A few weeks ago some of us were talking while waiting for Pool Guy to show up and let us in. Somehow diabetes came up in the conversation. I might have been saying how I had a very good diabetes day during the 70.3, or someone could have been mentioning how they heard about an advance in diabetes research and thought of me. I can’t honestly remember. I don’t make a big deal about the ‘betes at the pool (or most other places for that matter) and not everyone I swim with knows that I live with it.
“My sister has type-1 diabetes,” one of the pool regulars said. “She doesn’t take very good care of herself, though.”
Honestly, this is one of the hardest things for me to hear and respond to. It’s easy enough to educate someone about how the various kinds of diabetes actually work. I can tell people what my diabetes experience is, but I wouldn’t imagine trying to speak for others. Nevertheless, I know that lots and lots of us try hard and alternately succeed and struggle. And I know that friends and relatives don’t see enough of our lives with diabetes to get an accurate picture of how it’s going. Most of all, I know that comments about how well we take care of ourselves are rooted in concern for our well-being. I try to tread lightly and politely all without throwing any of my fellow type-1 folks under the bus. Besides what does “taking very good care of oneself” really mean?
So I made a sympathetic face—at least, as sympathetic as my face gets—and said what I usually do. “Diabetes is tough. There’s a lot that goes into taking care of ourselves, and it’s not always easy to see.” Fortunately, Pool Guy showed up shortly afterward to let us in to swim.
Fast forward to last Wednesday when I went for a run after work. I had miscounted the amount of carbohydrates in my lunch, and my blood sugar by the time I was ready to exercise was 410 mg/dL (22.8 mmol/L). I wasn’t sure if I really wanted to go for my regularly scheduled run, but I also figured that exercising would be the most effective way of bringing it down. I took a unit of insulin, put on my running clothes, laced up my shoes, and headed out toward the rotary two miles from my house.
I had originally intended to run to the rotary—which, BTW, hasn’t been a rotary since they did the construction work to turn it into an intersection with 3-way STOP signs—but I was feeling the need to go a little farther and to do something a little badass, so I kept going once I got there. Soon I was running down one of the biggest hills in town, dropping over 150 feet in less than half a mile. And then I was running up the other side of the valley, gaining 200 feet in 2/3 of a mile, before making a left turn to drop down another, shallower hill, and looping my way back to the foot of the first big hill.
It was slow, steady work to get myself back up those 150 feet. This is one of the most difficult hills in town (#3 by my estimation), and there are a few places where it doesn’t feel like you’re actually making any forward progress. Eventually, I got back to the not-rotary at the top of the hill and turned right, towards home, which was just two miles away.
About a half-mile later, I started to feel “not quite right” in that way that accompanies hypoglycemia. Is it possible that I had dropped 340 mg/dL (18.9) or more in less than an hour? It seemed inconceivable, but I had taken that insulin, and I’d been running a little longer than I had expected, so it was entirely possible. It certainly felt like it. My CGM hadn’t said I was low, but it was pointed sharply downward.
I ate four glucose tablets and kept running at a slower pace. And then a few minutes later, the feeling was more pronounced. I ate four more glucose tablets, stopped running, and walked slowly toward home. If I were riding my bike, I would hang out on the side of the road for the 10 minutes or so it would take to get over the low. For whatever reason I don’t do the same thing when I’m running; it just seems like a waste of time in my hypoglycemic-but-not-yet-incapacitated brain. So I walked and ate the last two glucose tablets in the tube.
I gritted it out and held on and got home. Testing my blood glucose, I saw 70 (3.9), and I could feel that my BGs were on the way up.
Later I thought about the somewhat one-sided conversation I had with the person at the pool about her sister. Would she say that I’m not taking very good care of myself? Some might look at that 410 mg/dL or the 340 drop on my run and say, no, I’m not. I didn’t almost pass out, but it was a possibility, especially with a drop like that, which clearly I had contributed to by taking more insulin than I needed.
It’s also possible to look at that experience and note that I’m training for an Ironman triathlon (with diabetes!), that I train everyday, that this kind of drop is uncommon but more likely given the amount I train, and that I prepared for the possibility of hypoglycemia by carrying glucose tablets every time I leave the house. Clearly, there’s a lot of gray in “Taking Care of Oneself.”
Diabetes is a constant fixture in the lives of those of us with it, and the best we can do is work with it, trying to actively manage it. Doing so falls on the tedious end of the excitement spectrum. Most of the time, we do the best with the information we have and the variability in our disease. Occasionally we get tired of it, have a momentary lapse in judgment or attention, or just do a plain ole half-assed job. But that’s true in all aspects of our lives, diabetes or no.