Letter to a New Diabetic: Leg Cramps

Dear Concerned:

I, too, have had the (un)pleasant experience of waking in the middle of the night mid-scream and in tears from the knotting pain of a cramp in the calf. Unfortunately, until you manage to get your blood glucose levels down to an acceptable level you will continue to be plagued by these nocturnal visitors.


Assuming for discussion purposes that you haven't been intensely exercising, the most probably cause of your leg cramps are due to dehydration or an electrolyte imbalance. If you haven't noticed, one of the ways that your body rids itself of excess blood sugar is to try and pee it out. If you aren't careful to take more water in, you can easily find yourself dehydrated. This is known to accentuate muscle fatigue, which some people think can result in abnormal neural activity whereby certain muscles get the signal to contract but not relax.

Another frequent cause of leg cramps is an imbalance in your electrolytes. Whether this is due to all the urination or caused by a lack of sufficient intake from the outset, the result is painful just the same. If you aren't regularly taking a multivitamin AND mineral supplement each day, you need to be. You should also have your physician order a complete blood work-up on you. That will tell you if you are deficient in calcium, potassium, magnesium,Vitamin D or other vital nutrients. (Note: unless you are farming and eating your own organic produce, have eggs from the chickens running around your backyard and raise and slaughter your own livestock, it's a safe bet that you aren't getting all the requisite nutrients you need from the food items you are purchasing from the grocery store.)

However, none of this is of much solace at three in the morning when you are hopping around on one foot, trying not to wake everyone else up as you sob from the pain. Things to try include eating a banana (potassium) or chewing a couple of Tums (calcium). More general suggestions can be found in this article over at roadbikerider.com on cramps.

Hope this helps,

Niko

Letter to a New Diabetic: Lowering Blood Sugar

Dear Concerned:

Welcome to the wonderful (and head scratching) world of blood sugar prediction. What works once may not work again the next time and what works for one person may not work for another. That's because reducing a high blood sugar is part science, part art and part luck.

The science is in doing the calculations. If your blood sugar is 200 and you want to lower it to be at 100, you need to know how much 1 unit of insulin will reduce your blood sugar (value of "x"). Then just take 100 / "x" to get the number of units to take. This is a fairly simple algorithm that you and your Endo (diabetic doc) can determine by fasting and doing food/insulin tests. You probably have a "basic" rule for reduction but the more you can do to make it specific to you, the more accurate and hence the better.

The art of treating a high blood sugar comes from knowing how YOUR body reacts to insulin, particularly when your blood sugar is at a higher level ( i.e., 1 unit = x reduction, but if the blood sugar is over 300, 1 unit only = 1/2 of x.) The only person that can take the time to figure that out is you. The other aspects that you have to consider include what you are doing at the time, e.g. exercising, moving, sleeping; how you are feeling at the time (as sometimes being sick = high blood sugar); and when and what you last ate and the amount of food still being digested in your system.

As for the luck in lowering your blood sugar, well, there is a dash of that as well. Sometimes you do everything right and "by the book" and then look at the numbers, scratch your head and wonder if it was all just a waste of time. It's not, of course, but it can certainly be frustrating.

Keep in touch,

Niko

Letter to a New Diabetic: Your first low

Dear Concerned:

Sorry to hear what happened, but it was a good lesson to learn early. It's a real learning curve, isn't it?

Two things caught my eye when I read your letter. First, you took insulin for a meal and then did not eat the meal. Second, you went for a walk without factoring in the affect it may have on your blood sugar level.

The first one is a huge mistake. If you give yourself a shot insulin, you MUST eat the meal or take some carbs to cover for it because your blood sugar will drop. In my experience, meals are missed either voluntarily or involuntarily. The voluntarily misses can be prevented by simply making sure you eat as much as you bolused for, whether you are hungry or not! The involuntarily misses are much more difficult. For example, I usually do not bolus at a restaurant until the food is at my table. I've had too many situations arise where I give myself insulin for my meal and then the food doesn't arrive for whatever reason. I've also had the situation arise where I became sick after the bolus but before I could eat.

The second issue is that you went for a walk. While perhaps not medically accurate, practically speaking exercise often increases the effectiveness of the insulin. So before you exercise, you need to check your blood sugar and either have it a bit higher, or have your meter and some carbohydrates with you as you work out/walk/run, whatever. It's a real pain in the ass, to be frank, but you do have to exercise. I've done some experience where instead of using insulin, I've used exercise to keep my blood sugar down. If you try it be sure to track your data and carry something to eat, such as the glucose tabs. For me, even something as common as mowing the lawn will cause me to get low, so I'll either eat before or keep an eye on my sugar level. A lot of people like the small boxes of Juicy Juice which are 15 carbs for those sudden lows. They are cheap and you can keep one or two in the car and drink them even when they are warm. Mmm, hot juice!

Hope this helps,

Niko

Letter to a new Diabetic: Welcome to the Club

Dear Concerned:

Good to hear from you but sorry it had to be under these circumstances. No doubt your head is spinning from your recent diagnosis and this is last thing you want to have to deal with. I'll not belittle the medical issues but, frankly speaking, have no doubt that you will do fine. Diabetes is a completely self-managed condition and if you pay attention to it you'll not be precluded from doing anything. There are type 1's (insulin dependent diabetics) who are in the Olympics, climb Everest, etc. I've traveled literally all over the world and have never had any issues. Some advance planning, yes, is needed. But nothing that you can't handle.

I can remember when I was diagnosed back in '99. It was a real surprise because I didn't know anything about diabetes nor even what a pancreas did. Mine, like yours, just burned out and quit making the hormone insulin. Like you, I had no family history and no one I knew who could answer my many questions--once I had enough information to even begin to formulate them. If you haven't already done so, you should find yourself a good Endocrinologist and Certified Diabetic Educator (CDE).

The first goal you and your doctor will work on will be to get your current blood sugars lowered from their high levels. There are two "numbers" you will soon learn are important: your at-the-moment blood sugar reading from your meter and an over-three-month reading (called your HbA1C) which gives you an average of the three months blood sugar levels. The aim of the diabetic management "game" is to get your HbA1C down to a normal level, i.e. something ideally in the 5 to 6 range. Mine was 14 or 15 when I was diagnosed. Yours is likely pretty high right now as well. The two weeks or so it will take to lower your blood sugar will, frankly, suck because your body had become used to the high levels so don't be surprised if you are irritable, tired, have headaches and the like.

There are essentially two types of insulin families: the first is for "basal" rates, that is to say a sufficient amount of insulin to keep your blood sugar level over a long period of time. The second is for a "bolus" or giving yourself an injection of insulin before you eat or to lower your blood sugar. Ideally, you want the basal amount to always remain steady so if you don't eat your blood sugar remains the same (say, 100). Then before you eat something, say a cookie, you give yourself a shot of enough insulin (a bolus) to balance out the increase caused by the carbohydrates in the cookie. Simple. ;-)

The days of "two shots only, one in morning one at night" pretty went out the window 15 years ago. My suggestion is that you immediately ask to get into multiple daily injection (MDI) therapy. If your current doctor doesn't know what that is then get another doctor. Essentially, that allows you to replicating a pancreas by giving yourself some shots of a basal rate insulin and separate shots of insulin before you eat to cover the carbs.

Oh, yes, carbs. They are every diabetic's craving and aversion. As you probably know, everything you eat is made of three things: fat, protein, or carbohydrates. The first two don't have much of an affect on blood sugar (although fat can cause change in the rate the body uses the carbs). Carbs, on the other hand, get turned into glucose, which is the form of sugar your body runs on. So before you eat a food, you just have to look up the amount of carbs in the food to figure out how much insulin you have to inject to "cover" the carbs and return your blood glucose level to what it was before you ate.

The other think you need to be aware of is a "low" blood sugar, called "hypoglycemia." That is what happens when you either take too much insulin or do something (such as exercise) which causes the body to use the insulin more effectively. If you do, you'll need to eat something to raise your blood sugar. I'd suggest you get some glucose tabs for the car and some Juicy Juice boxes or the like to keep on hand for when you go low, which you inevitably will.

The last thing to remember is that if you don't test your blood sugar, you don't know what the number is. Sometimes it is high and you feel one way, the next time you feel that way it is low. Check your blood sugar often.

Drop me a line if you have any more questions. Oh, and welcome to the club!

Niko