In February 2017, I started taking Levemir, a basal insulin to help manage my Diabetes Type 1.5/LADA. (I wrote about it in
this blog post.) Now that it's been more than a year of taking insulin, I thought I'd give an update.
For the first few months, I was taking 10-12 units of insulin every night, which turned out to be too much. I struggled with lows (50s-60s) sometimes - usually overnight and/or in the early afternoon before lunch. I even had a "freak incidence" one night where immediately after taking my insulin my blood glucose plummeted to 28 mg/dL (something that is decidedly NOT supposed to happen with slow-acting 24-hour Levemir - and thus totally flummoxed the doctor as to why it did). It took two juice boxes and more than an hour for me to get back into a safe glucose range, which was not only frustrating when I was trying to go to bed, but also a little scary.
My prescription was adjusted to 8 units every night, and since that change I thankfully haven't had any further hypoglycemia problems. Still, I make sure to eat a snack in the late morning/around noon on days when I'm at work, so that I won't have any problems driving my 45-min commute home at 1 pm. I would hate to go low while I'm driving, just because it's been too long since I ate breakfast.
I still count my calorie, carb, and fiber intake most days just to help me keep track of what I'm eating and make sure that I'm making smart carb choices. I also tend to check my glucose a few times a day - before breakfast (my fasting glucose number), usually once or twice in the middle of the day (either before or after a meal), and at night when I'm getting ready to take my insulin.
My post-meal glucose readings sometimes concern me... Depending on what I eat (and if I've eaten a more carb-heavy meal than I usually do), I've seen numbers in the mid-to-high 200s. These are usually after-dinner numbers, when after 20 or so hours, my Levemir is starting to wear off, but I do occasionally get readings in the 200s after lunch or even breakfast as well.
In the last couple of months, I've started to make special note of the meals I ate before 200+ glucose readings. I had hoped that if the carbs I ate were complex carbs (i.e. vegetables and beans, something with a lot of fiber), it would then be okay to eat 50g or so of carbs in a single meal, but that doesn't seem to be the case. I've had meals with 50-60g of carbs, 10-14g of which were fiber, that still caused me to get into the mid-high 200s. My body just can't process that many carbs at once - even if they're complex carbs - so I really have to watch my carb portion sizes. I usually aim for no more than 35-40g of total carbs in one sitting - even if they're healthy, complex carbs.
It can be hard to do. If I have time to meal plan and prep and cook, I can find lots of nice recipes that fit my dietary requirements. But going out to eat at a restaurant - even when I try to choose something that I think will be lower-carb - means that more often than not, my glucose will be outside of my target range for the next few hours.
It was a bit of a wake up call for me in late November, when I experienced my first actual, recognizable diabetes symptom - thirst. It was a Sunday night, and we'd just returned home after traveling and seeing family over Thanksgiving weekend. I'd done a pretty good job over Thanksgiving, where I'd tried really hard to manage my portion sizes of all those delicious, starchy side dishes, and we were tired and hungry and looking for something quick to have for dinner. I hadn't had any time to prepare or cook anything, since we'd just flown home, and we got carry out from a local pizza place that makes 10" personal pizzas with a lot of toppings to choose from. Typically when we go to this place, I make sure to only eat half of my pizza at once (two out of four slices), saving the other half for later. If I need to supplement my meal, I add a salad or something to those two pizza slices. Well, that night I had only the pizza. And I was hungry, and ate the whole thing. All four slices. I thought loading up on veggies and meat toppings might counteract the carbs in the crust, but it didn't do enough. I don't know how many grams of carbs I ate, but three hours after eating that pizza, my glucose was at 280. It wasn't until I saw that number - the highest I'd yet seen - that suddenly I realized the thirst I'd felt since dinner (and the two or three glasses of water I drank because of said thirst) was probably related to my high glucose.
Before, all of my diabetes management seemed like a preventative measure. I knew the numbers were a little high when I tested them, but they'd never been high enough for me to actually feel the telltale diabetes symptoms before. I knew I had to watch my diet and check my glucose regularly and take my insulin and continue to see my endocrinologist a few times a year - but I saw all this as something I was doing because I was being really proactive about my health, trying to delay diabetes for as long as possible. That night I had to admit to myself that I wasn't just
delaying diabetes anymore. I was doing these things every day because I AM diabetic - and if I didn't do those things, if I just ate whatever I wanted and didn't count carbs and try to make healthy carb choices, I would not have the good A1C numbers I have. Instead, I would have diabetes symptoms every day. And I would start seeing real diabetes complications. It made it a little more real, more urgent for me. These lifestyle changes are no longer something I'm choosing to do because I'm trying to be as healthy as I can be - they're something I really HAVE to do. They're things that, if I went a month without doing them anymore, I could find myself in the hospital.
That said, despite my occasional high post-meal glucose, my A1C numbers are great! My last two endocrinologist appointments (in October 2017 and February 2018) both yielded A1C results of 5.4. In fact, because my A1C is so good, my doctor isn't too concerned about my post-meal readings sometimes breaking into the 200s. He says that A1C is more directly correlated with diabetes complications (it looks at the average glucose over 3 months, rather than just the instantaneous current glucose), so that's what they look at more. So far, I'm just going to keep doing what I've been doing - being careful about what I eat and taking my insulin every night - and hopefully that will continue to be enough for now. I will probably have to take meal-time insulin when I'm pregnant, but otherwise my endocrinologist isn't concerned. My Type 1.5/LADA continues to be a slow-progressing illness (and I'm doing a pretty good job managing it), so for now I don't have to worry too much about any serious complications.
