The Bounce

images

Today I am going to talk about what I call the bounce. This is a phenomenon where my sugar will be going down, then bounce up. This is called the Somogyi effect and it is the body’s defense against low blood sugar. For non-diabetics, this is a good thing. For diabetics, it can get out of control.

So why does this happen? When the body senses low blood sugar, the liver kicks in and produces glycogen to get the blood sugar back up. In non-diabetics, this process is shut off when insulin levels are elevated. In diabetics, either there is no insulin being produced, or insulin resistance prevents the liver from receiving the stop signal. This can cause blood sugar to go from 60 to 300 in a matter of hours.

One thing that I noticed, at least for me, is that low blood sugar is relative. When my sugar is running in the upper 200s, a blood sugar of 190 can trigger the bounce. This can be troubling because on the one hand, I am trying to get my sugar down. On the other hand, if I bring it down too fast, it is going to go up. This is why I get so frustrated when I hear, “Oh, your sugar is high? Just skip a meal or two. It’ll come down.”

This is also why blood sugar is high in the morning. It is also called the dawn phenomenon. A diabetic goes to bed and their sugar is good. When they wake up, their sugar is really high. This is the same effect. The sugar got too low in the middle of the night and the liver kicked in and raised the sugar.

Another issue that I have is that my sugar does not always bounce. Sometimes it just falls and I end up with a sugar in the 40s and 50s. I have not yet figured out why that happens. I have been lucky and I woke up each time and was able to wake my wife, who made me a sandwich to get my sugar back up.

So there you have it. Another thing that diabetics get to deal with. The key to bringing down your my is to bring it down gradually. If I go too quickly, my body fights and raises my sugar. If I let my body get used to lower sugars gradually, letting my body get used to the lower values.

One Year Anniversary

March 1 was my one year anniversary. Anniversary of what, you ask? March 1, 2014 was the first day that I could not open either of my eyes. There was a four day span that started with my right eye drooping that ended with not being able to open either eye. Since then, there have been 4 times where my eyes popped open for a few seconds, but otherwise have remained the same.

A lot has happened in the last year. I lost my job, which is understandable. My last day of work was March 3. They let me go in September, but the hiring freeze was lifted and they needed to fill my position. They were very generous to hold my position that long. There was some ugliness with back dated letters that threatened to cost us money, but that got cleared up.

My freelance work came to a halt as well. I could not do any graphic design projects because I can open my eye with my finger, but then I cannot use the keyboard and the mouse at the same time. This makes it impossible to Ctrl-click or Shift-click. I am working on some graphics, but not for clients.

I have had to learn how to get around without being able to see. I can get around my house by feel and I have only fallen a few times. I have a mobility cane that helps me when I go out. I am opening my eye with my finger much more now than when this first happened. I start getting headaches and I get dizzy when I do that too much or when I’m moving.

If I am sitting still and looking at something that is staying in one place, I can open my eye for a longer period of time. I can watch a movie, especially on my phone (I can take my glasses off for that) or a TV show. I can do some stuff on the computer, as long as I don’t need to use the mouse and the keyboard at the same time.

I have started writing more because I can put the cursor where it needs to be and just start typing. It does take me more time because I don’t catch my mistakes right away, but it isn’t that much more time. I am currently starting to look for clients so I can make some money with my writing.

The hardest thing to deal with over the last year has been depression. When this first happened to me, I sat on the couch for about three months. My eyes would get irritated if I opened them. Who knew that you used muscles to keep your eyelid from rubbing against your eye when it closed? I do now. I have gotten better at it and somehow it is not rubbing now, but it took a long time to do that.

I went to Wisconsin in the summer to visit with friends and family, and that helped my depression for a while. Then, when I lost my job in September, I sank back down. I felt like a failure.

Then we moved in November. I went back in to the apartment when we finished cleaning it out and I was flooded with emotions. I remembered how excited we were when we moved in. I had just transferred in to a position where I would be programming, which is what I wanted to do. Now it seemed that we were running away with our tails between our legs. That empty apartment that seemed to hold so much promise four years ago now taunted me with failure.

I got involved with our church choir, which got me through the Christmas season. But recently, I have stopped going to rehearsal. I just do not feel comfortable there right now. Having so many people around me and not being able to tell if I am involved in a conversation or not is exhausting. I am an introvert to begin with, now it is so much harder for me to be in a crowd.

I have spent the last couple of months staying home. It probably had to do with the fact that the one year anniversary was coming up. For some reason, that just seems to be another sign of failure.

I am doing my best to just keep plugging away. Some days are better than others. I am not suicidal, but there are just some days that I do not see a reason for getting up in the morning. I have put together a daily to-do list that I am working off of and that is helping me get things done every day.

And that is good enough for now.

High Maintenance

Diabetes is a high maintenance disease. Please note that I am not comparing it to any other diseases or implying that it is better or worse to have diabetes. I am just making the observation that diabetes is an extremely high maintenance disease.

When you have diabetes, it takes over your life. There are so many variables to keep track of, and many of them seem to be arbitrary at times. Then you have to make calculations based on past data and future considerations.

To give you an idea of what I go through, I will outline a pretty typical day for me. I decided to use a day from when I was still working because that is more interesting than just sitting around the house all day.

I wake up at 6:30am for work. I check my sugar and it is 214. I go to the fridge to take my insulin. I get the syringes out and measure 50 units of Humulin-N. This is my long acting insulin and it provides a base for the next 12 hours.

I am allergic to the really fast acting synthetic insulins, so I have to go with Humulin-R for my short acting insulin. I need to take it a half an hour before I eat. I have a sliding scale for this, so I have to figure out how much to take when my sugar is 214. According to my scale, I should take 75 units.

At this point, I look at what I am going to have for breakfast, when I will be having lunch, and what I am going to be doing between now and then. Breakfast will be eggs and toast, so it should not affect my dose. I should be able to have lunch at around 11:00am, so that should not affect my dose. My plan is to stay in my office and work on paperwork all morning. I decide to bump my dose up to 85 units because I will not be moving very much.

I take a shower, get dressed, and make breakfast. I eat at around 7:15am, take my morning dose of Metformin, then head to work. When I get there, I put my lunch in the fridge and start on the paperwork that was waiting for me.

At 9:15am, I get a call that one of the departments cannot access the network, so I get up and walk over to their building to see what is going on. It takes me about an hour and a half and a lot of walking back and forth to troubleshoot the problem and fix it.

I get back to my office at about 11:00am, just in time to eat lunch, but I have not taken my sugar or insulin yet. I check my sugar, it is 294. I waited too long and I did not have a snack. This seems counterintuitive, but that will raise my sugar.

I know that since I have been doing some walking, I won’t need as much Humulin-R this afternoon. I take 75 units instead of the 90 units that my scale says. Then I eat my lunch: pasta with meatballs and a salad.

I have a couple more trouble calls in the afternoon, so I did walk a little bit. I am very happy that I went easy on the insulin. I also had a snack at about 3:00pm, a Twix bar.

I leave work at 5:00pm and head home. When I get home, I check my sugar and it is 141. We are having cheeseburgers and mac & cheese for dinner and ice cream for desert. I take 35 units of Humulin-R and 50 units of Humulin-N. I take my evening dose of Metformin with dinner.

I check my sugar at about 9:00pm and it is 121. I have a piece of toast with peanut butter on it. I check my sugar again at 11:00pm and it is 119.

That is a typical day. Some days I check my sugar more often, especially if I do not feel well. But on typical days there are 5 finger pokes to check my sugar, 5 shots of insulin, and a number of calculations.

Diabetes and Depression

Many diabetics go through bouts of depression. I’m not talking about being down in the dumps for a few days or weeks. I’m talking about, “Why am I giving my self these shots?” “What difference does it make?” “I’m done with it!” kind of depression. The kind where there doesn’t seem to be a light at the end of the tunnel. No, that’s not right. There is no end to the tunnel. There is no forward or backward. Just darkness.

I am no expert when it comes to depression. I can only tell you what I have gone through. Please, if you feel that you are depressed, especially if you are considering harming yourself or others, call a doctor and get help.

My journey with depression is a long one. I do not talk much about it to anyone. One of the reasons that I do not talk about it is that I already feel like a burden to people in my life. The last thing that I want is for my loved ones to be worried about my mental state. Another reason is that most of my close friends and family are over 1000 miles away from me, and they already feel helpless.

I have noticed over the years that when my sugar gets high, my depression gets worse. This is especially true if my sugar is high for any length of time. When my HbA1C is high, which is indicative of having high sugar for the last 3 months, my depression is usually deeper. On good days, when my sugar is good, I can usually deal with my depression. When my sugar is high, it is hard to find a reason to get up in the morning.

Depression and diabetes can be a double whammy. Many of the symptoms of each are similar, which leads to those symptoms being enhanced. For example, when my sugar is high, I am exhausted, to the point that there is almost nothing that will keep me awake. Depression also leads to sleeping because it feels like there is no reason to get up. Add those two together and you get a day or two of sleeping.

High sugar also makes it feel like the pit of depression is even deeper. I have felt this effect, and even though I know that it is because my sugar is high, I cannot snap myself out of it. I know that the batteries dying in the remote is easily solved by putting new ones in, but it still feels insurmountable.

Another way that diabetes messes with depression is how it affects some of the decisions that are made with high blood sugar. I have a tendency to go into what I call “The Rage,” when my sugar gets high. I am very thankful that I have never gotten physical with anybody during these incidents. I have said many horrible things, though, and I have had to deal with the consequences. This is the perfect time for depression to rear its ugly head and tell me what a horrible person I am.

I am continuing my journey with both diabetes and depression. It is sometimes a lonely journey, and sometimes I just need time to myself. I am doing what I can to get the help I need. The biggest thing for me right now is to keep my sugar down. As long as I can do that, I can deal with my depression.

Newly Blind

I’m going to start this article by saying that I am not blind. I can see as well as I ever could (which is not all that great). My problem is that the top half of my face is paralyzed, and I cannot open my eyes. I can if I use my fingers, but I start getting headaches and some irritation if I do that too often, especially when I am moving. So when this first happened to me, I was effectively blind.

It became obvious that I would need a cane to get around. I started with a normal walking cane that we had laying around the house. This was heavy and short, so when I bumped something with it (like my wife’s leg) it hit hard and did not give me enough time to react. That led to some bruised shins and some collisions. But it did let me get around a little bit on my own.

I upgraded to a rigid mobility cane within about a month. The National Federation Of The Blind (nfb.org) offers one for free for the newly blind. It is a light-weight, fiberglass cane that helped tremendously. We ordered a 52-inch cane which helped me locate objects farther in front of me. Now I was able to get around a lot better.

I ordered another cane about 3 months later. The new one is a folding, aluminum cane. It is much more convenient to be able to fold up the cane and sit it next to me when I am out in public. It can be a pain to try to find a place to put the rigid cane at church or in restaurants. It is a little heavier, but it is worth it.

I did not open my eyes with my fingers very often when this first happened. There were some times that I got lost in my own apartment, especially before I got the first mobility cane. It was extremely unsettling. I also found out that I was not good at straight lines or 90 degree angles. To this day, I still drift when I walk further than about 30 feet.

My wife and daughter have been extremely supportive. They have had to learn how to guide a blind person. It has not been perfect (I ended up apologizing to many, many empty chairs) but we just kept on plugging away.

Eating was another challenge. My wife tells me what I have on my plate and where it is located. From there, I use my fork to find where everything is. It has taken quite a bit of practice, and I ate a lot of empty forkfuls, but it has started to get easier. The hardest things for me to eat are corn and rice.

The other thing that I had to get used to was waking up and not being able to open my eyes. At the beginning, I would panic when I woke up because I could not get my bearings. My wife and daughter really helped with this. They would anticipate it and I would wake up to them telling me that I could not open my eyes and it was normal. That lasted about a month or two.

I am still learning how to get around and how to deal with this situation, but things are starting to get easier. I have started to learn how to play the bass guitar and I am singing in the church choir again. Slowly, but surely, I am getting back in to the swing of things. I still eat some empty forkfuls and I still apologize to the occasional empty chair, but I am getting back into life.

All Kinds of Issues

It has been quite a roller coaster these past six months. I’m not sure if any of this is related to diabetes or not.

It all started at the end of February. My right eye started to droop, so I went to see my primary care physician. We thought that it was Bell’s palsy since I had had that before, so she prescribed an antiviral and a steroid.

By the next day, that eye closed completely. My left eye started drooping the following day and was completely closed the day after that.

I went to work the next day, pulling my eye open in order to see. The only reason I even went in was to get a major project in a position to hand off to somebody else.

I went to the ER right after work and spent about 16 hours there. They ran all sorts of blood tests, a CT scan, an MRI, and even a chest x-ray. Everything came up negative, which is good because all of the big bad scary stuff was ruled out.

Of course, the neurologist on duty was certain that it was just my sugar was too high. They discharged me and told me that they were going to set up an appointment with a neurologist.

After a couple of weeks of calling, it became apparent that I was not going to get an appointment.
I went to my regularly scheduled endocrinologist appointment and discussed it with him. He set up an appointment for me with a neuro-ophthalmologist and another one with a neurologist.

The neuro-ophthalmologist was pretty dismissive and said that it will probably go away on its own. The neurologist was also dismissive, but he sent me to have an EMG. The EMG is the first, and so far the only, test that showed any abnormality.  It showed that my brain was sending the signals, but the muscles in the top half of my face were not responding.

We tried to set up an appointment with the neurologist, but they would not schedule an appointment for me.  We went back to my primary care doctor and she referred me to a neurosurgeon and a neurologist.

The neurologist prescribed a medication that helps with one possible condition that may not have shown up in the blood work. I took that medication for about a month and the only thing that it did for me was tear up my stomach.  I lost 15 pounds in the first two weeks of taking it.  When I went back for a follow up, he took me off of the medicine.

The neurosurgeon took a look at all of the test results and concluded that there was nothing he could do, as there was no reason for any surgery.  He did, however, spend some time going over what all of the tests meant.  He also referred me to a neuro-muscular specialist.

So for the past six months, I have been walking around functionally blind. I can open my eyes with my fingers, but walking around like that with my glasses on gives me a headache.  I have a cane that I use to get around with when I go out.  I have gotten to the point where I do not need it at home and some other places that I am very familiar with.

I will talk more about the blindness in my next post.

American Diabetes Month – Day 30

Wrap Up

Thank you for following me through American Diabetes Month.  I hope you got something out of it.  I will continue to blog about my experiences with diabetes.  If you have something that you would like to read about, let me know and I will write up a post about it.

If there is one thing that I could get people to understand, it is this: Every diabetic is different.  They require different medications and activities.  There is not a single solution that works for all diabetics.