Working the Fundamentals

Diabetes is a complex beast. There’s a whole heap of complicated things interacting with one another. It behaves differently if we’ve had a crappy night’s sleep, if the weather’s hot or cold, if we’re feeling under the weather, if we’re rushed off our feet, if we’re having a rest, and on and on and on.

It can sometimes be overwhelming, trying to balance all these things, and so sometimes it can be appealing to look for easy solutions.Β 

These days, lots of the hope for easy solutions comes from technology. I see lots of people posting on social media – across twitter and facebook – holding huge hopes for continuous glucose monitors (CGMs), insulin pumps and artificial pancreas systems. There’s no doubt that these things can be massively beneficial to people with diabetes (disclaimer: I’m a pumper myself), but are they the panacea that they claim to be?

The key with all of these tools is that they’re just that – tools – they allow us to use our effort in different ways to manage our diabetes. There’s no doubt that if you can dose your insulin in fractions of a unit, you can more closely dose to your carb intake. There’s no doubt that having a basal rate of insulin trickling in all the time is closer to the body’s natural processes than a once or twice a day injection. There’s no doubt that having near to real-time information on your blood sugar and the direction it’s going in can help you make decisions. But there’s a common thread between all of these things. They help, they don’t do it for us.

I use an insulin pump, but at the moment I don’t use a CGM. I have a pretty unpredictable lifestyle. I don’t eat a special diet. Despite these things, I was able to tweet this last week:

This isn’t just a blog so that I can brag about having a great BG day (although, you know, check me out πŸ’πŸ»), it was a way of showing that the technology is just one way of achieving good blood sugars – and changing the nature of the work you put into getting them. Whichever way you go about it, bashing your sugars into control will take work. I got those numbers because I tested my blood sugars, and I meticulously counted my carbs.

Sometimes we’ll all take our foot off the gas, and slacken off, and that’s fine, you can’t walk the tightrope all day, every day, for your whole life. But there are two key pillars to living with diabetes that make everything else a bit of a waste of effort if you neglect them.

Don’t be scared of the numbers

Knowing what your BG is, is the only way you can start to get to grips with things. To always know what your BG is, means not being afraid of what the numbers are.

Blood Sugar readings can be in range, they can be low, they can be high – but the thing they never are is ‘bad’. Knowing what the number you have is the first step to making a decision about what you need to do. Prick those fingers, swipe that libre, don’t disable those dexcom alarms. Know where you’re at.

We’ve all had times when we’ve felt a bit rough, and known that a BG is probably on the high side – and so not tested because we don’t want to be confronted with that ‘bad’ number. From my own experience I can tell you, you feel worse for longer when you try to ignore it.

Count the carbs

Counting carbs is the second pillar. If knowing what your blood sugar is sitting at is step one, then knowing what you’re putting into yourself is step two.

Without this information, insulin doses are guesswork – and guesswork might help you play a blinder from time to time, but it’s just as likely to end up in a hypo or a middle of the night rush for a pee.

It’s not always easy – but there are ways to make it easy. Carbs & Cals is a great app if you like to have visual representations, MyFitnessPalΒ is a fabulous source of both guesstimated contents for homemade stuff, but also actual factual details of stuff you’ve bought in supermarkets and restaurants.

The lowest tech way is still using the back of packets, but I know these aren’t always the most user-friendly. More and more have the Carbohydrate count for a ‘serving’ (and also then have to tell you what a serving consists of), but for those where the details are only presented ‘per 100g’ I’ve started outsourcing my maths. I ate a chocolate bar earlier, and worked out how to bolus for it by shouting ‘Hey Siri, what’s 50.6 times 0.42’ to work out the right carb content for my 42g chocolate bar. I look ridiculous when I do it, but I don’t care. I’M LIVING IN THE FUTURE DAMMIT.

Multiplying the per 100g by the multiple of 100g that you’re eating is definitely the easiest way to do this (250g means multiplying by 2.5, 25g means multiplying by 0.25) – and we’ve all got a handy calculator in our pockets (the icon for it might be nestled somewhere between Snapchat and Twitter…)

I know I’m not saying anything groundbreaking here, but building a solid foundation to your approach to diabetes is the only way to move forward. Once the foundation is dug, you can build on it – adding in more sophisticated tools like pumps and CGM if you want to – but a house with shaky foundations is liable to collapse, and so getting the basics right is really important (I’ll stop with the awful building metaphor now).

There will still be days when you simple dgaf and it all goes wonky, but if you can follow the fundamentals on the days in-between, things will get easier.

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