(Note: this is not intended as medical advice nor should it be used as such. It is simply the author’s recounting of her experience with diabetes.)
I always roll my eyes a little bit when I see that meme cycle through Facebook about never using algebra in real life. As a Type 2 diabetic, my life sometimes seems like nothing but algebra–especially at mealtimes.
I am tired of being sick. In order of diagnosis date I have major depression, type 2 diabetes, generalized anxiety disorder, and degenerative disc disease. I also have Factor V Leiden clotting factor disorder which has put me on multiple blood thinners following four strokes. (Clotting, it seems, is my super power. This might be useful if I was continually under attack by evil mega leeches from outer space, but in our dreadfully normal timeline it just makes my brain self-destruct.)
I can handle all of these, but the diabetes is a royal pain. It affects almost everything my body does. Plus I have to stab myself with needles up to ten times a day. (When I was writing this I was using voice-to-text which transcribed that line as “I have to starve myself with noodles up to ten times a day” and, to be honest, I really want THAT version of diabetes.)
I’m going to assume that, if you’re reading this, you probably fit into one of two camps: you (or a loved one) have diabetes so you know exactly where I’m coming from, or you know very little about diabetes. Since my experience has been that, other than endocrinologists, the majority of doctors and nurses in the US fall into this latter camp I feel reasonably comfortable assuming that this also applies to the general population.
On paper, diabetes may not sound all that complicated. Check your blood sugar in the morning and again before every meal. Take your insulin in the morning, with meals, and at night. Take any other diabetes meds. Don’t eat sugar. Lather, rinse, repeat.
The reality however is quite different. For right now, I’m going to focus on the joy that is mealtime insulin dosing.
Figuring out insulin with meals
Back when I could still work, my coworkers could never understand why it took me several minutes to figure out what my insulin dosage should be and why I would sometimes end up hypoglycemic. The best explanation that I could come up with (since I worked with math and statistics people) was to tell them that calculating a meal time insulin dose when you have type two diabetes is like solving the quadratic formula when, instead of having values for A, B, and C you have ranges (say -25 to 25) for the first two and are complete missing the value for the third, but you still have to solve the equation within five points of the correct answer on the first try.
There are a few ways of doing your mealtime insulin dose. If you’re someone who eats a fairly consistent meal day after day, at least as far as the number of carbs is concerned, you and your doctor can figure out your insulin dose once and then you just repeat it, ad infinitum, assuming that you continue to eat that same number of carbs per meal.
Maintaining a consistent number of carbs for every meal is not something that works for me. Instead, I have to calculate each meal individually. My doctor and I determined how many carbs each unit of insulin will cover given my body’s functioning. For me, one unit per twelve carbs usually works. I then calculate the number of carbs in my meal and do the math.
Neither of these sound too difficult, right? Well, hang on Sloopy—we’re not done yet.
High Fructose Corn Syrup
As time goes on, and you learn more about how your particular body processes carbohydrates, you may learn that you have your own little quirks that may or may not be shared by other people. For instance, say a bottle of soda has 60g of carbs. For my ratio of one unit of insulin for every 12g of carbs, that should mean that five units of insulin are needed to cover a can of soda. However, soda or any other food that has high fructose corn syrup (HFCS) is processed (at least by my body) differently than regular sugar. Through trial and error I’ve learned that for foods containing HFCS I need to increase my insulin by 50% meaning, in this case, a bottle of soda takes seven units of insulin. I use soda as an example because it’s obvious, but HFCS is in a plethora of food products, including salad dressings, condiments, cereals, granola bars, canned and frozen dinners, and breads. HFCS can make calculating the number of carbs in any item on a restaurant menu super fun, since you never know exactly what the restaurant has made on its own and what components are purchased.
This Is Real Life, Not a Fad Diet
And while we’re on the subject of sugar, let’s be realistic. Well meaning people seem to think that diabetics can never have sugar again-no desserts, etc., ever again. I once had a friend lecture me that “she couldn’t watch me killing myself” because I drank a glass of orange juice with breakfast. Listen, diabetes isn’t a fad diet. It’s not something that I’m doing for a couple of weeks and then I can go back to my real life. This is my real life. And in the rest of my entire real life, I’m going to have a slice of birthday cake from time to time. Maybe even a glass of orange juice. And if I do it in moderation, and adjust my meds and insulin as needed, that’s just fine. (And, yes, my doctor agrees.)
The next part of mealtime insulin dosing is correction dosing. This means that, again with your doctor’s help, you will calculate a correction scale of the number of units of insulin per the number of points that your preprandial (pre-meal) blood sugar exceeds a set number. For example, if I check my blood sugar before lunch and it’s 143 mg/dL, I would add four units of insulin to whatever dose I’m giving myself at lunch. (I have my doctor’s approval to do a tight correction scale based one unit per ten points and an ideal glucose level of 100 mg/dL. Often that ideal level may be set closer to 130 mg/dL to reduce the risk of hypoglycemia. Your mileage may vary.)
Other Factors That Affect Your Blood Sugar
Got all that? Good – that was the easy part. Going back to my quadratic formula example, remember how I said I got ranges for two out of the three values and the third was missing? That third value is made up of a variety of factors, including but not limited to:
- Physical activity
- Alcohol consumption
- Other medications
- Menstrual cycles
There’s really no way to account for these in determining meal time dosing, but they all potentially affect how well my body processes that insulin.
Also, since I’m a type two diabetic, my pancreas does still work, if only a little bit. This means that I do have some natural level of insulin, but since I have absolutely no way to determine how much, it gets tossed in here under the blind values.
Okay, I hope you all brought your number two pencils because it’s time for a quiz now. Lowest scorer buys dinner.
About the Author
Jen is a writer and painter living in Indianapolis, IN. Until her stroke in January of 2017, she wrote grants and contracts for a government agency. She is currently working on a novel which combines her experience in stroke recovery with her history as a paranormal investigator/ghost hunter.