20/20 Hindsight

20/20 hindsight is a saying often used to express the idea that if I would have had then the information I have now, I may have taken a different course or made a different decision.

I think that most everyone, to a degree, lives their life like that - using past experiences to help color their opinions or influence their decisions for situations at hand.

For a person living with type 1 diabetes, this phrase can take on a whole new meaning. The basic idea is the same, but it is magnified a million-fold. Not so much the concept of it, but rather the number of times through the day the concept is used.

How many times during the course of an average day, are we presented with a scenario where we don't know exactly what to do? Some mix of recently passed events (food, insulin or exercise), current state of things (stress, etc) and anticipated events.

Our recently passed events and anticipated events may also be strongly influenced by unproven theories. Ideas like "I've been high a lot today - is my infusion set working right?" or "my blood sugar is being 'stubborn' today".

Now, if we are being attentive, we can make our best guess (that's really all it is sometimes, right?) and see how things turn out. Storing that scenario with all it's variables, and looking to draw upon it and it's outcome the next time we run into something similar.

In one aspect, that is how life in general is - it's not much different for us, except that we have, quite literally, tens of thousands more "things" to store and remember each and every day.

I don't know about you, but I just don't have the synaptic connections for all of that. Sometimes I just simply don't have the capacity to remember how a particular situation worked out - even if it's one I've been in time and time again.

I feel a bit dim-witted when I am in a "spot" like that. Recognizing (again) that I've been here (in this scenario) before (again). Not having the slightest clue on exactly what to do, and feeling uncomfortably familiar with that feeling. Why don't I remember what I did last time? How come I can't remember if what I did last time turned out good or not so good? I know it was not a disaster - because that I would remember for sure (right?).

Then, however the situation works out this time, I have that "20/20 Hindsight" thing going on. "Well, maybe I shouldn't have had that last juice" or "I really should have eaten more for lunch" or "back off/ramp up on the insulin next time".

If I had the information then that I do now, I might have made a different decision or taken a different action.

But we manage to do pretty good most of the time. I don't know how. Maybe because we are constantly and continuously put into these scenarios all the time.

What if we tried to document all of the factors in those scenarios, the actions we took (or didn't take) and the outcome?

And what good is documentation if you don't reference it to help you as you encounter similar situations through the course of the day.

Let's literally imagine such a system. What would it look like? How would we record that information? How would we reference it? Do you have different "time points"? One hour post scenario, two hours post scenario, three hours post scenario, etc.

Where would we store it all?! There's no building big enough - and that's just me! And think about the growth rate!!

And what kind of cross reference system would have to be in place? How in the world would you find anything? Do you "red flag" those that didn't work well - or worked very well?

Let's see - I've got three components from scenario S-47563.876567, with a sprinkling of things from scenario S-27364.776453. I need an outcome at the two hour post scenario mark similar to O-47532.774987 because I'll then be doing something like S-11234.982245. At the end of the day I need to end up with an outcome of O-ALL.GOOD with no occurrences of O-OH.SHIT outcomes. Ok, got all that? So, what exactly should I do now?

It is, honestly, pretty impressive that we are able to do as well as we do.

Sure we get burned out and frustrated sometimes, but is it any wonder when you think about everything that's constantly swimming around our mind?

And on top of all that, we somehow find the capacity to live mostly successful lives too.

We are simply amazing.

Bloodsugars and Moods

I recently finished reading "Psyching Out Diabetes" by Dr. Richard Rubin, June Biermann & Barbara Toohey (June & Barbara have TONS of books out there on diabetes - you probably know them, even if you don't realize it yet). The book was a quick and easy read, and I would encourage you to check it out if the title rings any interest for you. Take a peek at the "Look Inside" feature that Amazon has, and you can get an idea of some things the book touches on.

Like any book, there are things you take out of it, and things that you don't really feel apply. I thought this book did a really good job balancing that, and I felt the "signal to noise" ratio was excellent.

One of the many things I started to notice after crossing a certain point in the book was my mood and whether or not any particular cranky or pissy spell might be related to a high or low blood sugar.

I usually have trouble identifying when I'm a bit cranky. I bet many of us do. Something rubs us the wrong way, and before we know it we're snapping at those close to us, or pulling back to "just be alone". Maybe without even realizing what we're doing.

Me? I'm a snapper. I usually hold it together pretty good, except when it comes to my wife & kids. Maybe that's natural - to be a little less guarded around those you feel most comfortable with?

The book talked about many of these types of events in relation to low blood sugars - giving some examples of completely irrational explosions, only to find the person was experiencing a low blood sugar (maybe therefore not having the normal cognitive abilities).

Those make sense, the lows, at least as much as they can I guess. But I'm also starting to wonder if I don't also have trouble on the other end of things - when my blood sugar is high?

My poor and ever so patient family (I am so thankful for you).

I've asked my wife if we can come up with some ways for her to express that she feels I'm cranky, so I can (theoretically) test my blood sugar, and see if there is some relation there.

This situation is maybe more delicate than the average person may appreciate. Have you ever been pissed off, and your significant other asks you why you're pissed off, and it just makes you more pissed off? Or maybe they just start jabbing back at you, and the spiral of emotions escalates until you are both ready to bite each others head off!

After all that you still don't know why you were acting all pissy in the first place. And to top it off you've gone and pissed off those around you. No good for anyone.

So to come up with some way for my wife to communicate the fact that she believes I am acting cranky, without me getting even more cranky, is what we're after here.

I'm skeptical, because I know how I get when I'm cranky. But she's optimistic. She said "yes, you might get pissed of, but I'll get over it and so will you" (isn't she great!?). I also think the fact that I'm starting to recognize that my moods are very much impacted by my blood sugars will help things too.

If I can recognize that my blood sugar is high, and I'm cranky, I can then ratchet up my awareness and work to calm myself down. It's no guarantee, but I think it's better than just being cranky and making life miserable for my wife & kids.

This ties into so many things. When I posted Friday about having trouble after basketball - spilling ketones & running high sugars for much of that afternoon - I got home and was just wiped out. I wanted to crawl into a hole and not do or think about anything. I realized that I had an appointment with my therapist the next day, and I said to myself "you know, I don't want to work on anything". Those therapist appointments (and the aftermath of uncovering something) are mentally exhausting.

After having such a tough day, of course I was not looking forward to a mentally trying therapist appointment. But then it hit me - that I was in that "mental place" because of the day I had, and that after some rest, hydration and time with in-range numbers, I would feel better and probably be all revved up for the appointment.

I shared those thoughts with my wife, and we felt good about realizing why I was feeling that way. It didn't make me magically feel better, but understanding why my head was where it was helped tremendously. I didn't try to "fix" it - just recognize the why.

The next day, my therapist and I had a great appointment (in which I also shared my revelation! She said "duh!").

The human body is such a fascinating work of checks and balances, and there is more than just the physical side of things that get thrown out of whack when we are outside of the "normal operating range".

At the very least, it's something to think about - that's for sure.

Housekeeping (no really, just some housekeeping stuff)

I've changed around the order of the "sections" in the sidebar. I was getting a little annoyed at how long and unmanageable it all seemed, so I reordered it.

I've also added a link to a web page I've had around for a while where I've been keeping track of my A1C's over the years (viewer discretion advised - explicitly high readings) as well as some weekly BG records. There's a large gap in the BG records, but that's life.

I also moved my list of links onto it's own page. I love all of you bloggers out there, and would update that list every time I came across a new blog. It just got to be too long and I felt it was distracting. So, it's on it's own page now.

I moved the webring code up in the page, so it should be more noticeable now and easier to get at.

I think that's about it - but I might continue to tweak it a little bit. Please let me know if you find something that is broken, doesn't work right, or simply looks funny (besides my picture, thank you!).

Thanks!

And The Winner Is...

****UPDATE****
Prize information updated below!
****UPDATE****

-------------------------
I intended to post the winner of my "AUTS Contest Number Two " over the weekend, but family activities and great weather kept me away from the computer for the whole weekend - as it well should have.

Instead I spent the weekend doing fun stuff and some yard work, and getting sunburned like an old lobster. It took a nice red coloring and most of Saturday morning before I remembered to apply the sunscreen.

Without further adieu - our winner is "J" from "Kiss My Sweet Sticks !". The winning guess? 347!

There were a WHOPPING 353 strips in the case!!!

No - I can't believe it either... I should be sent away for having that many used strips in any one given place. Wait until you see contest number three...

"J" will soon be receiving a "real world prize" (as opposed to some virtual internet kudos) for her winning guess. Congratulations!!

Thanks to everyone for their participation! And let this be a lesson to you - throw them strips away!!! Do not end up like me (if you do have a bad habit of holding onto test strips, just be sure to not let Julia (from Major Bedhead) know about it, or she'll give you a hard time about it)! :-p

Thanks again to all who participated!
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****UPDATE****
The prize that "J" has won is a $25 gift card to Amazon.com!

Congratulations again "J"!!

Stay tuned for the grand finale! Coming soon!

What else do they do?

Ketones.

We know that ketones are bad, and usually a sign that something has gone wrong with your insulin delivery.

However, there are times where the normal metabolism processes will also cause ketones, even when your insulin delivery is just fine.

When your cells can't get the energy they need through available glucose in your bloodstream, your body will start to break down fatty acids. A by-product of this process is ketones. I'm not a doctor, or even a medical professional, so there are many more accurate descriptions of the process available. My basic understanding for the purpose of this post is that when the body has to turn to fat stores for it's energy, you will have some ketones.

Yesterday was a basketball day for me (where I play ball for about 2 hours over lunchtime). I had eaten a bagel with cream cheese and a glazed doughnut for breakfast. I also had two bottles of juice during basketball to keep my bloodsugar up. My bloodsugar hovered between 74 at it's lowest, and 107 at it's highest (pretty damn good!). When I left the gym after showering and dressing, I tested 105. I felt good. I worked really hard during basketball and had an excellent workout. I was however very dehydrated - even before basketball. This is thanks in part to my official addiction to Diet Coke (caffeinated - a diuretic), and also the fact that I had not taken in much water in the past few days. I did drink 32oz of water during basketball, but I'm sure it did not "equal out". I sweat like a stuffed pig in a sauna, and probably lost 64oz of water through that alone.

I got back to work and felt really really worn out. I naturally just thought that it was because I worked really hard. I really pushed it today, much more than usual. So, of course I should feel a bit spent. It made sense. I was also immediately completely bombarded by work stuff - more so than usual after being away from my luxurious cube for a couple hours.

About 30 minutes later my muscles felt "funny", and my blood sugar had spiked up to 247 (with no food!!)! I had suspicions at that point that I was spilling ketones like a two year old using a "grown up cup".

I was again distracted by work stuff, and would you believe I totally forgot to correct for that 247?! It was another hour before it hit me that I had forgotten to take a correction bolus - I did another test to get an accurate reading, and by this time was up to 268. I corrected for that, found a ketostix and proceeded to the bathroom.

Remember the dehydration thing? Yeah.

I managed to produce a sample and the ketostix immediately turned a dark purple. Large ketones.

It's now 4:00pm. My breakfast was at around 9:00am, and the two juices I had were between 11:30am & 12:30pm. With basketball usually burning an insane amount of calories (2000+, I have worn my heart rate monitor a time or two), and me not having eaten very many calories, it's no wonder that my body was burning fat stores to survive. That's actually the point of all the exercise isn't it (well, that & to get the heart pumping)?

The issue with the presence of ketones is it makes you a bit more resistant to insulin. That's why my blood sugar was rising. If I would have known about the ketones I could have increased my insulin to balance the resistance. I now also need to flush the ketones out (lots of drinking water & peeing), and get my body to stop producing them by feeding it (so it stops burning fat for energy).

It's manageable, and information is the key. By (my) suppertime later that evening (7 or 8 o'clock) I was back down to 84 and managing just fine. Still working to flush the ketones, but blood sugar control was doing fine.

But I was totally & completely wiped out. In part because I really exerted myself at basketball, and in part from running high that afternoon, but I'm also convinced that all those ketones in my system also contributed to my exhaustion. I know that they can upset the acid balance of your chemistry, which can't be good. But what else do they do? How do ketones interact with your body? What trouble do they cause? Why do they make my muscles feel funny? What would happen if you spent an extended period of time with ketones in your system - managing blood sugars with more insulin?

I believe that a non-diabetic person can deal with them a little better because their pancreas will automatically match their higher insulin needs (ketones make them resistant too - but their pancreas just creates more insulin). But, don't they still deal with needing to flush them out of their system, and their acid balance should be thrown out of balance too right? How about when the Atkins diet was all the rage, and people were using ketostix to see if their diet was working or not - didn't they feel crappy with high ketones? Or is it different for a non-diabetic? Does their body do something besides the increased insulin to deal with them?

What else do ketones do? That is the question of the day.

But they are two different things...

My mind is such a tangled place sometimes.

I usually think of myself as a pretty normal guy (don't we all?). It's the rest of you that are crazy...

Sorry, I couldn't resist.

I'm trying to really pay some attention to what goes on upstairs. I feel that the past year or so has been just the start of a very interesting, very rewarding, very challenging, very long (life long?) and sometimes very difficult journey of understanding myself.

As many of you know, I've acknowledged that I need to change my behaviour and habits around my eating. In many ways I feel that this is one of the major reasons my A1C's are high. If I can reign in my eating habits and choices, my blood sugars will be much better (notice I didn't say great or perfect), and I'll see some rewarding A1C results. Hopefully also meaning I won't see much in terms of major complications or other bad eating caused troubles.

This (eating better) is much harder than you may think. At least for me.

I'm finding that my poor eating habits and choices may be the manifestation of some other deep seeded issues, such as denial and grief.

I was diagnosed at 5 years old. Can't remember much about it back then, but heck, I can't remember two days ago either. But my point is that I've always just done most of what I had to do - and that being just enough to avoid disaster or any other immediate pain. I've just made it through each day, then moving on to the next. Never really taking time to look at or deal with the mental aspect of dealing with a chronic condition.

So here we start to look at things I want to do, and things I need to do.

Two very different things when it comes to changing my eating habits. I know I need to do it. But I don't want to do it.

This realization hit me a couple weeks ago during an appointment with my therapist. We were talking about things I can do around my eating, specifically planning and packing food to bring from home. I am feeling a ton of resistance to even planning!! My therapist started to do something that many therapists do, and that was to dissect that a bit. What is it about planning and packing food that I don't like? The time? The energy? What?

I talked about how I can let some really stupid thing throw me off course. For example, if I discovered that we were out of Ziploc baggies, I would just say screw it and quit packing lunch. All the while standing next to a stack of Tupperware taller than the average house dog.

Then a thought hit me - I pack and plan a bunch of crap to play basketball a couple times a week during lunch. We're talking shorts, t-shirt, 2 pairs of socks, fresh underwear, small towel to wipe sweat during, large towel for showering after, shoes, ankle braces, preparing 32oz of Gatorade (made from the big tub of powder), making sure my pump strap is in there, checking stock of test strips and glucose tablets, and packing it all into my gym bag which I place in an obvious spot to grab on the way out the door the next morning.

Compare that to planning and packing a simple lunch.

Yes. I know.

So I mentioned that to my therapist, and talked about how much I enjoy basketball, and because I enjoy it so much that I don't even give the planning and preparation a second thought. I just do it.

It came down to the fact that I did not want to change how I eat. I recognize that I need to, but I don't want to.

She said "that is part of denial".

It seems so foreign to me, being diabetic for 26+ years, to realize that I may have never really dealt with that side of things. Acceptance & full responsibility for the choices I make on a daily basis.

I posted a while back about talking the talk. I got a lot of very valuable and helpful feedback (as usual!). One in particular really hit me though - it was from "Zazzy" over at Zazen in the Moonlight. In particular the fact that doing things we don't want to do that are good for us is really hard. It's not a trivial thing. It really is hard. And to "seek the solution instead of beating yourself up for having the problem". Very powerful statement. (thank you Zaz!!).

So how do you deal with denial? My therapist suggests certain sections and aspects of the AA "Big Book" - adapting the language and wording to my situation. I've also found another book that I'm getting some value from. I'm also very interested in any feedback or information that has helped any of you, or others you know of. Dealing with this, like diabetes, is a very individual thing - and what works well for some may not apply to others. But I think the more information and resources available the better off I'll be.

As difficult as this journey may be, I have found it, so far, to be intensely rewarding. Scraping off layers of mental avoidance strategies on some life long problem areas. Working my way through the mental diversions and trying to uncover the root causes where possible.

What I want to do vs. what I need to do.