So, we’re getting close to two weeks of this experiment — I’ve been counting each carb, measuring each insulin dose, and trying to figure out some scientific approach to diabetes management. I keep wanting to write a blog post about how I’ve had a breakthrough: that I’ve figured out how to bolus perfectly for a banana, or that I now know how to eat sandwich as long as I can tell how many carbohydrates there are in the bread. In other words, that I’ve rediscovered how to eat breakfast.
But I don’t. Yesterday I went to the doctor to ask about what I should do about my boluses, since I’ve spent more time high this week than over the previous month or so combined. I was thinking she’d probably want to bump up my bolus rates, since my incredibly reduced basals do seem to be holding me steady when I fast. But instead, she asked if I’d consider stopping Symlin.
Anyone who’s been following this blog knows how much I love Symlin. It replicates a human hormone called amylin and its main results are to slow the emptying of your stomach, and prevent your liver from dumping stored glucose into the blood. The result is that it smooths your blood sugar after meals. It also happens to have a pleasant side effect of making it much easier to lose weight — since I went on it in September, I’ve lost 10 pounds, no effort required.
I also have had, I thought, really good blood glucose control. Very few lows, no dramatic spikes (high blood sugars, sure, but not the jagged peaks that my body usually goes through on its own). My last A1c was excellent. So for a variety of reasons, I am very reluctant to give up on the Symlin (not the least of which is that I just spent a huge amount of money out of pocket on another three-month supply). I also already know what happens when I don’t take Symlin: my blood sugar starts peaking before I get up from the table. And then I’m hungry, and want to eat more.
But I did understand what she was saying: Symlin is an added variable in an already complex situation. Perhaps by taking it out for a while, we could establish some baselines to work from. And, to her great credit, she also told me that she wasn’t sure how long I wanted to keep doing these experiments for. I agree — I’m actually amazed by how long I’ve stuck with it. I think part of it is that I feel too paralyzed by uncertainty and confusion to go back to my former routine.
But anyway, yesterday I didn’t take Symlin for lunch. I also deliberately ate a meal with carbs — a sandwich from the hospital cafeteria that had 34 grams in its bread. (I know because I asked the guy at the panini counter if he could find the nutritional information for me — resulting in an misinterpretation where he thought the reason I wanted to know the carb count was because I had “washboard abs” [which I don’t, and which was a very unexpected question on his part.] It was a very odd exchange.) Anyway, I ate the sandwich, took 3.4 units just as I ate it, and then realized something unfortunate: I was still very hungry.
I couldn’t eat anything that didn’t have nutritional information, so I wandered around the hospital cafeteria for a while, totally clueless as to what else I could eat that had a measurable amount of carb and then stumbled on something I usually never would have given a second look: the vending machine. Oh yes, the land of sun chips and doritos and candy bars. Hell, even if I were NOT diabetic, I would never stop at the vending machine.
But yesterday I did. It probably had something to do with my frustration at having spent 10 days unable to eat my normal food, the hunger in my stomach, and the fact that I had been explicitly told to consume more carbohydrates. And, as could be expected when all those variables collide, I made what I knew even then was a very bad decision: I bought a bag of yogurt-covered pretzels.
You know what I’m talking about. The ones where “yogurt” is actually a euphemism for “frosting”? According to the bag, there were two servings (5 tiny pretzels each) for 42 grams of carb total. Again, usually I would have had one pretzel and stopped there. But yesterday, I decided to fuck it. I had no Symlin. I was hungry, frustrated, and angry. I felt resentful at the idea that I should be eating more carbohydrates. So I counted every pretzel in the bag to confirm serving size (there were 11 total) and then ate the whole thing, taking 4.2 units to cover it, thus dutifully following a 1:10 ratio.
In retrospect, it was a somewhat masochistic move, since I know full well that a bag full of frosting-covered pretzels is right up there with a gallon-sized Mai Tai in foods I should not be eating. And that hunch was quickly confirmed as I watched my blood sugar begin to rise. Within an hour and a half, my CGM said 249 with an upwards arrow; when I actually did a blood sugar test to check, it was actually in the 340s. Yes, the 340s. I never go into the 300s. This was bad. And it was making me feel sick.
I ended up taking a 3 unit correction bolus and walking around the block for 20 minutes which quickly began to work *too* well — I was 199 by the time I caught the bus back to downtown, and by dinner time, I had plummeted to 63. It was my husband’s farewell dinner from work so I didn’t have a good way to count carbs (yet another moment when life and diabetes collide). So I ate two glucose tablets, had two small slices of focaccia, and watched as my BS climbed back up to 202 by the time we sat down for dinner.
It was pretty awful. I managed to get things under control by the time I went to bed, but this morning has been no more encouraging: I ate my 6-ounce banana with peanut butter and no Symlin, took the recommended dose, and was 250 an hour and a half later. I’m still waiting to come back down (I’m trying not to take a correction bolus till lunch).
I really don’t know how much more of this I have left in me. I feel physically sick and emotionally exhausted. I’m also completely confused, and worried that whatever intuition I used to have is now gone, thanks to my newfound attempts to carb count on top of a drastically different basal regimen. (I do think my afternoon basals were too high, so I don’t want to just go entirely back to what I’m doing before.) I feel like it’s worse than when I was originally diagnosed — I mean, at least then you’re in your honeymoon period and have a bit more leeway about getting your doses perfectly right. I honestly feel like I cannot eat lunch. I have no idea how to do it. There is a tortilla sitting in front of me right now that I know has 28 grams of carbohydrate, and I am terrified to eat it. I also haven’t really exercised since last Monday, since it’s just screwing me up even more.
I’m very interested to hear other people’s thoughts and experiences on this. I’ve really appreciated your comments so far, and am particularly interested in what people find their own personal balance to be between intuition and calculation. I was worried I was relying too heavily on the former, but now that I’ve spent nearly two weeks being analytical, I feel like I’m going to revert back to a George W. Bush approach to diabetes care: relying on my gut.