“You have diabetes” can be a very difficult diagnosis to hear. I remember hearing those words on December 10, 1988 at the age of 29. I was at work when I heard, “Your blood glucose is a little high, and we need to redraw your labs to make sure everything is OK. You don’t have diabetes, do you?” My response was, “No,” but anything is possible, and possible it was.
So back to the lab I went. I asked what is considered a “little high”? The lab tech told me my glucose level was 559. On recheck of my glucose, my level was 494. The lab tech then notified my primary care provider of my lab results, and he wanted a fasting glucose the next morning. That glucose level was slightly better at 327, but it confirmed my diagnosis of type 1 diabetes.
Since that day in December 1988, I have had to be aware of my blood glucose levels, and every decision I make every day involves my diabetes and glucose level. As I get up in the morning, I check my glucose level, which influences how much insulin I need to take to get back into my target range, and what I plan to eat for breakfast. If my glucose level is high, what might the cause be? Did I sleep well? Am I in pain? Am I getting sick? If it is low, what could have caused my glucose to be low? If I know the answers, then maybe I can prevent it from being low in the future.
Starting My Day
As my day is getting started, the following come in to play: What am I going to wear today? Where does my pump go when I wear this outfit? (I do not pay much attention to accessories; my pump is my accessory.) What am I taking for lunch? Do I have the right snacks available at work, or do I need to take some? Do I have something to treat a low glucose level (immediate treatment and follow up treatment)? Did I remember my glucose meter? Do I have enough strips for my meter? If my sensor or pump fail and need to replace it, do I have the supplies I need? Is there enough insulin in my pump to get me through the day? Is my glucose level in the appropriate range for me to drive to work? When am I going to get my exercise today? Is the weather nice enough for me to take a walk around the park on my way home from work? Do I have the right shoes for my walk? These are all decisions I have to make before I leave home.
Living with diabetes is about self-awareness and the daily decisions I need to make in order for me to be as healthy as possible.
While I’m at Work
As my day goes on, I am aware of the timing of my lunch as I work with patients. Do I have enough time for lunch if I am running late with a patient? If lunch is running late, do I need a snack right now to prevent hypoglycemia? As I walk through the staff lounge to get more water to drink or at break, can I have nibble of the snacks sitting on the table? If there are veggies, then probably; if there are crackers and cheese, then maybe; if there are sweets, then probably not. If I really want the snack, do I need to take insulin? What is my blood glucose level at this time?
Do I share with my patient I have diabetes? I will if the patient is feeling that no one understands what he or she is dealing with. (Many people with diabetes feel alone, afraid and uncertain, especially at the time of diagnosis.)
On My Commute Home
As my day winds down at work, is my glucose level in the appropriate range to drive home? Do I need a snack or insulin? How am I feeling? Will I stop at the park to walk on my way home, or do I take a walk after dinner? How much water did I drink today? What are our dinner plans? Or, do I stop and get something for dinner? Is dinner going to be by 6:30 p.m.? Is dinner going to be late? What is my glucose level? Do I need Insulin now or later? What snacks do I have in my car? What is traffic like, and how long will it take to get home?
Once I’m Home for the Evening
What are my activities for the evening? Does my husband need my assistance with his business, and for how long? When should I be in bed to try to get 8 hours of sleep or least 6 hours? What is my glucose at bedtime? Do I need a snack, or do I need insulin? Will I need to check my glucose during the night? Do I have something to eat at my bedside in case of a low glucose level during the night? Do I have water available for a potential high reading?
Assessing the Day
Did I drink enough water today? Did I get enough activity? What is my pain level? What is my stress level? Do I need to take something for the pain so I can sleep better? What time do I need to get up in the morning? This are questions I ask to make sure my fasting glucose level is in range the next morning. The next, day my questions start all over. This may sound that my workdays are the only ones I have concerns about; however, these questions are mostly the same on my days off as well, with little variations.
After living with diabetes for more than 31 years, these questions are part of my everyday routine. I may not verbalize them to others, but my focus is and always will be my diabetes first, since it is part of who I am.
Leslie Merklin-Barber is a registered nurse and certified diabetes educator at Overlake Medical Center.
Overlake offers one-on-one education as well as two-part classes to help people learn practical skills to manage diabetes, including medication, meal planning, glucose monitoring and more. Classes are taught by certified diabetes educators. Please see your healthcare provider for referral. Learn more about diabetes education at Overlake, or call 425.688.5111.