The Crystal Ball (or Planning Ahead)

arrow-394142_640This post was inspired by a comment that Bernard made on a post I did back in July. He commented about having to plan ahead:

“For me, the only thing that really bites is having to sort of plan in advance if I want to play with my children. Otherwise I know that even a half-hour with them cycling or kicking a ball around can send my readings down to the 50s. Now that does stink!”

It does stink – and ever since then it’s been rolling around my head. The need to always plan ahead, and not always being able to spontaneously do something without running low.

According to the “Pumping Insulin” book (I only have the 3rd edition), the basal rate should be lowered 60 to 90 minutes ahead of the activity for Humalog insulin. I have had good results if I can start it even earlier than that, more like 120 minutes before the activity.

When things come up that are physically demanding, and I didn’t have two hours notice OR have a significant amount of insulin on board from a previous meal, I risk running low. This is not the end of the world, and there are a few approaches I can take that involve eating extra stuff and starting the temp rate as soon as I can.

BUT – I would like to point out that doing so is officially a major PITA (Pain In The Ass).

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The Time: 5:56pm, Monday
The Place: Front yard
The Scenario: Arriving home from work about an hour before the rest of the family gets home, I decided, spur of the moment, to do something productive and mow the weeds.
The Problem: Low Blood Sugar, again – even though I started a temporary rate when I decided to do yard work.

Frustrated, sweaty, covered in grass weed clippings and “blown about” dirt (that gives you a pretty good picture of the condition of my yard, yes?), and trying to figure out what I can grab quickly to treat my low and get back out to finish the yard – and without tracking a bunch of dirt and outside stuff all through the house.

It feels that I run low every time I mow the yard. Every stinking time! Why? Because I stubbornly try to avoid eating to boost my blood sugar high enough, and two hours ago I didn’t know I would be mowing the yard. The temp rate I started has not yet had time to have an impact on my blood sugar level.

The Time: 2:43pm, Saturday
The Place: Sunset Park
The Scenario: The kids wanted to walk up to the park and play. The park is a little less than a mile away, and it’s a great day to be outside.
The Problem: We’ve been playing for about 30 minutes, and I can feel my blood sugar dropping too low – even though I started a temporary rate before leaving the house.

I almost always have a tube of about 10 glucose tabs in my pocket, give or take a few depending on whether or not I’ve used any that day, or neglected to refill it – which does happen from time to time.

In this situation I have plenty of tabs with me, and can treat the low – but that’s not exactly the point. It is the interruption. The having to stop what I’m doing to take care of things (test, cram some tabs, wait for them to digest). The feeling of the low, and the exhaustion afterwards.

The Time: 8:10pm, Wednesday
The Place: Halfway down the basement stairs at my in-laws house. Working to steady the top half of a big, heavy, made of much glass & mirror, china cabinet.
The Scenario: On my way home from work. My mother-in-law called because she needed some help moving a couple of big pieces of furniture out of my sister-in-law’s house, to make way for some new furniture being delivered bright and early tomorrow morning. My wife’s family is the best, and I would not trade them for anything – but they are masters of the last minute arrangement. And I am the only one in the immediate and local family that drives a pile of rust & holes, on wheels pickup truck.
The Problem: We’re halfway down the basements stairs, moving the second of three big heavy pieces of furniture. I’m on the bottom side. I’m working with my nephew-in-law, who is strong, but he’s young. I’m bracing the cabinet, bearing 70% or 80% of the weight, as he works from the top to navigate and make sure we don’t break any of the glass or mirrors.

And I’m feeling low – even though I started a temp rate after getting the call. Muscles shaking, partly from the low, partly from the heavy ass piece of furniture. Sweat dripping everywhere, partly from the low, partly from the heavy ass piece of furniture. Feeling the feeling that I need to take a break, partly from the low, partly from the heavy ass piece of furniture. Hoping I can make my body do what I need it to do to get this piece safely down the rest of the stairs so I can deal with this low. Have I mentioned how frickin’ heavy this thing is?! OMG.

(Have you ever thought about what happens to the guy at the bottom if a big piece of furniture slips out of controlling hands and starts to descend down the staircase? Not. Pretty. I don’t know that from experience – I’m just using my imagination to picture how that series of events might play out. )

Most of the lows I have are not immediately severe. I can recognize that I need to treat the low, thankfully far ahead of when it would require help to do so. Meaning I usually have a little time to figure out what to do before it gets out of hand. HOWEVER, that fact did little to comfort me as I’m trying my best to a) avoid being crushed to death (or seriously injured) and b) keep from shattering glass and/or mirror all over the place.

We manage to get the cabinet down the stairs without any serious injuries or damage. I let them know I need a break, and chow down all 10 of the glucose tabs in my pocket. Take some time to recover, then it’s on to pick up the last piece of furniture. And yes, I’m weak and exhausted from the low (and that heavy ass piece of furniture).
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For all of these situations I should have better anticipated the need to do something to avoid the low. Being that I didn’t have time to start the temporary rate far enough ahead of the activity, I should have had a little something to give me a boost. I know that.

The point of this post is that with the absorption times of the insulins we use, and the amount of time they are actively lowering blood sugars in our system, it is still a very crude system that requires constant diligence and and almost uncanny ability to see into the near future.

Life just doesn’t always work that way.

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Scott K. Johnson

Patient voice, speaker, writer, advocate. Living life with diabetes and telling my story. Patient Success Manager, USA for mySugr (All opinions expressed are my own and do not necessarily represent the position of my employer).

Diagnosed in April of 1980, I recognize the incredible mental struggle of living with diabetes. Read more…