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Expect the Unexpected #dblogweek

Today marks the first day of dblogweek for 2017 and today's topic is "Diabetes and the Unexpected" which seems quite apt for this disease in general.
Diabetes can sometimes seem to play by a rulebook that makes no sense, tossing out unexpected challenges at random.  What are your best tips for being prepared when the unexpected happens?  Or, take this topic another way and tell us about some good things diabetes has brought into your, or your loved one’s, life that you never could have expected? 

In general, diabetes is a disease that does nothing but keep you questioning everything that you've been told is the "real way" that things happen, or the standard way it works for all diabetics.  You're continually told from your Diabetes Educators and Endocrinologists the simple ways to solve the standard problems, but if you're like me, you'll end up finding some of those simple solutions to be incompatible with your findings as a diabetic.  In the end, there is nothing that is the same for every single diabetic (type 1 or type 2) out there, so you have to be prepared to deal with the unknowns of being a diabetic.

The few things I've found to follow this line of unexpected expectations are somewhat built into much of the training.  These things include, your sensitivity (the amount of mg/dL your blood glucose drops when you give 1 unit of insulin), your insulin absorption rate (how long insulin remains active in your body after injection), your carbohydrate ratio (the number of grams of carbs or carbohydrate exchanges that 1 unit of insulin covers), etc. But then, you learn based on the food that you eat, it's not all the same.  Sometimes, a food with more fat will have a different way of acting on your blood sugar than a food with slightly less fat, and it might depend on your current blood glucose.  Do you have insulin resistance when your blood glucose is higher? Do you sometimes have extended high periods where after a certain amount of time, that insulin just gets delayed in its actions, which then causes extreme highs followed by extreme lows.  For me, there's usually nothing completely consistent enough for me to ever feel like I've got it all figured out.  Which leads to the concept of expecting the unexpected.

When I encounter one of these problems, I think back to my training as an engineer.  In biomedical engineering, I took a lot of classes on medical devices, cell biology, physiology, programming, physics, and biology and many, many others.  But the first step in everything is taking a step back and trying to remain calm.  When you encounter something unexpected, especially in a disease that relies on hormones and strong physiology of your body, you need to keep calm and try to keep your hormonal balance and keep your heart rate down, because you need to not be in the flight response. (from the fight or flight response your body normally has)

Then there are things that aren't hormone/stress related, like hardware that fails, CGM sensors going off early on in their life, insulin that appears to be going off, infusion sites that are leaking or potentially going a bit crazy with respect to bleeding or even tubing that didn't get connected, or your insulin pump simply deciding that your infusion site wasn't primed properly, or somehow got unprimed due to some random button presses.

In order to deal with ALL of these possibilities, I have, in my backpack backups of everything, another vial of insulin (good for 30 days at room temperature), another infusion set, an extra container of test strips, backup batteries to charge my meter, more lancets, an emergency syringe (in case I need a large injection to correct), etc. The one thing I don't keep on me at all times is a glucagon kit, mostly because I can't use that on myself, I keep one at home and at work to be safe when I can.  I now also have a sleeve on my seat belt in my car indicating I'm an insulin-dependent type 1 diabetic, just in case I'm in a wreck and it becomes important.  I want to feel like having an insulin pump should be sufficient to indicate that, but I've definitely learned that is not the case at all. After all, there are still hospital workers who don't know what an insulin pump is or what it does.


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