Monthly Archives: December 2012

Diabetic Word Problem

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Let’s work on a word problem.

Nel’s blood sugar is 272 mg/dl. She takes a correction bolus of 1.80 units and goes jogging for 30 minutes. What is is Nel’s blood sugar 15 minutes after jogging?

The answer is 42.

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All Things

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My mom tells me that I got  frustrated while learning how to tie my shoes.If you think about it, tying shoelaces is quite a complicated task for someone still developing fine motor skills. As a three or four-year-old, I didn’t see the point. We have Velcro shoes, right? Why try?

“I can’t do it!” I’d tell my mom.

And she’d always respond, “I can do all things through Christ which strengtheneth me.”  She made me memorize the verse and recite it to her when I tried to give up.

Now that I’m an adult (when did that happen?!), I’m tempted to think of this verse as something that only applies to big, more spiritual things. This year, God has been teaching me that the verse still applies to the little, everyday things, the things that pile up until they’re overwhelming. Things like actually starting to grade the first research paper of the year or inserting a new insulin pump infusion set. As dumb as it may sound, I pray before I insert each new infusion set. And I probably need to pray more before I begin grading.

I feel in especial need of everyday grace today. This semester has been perhaps the most hectic and challenging of my entire school career: I took 9 graduate credits including a project-intensive 8-week online class and had a teaching load of 64 students. That’s a lot of grading to do in the evenings on top of homework and my diabetes management suffered as a result.

Perhaps I’ve done just fine. I suspect that my frustration is in part due to an inaccurate view of how well I managed my blood sugar over the summer. Whatever the reason, the task of reexamining my management daunts me.  But I can do all things through Christ who strengthens me–and that includes all the diabetes things I have to do as much as anything else.

And I did eventually learn to tie my shoes, right?

It’s Complicated

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English: A pizza from the oven. Français : Une...

(Photo credit: Wikipedia)

Nothing beats a fresh slice of pizza.  Pizza combines all of my favorite things: crusty bread, spicy tomato sauce, loads of veggies and meat,  melted cheese.

But since pizza is not only full of carbs but also literally dripping with fat, eating a slice has gotten…complicated.

A large amount of fat in a dish delays its effect on blood sugar. A slice of pizza may have 40 carbs, but if I take a dose for 40 carbs immediately before eating I’ll end up going low. In fact, once I went low while eating a pizza crust. I’m still trying to figure that one out.

A few hours later, however, my blood sugar will start to climb as the rich, carby goodness I consumed finally hits my blood stream. While on injections, the only thing I could do was split my insulin dose in half and take two shots. (Ew.) My insulin pump has a more elegant solution: the combo bolus.

A combo bolus allows me to split an insulin dose in order to obviate the effects of high-fat, high-carb foods. I can take a little insulin up front, right before eating, and stretch out the rest in mini-doses over the course of a few hours. But a combo bolus is a bit…complicated.

First, I have to decide how much insulin to take up front. Do I take half of the dose? 60%? 40%? It’s different for each food. I can determine if  I took the right amount up front by checking my blood sugar two hours after eating. If I went up about 30 points, I’m golden. If I went up more than that, I needed more insulin to start. If I went up less, I took too much insulin. Of course, this assumes that carb counts for the slice were accurate. If I get twitchy about how a pizza is cut, that’s why. If I start rifling through your trash looking for the pizza box so I can figure out the circumference of the pizza, that’s why.

But the initial dose is only half the battle. I then need to determine how long I should stretch out the rest of the dose. Two hours? Three hours? If I don’t stretch out the dose long enough, I could end up going low and then going high a few hours later. Stretch it out too long and I could be high for a few hours and then go low. And then there are the times when, without thinking, I correct a high blood sugar while a combo bolus is still active and then I go low just as I’m about to go to sleep.

The biggest struggle? Once I finally figure out how to time the perfect combo bolus for a slice of pizza I HAVE TO REMEMBER IT. This fact frustrates me the most, since I figured out how to dose for a slice of pizza over the summer and cannot for the life of me remember how I did it.

If I opt for the salad at your party, it’s not that I’m a health nut. Pizza is just too complicated.