Fifty-One On, One Off (Kinda)

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Diabetes Self-Management. Sure, it’s the name of the Web site and the magazine, but, more importantly, it’s what we do. We, us—those of you reading, those of you with diabetes, those of you living with and helping care for people with diabetes.

Let me be immodest here and say that over the past year my diabetes self-management has been quite stellar—a claim corroborated this month by both a thorough physical exam by my primary care physician and a visit to my endocrinologist. Good self-management—if I can state the obvious—is really important. Tight blood glucose control, consistent exercise, a healthy diet, and on and on. There’s no end to the articles about how good self-management of our diabetes can help us live a long and mostly complication-free life.

So when my wife and I went on vacation a couple of weeks ago, to another country, I fully intended to do my best at continuing my good self-management practices. I was soon to discover, however, that the best-laid schemes for tight control while traveling can often go awry.

The food. The irregular sleep habits. The change in exercise routine (or lack of exercise altogether). Adjusting my basal rate slightly and bolusing somewhat less often to avoid low blood sugar on the flight or in an unfamiliar place. Did I mention the food? And, oh yeah, we were in the Caribbean, so, um, there was rum punch, too.

These and other factors helped contribute to quite a few blood glucose readings well over 200 mg/dl. Two hours after a meal I’d see 237, or 249, or 213. I’d issue a correction bolus with my insulin pump to try and bring it back down to around 120 mg/dl. Yet two hours after that, it would still be around 200 mg/dl.

What to do?

Panic, right? Fret and worry and think that all of my hard-fought self-management practices were going up in smoke. Assume that my carbohydrate ratio was off or that I wasn’t being diligent enough in counting the carbs in the restaurant food I’d been eating. Or, better yet, berate myself and feel overwhelming guilt because I was enjoying myself on vacation in the tropics. Yeah, let me stop with the delicious food. I’m going to refrain from the glass or two of rum punch. (And by the way, there’s some serious proof in Antiguan rum!)

No. No panic. Instead—surprisingly—after a year with Type 1 diabetes, I knew enough to realize that this was a snapshot moment of the rest of my life with the condition, that one week does not living with diabetes make.

I quickly put aside my worries, cast off the inclination I had to stress out about this week of anomalous numbers, and vowed to enjoy myself. I’d spent the past year achieving some pretty great diabetes numbers, and here was an occasion where, while not abandoning my self-management entirely, I could allow myself some slack for seven or eight days. When I returned to the states, then I’d pick back up where I left off. And I figured that I wouldn’t suffer any ill effects from this practice, either.

My endocrinologist confirmed that the approach I took was just fine. I visited him on Monday and explained what had been going on with my self-management during my vacation. He told me this was actually a great way to approach living with diabetes, and he used the analogy that I’d been banking all of those good self-management practices, so there was no harm in withdrawing some of it for a week or so.

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