspicious of research that looks at the benefits of regular exercise but only looks at specific activities like running, swimming, and biking. I can tell from my blood sugar levels that so many other activities give at least as much of a workout - especially house cleaning! Today, I can gloat about this opinion: The latest news on this was in the New York Times. According to the article, it doesn't matter whether you jog every day if you sit the rest of the time; but standing up a lot is actually a really good workout. Granted, I sit much of the work day. But even there, I take the stairs and get up and down a lot to talk to people or go to the printer. And then I go home and get the special toddler workout.

Still, I need another form of exercise. Walking outside does a lot besides give my cardiovascular system a (light) workout: It helps me destress, gives my legs a stretch, and, if my husband and I get to walk together, gives us a chance to reconnect. These are all things I don't get from playing with my daughter (much as I love that time with her!). For anyone, but especially a diabetic, all of these aspects of exercise are important.

This reminds me of a study I heard of a while ago that compared people's blood lipids (the artery-hardening stuff) after a low-fat meal without exercise and after a really high-fat meal (8 strips of bacon!) followed by about a half hour of strenuous exercise. Guess what? The bacon-plus-exercise won out! That study really made me realize how important exercise is - and how much it can help make up for other willpower weaknesses!

Sometimes I wonder whether I'm getting enough really strenuous exercise to keep fit. But on the rare occasions when I go hiking in Acadia or cross-country skiing (which I took up years ago to get more daylight in winter, and which I love, but rarely get to do these days), I'm pleasantly surprised to find I can climb, sometimes at steep angles, at a good clip without getting winded.

The one hiccup in my routine now is that, when I pick up my daughter and get home, all she wants to do is watch Elmo. No amount of cajoling from me or hubby can get her out. We used to plunk her in the stroller and head out regularly; now we have to take turns walking so one of us is home with daughter H at a time. It makes the walk time shorter and less fun. I'm hoping we can get her back out there soon!

So that's my own real-world routine. What are your exercise strategies? If you have kids, how do you work around that - or work them in - to get your workout?

Thursday, February 18, 2010

A little multitasking, anyone?

First, a short follow-up note; I realized that, in my last post, I linked to an article from the BMJ (formerly the British Medical Journal) that requires payment for full viewing. The little lead-in leaves a person hanging (of course): A woman with an A1c of 7.9 discovers she's pregnant. Well, assuming you don't want to pay for the full article, I'll ruin the suspense: The woman (it's unclear whether she's real or hypothetical) ends up having a baby with a heart defect that must be fixed with surgery soon after the baby is born. It seems the baby is fine in the end, but the case is supposed to be a cautionary tale about preparing for pregnancy if you have type 1 diabetes.

The article discusses a lot of interesting (to me, anyway) data about just what A1c to aim for, ideally before getting pregnant, and about just what the risks are with higher levels. But of course, "risk" is a difficult concept; just because the risk is somewhat higher as your A1c goes above 6.0 doesn't necessarily mean you risk is "high." I certainly wasn't anywhere near 6.0 when I got pregnancy, despite my best efforts to prepare; I did get down that low (and even a little lower) during most of my pregnancy, though. In the end, my diabetes wasn't the biggest factor - it was my apparently familial risk for pre-eclampsia (a.k.a. toxemia; high blood pressure during - and sometimes after - pregnancy). Yes, diabetes does increase the risk for pre-eclampsia, but it's common in other pregnant women, too; in fact, it's not very clear why women develop it.

What I've really been thinking about this week, though, is the extra level of multitasking that diabetes adds to parenting. Figuring out how many carbs are in the meal I'm about to eat, plugging that and my blood sugar level into my pump, and accounting for any other factors, like the walk I went on a few hours earlier, or the sprint up the stairs that I'll probably have to do right after my meal to get a toy or book; all while making sure my daughter eats her soup instead of putting it up her nose, and figuring out when she's going to be ready for her nap or bed before she upends the soup bowl as her definitive signal of the meal's end. And that's on the days I'm not working from home, when I'm also keeping in mind word deadlines. Still, work-at-home days are a relief from all the extra planning that it takes to get myself and my daughter out the door.

I've come up with some time-and-energy savers to help simplify - mostly just by making the things I need more accessible, so I don't have to run around so much or think about where they are. For example, I have three blood sugar monitors: One for my upstairs bathroom, one in my purse, and one in my car. I just got one more, so that's going in my suitcase. The one in my purse is the primary one, so I can keep track of most readings that way. But when I'm elsewhere, I can still test whenever I need to. If I were on one floor of my house and my meter were on another, and I was with my daughter, it would be impractical (sometimes impossible) to reach the meter. I admit I haven't tried to keep a log of my sugars in a while; but my pump now lets me download my readings onto the computer, so almost my readings (which I plug into my pump myself) are recorded together there. This does miss the low readings, which I don't usually plug into my pump (because it would just say 'Hey, idiot, don't take insulin right now!' or words almost exactly like that). I tend to remember the real lows, though.

We also have a diaper-changing station in our living room; I know, nonparents are probably grossed out just by the concept, but it helps to avoid those unplanned-for extra runs up and down the stairs that make my blood sugar drop. I've duplicated lots of little items upstairs and down that my daughter uses a lot, too, like sweaters, shoes (too bad she has one particular favorite pair that always seems to be on the OTHER floor from wherever we are), pain reliever, nail trimmers, and some clothing. We have a phone system with an intercom; my husband's used to the near-nightly buzz with the requests I call in for blanket, water, etc. (This system was his idea - I just hope he's not regretting it, but I think he secretly likes his role as runner!).

You know the old saying about necessity being the mother of invention? Well, as a diabetic mother, I've had to do a lot of inventing. Inventing (and constantly reinventing) seems to be a necessary skill for all parents, anyway, especially working parents; hence the reglorification of the crock pot! If you've got other time-and-energy savers you find useful, I'd love to hear about them!

Thursday, February 11, 2010

Moments of grace

I've had a few days of grace: The infusion set in my arm worked, and the next one, in my other arm, is working now, too (knock on wood). I know I'll need to find more sites that work. But not today!

I like that, with the infusion set in my arm, I don't have to worry when I pick up my daughter and she wraps her legs around me. I still get twinges when I used to put the infusion sets in my abdomen, but then I remember I don't have the set there, and I breathe easier. I probably really do need to let those sites rest for a good, long while. I haven't had the problem of her grabbing the site in my arm, say, when I'm getting her dressed. Maybe I have it far enough back on my arm. Maybe it's just luck.

Why did I use my abdomen so much, when we all have it drummed into our heads that you have to rotate sites? Well, for one, I was rotating all over my abdomen; and it worked quite well for almost 10 years. For another, when I'd tried the other sites before (well before pregnancy), it really, really, really didn't work; my BG went way out of control.I think there were far fewer options for infusion sets at the time. Even with several options during pregnancy, when I had this same problem (apparently not because of having a pregnant belly - some women have the set on their abdomens right up to, and even during delivery), I think it contributed to my BG going higher.

Now, I seem to be doing better, although it's only been a couple of days, and I wouldn't say my BG has been perfect. For example, my BG suddenly went to 49 after a dinner I've eaten often and know the exact card count for. Go figure. That quote comes to mind, "You are not obligated to complete the task, but neither are you free to desist from it." (apparently, this is from the Hebrew, from the Talmud). I feel like Sisyphus. If only the task were less mundane than keeping myself alive. But I guess it is more than that, because I have others to live for.

I feel I need to respond to the recent comment about losing a child (fetus) at 10 weeks (and whether you feel it's a child at that stage or not, the feeling of loss is no less). I have not had that experience myself, but I know several women who have (and at much later stages, too) - none of them diabetic. That stage of things is so emotional to begin with. Add the guilt of diabetes, and you've got a real emotional stew. I hope you come to peace with that, Amy. I can't imagine an A1c of 7.1 would, by itself, cause a miscarriage. Geez, I remember when I was on injections, I would have been overjoyed to get that number. I'm still there sometimes now. Yes, it's clearly still in the diabetic range, but who among us isn't, at least before pregnancy? If you want a straight-up discussion of A1c and pregnancy, there was a decent article in the BMJ a couple of years ago. Of course, the article doesn't convey just how hard it is to get the A1c down below 7!

I was so nervous during my entire pregnancy that I wouldn't tell anyone the sex of the baby until about 7 months along (though we knew it very early). We told our parents a little earlier, but no one else. I was so afraid of others in the extended family getting attached before we were sure there would even be a baby. I was so nervous, right up to the birth; I could not let myself believe it would even be possible, until my pregnancy was about 6 months along. Others seem so cavalier about it - as soon as they're pregnant, they're picking out names, making plans, worrying about exactly which baby items would be just right for them. I think I over-focused on my sugars as a way of avoiding thinking about that. I just figured I would do my best, and that was all I could do. But I could not start making plans until pretty late in the game.

From working in the medical publishing business, I know just how often things can go awry in human development - diabetes or no - so I know that actually having a relatively healthy baby is truly miraculous. Our culture gives us a false sense that it is ordinary. I know that is no great comfort when things go wrong; hey, I'm not happy to have happened to get this thing called diabetes, and no explanation of its cause would make me content about it. It's more like context; just because we have diabetes doesn't mean that's the cause of all our ills, though it sure seems like it sometimes, and it does create a gray zone of uncertainty.

Friday, February 5, 2010

Infusion confusion

I've gotten quite of bit of advice, some of it quite useful, in the past week in regard to my infusion site problems (see previous post). Thank you everyone! I'm currently successfully using the Quickset in my upper arm, having learned that you really need to push the set into the insertion device, pushing down on the needle guard (with the guard still in place, of course), and make sure it clicks in. I had been following the printed instructions (silly me!) and the infusion set was flopping around in the inserter, not a good way to get the needle to go into the arm. So far, the set it sticking okay; fingers crossed!

I still need to be able to rotate sites more, and I'd like to get something to work in my "hip," where even the 13 mm Silhouette set doesn't work. I've got some Sure-T sets to try (where the needle stays in, and it's very short; used a lot in kids, presumably because they're skinny). Also, I will check out the Orbit90.

I still had trouble a couple of nights ago, when I found the 13 mm Silhouette in my abdomen wasn't delivering insulin well. It was evening, right before my daughter's dinner and bath. I gave myself a bolus, then fed daughter H. My BG was even higher a half hour afterward, so I gave myself a small injection and ate a smaller than usual dinner. Then, while hubby gave H a bath, I went through three different infusion sets; first, the 13 mm in the hip (painful! I just can't reach well enough to get the right angle, even with the inserter device). Then I put a Quickset in my arm, only to find that, once I'd disconnected it to get it under my clothing right, I couldn't reconnect. Finally, the third one worked. By this time, however, my BG was seriously low. Of course, I should have known that the combination of bolusing from my pump, plus the insulin from the syringe, would bring it too low. It was a panic bolus.

I've recently read about "rage" bolusing, in a post on Kerri Sparling blog Sixuntilme (a great site). Yes, I've definitely done that. But this was panic bolusing - fear than my BG was rising out of control, which can happen very quickly with an insulin pump. Unlike when you inject, where you generally use a long-acting insulin, usually in addition to short-acting, when you pump, it's all short-acting; if it stops delivering insulin, you can go into a diabetic crisis within a day, as opposed to within a few days. So when my BG shot up, and I knew it would only go higher, I over-reacted. Of course, by panic bolusing, I ended up too low to put my daughter to bed. She was NOT happy about that! Then I felt guilty; then I felt mad about feeling guilty. Oh boy!

When your blood sugar is fine, and you're thinking about how to calculate the right amount of insulin, and how to handle a problem like a conked-out infusion set, you can usually figure out what to do. But when it's the end of a long work day, and you're blind-sided by a sudden high, and trying to manage your child's needs, and just exhausted, it's not so easy! Know what I mean? I should have changed the set out right away, but I didn't have a chance to, because I had to take care of H. Maybe I could have waited a little longer without taking more insulin. Maybe I could have taken even less insulin by injection, or I could have eaten more. I just didn't have time to think it through rationally.

And how about panic eating? I use to do that more before I went on the pump, especially at bed time. It took me a while to trust that my BG wouldn't go low overnight, like it did so often before I went on the pump. I still do, esp. when I'm running low. I've gotten better about that one, though. Pregnancy helped train me. I use glucose tablets more often, instead of food or juice; and OJ is usually right out, because it's far too sweet and contributes to rebound. Apple juice is better, when I don't have glucose tablets. Still, sometimes I just get too hungry to resist - especially when a low happens at meal time. When you're starving already, and then get a low (which makes your body truly believes it's starving), it's nearly impossibly to just eat a few glucose tabs and sit waiting. Often, I end up with a more-prolonged low (followed by a rebound), precisely because I ate more than just the sweet stuff.

But then, sometimes just when I think I've eaten too much and I'm going to get a rebound, my BG ends up fine. Like last night, after I'd treated the low by drinking a big glass of OJ (I know!) and eating a banana, then ate a sandwich and bolused normally just for that, I ended up with a BG of 93. And no rebound overnight, either. The glucose gods must have taken pity on me.

Have you ever panic-bolused? Or panic eaten (if that how you say it)? Do you have strategies that help?