Tethered to my Diabetes

“I’m a diabetic — but I’m not very good at it.”
That’s how I tend to tell people about my condition.

Despite a family history of diabetes, my basic reaction to my own diagnosis has been denial. One of my only direct memories of Granddad Massey involve watching Gran Massey grind up saccharin tablets for his tea and give him an insulin shot before dinner.

Granddad lost a leg to diabetes. I’d rather not.

I once busted in on him in the bath. His stump pointed directly at me — a sight seared forever into my memory. I already have minor issues with peripheral neuropathy, common to diabetics, so I know I need to get it under control.

Mom kept urging me to get tested regularly once I left home but it would be years before I bothered to do so. Even then, I ignored the slow creep of warning signs for years. See, diabetes is an insidious disease and can sneak up on the unsuspecting — and idiots in denial like me. 

My continued insistence I could control it when every indication proved differently made for a slow march to effective treatment. Dealing with diabetes through diet & exercise required self-control that I manifested only upon occasions but never managed to sustain over the long haul. Oral medications helped slow down the advance but never reversed it. 

Eventually, my doctor referred me to an endocrinologist. Looking at my paperwork, puzzled, he then smiled. “Oh, I see why you’re here, Dr. Roebuck sent you over for the ‘fear of insulin’ talk.” Indeed, it took significant hand-holding to get me going on a regimen of insulin.

Meanwhile, an old friend on his own diabetic journey told me to watch my A1C lab results. “That’s the ‘you can run but you can’t hide’ number.” 

“…measured primarily to determine the three-month average blood sugar level and can be used as a diagnostic test for diabetes mellitus and as an assessment test for glycemic control in people with diabetes.”

Good glycemic control is the target for diabetic treatment. Well, adding insulin to my oral medications helped, but working with my doctor, we slowly but steadily increased my dosage as my A1C numbers kept climbing. Non-diabetics’ A1C stays below 7, or even better, below 6. Mine climbed to 9 and even up to a peak of 12. My doctor threatened to put on an insulin pump if I didn’t get it under control.

My diabetic buddy boasted his insulin pump let him eat Bluebell ice cream.
I did not want an insulin pump.

Cut to Cañon City and our changed lifestyle since we moved here 7 years ago: less stress, more walking, specific dietary changes to directly address my health. I lost at least 15 pounds and cut out a lot of the carbohydrates in my meals and snacks.

My “better behavior” showed up in reduced A1C readings — under 6 for well over a year.

Unfortunately, my A1C’s been climbing back up since my injury 2 years ago. I knew it would. During those first many months, my entire focus health-wise was on that recovery. Diet was sketchy at best and my main exercise beyond basic PT — walking — was out of the question for most of 6 months. That old A1C noticed and now I’m back almost up to 7.

As part of my effort to reverse that recent trend, I’m using a CGM, a continuous glucose monitor. It’s a wearable device paired with an app on my phone. A small sensor inserted in the back of my arm transmits a blood sugar reading every 5 minutes.

With the constant monitoring, it tracks the data on a trend line. That allows me quicker feedback on my dietary and exercise choices.

It also alerts me whenever my glucose gets too high or too low. It compiles data into summaries over time to let me know how much time I stay “in range” and whether my out-of-range times are too high or too low. 

This creates a minor problem of TMI. In the same way that checking your weight daily is not the best approach to weight control, knowing every dip, drop or spike of my glucose level tends to mess with my mind. After years of checking my glucose twice daily (morning and evening), I find myself trying to micromanage every bite that goes into my mouth and carefully time ingesting any major carbs. I have noted some discrepancies in the readings with my glucometer as well.

The CGM also alerts me if I have walked away from my phone, disrupting its connection. I jokingly call it my “tether” and whine about being tethered to my phone. In fact, it’s a perfect representation of how I am tethered to my diabetes.

Still, I think it’s been helpful. I look forward to my next A1C reading in a couple of months. We’ll see if all this ongoing data is helping me or just driving me crazy.