Attempts at Perfection & It’s Failures

“Have no fear of perfection – you will never achieve it.” – Salvador Dali

I can’t get my head around it.  Does anyone with diabetes who is motivated in their management think they can’t achieve perfection?  Yes I said CAN’T.

As a Person With Diabetes I think that not only can I achieve challenging feats beyond my day to day life, such as ascending the Peruvian Tundra to over 15,000 ft BUT I can also achieve perfection with my diabetes.

As a PWD I know that this mindset is superfluous.  BUT, I still want to pursue it, just in case I can achieve it.  You never know, right??  Isn’t that a great goal to set and pursue. Almost like a cure, really.

BUT….yes, I said BUT…I am reminded of how the attempts of trying to be all that to my endocrine system and diabetes management isn’t that simple. Even after coming into 40 years of living with diabetes and being a Mom of a PWD for 14 years.

I am reminded on our flight to Peru, no matter how hard I attempt to make my diabetes perfect, I cannot.

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Upon take off I am aware of the potential impact the air pressure can have on my insulin pump delivery.  The rule of thumb despite there is not total clinical evidence with regards to this is to disconnect on ascension and descending. Why?  The talk of the town is that upon take off the pressure can change the delivery of insulin to cause a low blood sugar. During the flight the pressure change can create air bubbles resulting in missed insulin after landing.

I have experienced this throughout the past 14 years of travel on an insulin pump but was not aware of the ‘talk’ that circulated about this until the past few years.

So, whether clinically relevant or not, I decide to take heed to try and avoid this.

We are prepared for take off at Pearson.  Status quo.  Prior to boarding I check my Continuous Glucose Sensor.  All is good in my diabetes world.

As the plane positions itself for take off on the runway I disconnect from my site with the intention of reconnecting within a few minutes after the rapid ascension is complete.

I am excited.  I am thinking about our trip, the flight which is 21 hours with stop overs.  In my mind I am running through what we packed versus the list I print and check off.  I am nervous.  I am landing in a city that has an elevation of over 8,000 feet.  I am worried after the stories I am told of elevation sickness.

The airline steward serves our snacks.  I give it to Steve.  Packed full of gluten. I don’t need a snack anyway.  I’m not hungry.  I look at some magazines.  I do a Word Search.

Several hours pass by.  I start to feel like the Sahara desert lives in my mouth. My stomach feels like a brick made a home in it.  My chest feels heavy.

I question these feelings.  Why?  It feels like I am high.  How come?  I don’t clue in to check my sugar though.  I attribute it to the elevation, the dry air, the excitement.

The steward comes around again.  Offers snacks.  I pass mine onto Steve’s again.  Maybe if I eat and drink a ton of water I’ll feel better.  I take one of my gluten free bars out of my bag.  I bolus, I eat. I feel like crap.

Is it the flight?  The cabin pressure?  I just can’t make sense of it.  Obviously my brain cells are not firing on all cylinders.  Doesn’t being on guard all the time with managing diabetes do that to a person?

Then…I get an itch at my site.  And so I scratch. It is so itchy I must lift my shirt enough to place my hand under so I can make skin to skin contact to find satisfaction. While scratching I realize my tubing at my site is flopping back and forth….I am NOT attached to my site.

I forgot to re-connect after take off.  That was 3 hours ago.

In my effort to achieve diabetes management perfection, I fail.

Now, forgiveness is mine. I am so insulin sensitive that I only end up with a BG of 11 mmol/L.  I check for ketones as well.  They measure at only 0.3.  So…I correct for the gluten free bar and basal rates missed as well as a small amount for the trace amount of ketones.  It takes several hours to come down and even though my sugar is only 11, I feel like I’m on the edge of DKA.  I  know what it’s like, I’ve been there.

We land in Peru and I am almost in target.

After that incident I make a promise with myself.  Disconnecting on a flight to achieve perfect blood sugars is not a goal I wish to achieve.  For what I wish to achieve I fail.  I avoid a potential low but instead end up high and feeling terrible.

What’s the lesser of two evils.  I can’t answer that but I will tell you I will no longer disconnect my site.

Travelling with My Pharmacy

DBB Huchay Cusco Blog

There will a few posts/Blogs about my travels to and within Peru.

BUT..

I feel this post in particular is a huge one and is pressing upon me to prioritize even though it’s not in order.

We spent Christmas Eve in Agues Calientes. We planned to climb Machu Picchu Christmas Day.

I became very ill with a very high fever and ultimately sinus congestion, sore throat, fatigue among other things.

I am proud of the way the situation turned out as I recovered very quickly compared to most times I experience this. My husband questioned if I should take part in the venture to Machu Picchu but I insisted despite feeling down and out I would not miss such an amazing opportunity. This is a chance in a lifetime!!! And so we did.

With that being said, after we returned to Cusco a few days later we made plans to take part in a two day trek up the Andes mountains, through the Peruvian Tundra. We would then be hosted by a family overnight before descending back down the next day to another town a few hours away from our starting point.

We reach an elevation of 15,100 feet. Understanding that breathing would be a challenge at the best of times, I am overly concerned that with my congestion and swollen throat it would present greater issues.

On our way to the drop off point 1 1/2 hours away by jeep, I ask our guide to stop at a pharmacy to buy cold medication to help keep the symptoms from being too overwhelming throughout the climb.

As I walk into the pharmacy I take note this is the very first lesson I learn.  Never assume I can go away for 2 weeks and be healthy the whole time. I usually pack cold medications, gravol etc for those ‘just in case’ moments.

This is the first time I didn’t take my personal pharmacy with me. Sigh.

Our guide Henry takes me into the pharmacy in Cusco. I tell Henry in English that I need an anti-histamine/anti-inflammatory. I expect something along the lines of Advil Sinus & Cold or Buckley’s.

After the Pharmacist asks Henry a few more questions in Spanish….”Is it altitude sickness?”…”No, I had a very high fever, sore throat and sinus congestion.”…He recommends a product.

I take a ticket to the cash booth/dispensary at the front of the store. She gives me the box of medication. I am so relieved I will have the meds to help with the congestion, I don’t consider that I didn’t tell the pharmacist I have T1 diabetes OR that I took time to read the ingredients.   At this point I don’t make the connection that Dexametasona (in English “Dexamethasone”) is a steroid!!! I mean, come on, I am a Nurse. I should know the 5 R’s!!

AND I can’t buy a steroid over the counter in Canada! For good reason!

I am told to take one pill now (it is 7:30am) and again at supper. I can take it twice a day for a few days.

Within an hour I can feel the relief. I am overjoyed….until…

Fast forward to that evening and into the overnight…AND the next day…my blood sugars begin to climb…and climb…and climb.

I take insulin corrections like drinking water with no change. Not even a flicker in my Continuous Glucose monitor display. My finger pokes confirm all is not right within my diabetes world.

I reflect back on when we arrived in Cusco. Within a day I was setting temporary basal rates on my insulin pump for low blood sugars and now??? I am insulin resistant in the Andes Mountains??

I play scenarios in my mind. Is it the altitude? Is it dehydration? Is it the anaerobic feedback from the intense activity which leads us to experiencing burning leg muscles, shortness of breathe so bad our lungs are burning?

When I work out at the gym and do intense heavy weights my sugars spike. When I do hill training when I run I get the same effect. Is this the same?

At this point I haven’t made the connection yet that the cold meds contain steroids.

I do think that in part, the intensity of the climb did cause an adrenalin surge that did cause my need for more insulin….pair it with an exogenous steroid in my cold meds and here is a recipe for blood sugar disaster.

My key take away?

Bring my own cold meds and pharmacy.

If ever in an emergency that I require medications while in another country, make sure to tell them I have diabetes.

If and when I decide to ascend to 15,100 feet (or higher), take note and act that if it feels anaerobic, increase my insulin rates to accommodate to it.

No doubt it is a tough balance to achieve but I wouldn’t want to throw my hands in the air and not keep playing the game. Next time I want to improve on this experience. I accept my sugars will never be perfect in these situations especially, but, I will do my best.DBB Dexalor

How To Cross the Road

How To Cross the Road

In June 2012 we travelled to Vietnam and Cambodia.  It is considered a trip of a life time.

This picture is one of the streets of Ho Chi Minh City in Vietnam.  One of the first strategies we learned; how to cross the street without getting maimed or killed.  The bikes were a barrage with what seemed to be no break.  There were very few traffic lights.  The motorcyclists seem to be on a mission to travel from point A to point B.  Period.  It was quite a sight to see.  It was organized chaos.

It reminded me of a symphony.  The music was in front of them and they played at the right time with the right notes. We wish we could see the music so we could read and play it too.

The picture you see and the description above is how best to describe my mind.

I have a plan, similar to crossing the road in Ho Chi Minh City.  I need to get across.  The great part is, I can see the other side of the road.  The challenge is all of the opportunities and work that comes with meeting these goals is overwhelming me, like the constant barrage of motorcycles with what looks like no rules, traffic signs or signals.

Several challenges are new to me thus a few major learning curves.  I am in a different world with different rules.  Many opportunities have recently come to me which I have wanted for quite some time.  These opportunities are very promising, but, have changed the focus I thought was in place.  With that comes an abrupt change in how to complete the ‘BIG PLAN’.

I am aware of the multitudes of phrases and quotes that summarize how to eat an elephant, take baby steps and carpe diem.  Believe me, that is top of mind each day.

I make lists, I cross them off.  I thought crossing off the little stuff first, leaving the really big stuff last would be best.  I understand now this is not going to get me across the street.  It’s like taking a step on the road, seeing the bikes and stepping back on the sidewalk.

How did we cross the street in Ho Chi Minh City?  We looked for the biggest gap of motorcycles.  We held hands tight and began to cross.  We were concerned we would be hit.  We were surprised when we came in front of a bike that it would stop and let us cross.  We finally had the music.  We were learning how to be part of the symphony.

The Vietnamese motorcyclists chuckled at us.  I am certain I could hear them say in their chuckle…”Foreigners.”.  It was a huge sense of accomplishment to get to the other side.  And…we learned the motorcyclists had compassion and understanding of our goal.

It is time for my mind and actions to know and do the same.

An Old Love Renewed

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An Old Love Renewed

I have arrived at the resort in Honduras. We have ‘about’ a 3 hour wait before we can gain access to our rooms. We have not had lunch yet. All 7 of us (2 adults over 40 & 5 young adults 19-22) have been up all night. With a combo of fatigue & little food during our trip, the  suggestion by front desk to make our way upstairs to the buffet and have some lunch is quite welcomed.

Upon entering the ‘mess hall’ I graze over the 4 sections of food presented before us. I saunter slowly over to the first section of warming trays….nope. Deep fried, sitting in gravy, simple carbs. Ugh! Potential havoc on my wheat & lactose intolerant stomach as well as my blood sugars. Not good. I slouch a bit in disappointment, take a big sigh. I have 2 left, something, anything.  I have already automatically excluded the dessert table.

As I apprehensively approach the next section of warming trays, what do I see?? A big ‘cauldron’ full of soup! There is hope…if its not cream based…. I can’t see inside but when I lift the ladle I see what is a broth based preparation with chicken, potatoes & veggies. Bliss!!

As I stand there taking in the moment, memories bring me back to my childhood. Every week my Mom would take my sister, brother & I into town to my Great Grannies. My Great Uncle Neil & my Granny would always, always have a big (it seemed to me) pot of home-made chicken or turkey soup simmering. Not home-made as in a can or store-bought stock at the grocery store with some added poultry that needs to be cooked before hand.  This was the real deal!! Granny & Uncle Neil would take the carcass of the poultry with all its accompaniments & boil them down to make stock. From there, left over veggies & seasonings were added. Oh, it was so, so good!! Now that is comfort food! I always looked forward to going to Grannies house to eat her soup & hear Uncle Neil play songs for us on whatever instrument he felt inclined to play that day…piano, mandolin, ukulele.

I think that making delicious soup from scratch is genetic.  Definitely not something everyone can do.  With the creative mind & culinary tools I have, Easter, Thanksgiving & Christmas turkey transform into what tastes like the very same soups Granny & Uncle Neil made for us. I bask in the talent I have, the preparation, the outcome. I take pride in deboning the poultry, boiling it all down to the perfect broth that will be the base of my creation.  I want to share with everyone. But, for whatever reason, I just can’t seem to justify making it more often than three times a year…until last week during our family vacation in Honduras.

Each lunch & dinner the soup ‘cauldron’ was full. The ladle would introduce me to another episode of excitement. The tastes were incredible. Seasoned, spicy at times, tender meat, healthy veggies, it filled me, met the nutritional requirements, if so inclined, in one pot! I was teased when I left to get second helpings, but, I just couldn’t help myself!

As I relished in the pure ecstasy of the tastes & simplicity of these culinary delights, at times, I would flash back to 10 years ago. I would fondly recall from then a period of time when I was in the best shape of my life. I have a picture that was taken then which I had posted on my fridge until a few years ago.  I still look at it on occasion & say to myself…how did I do it? I wasn’t certainly some crazed, obsessed exercise guru that needed the rush & couldn’t get enough and as a result it burned my body fat down & built muscles up to this admirable shape….I was raising 2 children, working part-full time, 12 hour shift & shift work. Although I was active playing ball hockey, floor hockey, long walks with my dog & karate a few times a week, I did not have time for hours and hours at the gym lifting heavy weights.

As with any relationship I reflected on what made it so good & what made it difficult to ‘stay’. What were the key factors to creating a svelte, lean, healthy, muscular body?  Honduras probed me to reflect further. Reflecting more deeply into the relationship I once had with food 10 years ago I wanted to recall the key factors that made it good & provided such great results, I feel at peace with what didn’t work & what I could do to improve in my future relationship with healthy eating!

Of the many ‘habits’ I developed, of which I will blog about others separately, in this I will share, I recall ingesting a lot of soup. A lot! Before every meal. Even when I ate out. Always broth based, never cream, always veggie protein & veggies. If I made it at home it consisted of very basic ingredients. Sometimes it was just broth or miso. It was my tummy filler before the main meal. I never used it to replace my meal but it satisfied me enough to slow the main course to a pleasurable gastronomic enjoyment. AND…never gulped or inhaled without awareness.  I never regretted my meal 20 minutes or 1 hour later because I was uncomfortably full.

In that time, my blood sugars & blood work were amazing! Few lows, even fewer highs!

With that being said, I have just finished an amazing meal with Garlic Soup to start followed by a main course of Shrimp Stir Fry consisting of kale, broccoli, sweet peas, bean sprouts & carrots prepared in heated olive oil, salt & pepper. Learned satisfaction, no regrets. I am in love with soup once again.

Travelling with Diabetes in Honduras

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Travelling with Diabetes in Honduras

My experiences this time around are not so much about travelling & diabetes but more so how a change of environment can open my eyes to what I didn’t realize at home given my daily schedule. Recently my time at home has been terribly busy. As a result based on my experience I’m going to share the sensitivity to changes can be more difficult to determine.

Based on previous travels I know that heat & travel affect my blood sugars, that is a known fact. I understand that I need to accommodate to this. One elimination of variability is that Honduras is only one hour time difference. That does not seem to be enough to affect my blood sugars. The heat is a definite contributor to a higher risk of having a number of low blood sugars. Adding activities such as swimming & kayaking frequent testing & temporary basal rates on my insulin pump are essential to hopefully avoid or at least minimize the number and severity of low sugars.

With that being said I had one late evening & night that the lights were on but nobody was home. Upon coming to my ‘senses’ I was perplexed. My activity level & the heat didn’t seem to be enough to affect my levels for so long & so severe. Still, I have not been as active in the past number of months as I used to be & decided it was attributed to increased activity. Based on that, I didn’t make changes, I determined I needed to be more aggressive in how I set my temporary basal rates.
The next night was just as bad. But, I clued in. I reviewed my basal rates on my insulin pump. I suddenly came to the realization that from 6pm to 12am I had increased my rates a few weeks before leaving. I did so due to the fact my sugars were running too high for my goals. I made the changes due to the fact I thought it was from hormones.

The other variable which was the ultimate eye opener….I was getting frustrated with my current infusion site (Sure-T stainless steel 6mm by Medtronic). As a result, I switched back to the infusion site I had used for 8 years, the Silhouette by Medtronic. It ‘felt’ better.

With the low blood sugars I experienced I realized that the Sure-T was driving my basal rates higher due to the fact it was not always a good ‘fit’. It ‘clicked’ when I saw that my basal rate from 6pm-12am was 0.6u/h. I have NEVER ran a basal rate that high! When I switched back to the Silhouette my insulin needs were not as high due to the effective infusion of insulin it provided. With that, I ran into very serious low blood sugars I have not experienced in quite a long time.
Once I adjusted my basal rates & did what I usually do when travelling, all was good!!
After 38 years, I’m still learning how to live with diabetes. Always learning to live Beyond the Borders. Sharing with you so you can live with Diabetes Beyond Borders too!!