Moving Target

Katherine Marple

| Mar 16, 2014

So, what is it that affects my glucose levels and why is it so hard to manage diabetes? In this case, we're talking type 1 diabetes; mine seems to be extremely stubborn and "brittle" by nature. Honestly, sometimes balancing this chronic condition is downright exhausting. Some days it's a scientific equation, weighed and measured, a standard protocol. Other days, it's a roller coaster, a compounding tidal wave, a boxing match.

The following is a list of how emotions and activities affect my glucose. It's a list of mundane events which a non-diabetic wouldn't even bat an eyelash at, but these cause a reaction in my diabetes control. Here is a peek into the hardships of balancing my diabetes life.

Waking Up in the Morning. Yes, simply waking up is a fight against the diabetes bully. To get the body prepared to awaken, the liver naturally dumps glucose into the bloodstream to kind of kick start the body into action. To people with diabetes, this is called Dawn Phenomenon. Non-diabetics don't notice anything except a burst of energy to help swing those legs over the edge of the mattress. Diabetics see a sharp increase in glucose readings, despite having just woken up and not having eaten or drunk just yet.

Battling dawn phenomenon requires pro-active treatment: waves of insulin therapy (usually via insulin pump) and midnight non-carbohydrate snacks (like a slice of cheese or handful of nuts) to keep the body's metabolic rate from "going to sleep."

Negative Emotions and Stress. Any person who feels emotions has it affect them on some level. You get into a fight and feel a little anxious, shaky, angry, and it just takes a little bit of time to calm down. For me, if I get into a fight, I can literally see how it affects me through my glucose trends. If I'm stressed, my blood sugar increases and stubbornly refuses to come down until I calm myself, despite insulin injections or metformin.

This is a sort of Catch-22: I'm stressed, so blood sugar goes up, which stresses me more. We're talking a sharp increase of 200 points or so, from a standard 100 reading to over 300 within 15 minutes of experiencing an emotional situation. It's a constantly rolling ball, which I rarely seem to be able to catch. If the stressful situation is chronic, my stubbornly raised glucose is chronic as well.

I've spent years, many techniques, therapy, and exercise to learn how to calm myself as quickly as possible to avoid glucose impact. It's difficult to manage because I care so much about everything and everyone around me--but I sometimes have to make difficult decisions to distance myself from stressful situations and people so that my health is not in jeopardy.

Exercise. Feeling sluggish and tired? Go work out. Feeling stressed and listless? Take a brisk walk. Moving the body and getting the blood moving is a wonderful thing for all of our physical health over time. It's also immediately beneficial because it increases dopamine release in the brain which boosts morale. But, for a diabetic, moving the body costs us. Going for a walk, jogging, biking, light aerobics, means an increase in energy expense and a drop in blood sugar.

Sometimes it can go so far as to deplete our glucose reserves so low as to put us into insulin shock (using an insulin pump to stop the basal rate during exercise can help combat this). But, heavy exercise like boot camp, Zumba, or high-intensity cardio on the elliptical or Stairmaster, will cause the opposite effect of a sudden increase in blood sugar. So, we can exercise, but we have to be careful not to go too far in either direction.

I'm undecided on whether we can condition diabetes to handle different types of exercise. I've noticed my body being able to better handle high-intensity Zumba the longer I do it. When I first started the regimen in April 2013, my glucose would rise to over 300 post-workout. Now that I've been consistently going several times per week for this past year, my glucose only rises to mid 200s after each class. Though it's frustrating to have a high blood sugar after exercising, I see more long-term benefits from doing the routine, versus the negatives of fighting a poor glucose reading for an hour after the class.

Weather. I know this probably sounds crazy, but even the weather affects my blood sugar. I tend to drop glucose levels when the temperature is below freezing; probably it has to do with the energy that is used to keep the body warm. I also have seen my glucose rise drastically after a day of temperatures over 90 degrees, especially when there is high humidity. Now, the only "proof" I have of this theory is my own experience. But, after 15 years of seeing the same trends over and over again, I have to treat my diabetes as if this is truth. I realize it may not be the same for every person with diabetes.

Menstrual Cycle. Hormones are complicated. Every month, for a week prior to my cycle, my blood sugars act extremely stubborn and I require about 1/3 more insulin than normal. The week of my cycle, my insulin needs return to normal. Add to it that my cycles are irregular and I'm in a bit of glucose turmoil every month. So, am I more irritable due to the hormones, the cramps, or is it my raised glucose levels? Pick one.

Infection. It takes a lot of work for the body to heal wounds. It's even harder for diabetics because infection raises glucose levels. Raised glucose levels also slow the healing process. There are many compounded issues in diabetes.

The Flu. Being ill is the worst. It is extremely rare to find sick people who are smiling and enjoying themselves, right? As a diabetic, being sick affects our blood sugars too; especially when we're vomiting. Puking spikes my glucose drastically, and a fever raises it at a steady incline for hours at a time. I know that when I get that first cough and sniffle, it's going to be a rocky diabetes week.

Food. Every single thing I drink and eat needs to be measured, calculated, equated, and treated with insulin. Non-diabetics should really take a second to think about this: That sip of coffee before you run out the door, the bite you absentmindedly scrape off your child's plate, that taste of your husband's dinner at the restaurant: It all needs to be accounted for. All of it.

I'm sure there are more conditions of living which affect my diabetes life. But, the long and short of this is that diabetes is complex. It takes an incredible amount of control, determination, accountability, and perseverance to manage a disease which is a part of nearly every aspect of our lives. It also takes a lot of forgiveness and compassion for ourselves to really take a look at this list and accept that this disease is hard. It is HARD.

The multi-tasking, background, constant tick of this disease is really mind-boggling. There aren't many who can fully understand what it takes to be diabetic, unless they are also in these worn down shoes. You can love it, you can hate it, but it is a huge part of our lives. I am diabetic and I am awesome.

Katherine Marple was diagnosed with type 1 diabetes at age 14 in 1998. She is the mother of two small children, has battled insulin resistance, pre-eclampsia, and pump failures, leading to insulin therapy via MDI, using Levemir and Apidra, and sometimes metformin and CGM. She is the author of two diabetes related novels: "Wretched (this is my sorry)" and "Deathly Sweet."

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Categories: Exercise, Flu, Glucose, Infection, Menstrual Cycle, Negative Emotions, Stress, Type 1, Waking Up, Weather


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