Molly Johannes was diagnosed with type 1 diabetes in 1997 at the age of four. Molly controls her diabetes with a combination of insulin shots, daily exercise, and a healthy diet. She utilizes a Dexcom continuous glucose monitor to remain aware of her blood sugars throughout her busy days at school. Molly is a sophomore English major at the University of Massachusetts, Amherst. Read full bio

Getting Started on my First Insulin Pump, The OmniPod

The Omnipod - My new PDM!

Today marks a new beginning for me. After seventeen years of taking insulin shots, I’ve made the move to a higher form of technology: the insulin pump! My pump of choice? The OmniPod, which appealed to me mainly because it is tubeless and my mother also uses it.

As the day went on, I experienced an array of emotions. I woke up feeling pumped (ha-ha, diabetic humor) because I realized I would be taking my last shot via insulin pen for the time being at breakfast. It was pretty anti-climatic, but a major moment for me nonetheless.

Some anxiety started settling in around midday. This was partly due to the fact I knew my visit with my diabetes educator would last roughly three hours in duration. I wasn’t exactly thrilled about having to spend a good chunk of my day off at the doctor’s office. I also had a few lingering questions. When would I take my first bolus? When would I be able to eat my next meal? Would it hurt when I inserted a new pod? I was driving myself nuts with my ceaseless stream of questions.

When it came time for me to actually leave for my appointment, I felt as ready as ever. I decided it would be best to just go with the flow and be patient as I listened to everything my diabetes educator needed to say to me.

The Omnipod - A box full of new supplies home

Much to my relief, the three hours flew by more rapidly than I thought they would. In that span of time, I learned not only the basics of my pump, but the finer points that I may not have necessarily understood or picked up on my own. And I was reassured when upon inserting my first pod, I learned that it’s painless – my Dexcom causes more of an unpleasant pinch than the OmniPod system.

By the time I left the office, I had three more follow-up appointments scheduled and a fully active pump stuck on my belly. I didn’t give it much more thought until dinnertime, where I tested (more diabetic humor!) its abilities. I was impressed with how simple the entire insulin delivery process was, and I liked that my PDM would beep periodically to inform me of the status of my bolus.

Post-dinner, though, brought some frustration. As I write, I am still higher than I would like to be. It could be due to anything, which makes it especially irritating. Maybe I miscalculated my carb intake, or maybe my basal rate or insulin-to-carb ratio needs tweaking. For now, all I can do is accept the fact that the beginning of this new regimen will bring lots of trial-and-error with it and monitor my blood sugars carefully – it means waking up a couple times during the night, but I know I just have to do it.

I am not looking forward to this start-up period, but I am hopeful for what it will bring and what I can learn from it. I do look forward to sharing my experiences along the way, so stay tuned for my next post about my transition!

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Mealtime = Math Time

“Okay, let’s do the math here. There’s 30 milliliters in 1/8 of a cup, so that means there’s 60 milliliters in 1/4 cup. This little container is filled with 45 milliliters of granola, and according to the nutritional information on the bag, there’s 38 grams of carbohydrate in 1/2 cup…”

Meal Time = Mathe TimeUgh, typing out that sentence was enough to give me another headache. But I was faced with solving this tricky little math problem the other night knowing that the solution would make lunchtime insulin calculations easier for me the next day. Since I’m not a particularly talented mathematician, I walked myself through the problem with my mom. It took us a few minutes, but eventually we determined that the mini vial of granola couldn’t contain more than approximately 12 grams of carbohydrates.

This scenario is the perfect example of something that I believe isn’t understood or realized by those lacking familiarity with diabetes. I think that people make the assumption that diabetes is more about managing a healthy diet and an exercise routine – which is true, to an extent – and less about calculating nutritional content or insulin dosages. In other words, if I elect to order a salad as opposed to a sandwich when dining out, my restaurant companion(s) might think it’s just in an effort to eat healthfully. They forget that it could be more due to the fact that salads are typically lower carb options and therefore easier to calculate when it comes to bolusing.

I guess what I’m trying to say here is that I find it really frustrating to do the math in more complicated situations such as this, and I’m kind of bitter that most other people I know don’t have to give the nutritional content of foods they consume a second thought. While I wouldn’t wish diabetes on anyone, I do wish for greater consciousness of some of the more complex aspects involved in daily care and management.

In the grand scheme of things, not every mealtime carb count is going to yield a cut and dry computation. Bear this in mind whether or not you’re someone who’s directly affected by diabetes. That way, you’ll be more understanding when you need to break out the calculator before you break the bread. Just remember that in the end, it’ll be worth it when doing the math improves your accuracy and causes better blood sugars. You’ll be glad you took those extra steps, and whomever you share your meals with will be happy to see you benefiting from it.

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‘Twas the Night Before Christmas…

Just a few of the sweets we have at my house

It is officially Christmas Eve, and if I’m being perfectly honest, I have far more than visions of sugarplums dancing in my head. Throw some cookies, cakes, and candies into the picture – oh, and some complex math formulas representing how I can possibly maintain good blood sugars while eating these foods – and you’ll have a better idea of what I’ll be thinking about in the hours before Santa Clause makes a stop at my house.

In the past, I’ve talked about how difficult it is for me to deal with my diabetes on holidays. I struggle with wanting to indulge in rich foods and needing to be concerned over how they might affect my blood sugar. For instance, I had to chase highs for most of the evening this past Thanksgiving, and I’d like to avoid having to do the same thing this Christmas Eve and Day.

The holidays are arriving just after I found out that my A1c dropped a half point since my last reading in June, which is spectacular news! It’s an especially huge accomplishment for me because I’ve been with an uncomfortable number of highs lately. Ever since I started my new job, I’ve noticed that remaining sedentary for several hours at a time has a negative impact on my blood sugar. As a result, it’s been really important to me lately to remain diligent and figure out how to address this between tweaking my insulin doses and incorporating an exercise routine into my weekdays.

That being said, I really want to prevent any additional highs so I can enjoy the holiday without having to sacrifice a few treats. So here’s my game plan:

  • Figure out what exactly will be served, from dinner to dessert to drinks. That way, I’ll be able to determine which foods I should definitely account for in my meal and which foods I don’t need to worry about. I’ll also know that I’m not missing out on anything – if I didn’t realize there would be desserts, for example, then I might either have to stack my insulin or forgo something that I would’ve really liked to eat.
  • Consume fewer carbs. I know for a fact that tonight (Christmas Eve) my family does Chinese food for the main meal. If I stick with higher protein meats and skimp out a bit on starchy fried rice, then I’ll be able to account for more carbs in the dessert portion of the night. The same concept applies vice versa or if I choose to not have dessert and fill up on the main course options.
  • Be prepared with Tupperware. If there’s a food item that I really want but choose not to eat due to either a high blood sugar or wanting to keep a steady blood sugar, then I can just save it for later. There’s bound to be leftovers anyways, and just because something is there does not mean that I have to eat it right away.

These steps sound fairly intuitive, but sometimes it’s nice to really think them through so the meanings behind them sink in. I feel better knowing that I’m actively trying to manage my diabetes on tricky holidays, and it makes any potential mistakes feel less aggravating.

With this positive mindset, I’m more apt to get the most out of the most important parts of this holiday: family, peace, joy, goodwill toward men. And so I wish the happiest of holidays to all – and to all a good night!

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Nifty Fifty

Nifty Fifty: Celebrating My 50th Post on ASweetLife

As I sat down to write a blog post for this week, I realized that it was my fiftieth post for ASweetLife (not including any of the feature articles that I have written). I’m pretty excited about this milestone. It’s a good feeling to know that I have accrued fifty pieces of my personal writing during a pivotal period of my life: college.

This past Wednesday, I officially completed my undergraduate career at UMass Amherst. My degree is in English, with a minor in Psychology. On Monday, I started a new full-time job with a company that I interned for over the summer.

When I combine these major milestones with the knowledge that my seventeenth diabetes anniversary is right around the corner, it’s kind of mind blowing.

I guess what I mean by this is that I feel like I should recognize how much I’ve accomplished over the years despite having diabetes. Often, it is assumed that diabetes slows those affected by it down, that it is so dramatically life-altering that it takes a serious toll on a person’s daily activities. On the contrary, I think the exact opposite is true. If anything, diabetes has been a huge motivating force for me. It’s pushed me to prove to myself and to others that I’m capable of anything.

Specifically, I went to college and succeeded. I was terrified to leave the comfort and safety of my home and live independently. But when it came time for move-in day my freshman year, my only option at that point was to make the most out of this new chapter in my life. Three and a half years later, I think I can say that I truly did.

During my time in college, I made many new friends. I took some classes that I absolutely loved and some that I positively hated. I made my fair share of mistakes and I learned from them. I stepped out of my comfort zone on more than one occasion, and despite panicking each time, I was always proud of myself for doing so anyways. I started to pursue my interest in writing by blogging for ASweetLife. I became the chapter president of the UMass Amherst College Diabetes Network. I was crazy enough to take 18 credits during my last two semesters and still somehow managed to secure employment before I was done. And I did it all while managing my diabetes.

It didn’t really occur to me until just now – a week after finishing school – that I ought to congratulate myself for my success both academically and physically. Maybe it’s the fact that I’m aware that the arrival of Christmas Eve means that I’ve had diabetes for just over 80% of my life, or perhaps it’s knowing just how much I’ve done in the short span of seven semesters. Regardless, these numbers are more than mere statistics to me; they represent how I refuse to let diabetes get in my way. Fifty blog posts later and I’m feeling more secure than ever in terms of my diabetes care and consciousness as well as in my membership to the Diabetes Online Community.

As for right now, I’m looking forward to writing even more about my upcoming experiences (both diabetes-related and not!) in the so-called “real world” – definitely stay tuned!

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Thanksgiving Lessons Learned

Thanksgiving Lessons Learned

There’s nothing like a break from school during which time you’re surrounded by tempting foods and lack of exercise facilities to teach you a few diabetes dos-and-don’ts.

I’m approaching my seventeenth year with T1D, so you might consider me a diabetes veteran. But I’m constantly learning ways in which I can strengthen my diabetes care regimen, proving to myself and others that diabetes management is not a static thing.

The proof is in the pudding – or in this case, the turkey dinner. This year, my family gathered at my Aunt Paula’s house for an absolute feast. The selection of dishes included staples like mashed potatoes, rolls, green bean casserole, broccoli casserole, asparagus, stuffing, squash, cranberry sauce, and the turkey centerpiece. Oh, and I can’t forget to mention the several different kinds of wine to wash it all down with.

When I scan that list of food, all the starches jump out at me and make me cringe. The fact that I indulged in a bit of all of them, however, makes me throw up a little. Don’t get me wrong, each and every one of them was positively delectable. What makes me nauseous is the amount of carb counting (or in my case this year, the lack thereof) that is involved in the process of consuming them. Needless to say, my carelessness resulted in some unwelcome hyperglycemia that lingered through dessert time. As a result, I found myself rage-bolusing to correct the high and to account for the slivers of pumpkin pie and blueberry pie that were calling my name. I waited about 45 minutes for the insulin to really take effect, then happily helped myself to some treats.

I’m proud to say that I exhibited impressive self-control when I went to cut my super-skinny slices of pie…but ashamed of my inability to resist adding a couple of fancy chocolates to my dessert plate. Before long, high blood sugars haunted me again. Luckily, upon returning home that evening I was able to get them level again in no time, but the misery of chasing self-induced highs all afternoon long really drove the point home that I need to be more careful.

Lesson 1, learned.

The second lesson is the story of my dependency on my CGM – and its apparent dependency on me. I’m trying to give myself some distance from my CGM. After all, its incessant buzzing and beeping drive me up the wall half the time. But it seems as though my CGM simply cannot bear to be away for me from long before it gives me the cold shoulder and refuses to report my blood sugars.

When I’m at work, visiting family, or hanging out with friends, it can be annoying to have my CGM clipped on my body at all times. So sometimes, I’ll leave it behind in my pocket or in my purse, never straying too far in case it needs to alert me to a blood sugar that I’m not fully aware of yet.

Usually, my CGM is great about picking up a number up to 20 feet away, letting me move into another room or up the stairs without there being an issue. But the other day, when I slipped my CGM into the pocket of the jacket I was wearing, it totally rebelled against me for being shunned into this location. For nearly an entire hour, my stubborn little CGM said it was out of range. I couldn’t understand why it was doing this to me. I felt betrayed. In an attempt to compromise with Mr. CGM’s needs, I clipped it onto my jeans so it could be as close to the chip as possible. This strategy worked, and my CGM gladly recommenced communication with me. I know, we have a complicated relationship, but we’re trying to work things out as we get to understand each other better.

Lesson 2, learned.

As you can see, there are issues faced on a daily basis – some big, some small – by people with diabetes. A little patience, good observational skills, and occasional cursing help us cope as well as prepare for the lessons the next day of diabetes has to teach us.

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Stair Breaks

Unbelievably, we’re more than halfway through the month of November – how did that happen? In any case, this means that I’m in the beginning stages of hibernation. In a college student’s dictionary, this is defined as the following:

Hibernation (verb): to be in forced isolation, as a result of impending final projects and exams. May or may not result in productive behaviors.

This compulsory state of being means that I seldom leave my apartment, let alone my room. It often causes me to feel restless as my eyes glaze over from staring at my computer screen for long stretches of time.

These stairs couldn't look less inviting.

These stairs couldn’t look less inviting.

In turn, this also means that I don’t get to fit in as much exercise as I’d like each day. Tuesdays and Thursdays tend to be the most difficult days because they’re the busiest. Granted, I only have three classes on those days, but they’re spread out so by the time the last one ends I want nothing but to go home and process what I’ve learned over the course of the day (and maybe sit back for a bit and relax while I’m at it).

However, this sometimes has an undesirable affect on my blood sugars. The lack of activity sometimes results in yucky spikes that make my CGM buzz as well as infuriate me.

Normally, I would just take insulin to correct this. But as I’ve discussed in the past, I try to avoid stacking my doses at all costs. So what’s my next go-to?

It might sound kind of weird, but the answer is stairs. I live in a five-story apartment building, and right next to my apartment’s entrance is a stairwell. It’s kind of the perfect solution because most of the time, it works more quickly than insulin and it also forces me to get up and move around. They’re literally located right outside my front door, and I don’t have to brave the cold or find a spare block of time to make it to my school’s gym.

It’s fairly simple. Just as I’m starting to feel antsy and notice an unfavorable blood sugar, I seize it as an opportunity to take a break from my work and climb the stairs. Usually, after about 15-20 minutes, I’ll notice a difference. It’s a good feeling to know that sometimes control can be as simple as taking a brief timeout from homework just to walk around my apartment building.

Now if only the stairwell wasn’t so bleak and gray, then my little exercise breaks would be visually AND mentally appealing…

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Exams and Unexpected Hypos

If someone asked me what my least favorite part of college was, I would say it’s the exams.

I understand they’re a necessary evil to evaluate my knowledge, but there are few things in this world that are more anxiety-provoking to me. As a result, I get sweaty palms and restless feet the moment the dreaded Scantron and exam packet are placed before me.

The other day, I had a communications exam that evoked all of these symptoms about an hour prior to the exam. At first, I brushed it off as nerves. But when it evolved into feeling shaky and a little dizzy, I realized I might have a bigger problem on my hands.

It couldn’t have been a more inconvenient low. I had just finished eating an early dinner a half hour before, so it didn’t seem possible to me that the insulin had already started working that quickly. I tried to ignore how I was feeling and study my notes, but an inability to concentrate forced me to test my blood sugar.

Yep, I was going down – I was 71 and perplexed. Just 45 minutes before, I was something like 191. Usually, I have to wait about 60-90 minutes to really see my insulin kicking in, regardless of whether or not I’m high before taking the shot.

In addition to freaking about my exam, I was now freaking about my blood sugar. The fact that I had to leave in about 20 minutes to get to the exam room in a timely manner wasn’t helping me keep my cool.

As my CGM started to alert me to my falling blood sugar, I shoved four glucose tablets in my mouth and decided to call my mom. I explained the situation to her and she talked me through it, mitigating some of my concerns. She gave me advice that I already knew to follow, but I still found it comforting to hear it from someone else as affirmation that I had a good plan to follow from that point up until my exam.

Fifteen minutes after the 71 reading, I tested to see if I was coming up at all. I went up to 87 – a minor increase, but it was just what I needed to see and I got ready to head out. I packed my bag, putting an extra juice box as well as a granola bar and Humalog pen in with my regular set of supplies (it couldn’t hurt to be prepared for anything). I set off for my exam, wondering all the while whether I was more worried about doing well on it or what my blood sugar would be doing during it.

A short while later, exams were being distributed by my professor: it was officially go time. Gradually, my mind shifted focus from my diabetes to each of the 100 multiple choice questions. It was all over within an hour, during which time my CGM did not go off once. I walked home and tested again, with a blood sugar reading in the 170s. Not my best, but I was proud of myself for catching the low before it got worse. And I’m pleased to report that I did just fine on the exam, proving to myself again that I can overcome just about any obstacle associated with my diabetes, which is an A+ in my book!

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To Stack or not to Stack

To stack or not to stack...that is the question.

That is, indeed, the question. What exactly do I mean by stacking? This is when a person with diabetes takes multiple shots of insulin in a relatively short span of time.

Personally, since I’m still on insulin shots, I typically will wait at least three hours in between insulin dosages. Once that minimal amount of time has elapsed, I can be fairly certain that the insulin I took earlier has run its course through my system.

I try to avoid stacking at all costs, because it seems to do more harm than good. The most common problem it causes for me is lows. If I’m too impatient for insulin to kick in and give myself a corrective dose, the stacking can work against me and make me go from a horrible high to a horrible low.

So I didn’t really want to resort to stacking, but my disrupted schedule on Saturday prompted me to do so. I ate breakfast at 9:30 and left my apartment at school around 12:00 on a ninety minute drive home. Before I left, I tested my blood sugar to see where it was at: right around 180. I took a small dose in the hopes that I would come down to a better number over the course of my drive.

Around 2 o’clock, I found myself at my parents’ house with a blood sugar of 179. Frustrated, I decided to correct for this as well as bolus for lunch, which consisted of some delicious homemade tortellini soup and a biscuit. I was well aware of the carb-y nature of this meal, so I tried to be a little more aggressive in treating it.

No dice. By 3:30, I was on the road to Boston with my boyfriend and our friends for an exciting evening during which we’d view a screening of The Evil Dead, preceded by a meet-and-greet with the cult film’s star, Bruce Campbell. Over the course of the ride, I kept an eye on my CGM and tested to confirm a spiked sugar of 250. At 4 o’clock, I took yet another shot to correct for this high. Note the time intervals in between each shot – 2.5 hours, 2 hours, and 2 hours…which translates to an inordinate number of stacks for this girl.

It seemed as though I made the right call, though. At 4:45, my boyfriend and I were shaking hands with Mr. Campbell and proudly posing next to him in a photograph. We rejoined our friends and decided to go across the street to a bar to kill some time before the movie at 7.

When I tested at the bar, I was much better with a reading of 140 mg/dL with a single arrow going down. But I had to make a choice: do I skip this one chance to order some drinks and a small appetizer in order to maintain a predictable blood sugar pattern, or do I take another shot and compensate for food and drink alone, assuming that my earlier correction dose would bring me down to my desired target of 100 mg/dL? Clearly, it was a complicated decision with multiple variables.

I went with the former and took a shot to cover a couple bites of a shareable appetizer as well as two beers. I found myself relaxing as my CGM did not vibrate once over the next few hours. It felt refreshing to enjoy my time with my boyfriend and our friends, and I felt comfortable with my stacking. I’m glad to say I survived the guts and gore of the movie, as well as Bruce Campbell’s twisted sense of humor as the night came to a close. My last blood sugar reading of the night was 127, much to my relief and satisfaction.

After this experience, what do I think about stacking? I still don’t love it. I think it’s more anxiety-provoking than anything else if you’re consciously doing it. For much of my Saturday, I wondered if I would come crashing down at some point and curse my impatience. On this occasion, though, it seemed to be the right thing to do as it decreased my hyperglycemic readings. Plus, this particular incident did give me a newfound appreciation for my normal insulin regimen. But when it’s all said and done, for me, stacking falls short.

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Un-fogging the Future

Crystal BallI don’t own a crystal ball. I can’t read palms. I don’t have the fortune-telling prowess of Professor Trelawney (or, more accurately, the centaurs) from the Harry Potter series.

But I find that I am constantly asked, “What are your plans after graduation?”, “Where do you see yourself ten years from now?”, “What do you hope to accomplish in life?”, and other questions of this nature.

Let me state the obvious here: these are HUGE and LOADED questions! As a college student in her final semester, I am asked about my future plans with increasing frequency. It seems as though anyone who asks me about my future is expecting a detailed answer, as if I can simply foresee what my life is going to be like. Whenever I do take a stab at explaining my future, I generally try to say something along the lines of, “Well, I hope to be working full-time for either a publishing or editing company, I think. I want to be able to use my reading and writing skills in a job that makes me happy.” I used to think that this answer was satisfactory, but I still often get the same reaction – a simple head nod or an “Ahhh, I see!”

These kinds of reactions evoke a few different responses from me, all of which I internalize. First, I feel a wave of confusion as my answer doesn’t seem good enough to most people. Then, my mind goes into overdrive as I think about how I should maybe rethink my entire short-term plan and make it more concrete. If I come up with something more specific, maybe, I’ll get a better reaction from people – and then I stop.

Why am I so concerned with what other people think? After all, it’s MY future, my potential job prospects and life plans that I am solely in charge of pursuing. This dawned on me the other night as I was working on an assignment for one of my classes.

The prompt was to write out an answer to a series of mind-boggling questions: What happens to you in the ten years after you graduate UMass? What obstacles might you face? Tell a story or discuss what you might be doing.

I had no idea how to answer these questions, so I just started writing. I wrote about my hopes and goals, keeping everything sort of vague and focusing in on the facts that I want happiness and good health for myself and my family. I talked about the success I will work to achieve. While I might not know exactly where I’ll be ten years, I do know that my motivation, passion, and hard work will help bring me to that place.

Now, what does this have to do with diabetes? I think the most prominent commonality between the two is the drive that pushes me to take care of myself as well as accomplish certain goals that I have set for myself. The incentive to flourish as an individual will always be present for me, particularly regarding my diabetes.

So, while I don’t have the ability to un-fog the future, I do have the ability to control it using my motivation to thrive – not just in terms of my diabetes, but in every other aspect of my life.

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A Nearly Perfect Day of Diabetes

Personally, I find it easier said than done to have good, consistent blood sugar levels on a weekend – forget it if said weekend involves alcohol consumption or an imbalanced diet.

That being said, I think it’s an absolute miracle that I had a nearly perfect 24 hours on this past Friday according to my CGM readings and blood sugar tests. On a normal day, I strive very hard to stay within those lines on my CGM. It’s my goal to stay above 80 mg/dL, but below 180 mg/dL. It sounds simple, doesn’t it? In reality, it involves a lot of hard work.

A nearly perfect day of diabetes

It was made more complicated by the activities I did this past weekend. My friends and I made plans to celebrate the beautiful autumnal weather by participating in the stereotypical fall activities. You know, by carving pumpkins, watching scary movies, and consuming apple cider and candy, among other goodies. We also decided to venture downtown to check out some of the bars in Amherst.

Phase one of the day went by almost seamlessly. I was able to get a good workout in which helped my blood sugars level out in time for the pumpkin carving and candy eating. I don’t believe in depriving myself completely of treats because of my diabetes, but I’m also careful to not overindulge. As a result, I was able to have a bunch of mini candies as well as some surprisingly good sugar free cider without any intrusive buzzing from my CGM.

The fall fun was followed by an evening trip to the High Horse bar. I’m still trying to figure out drinking and diabetes – they don’t exactly complement each other – so I made sure I was armed with everything I might possibly need over the course of the evening. I brought a large bottle of glucose tablets, my humalog pen, my test kit, plenty of needles, my CGM…I wasn’t fooling around, I know well enough by now that it pays off to be prepared.

I was more paranoid due to the fact that I had somewhat of a low prior to leaving my apartment. I think it’s safe to blame it on the fact that I overcompensated for the beer that I drank with my dinner because of its presumed carbohydrate content. I corrected the low in no time, but worried some more when I saw that I was creeping past the 180 mg/dL mark. I didn’t stress too much, though, because I knew I would be walking downtown to get to the bar.

It was great to spend more time with my friends and indulge in a few drinks with them. It was even better to (sort of) forget about my diabetes for a couple hours. Instead of declining drinks because of a high or low blood sugar, I was able to enjoy them because of my persistence in maintaining healthy readings. I stayed constant the entire evening without dramatic drops or highs and it felt fantastic. And when I saw the 24-hour results on my CGM, I was very happy to see scarcely any of the dreaded yellow or red dots littering the screen.

It’s a moment like this that makes me feel better about my diabetes management. It proves to me that I can successfully get past the trickier diabetes obstacles, all it takes is some monitoring and motivation.

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