Every Bite

I have an appointment at the Diabetes Centre in two weeks. Seeing that appointment looming on the calendar means a few things:

• bloodwork
• meal tracking
• A1C results 
• guilt

I got my bloodwork done last week. It is SO much easier when I don't have to fast before going.  Ever since I got my cholesterol down to the ridiculously low number required for proper diabetes management, I no longer have to have my cholesterol tested every time I get lab work done. No cholesterol test = no fasting.  Which, for a pancreatically-challenged person like myself, can be quite challenging. (Last year's post chronicles one particular fasting adventure if you're interested.) Anyway, I waltzed into the lab at 9am, after all the fasters had come and gone, and I was out the door again in 15 minutes with my bloodwork and requisite pee in a bottle done in plenty of time for my appointment.

I am also required to track blood sugar numbers for two weeks. That's the fun job of writing down every morsel of food I put into my mouth, every blood sugar result, every basal change, exercise, bolus correction and whatever else I can think of that might somehow explain why my blood sugar was a particular number at a particular time on a particular day. I'm tempted to include weather reports and pollen counts in case they might help decipher the numbers.

I really dislike this part. I dislike writing down a 3.9 an hour after exercise because I know what they're going to say. I dislike writing a 16.5 after a big meal because I know what they're going to say. I hate having more than one low in one day because I know the look I'm going to get. And I hate having to explain every number that they've circled in red pen.

"Can you explain this low?"  "This high?"

And the comments like: "Oh, you exercised yesterday, that's why you were low" (Um, I exercise pretty much every day). "Wow, you exercise every day? What do you do to your basal rates before you exercise?"

Well, that depends on:

• what time of day I'm exercising
• what sport I'm doing
• how intense the workout is going to be
• how long the workout is going to be
• whether or not I have my period
• what my blood sugar was doing for the few hours before the activity
• what I'm planning on doing after I exercise

That's usually when I get the comment "Wow, you're really active. We don't see a lot of diabetics like you. We can't really suggest any changes to what you're doing. Just try not to have lows so raise your basal rates a bit to avoid them."

Sigh.

I know that the Diabetes Centre is really really important for a lot of people. They teach so much and have so much advice about nutrition, carb-counting, healthy living etc. I'm sure they have helped countless people.  But I go because I need my bloodwork results and I need to go there a set number of times per year in order to quality for government funding for my pump supplies. They really like me and they love the fact that I take care of myself so most of the appointment is spent chatting about little things like my blog and what race I'm training for.

I also dread going to be appointment because of the A1C results. (For those of you who don't know what that is, this blog tries to explain it). My A1C is usually pretty good (around 7.0) but I've had higher and lower numbers and there's always a sense of randomness about it. I feel like my control is pretty consistent in terms of highs and lows and overall care so when it goes up to 7.5 or down to 6.8, I never really know why.

So I see the A1C result and I start trying to explain things (I was injured, I was sick a few times, I had more lows, I had more highs, I was training for a race, I wasn't training for a race). I feel like that number somehow explains me and defines me and I feel guilty when it's not exactly what it's supposed to be.

I know it's ridiculous - it's one damn number. An average of my blood sugar over the last three months. Someone with horrible control could have an A1C of 7.0 and someone with fabulous control could also have an A1C 7.0.  I know the effort I put in and I'm ok with how well I'm doing - but when I see that number I suddenly feel 'not ok'.

I have a love/hate relationship with that test. It validates what I'm doing and yet it invalidates how I feel about it.

So for the rest of this week I will dutifully document how many mini chocolates I snack on during the day and write down every low and every high (trying not to cringe as I do it). At in two weeks I will find out what the A1C results are this time around.

And then I get a few months of just taking care of myself before I get to do it all again.

Aside: Is it just me or do other people care a little less right after your A1C test is done? I figure the next test isn't due for four months and it's only a three month average so....yes I will have baklava for dessert thank you very much!