The Real Time revolution
The Real Time Revolution:
the art and science of controlling diabetic blood sugar using Continuous Monitoring Systems
….yeah, I know that the sub-title is a little long but there is a modern trend of plugging all the possible Google search words into your subtitle to try and drive book sales.)
The revolution started as they often do: with violence. I was so pissed off with the Guardian that I wanted to throw her against the wall.
I had just spent two weeks entering every move into her “memory.” Every fingerstick, both calibrating and non-calibrating. Every carb that went into my mouth. Every drop of insulin that went into my body. I weighed all my food and made copious notes in my food log. I was preparing for the ultimate post-game.
I was in control freak… errr…control enthusiast mode.
I logged on to CareLink, plopped the ComLink in my lap and downloaded, and downloaded, and downloaded, and downloaded, and…
Eventually, in the fullness of time, with the passing of the seasons, it was done. I eagerly ordered up a batch of reports and printed them. They were filled with red “no data” and blanks where the carb info and insulin numbers were supposed to go. Virtually all my carb and insulin markers were gone. All I had was SG (Sensor Glucose) data. I called up the log to see what happened. All the data was there, but it was not populating the reports.
Following anger, depression set in.
For the next week I didn’t enter anything. Why bother? It’s a pain in the ass, and it did me no good.
Then a number of things happened to me in rapid succession. I don’t know if I mentioned that I’ve felt like crap for some time. Months, maybe longer. Recent blood tests, done months late ‘cause I owed the hospital lab for ordered tests that weren’t covered by insurance so they would not accept more samples from me until I was paid up, revealed that I was VERY seriously over-medicated on the thyroid front. So that was adjusted. And my anti-depressant was doubled ‘cause I’ve been twice as depressed as usual.
Then I was exposed to the raw emotions of the survivors of T-1 who died from a hypo that may or may not be connected to a pump malfunction; but at the very least was exasperated by the worst possible medical advice. (Editor’s note: I’m working on this story and will post it in a few weeks. Stock up on Kleenex, you’ll need it.)
Anyway all of these things piled up and I re-discovered the Religion of Diabetes (ROD?) and became, once again, a Born Again Diabetic (ironically, “BAD,” which gives a whole new meaning to Bad to the Bone, given that it has recently been discovered that the skeletal system plays a major role in glucose regulation to the point that it may have to be considered part of the endocrine system).
(Oh yeah, that’s another title you can’t steal. I’m using it for the other book I’ve been charged with writing. So sometime next year you’ll have to add “Author of The Real Time Revolution and The Born Again Diabetic” to my tomb stone.)
So with a new sense of purpose I strengthened my will-power and started eating sensibly. While my Type-3s feasted on pasta I ate salad. While they had pumpkin pie in front of me, I drank water. Normally the first to answer the siren’s call of carbs I boldly walked past the brownies in front of my boss’s office and turned down a sample of allegedly sugar-free girl scout cookies.
Very quickly my sugars went from this:
But do you want to know the best part?
I feel good. Really GOOD. I haven’t felt this level of energy and mental clarity for…. Well, over a year anyway. I recovered from my EBay obsession (although I haven’t actually gone there for a few weeks to test my resolve, I’m not a complete fool. Not good for alcoholics to just “sniff” whiskey after all.) I have less aches and pains. I’m sleeping better. My mood and humor have recovered and I’m once again full of restless mental and physical energy that have always driven me forward under full sail.
Now, will feeling GOOD be enough to resist temptation in CarbLand? Time will tell. I haven’t been to the Elephant Bar since becoming BAD.
Coming to T-1 as an adult, I’ve got a lot of bad habits to overcome. Peers who’ve had T-1 since kid-hood generally agree as adults that it was easier to grow up under a set of rules than to change as an adult.
But some how, in the middle of this, I still didn’t start re-entering data in the Guardian. Unplanned, un-premeditated, and unconsciously I started using the Guardian Real Time in real time. I didn’t do post game. I took real time information and made real time decisions.
Damn, is it ever working.
On the second night of decent day-time sugar control I woke up too low for my taste and mental security. I ate my breakfast bolus-free to get back up above 100. The next night the same thing happened. I backed off my Levemir from 20 units to 18. And then to 15. Then 10. My total daily insulin is mere sips.
I am beginning to suspect that there is an un-discovered link between total daily basal requirements and total daily carb intake. But that science will have to wait for another day.
On the way home from work one day this week E asked me what I was eating. Quarter cup of Kashi with a sausage patty for breakfast, two low-carb SlimFast shakes at the clinic, and a salad for dinner.
“Huh. So you get to choose between your blood sugar killing you or starving to death? Is that what it comes down to?” she asked.
Yeah, pretty much.
Actually, I have a PLAN. I’ve put on almost twenty pounds over the last year. I’m somewhere in the mid 190’s now. I feel best between 175 and 180. Of course at that weight I have to put up with both my mother and wife insisting that I’m TOO thin. It’s nonsense, but they still remember the pre-diabetes fat man.
So I’ll coast down on weight until I close in on my goal. Then I’m going to try the Hunter-Gather Diet. I’m going to eat six or so small low-carb meals throughout the day. By keeping the carbs low I’ll avoid the excursions. By keeping the number of meals high I’ll pull in enough calories to avoid starvation.
The only risk is that I’ll die of boredom.
Oh yeah, and before the comments start piling up on the protein front let me tell you a little more about my salads at dinner. If the two T-3’s are eating something carbelicious then I’ll have a nice heaping pile or Romaine or Green Leaf lettuce with baby carrots, red bell pepper, sunflower seeds, and chunks of grilled white meat chicken. (I grill it on the weekend to stock up for the week, with heavy pepper, garlic salt, and paprika—you wouldn’t want to eat it straight, but it’s great on a salad.) On the side I have a third-cup cottage cheese, some slices of hard salami from Sam’s Club, and macadamia nuts from Trader Joe’s. If the T-3s are having fish, beef, pork, or chicken then I’ll join in on that portion of the meal and down-size my salad, passing on the dreaded high-carb side dishes.
Anyway, back to the subject at hand: I had wanted to flesh out some more detail on using the Guardian in Real Time to control the blood sugar in Real Time, but I think I’ve exhausted everyone’s attention span just setting the stage. I’ll have to blog the rest later.
Or maybe I’ll make you buy the book.