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I've been a diabetic for 23 years and today was the first appointment I've ever had with a dietitian. When I was diagnosed in 1985, the resident dietitian at Children's Hospital of the Kings Daughters claimed that I could have as much juice as I wanted since natural sugars were not a problem and it was only refined sugars that affected my blood sugars. Just in case you were wondering, that's patently false. So needless to say I've never had a high opinion of dietitians. Today I met with Gisela (pronounced GHEE-seh-lah) for two hours to discuss my diabetes (hey, better late than never, eh?). My homework before arriving was to write down everything I ate and drank for three days, bring my glucose meter and a list of all my medications. Me being me, I opted to bring six days of everything I ate/drank as well my blood sugar readings and insulin doses for those days. I also kicked it up a notch and took pictures of everything I ate and included those in an Excel file. Needless to say, Gisela was impressed.

The short version is that for 23 years, my HbA1C has been hovering around 7% and for 23 years that's been just fine. But the times, as they say, are a changin'. Depending on who you talk to, a person's HbA1C should be closer to 6% or even closer to 5%. Basically that percentage is an estimate of how much of your blood is "blocked" with sugar to keep it from carrying oxygen. The higher that percentage, the less oxygen your blood can carry to all your body parts. Over time that adds up. Fascinating stuff, really.

A few weeks ago, I went to the gynecologist for an annual service check. I recently switched from a very old male gynecologist (actually the guy who was my mother's OB-GYN when she was pregnant with me) to a much younger female one. She's very nice and we were chatting about my health record and she asked if I planned on having kids. I told her "um, no, not right this moment, but my husband and I would like to eventually." She casually told me that "they" say that before a Type 1 diabetic gets pregnant, her HbA1C should be 5%. I looked at her and told her "you're insane." We then discussed that while getting pregnant with a percentage higher than that is not forbidden, they'd like it as low as possible. This whole thing just annoyed me because it seems like the medical community is just covering its collective ass. You can get pregnant if your A1C is over 5 but don't come crying to us if your baby has three heads.

The next week, I had an appointment with my endocrinologist for a routine checkup. I talked to him about this magic number and he was a little more lax about it. He claimed that if my A1C was closer to 6.5 or 6, that would be nice, but that I'm not on fire. I requested that I talked to someone about counting carbs and if there were any hints on how to make sure my blood sugars were closer to perfect.

For reference, the American Diabetes Association says that your fasting blood sugar should be between 70-110 mg/dL (both at waking up and anytime before meals). The ADA also says that two hours after meals, your blood sugar should be under 140 mg/dL. These numbers will come in handy in a moment when I explain my day. Just remember that the goal is your blood sugar never goes over 140 throughout the day, otherwise your poisoning your body. No pressure.

So let's look at my day today. I woke up and felt slightly low (we won't even get into all the different shades of low that I can sense). I took my shower and checked my blood - 84 mg/dL. I didn't want to just "correct," since that number is supposedly fine, but I also didn't want to get in a car, pass out and end up on the front page of the newspaper tomorrow after I've killed a bus load of schoolchildren. So I begrudgingly ate a granola bar (18g) and took one unit of insulin cover 11 of those 18 grams.

Two hours later (10:45am), while in the lobby of the "lifestyle center" my sugar was 144. Not ideal, but nothing horrible. I took half a unit and went on my way. At 12:45pm after leaving the dietitian, my sugar was 155. Hmm, that's odd. Maybe it's stress. I took another 0.7 units (try doing that with a syringe).

I worked my way back to the office with a small chili from Wendy's (23 grams of carbs). At 1:25pm, my sugar was 143 but I knew it was on its way down. I took my 2 units for the chili (1 unit for each 11 grams of carbs) and did my online presentation. At 3:45pm my sugar was 100 (high fives all around!). At 6:22pm my sugar was 83 but the ADA says that's normal.

I ate a bagel sandwich (56 grams). The pump suggested 4.8 units but I only took 4 because I was about to walk the mile to my parents. At 8:05pm, my sugar was 136 (living on the edge, eh?). I ate 2 mini Reese's cups (22 grams for 5 but I only had 2 so ... 8.8 grams?). I took one unit and got a ride home from Mom. This evening I've done nothing but drink a diet Pepsi and surf the internet. But at 10:43pm my blood sugar was 193. Can you explain to me what the hell?

Nothing is different today than any other day for me. And nothing is different this month really than in the past. I just want to take care of myself in the best way possible. I don't want to be so spaced out in the shower I can't remember which step of the bathing process I'm on. I don't want to be worried about walking a mile without bringing a granola bar with me in case my sugar goes low. And I certainly don't want the pounding headache I have right now and the inexplicable high blood sugar.

But right now, I'm just pissed. I'm pissed that my insurance will only cover six test strips per day and I used nine today. I'm pissed that I'm not sure what I should have done between 8:05pm today and 10:43pm today to sense some disturbance in the force that my blood sugar was going higher while I was sitting on my ass watching TV and using the computer. I'm pissed that I've had a granola bar, cup of chili, bagel and two miniature Reese's cups today and I know the exact numbers for all the carb content in them and it still didn't fucking matter. And I'm pissed that I have an elite task force of medical professionals all doing their best to help me and it's still not enough. Two hours later, my sugar is still only down to 153. Do I take more insulin and go to bed, hoping I don't go low in the middle of the night? Or do I leave it and wake up with high blood sugar in the morning? Remember ... no pressure ...

Maybe being so pissed off is why my blood sugar is high right now.