For a few weeks, I’ve been thinking about launching a new blog about diabetes called The Blood Sugar Whisperer.

I know what you’re thinking: Why do you need to start a new blog about diabetes? Don’t you already talk about diabetes here?

Well, yes and no. Although I’ve tried for many months (years, even) to incorporate the two sides of my life, I’ve come to the realization that there are just some things that the average non-diabetic doesn’t give two hoots about and those are things that I’d like the freedom to talk about a little more frequently. I don’t necessarily want to talk about diabetes every day, but I’d like the option to post my thoughts about what’s going on in the D-community without wondering if I’m totally going to bore everyone else. Diabetes is so highly specialized that I sometimes feel awkward trying to explain what I’m saying to my non-D readers while simultaneously trying to help my D-readers. It’s just complicated and I want to try something new to see if it gets better.

In addition, I’m also working on a book and am also trying to ramp up my freelancing career, and I feel like having a place that is specifically devoted to diabetes will make my “marketability” a little better. I guess everything really does come down to branding, huh?

Of course, I’m not going to give up With Faith & Grace. Heavens no! If anything, this will help me focus a little bit more on topics on this end of the Allison spectrum. Nothing will change, actually, you just might see more things along the lines of health and fitness, personal development, and relationships with significant others, friends and family. Sound good? Good.

So if you haven’t already checked out, you can head on over. I’d love to hear what you think!

Every month, the Diabetes Social Media Advocacy team posts a prompt for the Blog Carnival. This month, the prompt is about exercise!

Does the sunshine and warmth of Spring urge you to change up your exercise routine? If you don’t have an exercise routine, does it inspire you to start exercising? And if it’s not Spring in your corner of the world, what season are you heading into and how does it impact your fitness routine?

While I’ve been exercising pretty consistently since last fall, the warmer weather and later nights have definitely made an impact in my running schedule. It is so miserable running on a treadmill that I usually hold out for the one or two days during the winter when it might pop into the 40s. But many times, I do have to rely on strength training and the treadmill to get my fitness routine into my schedule. Otherwise it’s just too easy to let the cold and snow keep you inside!

Although I love warmer, sunnier weather, I’ve personally noticed that I run poorest during midday. There’s something about the sun beating down (even when it’s not very warm) that seems to zap me of energy. I prefer running in the early morning or in the evening, when the sunlight isn’t as intense. I can weight train at any time of day because I do it indoors at my gym. I’m not sure if anyone else is as sensitive to the light as I am, but it’s something that I’ve noticed really slows down my pace.

I can’t say that Spring totally changes up my workout, because I have tried to stay consistent with running throughout the winter and now throughout the summer, but I do think that I’m more consistent in how often I do it. I also feel like there are more options during the summer to do a variety of exercises. Cycling, for example, is something I would only consider doing during the warmer months, because the wind from cycling and the cold weather does not sound like a pleasant experience! Erik and I also enjoy hiking, which is something I’m more likely to do in the summer when the trees and plants are in bloom and everything is pretty and green. Not that you can’t hike in the winter, but I find it more enjoyable in the winter.

I suppose the warmer months also make me a little more self-conscious! With summer dresses and tank tops, there’s a lot more skin showing so I’m more inclined to try to stay fit and eat healthier. Of course, it probably makes more sense to be active and lose weight earlier in the year (which is something I’ve been trying to do), but sometimes you don’t really feel motivated until those flabby arms and spare tire are really obvious!

This post is my April entry in the DSMA Blog Carnival.  If you’d like to participate too, you can get all of the information at http://diabetessocmed.com/2013/april-dsma-blog-carnival-3/

Last week, I read an amazing post by Ashlee Gadd that stopped me in my tracks. I’ll give you a moment to read it yourself as I don’t want to paraphrase her brilliance.

Good? Good.

For the most part, Ashlee’s post is a series of rhetorical questions designed to make us think about the intentions people have when posting good news and bad news on social media. And think they made me.

I read this post two days after receiving the results of my last A1C lab test, and I have to admit, I really wanted to share the results with everyone. But last year I had written a blog post on DiabetesMine about how I wasn’t going to share my results anymore. The reason was because these results are often taken in isolation from both the work that someone is doing and also the results that came before. An A1C result of 8% might be a disappointment for someone who was 7.5% three months earlier, but if they had been 9% before, then it’s cause for celebration. Instead of sharing the actual result, I was only going to share the direction of the A1C and by how much.

I found that personally I often got upset when I would read commentary about someone’s A1C result. I remember one time someone had posted that they had never been above 7%, whereas I have never been below 7% and that really upset me. It felt like an unfair reaction to something that I should have been happy about — another PWD’s success — but I wasn’t. It was like Ashlee’s example of someone looking at Instagram and seeing only happy, beautiful pictures. An A1C result doesn’t reflect all the hard work and sacrifices that this particular person might endure. Instead, I’m only seeing a single image of an otherwise extremely complex existence with a chronic illness. Frankly, I should know better.

So then it made me think about my own attitude toward my A1C, especially my most recent one. My A1C dropped more than a full percent since my last result, and yet, as I wrote last week, I have still not accomplished my diabetes goal for the year. It doesn’t take a rocket scientist to do the math and realize that my A1C prior to this result was in the 8% range.

And the truth of the matter is that my A1C results have been in the 8% range for most of the last five years.

I have written that I don’t want to post my A1C because I don’t want to make anyone feel bad, that I don’t think it’s anyone’s business, and that I don’t think it promotes anything but unhealthy competition on who is doing better or who is perfect or who has it all figured out. (Hint: nobody has it figured out.)

My A1C results have not been something I have been proud of. Appointment after appointment have been a series of me telling my wonderful endocrinologist that I know what I need to do, that “life has been rough lately” or that “I’ve been traveling a lot” or “my apartment building flooded” and that things would be better next time. Occasionally that was true and I would knock a couple tenths of a percentage off my “score” but it has never landed me lower than a 7.8%.

The real reason that I didn’t want to share my A1C result with people isn’t because I was afraid of what people would think about themselves, I was afraid of what people would think about me. I knew my diabetes management wasn’t where I wanted it to be, and so I hid it under the guise of protecting others’ feelings on the subject. And there is some truth to that still. I do think we need to be aware of how our posts might affect other people. But at the same time, I think that we — especially the diabetes community, but also anyone else reading this blog — need to realize that being vulnerable with our struggles and our weaknesses are not bad things. They make us human, they make us real.

I’m not saying that our social media persona needs to be entirely negative or that you need to post all the skeletons in your closet, but I do think that we need to take a hard look at why we choose to omit something. Are we doing it because it’s not our place to say something about a certain topic? Are we doing it because it might be hurtful or misrepresent ourselves or someone else?

Many people have commented that blogs and other social media platforms — especially Pinterest — are feeding into the idea that bloggers lead perfect lives. But my question to you is: are we omitting the struggles and challenges in our lives for the very purpose of portraying a happy, perfect life? Are we omitting details about our lives because it’s the right thing to do, or are we doing it because it’s the false persona we want other people to believe we are?

I spent many years not sharing my A1C because I didn’t want to be the Girl with the Bad A1C. I was ashamed of it, and so I created a story that allowed me to hide it. People might not fully understand the reasons why my A1C results ended up so much higher than our target goal of under 7%, but I’m here to tell you that it did. I’m also here to tell you that I finally did something about it. I’m here to tell you that my A1C dropped from 8.3% in November 2012 to 7.2% in April 2013. I’m also here to tell you that my goal for my next appointment is to be under 7%. I’m here to tell you that I’m working diligently to do this by tracking my carbohydrates more closely, exercising regularly, logging my blood sugars using my RapidCalc app, and wearing my Dexcom CGM.

There are plenty of things that shouldn’t be shared online, for a variety of reasons. But the truth of the matter is that sometimes the one thing you don’t want anyone to know about is the one thing everyone needs to hear.

It’s official, folks. I have been reassimilated back into the Collective.

Well, not completely back into the Collective. I’m still rocking shots like it’s 1999, but I have finally jumped off the bridge with everyone else and gotten myself a Dexcom continuous glucose monitor. Woohoo!

Just call me One of Twenty-seven Million

For those of you unfamiliar with CGMs, it’s kinda-sorta-basically a device that reads your blood glucose values 24/7. Pretty nifty, huh? It actually doesn’t read blood sugar, it reads the sugar in your interstitial fluid (which is the space between your blood vessels and your cells that nutrients, like glucose, pass through — I actually learned about it last week in Anatomy & Physiology!). The Dexcom CGM is separate from a blood glucose meter, and you still have to test your blood sugar at least twice a day to calibrate the machine. The CGM is kind of like your microwave’s clock — it doesn’t know what time it is on its own, so you have to use another clock to tell it how to measure time.

Here’s the most common analogy: A blood sugar reading from a meter is like a screen shot, whereas the continuous glucose monitor is like watching the entire movie.

I like this analogy better: Imagine that you are driving along a highway and every mile you were allowed to open your eyes. What do you think your chances are that you would run off the road? Probably pretty high, right? Because even though you felt like you were going straight, you might actually be turning slightly to the right or slightly to the left, but you wouldn’t know it until you actually crashed your car. That’s basically what it’s like when a person with diabetes goes high or low. They think what they did is going to lead them in a straight line, and it’s not until they go high or low that they realize they were slowly driving off the road.

My biggest problem is that when I’m exercising, I don’t realize I’m driving off the road until I hit a tree, roll the car five times and burst into flames. (Okay, it’s not that bad.) That being said, I am basically hypo-unaware when I’m exercising, which means my body’s normal “Mayday! Mayday!” detection is switched off. It’s kind of ironic that the one time I’m most often going to have a low blood sugar is the one time I can’t feel them. Nice one, Universe.

So why has it taken me a freaking billion years to get a Dexcom CGM? Well my adventures with CGMs is sort of long and meandering. My first one was a Medtronic CGM back in early 2010 when I was still using the Medtronic insulin pump. I used it off and on for a few months, and then stopped, and then started up again, and then stopped again. In theory, Medtronic is awesome because your CGM device and your insulin pump are one machine, although you have to have two separate insertions. However, Medtronic’s sensors are not nearly as accurate as one would hope, causing much frustration.

On top of this, I’m convinced that I am allergic to the Medtronic sensor. Not the adhesive that sticks to you. The actual sensor. More often than not I would find myself itching and writhing in pain after just a couple of days on the sensor. When I finally ripped the damn thing off, there was usually a welt or some kind of small infection at the insertion site. Not cool.

Since most CGMs work better the longer you wear them (because it gets used to you and your body), having to rip off the sensor after 2 days was sort of pointless. I eventually gave up and swore to myself that I would get on a Dexcom. Yeah…

Well, I was still hesitant about getting on a system without knowing for sure if I was allergic to it or not. Eventually I worked it out with a local Dexcom rep to wear just the sensor for a few days to gauge my body’s response to the sensor. I wore it more less comfortably for about six days, but then it started to get a little itchy and I took it out, but there was no sign of any infection. I was confident that the itchiness might have been an isolated incident (it can happen) and so I said I was interested. Unfortunately (although fortunately in the long run), we didn’t have the FSA (Flexible Spending Account) money available to buy the Dexcom system.

The reason I say fortunately is because a few weeks after this is when the newest Dexcom system came out! Woohoo! So I saved a bunch of time and money by waiting. I finally got around to ordering the system at the end of March (I’m nothing if not a huge procrastinator) and it arrived last week.

My CGM rep told me to schedule an appointment with a CDE at my diabetes clinic, which is down in the city. Not a terribly convenient place to get to, so I queried the Internets about whether or not I should just set myself up. Since I had CGM experience, everyone just told me to go for it. So I did. The first few days have been a little rough, getting used to the new system and whatnot, but for the most part I’m really liking it. It’s had its moments of being totally inaccurate (like telling me I was 135 and dropping rapidly when I was actually 175 mg/dl and spent the rest of the night in the 200s), but overall the numbers have lined up quite well. I have not had any itchiness and can see myself wearing the sensor for a number of days with ease.

I doubt I’ll write a full review of the system, since there are many reviews of the Dexcom CGM around the diabetes community. But you can be assured that it will be mentioned when appropriate.

Of course, if you have any questions, leave ‘em in the comments!

This past Saturday, Erik and I ran our very first 5K race! Earlier this spring, I scoured the Internet to find the perfect race and decided on the NYC Runs Spring Fling 5K on Roosevelt Island, which is an island located in the East River. It’s smack dab between Manhattan and Queens, so you have views of both from the island. It’s very cool! I have been running fairly regularly for the past few months, but more so since in the beginning of the year. My fastest 3 mile run so far was 40:18 so I really wanted to run my first official 5K in under 40 minutes!

The night before the race was, as you can imagine, not very restful. But it wasn’t actually from excitement. On Friday, we attended our first Christian seder, and our hosts had some delicious matzo ball soup and raspberry cheesecake for dessert. My blood sugar skyrocketed to 344 mg/dl which woke me up at 5 a.m. (because I had to pee). Yikes. I bolused and headed back to bed, but I had a hard time falling back asleep, which is typical for when I’m feeling yucky from a high blood sugar.

The alarm finally went off at 7 a.m. and my blood sugar was 299 mg/dl. Not what I was hoping for after two hours. Erik and I had scrambled eggs and a Larabar for breakfast, along with a big glass of water. I bolused normally for my meal, but I didn’t take any insulin for the protein as I normally would. I also corrected for the 299 mg/dl as usual. I have found that for the most part, I manage my diabetes while exercising by consuming extra carbs, and not by manipulating insulin. I planned to monitor and drink juice or eat a snack later if I needed to.

We finally arrived on Roosevelt Island at around 8:45 a.m., with the race set to start at 9 a.m. Just before checking my bag, I tested again and I was down to 210 mg/dl. That was a good number to start with and I didn’t have that much insulin left on board. In my spibelt I had a Gu if I needed it while running, but I suspected I would be fine.

Erik and I do not run at the same pace. He is much faster than me. So my first race was basically alone. I didn’t listen to music or my usual podcasts, so it was a bit of a challenge, but like most people say, you do get swept up in the noise and scenes around you. I enjoyed people-watching the other runners and of course I had a glorious view of Manhattan for the majority of the run.

Through sheer force of will, I managed to run the entire length of the 5K, except for a very short water break about halfway through. It was definitely a challenge for my muscles, but I felt good. I didn’t feel at any point that my blood sugar was tanking. Although I’m more or less hypo-unaware while exercising, I have developed my own “sense” for my blood sugar to make up for the lack of traditional symptoms. Normally it’s an intense fatigue that comes on very suddenly, and I didn’t have any of that.

Not having any sense of time or distance meant the run felt a little on the long side. I had no idea how far I’d gone or how much longer I had. Eventually I could see Erik waving in the distance. My final time, which we didn’t receive until a couple hours later, was 39:52. Woohoo! I did it!

We retrieved our bags and I check my blood sugar. I rang in at 158 mg/dl! Totally thrilled about that. I took my normal Lantus dose as well. After that, Erik and I went off to get lunch and basked in the glory of finishing our first 5K. My blood sugars stayed normal the rest of the day.

I already have a second 5K lined up as well! I’ll be running The Stride 5K in a couple of weeks, which benefits a local diabetes center. My Junior League chapter are sponsors, so it’s a win-win. I’m excited to see if I improve!

And as if all this wasn’t good enough, I have even more awesome news! Yesterday I had an endocrinologist (diabetes doctor) appointment and I found out that my A1C (the measure of my average BG) dropped a full percent! Just to put this into context for you, A1Cs are measured by the tenth of a percent. So dropping a full percent is quite significant. I’m not sure I’ve ever dropped more than half a percent between appointments, so I could hardly believe it dropped as much as it did. Although I’m not in the 6s yet (my diabetes goal for the year), I am very close right now. I recently ordered a Dexcom continuous glucose monitor to keep even better tabs on my blood sugars throughout the day, so I have no doubt that I will be in the 6s by my next appointment later this summer.

Here’s the thing that really bugs me about trying to lose weight with diabetes:

A good portion of the insulin that PWDs (people with diabetes) take on a daily basis comes from their size. The bigger you are, the more insulin you need, and vice versa. Of course, the food you eat, hormones (like birth control or stress), and activity level also play a big role. But your size matters. So when I exercise and subsequently start dropping the pounds, the amount of insulin I need starts to drop.

Which is great. In theory.

In practice, however, it usually ends up with me having a string of low blood sugars that actually prevents (or at least temporarily interrupts) my weight loss endeavors until I get to the point where I’ve managed to figure out where my new insulin needs are. But then give it another five pounds and we start the process all over again.

In short: Exercise equals less insulin, but the current doses equals low blood sugar preventing exercise. Plus: low blood sugar means treating it with juice. Juice = calories. Calories that I neither want nor need!

Sigh. Right?

In theory, it’s great that I need less insulin. I want to take less insulin because less insulin is yet another barometer of the fact I’m getting smaller. But it isn’t so easy to just change doses. The body is a fickle thing and what prevents a low blood sugar one day might actually cause a high blood sugar on another day if you start over compensating. High blood sugars are also frowned up on when exercising, although a moderate high can be a nice buffer to prevent a low blood sugar after working out. But if those high blood sugars are popping up all over the place, then that’s bad.

When you start experimenting to find your new dose, you might actually discover that you cut too much because changing one factor in diabetes management has repercussions throughout the whole day. You might find that preventing a low blood sugar at one part of the day now causes a high blood sugar somewhere else, which has you, guess what, taking more insulin!

You see where I’m going with this?

This is why I was always really nervous about changing my basal rates. It always seemed like — again, in theory! — that my simple modifications would solve the problem. But then it would either 1) not be enough and I would still go low or 2) it was too much and I would go high. And so then the experimentation continues until you have it figured out.

But then if you’re consistently losing weight, you might have 2-3 weeks of “stability” (ha!) and then you’re back to do this all over again.

No wonder people with diabetes hate to exercise!

Right now, I’m trying to not let it get in the way. I’m trying to keep my blood sugars stable while futzing around with the right dose so that I can prevent low blood sugars. I know this will be a consistent theme of my life for the next few months, because the Allison who weighs 160 lbs. (my goal weight) needs different insulin amounts than the current Allison (who is, uh, bigger). It’s not something that will happen in one fell swoop. It will happen slowly. Obnoxiously.

Despite being 27 years old, I’m dealing with two health problems: type 1 diabetes and obesity. Obviously my obesity is not related to my diabetes, because I have the autoimmune form, and not the metabolic. Nevertheless, they are there and they are affecting my health, so everyday, I have to consider how I can manage my weight and my diabetes better.

But sometimes I just feel like saying, “I don’t know and I don’t care.”

(Not really, but sometimes.)

Over the last few weeks, I’ve noticed that my blood sugars have been stubbornly in the low 200s and high 100s. It was really just the month of February, as the month of January was when I started Paleo and was at my pre-Paleo insulin doses. As soon as I cut a lot carbs, my blood sugars started dropping. But of course, I realized I didn’t need as much insulin, and when you don’t have as much extra sitting around, your safety buffer goes out the window.

The thing with being on injections is I feel like I’m much more apt to change my doses. Maybe it’s because I have to individually draw up every single dose, but I feel like I’m always modifying how much Lantus and what my basal rates are every couple of days based on how I feel I’m doing. When I was on an insulin pump, it sort of felt like my settings were out of sight and out of mind, so I never really thought about making changes. I just sort of put up with bad results until I finally realized how ridiculous I was being. And then I would make changes.

Now I’m wondering if I’m making changes too often. How long do you stick with something before you decide it isn’t working?

This relates also to my trouble with weight loss. When I went on the Paleo diet, I was told “You don’t need to calorie count!” So I was like, “Eff yeah! Woohoo!” I figured the pounds would just melt off. But they didn’t. Sure, I lost 5 lbs. but that’s hardly anything to write home about and this was on top of exercising.

What modifications do I make now? Should I start calorie counting again? Change my workout? Keep doing what I’m doing and hope it eventually starts working? And then there are issues with calorie counting itself, because some people find that they lose weight better when they eat more, and some people find themselves doing better when they eat less, or when they eat only when they’ve worked out or when they don’t eat after they work out. There are so many options for how to change things that I sometimes feel totally overwhelmed with my options for modifying.

Which usually leads me to not doing a damn thing.

And then I have a hard time figuring out if what I did worked. Yesterday, I thought I had figured out my Lantus dose. My blood sugars were good all day and I was excited. But then I went low at 5 a.m. this morning. Of course, I realize that could be a one time occurrence and that I should be patient. Having the ability the ability to tweak my Lantus dose every single time usually leaves me with totally inadequate data because I won’t sit still. First I was sitting still for too long, and now I’m not waiting long enough to have quality information.

I realize that figuring out how to lose weight and figuring out how to manage my diabetes are slightly different in practice, but the idea is that both of these struggles that I have relate to me making modifications on something I don’t really understand. I don’t really know what my body needs to lose weight, because there are so many variables. I don’t really know what my body needs to have more stable blood sugar (never perfect, just better), because there are so many variables. I never feel like I really know when to change, what to change and how much to change. It’s very aggravating and I can see why a lot of people just stop trying to figure things out and they just go by what is easy. Because at least that I know.

I wasn’t planning on writing a response to the latest news from the Diabetes Research Institute. Plenty of my peers have written their two cents and for the most part, I agree with them. But then this afternoon I saw a comment to a book review I had written for a book by my CDE, Gary Scheiner, which was actually posted yesterday, the day before the DRI’s big announcement. At the very beginning of the post, I wrote, “Barring a miracle, there probably won’t be a cure within the next 10 years. So we know that managing our diabetes well is the only option if we want to live a long and healthy life.”

Honestly, I was just trying to write a catchy intro to a book review, but apparently it sparked something in a woman who then wrote at the end of her comment: “And Allison, try not to be the Negative Nancy right off the bat in the first sentence. All of us supporting fund raising and research are optimistic large strides or a cure WILL be soon!”

I was left feeling a mix of emotions, including irritation, frustration, and agreement! I have been raised money and donated my own money to the Juvenile Diabetes Research Foundation, the Diabetes Research Foundation, and even the American Diabetes Association for the last 19 years. Please do not question my commitment to Sparkle Motion — er, the cure.

That being said, I don’t necessarily think the cure is coming ’round the bend anytime soon. Hell, I’m not even sure we know where the bend actually is. A little more than two years ago, I wrote that I had lost my faith in a cure. The premise of the article was actually about the new focus of JDRF on new technology, and how an organization that was supposedly devoted to finding a cure was betraying their thousands of supporters by doing so. I — and many other — totally disagreed with this point of view, and I explained why I felt that way.

This time things are a little different. The DRI (for those unaware or not involved in the diabetes community) announced today that they are planning to develop a “BioHub,” which is essentially a little pocket to hold and protect islet cells from being destroyed. Islet cells are the cells that make insulin, which have been killed off by the immune system in every type 1 PWD. So in theory this is big news. The problem is that it was hyped by the DRI prior to the announcement that this is “what we’ve been waiting for.” And it isn’t, really. Because what we’re waiting for is the bloody cure. In fact, some people I’ve talked to are suggesting that this might be a marketing ploy just to fundraise. Plus other people have already been working on similar ideas, so this isn’t even ground-breaking. This really isn’t any different then every other announcement that has ever been made about new cure research projects. Researchers have found more than 400 ways to cure a mouse. None of them have worked in humans. I’ll reserve my excitement for the cure that is FDA-approved, and not a minute sooner.

So when someone comes up and says “Stop being such a Negative Nancy” I have to pause. Because I’m not being a Negative Nancy. I’m being a Realistic Rebecca. A Cautious Caroline. A Living-in-the-Present Lindsey. (I could go on all day.)

At the end of the day, do I think there will be a cure? Yes. When? I don’t know. My crystal ball is on back order. And they don’t know either, which is what really rankles my ire. They say something is coming in five to ten years, but can I let you in on a little secret? They don’t have a fucking clue when the cure is coming. So quit asking.

It’s okay to hope for a cure. It’s okay to work for a cure. It’s even okay to dream about what you will do when you don’t have diabetes (my plan since I was 15 years old is to eat an entire Mud Pie at Red Robins by myself! And then vomit.). But for God’s sakes, don’t plan your life around the cure. I think most people get this. I really do. I think most of my readers are very smart and they understand not to plan life around the cure. Because I remember when I was a little girl and my doctor told me that he was really sure that it was coming in the next five to ten years. And I remember giving myself a little wiggleroom and I said, “Well, as long as I have a cure before I have kids…”

I’m twenty-seven years old and married. There’s a pretty good chance even my wiggle room isn’t going to cut it.

I wish we could be certain about when the cure is coming. I wish we knew how it was going to happen so we knew what to fund. But we don’t. And I’m not going to live my life like we do. Hell, we’ve been trying to get an insulin pump approved in the United States for the last three years. If that doesn’t give you a picture about how long it will take to get a cure approved, I don’t know what will.

I would much rather say there won’t be a cure in ten years and be wrong, than to say there will be a cure in ten years and be wrong. If that makes me a Negative Nancy, then so be it. But hopefully you’ll understand a little bit better about why I am.

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There aren’t many things that I’m afraid of trying. I like to think of myself as fairly adventurous. I love to try new food and travel to new places. Generally I like to meet new people, although there are still certain groups that never fail to intimidate me. Even then, I try to not let that get in the way of my participation. I suppose I always liked the idea of putting in effort and making the attempt, even if I wasn’t sure it would really work out. I remember my dad telling me a long time ago, “If you don’t ask, the answer is automatically no.” So I suppose I always liked the idea of trying for the yes.

But rejection isn’t easy. I’m not perfect, of course, and I haven’t always tried. Sometimes nerves do get in the way, but I feel like when I have found something I’m really passionate about, I’m less likely to let my nerves interfere. I’m passionate about my book, so I faced rejection when I attempted to get my book signed with a publisher. I’m passionate about Blue Cupcake, even though I had no idea if anyone would actually buy them. Now I’m setting myself up for potentially more rejection because I’m in the middle of applying for nursing schools. Although I know I need to try (because I’ve already put thousands of dollars toward my pre-requisite education) there is the ever-present fear that comes along with every decision to try for the yes.

On Monday night, I attended an Open House at a college I’m applying to. Their method of admissions is to look holistically at the whole student — GPA, grades, personal essay, recommendations. The whole enchilada. I asked if there was anything that the Admissions committee looked for, and the director was fairly vague.

I tried again and asked, “So why did students get rejected?”

Because that’s sort of what I always wish I knew. Even though I always try if I think there might be a chance, I also like being able to prepare myself for a rejection. When I applied to my first school of choice, I knew it was a long-shot. My GPA is much lower than their minimum, and I only had two out of their pre-reqs finished (although that’s not a requirement to apply, just a requirement before you actually enroll). I applied at the beginning of January. And I still haven’t heard anything. I’m sad, but I’m also not surprised. It could still turn around, but I feel like trying was safer because I had some idea of where it might go.

I try to have faith in myself that this whole nursing career — and thus diabetes educator career — will pan out and actually happen. But each phase of this process seems more nerve-wracking than the last. Someone has to accept me into a nursing program. I have to graduate the nursing program. I have to pass the NCLEX (the nursing equivalent of boards). Someone has to hire me to be a nurse. Someone has to hire me to be a diabetes educator. I have to pass the NBCDE exam. There are a lot of phases. A lot of potential rejection.

So I get a little nervous. My nerves over the process was the entire reason it took about ten years to finally convince myself that I actually needed to stop pretending I was a diabetes educator and actually become one. And now that I’m actually trying, my nerves are freaking me out. Some people are worried they’ll never find their calling. Well, I know what my calling is. But will I actually be able to live that out?

My faith in myself has always been a little shaky. But this is something I’m passionate about, so I’m trying for the yes. But I wish I had more confidence in my abilities to know that this will happen, instead of crossing all my fingers and toes, hoping that it will. I wish I had as much confidence as my husband, my family and my friends when I tell them I’m worried I won’t get in. I know I won’t get in if I don’t try, but how do you prepare yourself for rejection? Is it even possible?

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There are a number of things I loathe about living with diabetes, but I think managing diabetes while exercising probably takes the cake (no pun intended). There is just so much that can go wrong that it’s hard to know where to begin.

First of all, the simple act of exercise is designed to spur the body to burn up glucose. I mean, glucose is the body’s first choice when it comes to energy, so that’s what’s going to go first. In normal people, the body can handle that because it can produce its own glucose fast enough, plus it knows exactly how much to dial down on the production of its own insulin. Guess what a type 1 PWD can’t do?!

The second issue is that exercise affects your body’s metabolism for longer than just your workout. Which means you can see low blood sugar drops all the way until the next day! What the crap? Sometimes it feels like a game of Russian roulette: when’s the low blood sugar going to hit?

The third issue is that exercise is usually performed because the person exercising (I won’t go so far as to athlete…) wants to lose weight or at least not gain weight. Guess what you have to do when you have a low blood sugar? You have to consume glucose, which comes nicely packaged with calories. Sometimes it can feel like you’re “eating the gym.”

These are just a few of the things we have to deal with.

Of course, once you realize the physiologically your body actually needs fuel after a workout, you can start to feel a little bit better about the whole eating thing. But still, I would much rather much on a tasty apple with almond butter than sitting in a puddle of misery at the gym sucking on a Minute Maid juice box. Not where I want my calories to come from.

That being said, exercising with diabetes is totally possible. And I totally advise you not to look at me when figuring out how to do that.

Sorry, but it’s true.

I have been semi-active for most of my life and I have yet to really figure out what the hell my body likes to do with exercise. Sometimes I drop like crazy during exercise. Sometimes I spike like mad right afterward. Sometimes I stay so stable I wonder if I actually did anything (until I look at my tomato face in the mirror and remember otherwise).

These days, I’m on MDIs (multiple daily injections), which is a technical sounding term for poking myself a bunch. The upside is that I don’t have to worry about an insulin pump bouncing around while I run. The downside is that once I take my long-acting insulin, I’m stuck with that dose for 24 hours. I can’t lower it one iota (see aforementioned dialing down of insulin prior to working out).

That said, I do seem to have a relative groove going on with my running scheme and the Best Body Bootcamp, so I thought I’d go ahead and share.

Before a Workout

My preferred time of day for working out is typically right before or right after dinner. It’s just what works for my and my husband’s schedule (since we go together typically). I prefer to have my blood sugars in a mid-normal range. Not too high, not too low. Typically around 150 mg/dl. If I start too low, then I’m probably going to go low, and if I start to high then I don’t perform as well.

If we eat dinner before working out, I’ll adjust my insulin depending on my blood sugars. I might shave a few units off my dose if I feel like I’m going to be working out intensely or if I’m eat a particularly low-carb meal. I rarely have to worry about doing anything if I exercise with no active insulin. I usually just go to the gym as usual. I might drop twenty or thirty points, which is why I make sure that I never exercise too low, but since I’m eating right when I get home, it’s rarely an issue.

During a Workout

I don’t typically test while working out, but I do have hypoglycemia unawareness when exercising. Going low while exercising is rare, but it does happen, so I’m in the process of getting a continuous glucose monitor. This will hopefully keep tabs on me.

At the gym, I bring my purse with me, which has my diabetes bag and a juice box. When I go running, I wear a SPIbelt with a GU inside. I don’t run with a meter (I’ve tried, hence the CGM that should be arriving soon) because it’s too heavy. On occasion, if I start to feel abnormally sluggish, I’ll treat myself, wait 15 minutes, and then walk back. I also always go out with my phone so that I can call someone, and I also wear a medical ID bracelet. My adventures in running definitely motivated me to get that after years of being without one. (I know, I suck.)

Right now, my workouts are not long enough that I need to fuel in the middle. I think once I start upping my mileage, I will start consuming carbohydrates mid-run. I received a Nathan’s running pack for Christmas and I’m actually eager to break that out when I start reaching 60 minutes of running!

After a Workout

My after workout procedure is much like my before workout procedure: it all depends on where I’m at. If I end at a decent blood sugar, it’s nice because then I can eat dinner and not worry about anything. Strength training seems to give me the most sporadic end results. Most of the time, I end at my target, which is 20-30 points lower than where I started. But occasionally I’ll end higher or lower than I expected, but I’ve never taken a close look as to why. I think it’s part of the diabetes variability, but I also think it’s part of the exercise variability. How many of us exercise the exact same way each time?

I have noticed over many years that everyone has certain things that will make them drop or spike more than others, or certain routines or certain blood sugars they must be at to handle their diabetes and exercise. It reminds me that diabetes is very much a science experiment, which is why I’m glad my friend Ginger wrote a whole book about it! Working out on an insulin pump used to frustrate me a lot, because I always wanted to take my pump off, but then I would go high with the missing basal. I actually find that my own body really likes to keep things as normal as possible, with very little futzing around when it comes to compensating with lower doses. My adjustments tend to be fairly minimal, and I think that has helped me avoid a lot of roller coasters. Of course, YDMV (your diabetes may vary)!

How do you manage your diabetes and exercise?