Fear of Fainting

One of my greatest fears as a type 1 diabetic is passing out due to low blood sugars.  I’ve been fortunate to have never had this happen in the 9 years that I’ve had diabetes, but there have been enough close calls to know it would not be a very enjoyable experience.  However I have had a couple unpleasant, non-diabetes related, fainting experiences.

I had gone my whole life not knowing what it felt like to faint, until a couple years ago when I was working at an art school in the summer.  The first day of work, I clumsily cut a chunk of skin off my finger, right to the bone.  Since the cut was so deep, I went to my doctor’s office to see if it could be stitched, and the nurse unwrapped the bandaids I had applied, before going to fetch the doctor.  As I sat there with the wound unwrapped, the blood began to pool on my finger and I felt my vision slowly going darker.  I think it is important to note that blood has never grossed me out or made me queasy, nor have needles or any of the other medical related necessities that seem to cause many people distress, and as my vision slowly got darker, I was thinking to myself “This is silly, I’m not panicked or grossed out at all. Why does it feel like I’m going to faint?”.  Yet I fainted anyways.  My blood sugars were not low, but according to the doctor, tall people (I’m a 5’10 female) are more likely to faint because their hearts must pump harder to get the blood to their heads. 

In the 4 years since that initial fainting experience, I’ve fainted a few times, usually during instance when I’m in pain.  On the weekend, I was walking down my stairs holding my cat, as I do a billion times a year, but this time my foot slipped on one of the lower stairs and I fell hard. Most of my weight came down on my left elbow, but after the initial moment of shock subsided, I could feel pain shooting up both my arms and my back.  I’ve always had a high pain tolerance, but this didn’t stop me from passing out quickly.  According to my mom, I wasn’t out for very long, but when I came to the first thing I shouted in panic was “What happened? Am I low?”.  Even in this confused, hurting state, my first thought immediately went to diabetes, and my fear of fainting from a low.  The pain combined with the panic made me feel like I was going to faint again and I had to lie down on the floor while my brother got my tester.  My mom fed me some juice, and it wasn’t until I tested and realized I was 9.0 mmol/L (actually a bit on the high side!) that the panic subsided and I was able to calm down.

Fainting is definitely one matter that is much more complicated, and frightening, for a diabetic.  Even though I’ve never passed out from a low blood sugar, I know that the fear of doing so will probably scare me any time I faint or come close to fainting.  That’s just one of the scary realities of living with type 1 diabetes.   

The Week of Cake

When I was a child, the week in May which held both of my brothers’ birthdays was always a week of excitement.  I was the middle child, stuck between two boys who had their birthdays within 5 days of each other, but I never had a problem relinquishing the spotlight to them since two birthdays meant double the birthday parties, double the cake and double the candy-filled grab bags.

Once I was diagnosed with diabetes, this week in May became a bittersweet time because eating cake was no longer a carefree experience.  Diabetes had transformed it into a carefully calculated procedure of matching cake piece size and sweetness with insulin dosage.  When I was on needles I struggled the hardest with this balance because extra carbs for dessert meant I needed to cut carbs in my meal, which was often difficult when special birthday dinners included my favourite homemade fries.  Once I began using an insulin pump I gained more flexibility in being able to have more or less carbs as I chose, but even still, I find that having over 60g of carbs in one sitting is too many carbs to deal with and giving the proper insulin to carb ratio won't necessarily stop me from flying high.   

Mmmm....Chocolate Chip Banana Cake

This year, there were actually three cakes featured as we had one cake for each brother’s birthday as per usual but the day after my older brother’s birthday, his girlfriend brought over another home baked cake.  Monday I baked a New York style cheesecake that we topped with whipped cream and strawberries, Thursday involved a cookie dough explosion ice cream cake and Friday was a delicious banana chocolate chip ganache covered cake (definitely my favourite of the 3, and the one pictured here).  Since I wasn’t home Friday, I had my piece of delicious banana cake Saturday morning (dessert for breakfast...it’s a thing), which caused some elevated blood sugar levels in the morning, but everything was under control by noon.

The week of cake will always be a great week in May, and my diabetes will definitely never stand in the way of great celebrations with friends and family.  Despite my diabetes, I can still have my cake, and eat it too.

Guest Post: My Best Friend is Diabetic

I met Em when I moved to a new town and a new school in grade three. I was the shortest girl in the class with a floppy denim hat and braids that my mom still tied ribbons in. Em was tied for tallest in the class in a highly contested match-up with another girl/Amazon woman. Physically, the differences between us were striking, especially when my hair was undone to reveal a mass of tightly wound curls that looked particularly frizzy when compared to Em's pin-straight locks. However different we looked, we were both particularly assertive (bossy) and headstrong (stubborn) little girls. We built forts on the playground, dramatically re-enacted pioneer life in my backyard and worked on class projects.

Em drew this masterpiece for me in grade four.

When Em was diagnosed with diabetes at the age of 11, her life changed in ways that I am only now starting to realize and appreciate, but the life we shared together remained relatively unchanged. After the initial confusion upon learning about her diagnosis, we quickly returned to trying to figure out how to pass notes more effectively in class and how to eat even more sunflower seeds than we were already eating. Over time I got used to seeing Em prick her finger under the desk or scowl at her glucose meter or discretely munch on a fruit-to-go in class. It was just part of our day at school.

As we grew older, the challenges or hassles associated with managing her diabetes slowly revealed themselves from time to time. When Em first came to school with her insulin pump she told me it was her brand new cell phone. At recess, when a rowdy grade two accidentally pulled her pump tubing out from the infusion site, she stuck it back in and returned to our soccer game. In the first few years after her diagnosis, when she wasn't allowed to sleepover because her parents worried about night time hypoglycemia, we snuggled down in sleeping bags and talked at a mile-a-minute to do all of the important late-night secret telling before the clock struck 12 and her mom came to pick her up. In high school when we had a late lunch and Em needed to chow down on crackers in class to keep her blood sugars level, I followed suit and ended up with more crushed crackers on the front of my sweater than in my mouth. When we started going to the movies regularly we settled on the perfect combo of popcorn, chocolate and a diet coke. Neither of us really liked coke but drinking a diet option to cut carbs was worth the free refills on popcorn. When we went on bike rides or hikes, Em was always diligent about packing snacks in case her blood sugars dropped but this was a non-issue considering our mutual love of picnics.  Now, rather than dealing with the risks associated with alcohol consumption and diabetes, Em chooses not to drink- instead we mix ginger ale with every fruit juice known to man to make tropical beverages that we occasionally dress up with festive paper umbrellas.  

As Em's best friend I don't have a lot of responsibility in terms of her diabetes- she is the one who is testing, doing calculations and making sure that she has her health under control. All I really have to do is be flexible and understanding when we have to make adjustments, which is really the mandate of any friendship. We don't play dress-up or build forts as much as we used to, but I'm still the same curly-headed little imp and she's still my straight-haired, long-legged, best friend.    

My Little Brown Book

Though the notion of the “little black book” may seem archaic in today’s wireless world of Blackberrys and iPhones, I find something charming in the idea of a little book with neatly penned names and phone numbers lining the pages.  I do not own such a book, however charming it may be, as I do succumb to the wonders of wireless technology.  But I do have my own, albeit diabetic, form of a little black book. 

It’s a beautiful, brown leather book, with a ribbon to hold one’s page, approximately the same width and length as my tester, which I use as my daily blood sugar, insulin and carbohydrate log.  It had been a gift for me from a friend before I had diabetes, but I had never been sure what to use it for.  When I was diagnosed with diabetes I started using a standard spiral bound notebook to record my blood sugars, insulin dosages and carbohydrate intake as recommended by the doctor, in order to better control my diabetes.  I went through spells of using large notebooks, small ones, and not using one at all.  Regretfully, the latter stage lasted longer than it should have and directly correlated to an increase in my A1C levels.    

My doctor had recommended the log to better track blood sugar patterns and make appropriate basal or carb ratio changes, but this isn’t the number one reason I feel I need to use one.  Writing down my blood sugars and carb intake as they occur forces me to pay attention to the fact that yes, I am diabetic, and yes, that means I need to do all that fun stuff like monitoring my blood sugar levels, giving insulin and calculating carb intake.  As a result, I am more attentive to my diabetes when I’m using the log book than when I’m not.  This is why I’m a fan of a log book over the digital options that track insulin and blood sugars via a pump or tester, because although those can create some great graphs, they allow me to ignore my diabetes too easily. 

So despite my Blackberry, laptop, iPod, and all the other wireless wonders I indulge in, when it comes to logging my blood sugars, I’ll stick to my old fashioned log book, which constantly reminds me to pay attention. 

Summertime and the Livin' Is Easy

Finally the sun has blessed Westdale after what seemed like a month of cold, rainy November-esque weather in May!  Walking around town, it seemed that many people were taking advantage of the sunny weather to go for a walk or a bike ride and soak up some UV rays.  I have always loved summer and everything that it brings; sunny days at the beach, sandals, sweaty runs, ice cream, summer dresses, swimming, and the general good vibrations that seem to accompany the fair weather. 

As a diabetic, summer also brings some concerns.  I’ve always found that a surge of warm weather causes my blood sugars to run low.  I had been led to believe that this was related to the general increase in (particularly outdoor) activity that generally accompanies warm weather, but I’ve noticed that if the weather suddenly warms up on a day that I spend sitting and studying, my blood sugars will still run low, despite my lack of activity. Whatever the cause, it’s always something I have to watch out for, particularly when I’m planning on taking advantage of the weather to spend some active time outside.

Yesterday, inspired by the sun, I grabbed a pair of rollerblades and a friend and headed to a beautifully scenic, well-paved, lakeside path, where the cool breeze coming off the lake nicely complimented the heat.  I set a temporary basal rate to 0 units for 2 hours, about the same duration of time I expected to be rollerblading for.  We rollerbladed for about an hour to our destination- a cafe- at which point my blood sugar had already dropped to 3.5 mmol/L.  I ordered a large mango smoothie, and we sat around for about half an hour, enjoying the weather and the view.  Before heading back, I tested again only to discover I was still low (drats!).  I finished off a juice box (those are generally what I keep handy for hypoglycemia) and by the time we had rollerbladed back to the car, my blood sugars were in a normal range.  I considered it a pretty successful outing, as I managed to control my blood sugars, enjoy the good company and drink a delicious smoothie without my blood sugars dropping low enough to make me grumpy or sluggish.

Another nuisance of being a diabetic in the summer is the issue of how to hide a pump within one’s clothing when wearing shorts and t-shirts.  When I was younger, I usually used a black spandex “holster” (like a spy, cool, I know) for my pump that fit around my thigh and had a little pocket for the pump.  I still use that when I’m wearing nice, flowing dresses or skirts, but I quickly discovered that the pump holster was pretty obvious when wearing shorts or tight jeans.  I know a popular option is to wear the pump like a pager, in a clip on your waist, but I’ve never been a particular fan of this style because I find it gets in the way.  I always cursed the ease with which diabetic boys could hide their pumps, as their clothes were always loose fitting and well equipped with big pockets, unlike the typical tiny, tight clothing fashionable for girls.

My solution to my pump-placement problem came one day when I was sitting in my high school cafeteria and noticed a girl reach in to her shirt and pull out her cell phone.  Though I had always found the trend of girls storing their cell phones, keys, money, combs (really?!?) and other important items in their bra rather strange, I realized that a pump, which is only slightly bigger than a heavy duty Blackberry or iPhone, could also be stored in a bra.  Since that day, I’ve discovered ways to strategically place the pump in my bra so that it isn’t really obvious that it’s there, and it is now definitely the number one place I keep my pump.  The biggest drawback is that I still find it awkward to reach into my shirt and whip out my pump in public, so I often go to the washroom to do this, or tactically place a backpack or sweater so that what I’m doing is less evident. 

All the things about summer that I love -the shorts, the outdoor activities, the icecream- are just as enjoyable with my diabetes as they were without.  Summer with diabetes just means a bit more planning, especially on those long rollerblading trips, and a bit more innovation, especially with pump placement. 

Why I Aim for Average

I have always been a high-achiever.  As a kindergartener, I would rush to clean up my toys the fastest so that I would be the first sitting down for story time.  In grade three I played a leading role in the class play.  In grade five I cried when I didn’t receive 100% on a project that I felt was flawless.  In grade six, unknowingly battling a life changing disease, I trained hard enough to place in the school board’s cross country event. 

Within two months of this achievement, however, I began to deteriorate.  It began subtly, I didn’t have the same energy on the basketball court or the soccer field that I use to have.  Then I badly sprained my ankle in gym class, the first time I had ever suffered a severe injury despite years of contact sports.  I developed a very bad ear infection and became extremely lethargic.  I missed days and days of school as I became sicker and sicker- my appetite dropped, I developed dark circles under my eyes and I lost 7 pounds in 2 days, an alarming amount on anyone, but particularly noticeable on my skinny, athletic body.  Then one night the reason for my illness was discovered, and I was woken up and rushed to the hospital.  My blood sugar tests had come in at a whopping 47.3 mmol/L  and I was nearly comatose.  On the ride to the hospital, my mom sat in the back seat with me and told me that the doctor had said it was very likely I had diabetes.  As an eleven year old, I didn’t know what that meant or how it would affect my life, but I knew that I was scared. In the safety of my mother’s arms, I cried. But that high-achieving person inside me made me put on a brave face for the nurses, who exclaimed at how courageous and well behaved I was as they pricked my fingers and hooked me up to an IV, for my aunts and uncles that visited,  and later for my teachers and friends at school.             

I soon learned that living with diabetes was a daily struggle to be average.  There was no such thing as 10 out of 10 or 100%.  My aim was to stay between the average, non-diabetic blood glucose range of 5-7 mmol/L, which, as any diabetic knows, often feels like an impossible task.  I still excelled in the areas of my life that I had always excelled in: I was an honour roll student and went on to become valedictorian of my high school graduating class, I raced my way to a spot on a track team, played on numerous competitive basketball and soccer teams, participated in enough high school sports to win me senior athlete of the year, sang in choirs and played piano.  But all these things were now accompanied by the new challenges of my diabetes.  I learned that my race performance greatly decreased if I had high blood sugars the night before a race, that low blood sugars during test writing would result in a similarly lower mark, that my coordination on the basketball court would deteriorate if my blood sugars dropped, and that my fingers would stumble over each other if I played piano when hypoglycemic.  Discovering these challenges of diabetes was frustrating, and I often indulged feelings of self pity or anger.  But ignoring my diabetes wasn’t an option simply because it was impossible to do. Ignoring it led to my blood sugars soaring or dropping, which would not only affect my mood, but also my performance in every aspect of my life.  So I fumbled along, trying to make sense of the disease I had and trying to prevent it from defining me.

It’s still a struggle, but finally I’ve accepted that being average in my diabetes means the possibility for success in the rest of my life.  And that, in at least one aspect of my life, success is being average, or at least, is having that average, non-diabetic A1C level.   So with the hope that I may one day achieve this understated goal, I’ll keep aiming for average.