Toe Story 2

Today I saw my nurse practitioner at the Joslin Diabetes Center for a regular appointment. We discussed, among the usual matters, foot care for people with diabetes, in particular, foot care for me.

Even though, as she said, my feet have always passed the filament and tuning fork tests with flying colors, it would be wise to see a podiatrist to establish a baseline against which future changes in my feet could be compared. “Most people with diabetes eventually see a podiatrist, and many see them regularly. Why not see one now, as preventative care?” I like that word: preventative.

I unwrapped and showed her my injured toe and described my careless run-in with a suitcase. With her gloved hands, she pressed gently around the nail and tip. She leaned in. “This looks good. You did all the right things, washing it, using the ointment, keeping it covered and protected. It’s not infected, which is what we worry about.” I like having my natural caution periodically affirmed.

What else did I learn during my visit?

1. I should take 1,000 to 2,000 units of Vitamin D per day, or make sure my multi-vitamin has that dose. Preliminary studies have been showing the correlation between health and Vitamin D, and while no cause-and-effect has been verified yet, the findings are provocative. “Furthermore, and we don’t know why,” she added,”People with chronic illnesses show lower levels of D. So why not take the supplement? There’s no harm.”
2. My periodic bouts of low blood sugar may be related to over-correction of highs. Instead of focusing on the lows right now (BG sometimes around 45 or 50), I’m going to address the the occasional highs (BG around 180 to 200). If I can prevent those, I won’t need to correct, and I may be able to avoid some of the hypoglycemia that boggles me.
3. For the mornings at work I am hunkered down at my desk, grading papers or prepping for class, I might experiment with taking a little more insulin with breakfast and snack. (Because I think of myself as pretty active overall, I don’t always account and adjust for sedentary times.)
4. When exercising, if my blood sugar is 150 or lower, I will adjust my pump’s basal rate down temporarily and may even eat a small snack with 15g carbs. If my blood sugar is 200 or slightly higher, I won’t take more insulin OR alter my pump’s basal rate; I’ll use the exercise to “treat” the elevated blood sugar.

I’m also going to take some data on BG, insulin, diet, and exercise for a week or two, and see if items 2, 3, and 4 have any effect on the ups and downs of my glucose levels.

And tomorrow I’m going to the podiatrist for the first time. Stay tuned for Toe Story 3.

Jane Kokernak

Jane Kokernak teaches in Northeastern University’s College of Computer and Information Science as communications specialist, working with graduate students and faculty on writing and speaking to different audiences. She lives with her family and dog near Boston. In 1992, as an adult, she was diagnosed with Type 1 diabetes; in 2003, she switched from multiple daily injections to an insulin pump and has stayed with it. A contributing writer to ASweetLife since 2010, she is especially interested in how having a chronic illness affects self identity and perceptions of health.

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Jane Kokernak

Jane Kokernak teaches in Northeastern University’s College of Computer and Information Science as communications specialist, working with graduate students and faculty on writing and speaking to different audiences. She lives with her family and dog near Boston. In 1992, as an adult, she was diagnosed with Type 1 diabetes; in 2003, she switched from multiple daily injections to an insulin pump and has stayed with it. A contributing writer to ASweetLife since 2010, she is especially interested in how having a chronic illness affects self identity and perceptions of health.