Good Intentions

Boxes of Pasta Roni & Rice RoniIt started with a mobile Symlin bolus (a symlin dose delivered via pump while driving) on the way home from work.

I was hungry for dinner and I wanted to eat soon after getting home.  My wife has been graciously helping me with dinner (one of my trouble spots) and was cooking a portioned serving (a.k.a. “box”) of pasta roni fettuccine alfredo for me.  Yes, far from gourmet, but the carb count is clearly labeled.  That counts for a lot in my book.

Similar to traditional insulin dosing, Symlin is best delivered a bit before the meal.  I’ve been aiming for 15-20 minutes pre-meal when I can.  Since my I had about 10-15 minutes left in my commute, I figured the timing would be perfect.

But as I got home and made my way to the dining room table I was feeling the tell-tale symptoms of a low blood sugar.  56 mg/dl.  Damn.  I must have had some phantom insulin on board from a late lunch bolus.  Symlin and insulin on board do not mix well (nod to Bernard for this info).

I had to treat the low with something much faster than fettuccine alfredo, so I had a couple rolls of smarties and reeling from low starvation I nabbed a couple small squares of luke warm pizza that the kids had.

I sat down and started eating my pasta.  Not more than three or four bites into it and I was hit with the post-low exhaustion that sometimes happens.  I was wrecked.  That low really took it out of me.  I was very much not interested in finishing my plate.  I think this was a combination of feeling run over by the low and the Symlin doing its thing with my appetite.

I was suddenly quite frustrated and emotional.  I didn’t have any simple way to figure out how many carbs I had eaten between the partial pasta dish and the pizza.  I think the pizza was nominal – less than half of a typical thin crust slice.  The main goal of eating some crappy boxed pasta dish was to have a (fairly) accurate carb count, and now I didn’t even have that anymore.  I had to guess, and I got it wrong.

I woke up the next morning with a 200 mg/dl blood sugar, and felt a bit upset that I had probably been sitting at 200 mg/dl all night long.  Highs overnight are a sure way to ratchet up that A1C.

As I reflected about the night before it struck me that I had nothing but good intentions with that Symlin bolus.  But rather than help things, it set off a slight chain reaction that worked its way to a 200 mg/dl blood sugar for a solid eight hours overnight.   I just wanted good blood sugars.

That thought ran a bit and I thought about how each and every one of us has good intentions in regards to our diabetes management efforts.  I don’t know a single one of us that willingly runs out of control.  We all try very hard, but maybe run into challenging scenarios that we haven’t figured out yet.  Sometimes it seems hard to muster up the energy necessary to figure out those challenges.  Sometimes despite our good intentions we can’t seem to get that A1C where we want it, or successfully manage an intense work out without a low blood sugar, or whatever.

Our good intentions do count for something, and our resolve to keep working towards the good is critically important.

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6 thoughts on “Good Intentions

  1. I think this post is great. Honest and accurate. I found myself smiling in recognition several times. Right now I only take rapid acting insulin with my meals so I know what you mean abou the value of a boxed meal that you can count the carbs of. And yet, even then I too sometimes just process it all differently depending on if it is really hot outside, if I feel tired or sick or stressed out. Ack so many things that we have to account for but yet cannot COUNT … You did the best you could and no one will find fault with that!

  2. I love that you’re so honest about the every-day difficulties in your posts. My wife tries so hard to get her blood sugars perfect, and she never gives herself credit for how much they’re effected by these factors for which you can’t perfectly account. These are the every day trials that make diabetes management so emotionally challenging. Most people have the best of intentions and are willing to do the work, but it’s so hard to stay motivated when you get screwed up by something beyond your control. Thanks for your candor about your struggles…somehow, knowing that it’s normal to struggle makes it easier to keep trying.

  3. Your Symlin (and Bernard’s) experience has called attention to the fact that while these new tools are supposed to improve the ability to manage things, its just another, non-physiologically administered hormone being administered to make an already complex disease to manage even more difficult. On the other hand, others have told me that adding Symlin to the mix enabled them to significantly reduce their total daily dosage (TDD) of insulin, and in doing so, also dramatically reduced their lows … the main challenge seems to be that these things don’t seem to follow particular rules, and doctors have the audacity to call this “control”? I think it’s time to change the nomenclature for this disease — anyone else agree?

  4. So you “had to guess”. At least you guessed, hon, and didn’t totally throw yourself into random chaos.
    I always feel that no effort is wasted, even if we do not get the results we want, whether it’s a specific post prandial reading for my breakfast today or a longer term info from an A1C. Now it’s disheartening and upsetting to work so hard and not get a “good” number, but still we might have learned something that will be of value tomorrow, next week, or next year. It all adds up.
    You are making a good effort with the Symlin, and, obviously still gaining knowledge about how it works in your body.
    Scott, I wish you a good day ahead (…….and maybe some sun?)

  5. I only fell upon your blog recenlty but I am already inspired. Just the effort you put into lowering your A1Cs shows for so much. My goal is to be able to relate to you. I am already feeling like I can do it.