1 down, about 50 more to go

People showcase anniversaries. Most notably, romantic anniversaries. Behind that, work anniversaries. The former is an expression of love; the latter an expression of accomplishment. People in recovery use anniversaries heavily, both as an expression of accomplishment as well as progress. Humans like round numbers. It’s why $19.99 feels markedly cheaper than $20. $20 feels much bigger because it’s a new set. We do the same thing when we turn 30, 40, and, I’m assuming, 50 and beyond.

Rarely do we celebrate anniversaries of terrible events. Who wants to remember those? Sometimes we do it in mourning or remembrance, but that’s not celebratory as much as it’s reflection. And sometimes, it’s both. Today marks my first anniversary or what those in the diabetic community call a diaversary. We can look back and say that it sucks to have to remember the day that happened, but whether I remember it or not it still happened. And there’s a much worse alternative - having not survived it in order to remember it. And believe me when I tell you, that was a real option.

Hitting the one year mark today means I’ve been creeping up on this. Over the last few months, I’ve been thinking about what was going on one year prior. I was so sick and didn’t know. We had that freak snowstorm in winter of 2018 and I was stuck in the car for 9 hours! The amount of times I had to pee into a water bottle, stealthily, was not normal. But sitting in traffic and snow watching accidents galore was much more cause for alarm at the time. I couldn’t stop ordering cases of water on the cruise in December 2018 - but we were drinking alcohol and sitting in the sun and eating mass produced salty food. Another alarm hiding in plain sight. I lost weight rapidly. Thank you Peloton, right? I was exhausted constantly. Thank you Olapic, GDPR, 65k miles of travel and the holidays, of course. Meanwhile, I was creeping toward certain doom.

And it all came to a head a few days prior to January 17, 2019. Away in Tampa, Florida for work. Couldn’t get out of bed. Tired, sluggish, lethargic. Ashen gray. Guzzling everything I could muster the energy to get to my lips. My blood glucose had to have been 200-300 for several years as my pancreas fought a losing battle. When the war was lost it was 6 months of steady increase. That rise hit critical levels that fateful week in January.

But enough about the diagnosis. In the 12 months since that happened my BG sits around 120 with a standard deviation of about 20. My A1C is in the low 5s (down from 14). I have no symptoms of side effects - neuropathy, vision, cardiology/circulatory issues, foot/hand, etc.

I’ve learned how to eat and enjoy my life while staying in range. I’m in a routine of changing my infusion sites and continuous glucose monitoring. I can travel the world with little interruption (but a ton of planning).

When you boil it all down, here’s the outcome. In 1 short year, that is 2.5% of my life, my life has changed completely while not changing at all. I quickly learned how to make proactive, habit forming changes so I could live every day mostly unaffected.

So, I’ll reflect on what almost happened and remember the feeling of being afraid. Fear is good; it keeps you sharp. But celebrate:

• where I am today

• my long, healthy future

• the people who enabled this success; the list is long:

  • my wife, Linda

  • my motivation, Nicky

  • my parents

  • my friends

  • my colleagues/bosses

  • my medical team

  • the strangers at Tandem and Dexcom who created the equipment that are foundations for success

• the fact that anniversaries of bad days are still anniversaries you’re here to celebrate

I probably won’t celebrate with cake, though.

Winning with data

I love data. I always have, but even more so now. I spend my days at work entrenched in data-backed analysis. Sometimes it’s sifting through our 100 million+ lines in our database. Other times it’s tracking and measuring trends to look for efficiencies in customer support. I work to retain customers using data.

When Nicky was on the way and we needed to find a daycare, I used data to choose the right one via a spreadsheet with 18 categories, weighted and graded.

My life went from scribblings of information, formulas, and algorithms piled on my desk to a complicated structure of Google sheets tracking everything I do - savings, spending, miles on my car, future plans, trips taken, miles flown, loyalty statuses achieved, and so on.

When I got diagnosed with Type1 in January I was given a simple formula - eat 35 grams of carbs per meal and dose on a sliding scale based on the finger prick measurement. Do it again as a correction before bed. I had 4 measurements and standard, programmatic reactions. That’s all I had to manage a chronic disease actively trying to kill me every day. And my A1C was 14.2 at the beginning of this. This was like building a road that takes me through the rest of my life and manually laying 4 bricks per day. That’s not the way to progress.

Around March, I got my Dexcom G6. I now had data points every 5 minutes around the clock. The only thing worse than no data is data you can’t use in a meaningful way. Every 5 minutes I knew where my sugar sat, but I couldn’t do much with it. I had pen injections with meals for for corrections, but the baseline insulin delivery (basal) was also coming from a long acting injection every night. In the morning it was still going strong. By afternoon/evening it had started to peter out. The arc of efficacy was guesswork at best and made things really hard.

In April, maybe, I got my pump. The Tandem t:slim x2 was my choice despite the pain in the ass tubing that loves to get snagged on doorknobs and toddler feet. It was the algorithm. This doesn’t just give me a basal rate of insulin and let me dose (bolus) for meals and corrections simply. It receives information from the continuous glucose monitor (CGM) and applies its own algorithm to determine if I’m falling. I can eat 50 grams of carbs and bolus accordingly. If I under bolus, I can give more without sticking myself again. If I over bolus and start a rapid decline, the pump sees the fall and cuts off basal insulin. Now some of my bolus is used as basal and the rest fights the carbs and I have no surplus. Instead of crashing to the ground, I glide smoothly to a good place.

With the ability to constantly measure and correct and adjust on the fly in micro movements, I have unlocked the ability to eat whatever I want. I still don’t eat pure sugar, but I’m liberal with carbs - as my dad bod would suggest with a glance.

For reference, here is a range of A1Cs

• <6.4 non-diabetic

• 6.4 - 7 - pre-diabetic (for the Type 2 crowd that grows into diabetes)

• 7+ - get your shit together

• 14.2 - you’re on death’s door and I can’t believe you were on an airplane an hour ago

I was on a mission. I learned how to count carbs, bolus appropriately, do an extended bolus (a little up front and a bunch on the back side - like the mullet of bolusing), pre-bolus, set temporary basal rates, ignore my endocrinologist’s scare tactics about insulin stacking, and generally be #BoldWithInsulin. Hat Tip to Scott Benner from The Juicebox Podcast for that last one.

Yesterday I got my results for my most current A1C.

5.4!

It’s not easy. It’s tons of work. I think about my Type1 almost every minute of the day. I dream about it. It interrupts my thoughts and conversations. Friends, family, and co-workers are at its mercy every time we mention food. There are days I want to rip my site off and say “fuck it” about the whole thing.

My son, who is 3 as of this post, tells me he wants me to be better. He asks if I have my “shot stuff” and “is you medicine machine charged?” and rubs my arm while saying “I don’t want this to hurt you daddy.” On his birthday I had a slice of cake and he squealed excitedly “this is a special treat for daddy” because let’s be real, there’s no way I’m not having cake with my little boy on his birthday. Thinking about him worrying about me upsets me. He’s the baby. I’m supposed to worry about him. He’s supposed to worry about playing and whether Simba ends up being king. He’s not supposed to worry about me. And I’m typing this through tears because this disease has given my son his first true fear and he’s not even the one with it.

But I have the tools, the data, and a gnarly competitive streak. There’s no cure. I can’t win the war. But you better be damned sure you know I’ll win every battle in the war.

It takes a lot out of me. When you really boil it down you realize it’s not hard as much as it’s constant and exhausting. Giving up will kill me, quite literally. So I have no choice but to persevere. Diabetic burnout is real and is always nipping at my heels. It takes all I have to constantly outrun it, but I will not let it catch me.

5.4!

Keep reminding myself that. I’ve had bagels, pizza, sandwiches, occasional ice cream… and 5.4! Sorry diabetes, not today… not ever!

Members of the club

It’s amazing how quickly I’ve become oblivious to the presence of my insulin pump. When I was first diagnosed I hid the fact that I had Type1. I’d sneak off to give injections. Slowly I got more comfortable with all of it. Then the pump came. A 1990s style pager looking device clipped to my belt. If not for the obvious tubing, it would look like I’m in full dad swag mode. I’m not sure if I was more embarrassed by the fact that I had Type1 or the seemingly nonexistent fashion sense. Naturally, I kept it hidden.

Here’s the rub. The pump doesn’t want to be hidden. Your shirt catches on it and it shows. For a while I’d quickly cover it back up while my eyes darted around the room as if my fly was down. And then I stopped caring. I didn’t mean to. I didn’t decide to. I just, kinda, did. I have Type1. I can’t get rid of it and I have enough to think about on a daily basis that the state of coverage of an insulin pump didn’t make it onto the priority list.

Every day I take the same train from work to my car. Every day it’s around the same time of day. It’s that magical hour where the rest of us in the rat race pack into metal subway cars like cattle and get whisked through underground tunnels. It’s robotic. Almost everyone has headphones on and definitely everyone is looking down, transfixed at the glowing rectangle of addiction. I don’t hear for my stop. I instinctively know it’s been roughly the right amount of time or Candy Crush levels to get off the train. Doors open and we spill out as one blob of commuters, while being unaware of the very existence of each other.

One night I stuck around in the city for a social gathering after work. By the time we finished up, rush hour was over and the trains were mostly empty. My routing was unchanged except for the massive amounts of room around me and the lack of the non-deodorant wearing guy who always seems to want to stand 3 inches from me.

I’m leaning against the doors, queuing up podcast episodes (probably The Juicebox Podcast) and look around briefly and notice a family across from me. I think nothing of it and look away. As I’m looking down I feel the burning of someone’s gaze on me. Without lifting my head in an obvious manner I glance up. There’s a young boy about age 11-12 across from me. He’s looking at me and looks away. Nosy kid! I feel it again. I glance again. He’s looking again. This time I see it. He’s got an Omnipod insulin pump on his arm. What a coincidence. I look back down but not at my phone. AHA! My pump is exposed.

View fullsize

I looked back at him quickly. I wanted to connect before he looked away. He was staring right at me. He gave me a bashful little wave with half a smile. I smirked back and left it alone from there.

At the next stop I looked up again, they didn’t get off. Back to what I was doing. Next stop I checked. The family was standing up preparing to get off. I looked right at him. He gave me another meek smile and tiny wave. I gave him a knowing look that consisted of a wink, nod, and another smile. And I watched him get off the train.

That was it. That’s all there was to it. His family didn’t know this exchange took place. They weren’t meant to know. Not that it was hidden from them, but it wasn’t for them. They aren’t in our club. My wife supports me and sympathizes as best she can. I’m sure his family does the same. But they don’t have something stuck to them 24/7. They don’t stare at ice cream and think “I’m low on insulin and it’s almost time to change my site. I could cover it with insulin, but I have to eat soon and I don’t have time for the bolus to work before a meal so it’s better to just wait. Or maybe if I up my temp basal I can stay even. Oh fuck it. I’m exhausted. It’s just ice cream. I’ll try again tomorrow.” That pattern of thought cycles through our brains almost every minute.

So, it was our moment. Two dudes in the T1D club. In our own little world on train car #3 for 10 minutes. A place where glances across a train say “I get it. You’re not alone.” And we went our separate ways, alone again on each of our journeys, but maybe a little less alone in spirit. I hope my little diabuddy remembers it and gives himself the little smile he gave me when he thinks of it.

The Blame Game

It happened. I hear so many in the community talk about it. It seemed common. I figured I was either just really lucky or everyone in my life magically understood. Then it happened. I ran smack into an ignorant conversation where I was blamed, told I was wrong, and then brushed off. I’ll tell you the story.

I saw someone I hadn’t seen in a while at a small gathering. Earlier in the day I had a conversation with someone else who’s been fighting Type 2 later in his life. Even with his own diabetes war going on, he still wasn’t as clear on the difference between Type 1 and Type 2. I don’t fault him. He was head down in winning back his own health and simply hadn’t invested into learning about a version of the disease he doesn’t have. Fair enough.

So the day winds on and we were sitting to eat. I was hovering around 107 and feeling good. We had a hefty amount of meat on the table that my dad and I made on the grill and smoker. But to balance it out, I had some carbs. It was a father’s day barbecue and I wasn’t going to not have a burger and a hot dog. Oh and I had an ice cold beer in hand. It was also day 1 of my infusion set so my absorption was amazing. Perfect time to indulge just a little. Invariably, the topic comes up.

The person in question immediately got on the soapbox of how I’ll never get it in control if I eat like this. I explained that I was eating that because it was well under control. She goes on to say she meant I won’t get better. I won’t make it go away and that the way I ate was why I had it in the first place.

Hold it right there!

I had to get clarity. Did she mean to say I gave myself diabetes and would continue to make it worse? Did she believe that? She did. I explained that’s not how it works. Type 1 is autoimmune. For some reason, at just about 40 years old my body decided the pancreas was the enemy carried out a full on assault. If my body wanted to attack something on itself, how about all the belly fat? I’d have gladly watched my dad bod lose the war to my immune system! But NOOOOOOOO… it goes after my poor, innocent pancreas. What did my pancreas ever do to my white blood cells to deserve that treatment anyway?

Anyway, this newly minted endocrinologist (surely she got her medical degree since last we met and that explains how she knows so much more, right?) then tells me how the other person at the table got his from his behavior (poor diet and weight management) and has lost a bout 70 pounds to reverse it.

I calmly, once more, explain that Type 1 and Type 2 are very different. This is autoimmune and there was nothing I could do about it. You wouldn’t blame someone with Crohn’s for the onset, why is it so normal to do it to our community? Multiple Sclerosis is autoimmune disease that that disrupts the flow of information within the brain, and between the brain and body. Maybe people with it just don’t read enough books to keep information flowing properly. See how insane that sounds?

She was clearly disinterested and I got a little louder and more aggressive just to make this painfully clear. I didn’t do this to myself. I wrestled with guilt after my diagnosis, knowing full well I didn’t do it. I got over that. What I don’t need is an arrogant, indignant, uninformed person reintroducing that guilt. And then came the coup de grâce. She looked away, waved the back of her hand at me, scoffed and said “yeah, ok.” And that’s when I stood up, found my wife (who was changing our little guy from this bathing suit back into clothes) and told her to pack it up. It was time to leave. I was mad, upset, frustrated, and confused all at once. I didn’t know what to say next and wasn’t ready to let it go. My wife caught the brunt of my mini-meltdown.

Early in my life I made stupid choices. I drank too much. I ate like shit. I lived outside my means. It too me 15 years to finish school and I didn’t even become a doctor; that was just my undergrad degree. I was lazy. I procrastinated. I smoked a pack a day. I ended up with an interrupted career trajectory, no money, and a listless life plan. I’ve since gotten my head out of my ass and improved everything. I have my family to think about. It’s not just about me. And beyond my wife, I have my little NickyT. I’d never under any circumstances do anything to jeopardize his life. For someone who’s known me for 30 years to be so dismissive was truly a gut punch.

And just like that we left and I calmed down and reminded myself that it’s not my fault. I logically knew that, but when you’re diagnosed at 40 you think of all the years you didn’t have it and sometimes can’t help but wonder if you could have avoided it. It took me these weeks to sit down and collect my thoughts and be able to tell this story. Every time I think of it I’m infuriated all over again. I have to get over it because although she was the first, I know she won’t be the last.

Getting a sense of all of this

In my post "Type 1 is such a prick" I told you the story about moving from finger stick sugar checks to my constant glucose monitor (CGM). I had just gotten it and was still getting used to it. At that point all I really knew was that I no longer had to abuse my finger tips with lancets and I'd get way more visibility into my sugar levels.

I've now been on the CGM for 2 months and it makes a world of difference. I lift my wrist and immediately see my sugar level. Beyond that, I see one of a variety of arrows telling me which way it's trending. This is arguably more useful than the raw number itself. 150 is a good number. Not great, but good. 150 with a diagonal arrow down is better. That means it's slowly dropping. If I have some insulin in me and working from my last bolus that means things are balancing but I have to watch and make sure I don't get low. If I have an arrow straight up that means I'm on a rocket ship over 200 and I need another bolus. This thing adds so much more context. Now add in that one critical function a watch does that we almost never actually use it for - telling time. Imagine that 150 with 2 arrows straight down, which means my sugar is dropping like an anchor. Big difference between 1pm on a Saturday afternoon, 5pm when I'm about to drive home, and 11pm when I'm about to sleep. Only one of those situations leaves me comfortable. The other 2 requires Skittles.

It also helps me decide my insulin treatment plans. I think about the last bolus. Am I still processing insulin or is this just where my number is sitting? Should I give more because my sugar is high and I'm fresh out of ammo or do I need to have some patience while it works? These are all key indicators.

The last important piece is the thresholds. I have it set to alert me below 80 and above 200. If either of those happen, my phone beeps like a lunatic regardless of my volume settings. It will also beep like that regardless if I'm in line at the airport and about to board an international flight and there are 200 people staring at me awkwardly. Not that that's ever happened. If those thresholds are broken for longer than 30 minutes, it'll notify whoever I have listed in the app. But it has its own thresholds for reporting. 70-180 during the day. 80-150 at night. Tighter ranges means even better success if I'm within range. I'm proud to say that my lowest success was 92% within range during a 7 day period. That was my worst!

What does all this data, tracking, and reporting even mean? It sounds like it's lots of work to watch it all the time and make calculations. The reality is just the opposite - at least as a function of time. Week over week I obsess less and less. It started with finger sticks giving me limited information an even more limited amount of time. Then it was limited information but frequently. Then I learned how to use the arrows and put them at the intersection of the clock, dose, and food. It became lots of information with lots of context and frequently.

Now I just often know. I can look at food and know how many carbs it is and roughly what it'll do to my blood sugar. I know how much insulin I took and roughly how long it'll be in my system. Of course I know what time of day it is. I glance at my watch and check the number to confirm what's already in my head. It no longer informs my decisions. It just validates the ones I've already made. It's a sanity check. The sensor sensed what was happening. Now I sense it and the sensor confirms or vetoes. To be honest, I'm ok at it. I'm not great or even good just yet, but it's been just 4 months since the diagnosis and 2 since the CGM arrived.

And tomorrow, the game changes again when we add a new piece of tech. Stay tuned for more.

What am I?

I’ve recently become aware of a debate of nomenclature around people who are… or have… see? This is the issue. Let me back up a minute here. Growing up, I had one very good friend who had diabetes - Type 1 specifically. Being the only person I knew who suffered from this disease (and the fact that I was 7 years old), I figured that was the only kind. As I got older, I learned there was a 2nd type, aptly name Type 2. This is the type that has been publicized and stigmatized. Type 2 is what’s talked about as a result of bad behaviors and decisions and lifestyles. When I was first diagnosed, I had a hard time explaining it to people without feeling some form of media-induced shame. I couldn’t bring myself to say “I have diabetes” without thinking this:

Wilford Brimley did diabetes commercials for years and ended up as a meme.

I would tend to say, “I am a diabetic” and when that didn’t feel right I’d say “I’m a Type 1 Diabetic.” I then realized that the difference between 1 and 2 meant nothing to many people so I started saying, “I’m an insulin dependent Type 1 Diabetic.” That was just a mouthful. In the end I’d just say “I’m a diabetic” because anything was better than having them picture me as careless and causing this myself, right?

I recently joined an online community for Type 1 folks like myself. This conversation came up. Someone addressed the group as “Diabetics!” and another member preferred to be called “A person with diabetes.” So I got to thinking. What am I?

They say the key to success in living with this is to not let it own you. I don’t. I just finished a Jersey Mike’s sub because my sugar was below 100 and it’s delicious. I treated it with the right amount of insulin and went on my way. I ate a small piece of Nicky’s Easter candy because Daddy can’t resist his little boy. If I am a diabetic, will it consume me? Am I a person with diabetes? I even did a poll with the community.

After seeing the results and reading some of the comments, which I won’t share outside of the group, I came to 2 conclusions about my stance on this.

1. I’m a diabetic in terms of how I view myself.

2. I don’t care what other people address this as.

Let’s start with 2 first. There are 2 kinds of people in my life. The first kind are the people who don’t know the difference or the stigma or the connotation and are just looking for a way to verbalize it. They mean no harm. The second kind are the people who do know me well enough to understand it all, but still don’t know the nomenclature. They also mean no harm. There may be a very small subset of insensitive assholes who do mean harm. But… since I don’t care, they’ll fail. And if they are that way to me on purpose, despite their success rate, they don’t have a place in my life anyway.

As for Number 1, here’s how I arrived at that conclusion. This isn’t like Prilosec I take for heartburn every day or something people take for high blood pressure or cholesterol. I don’t pop a pill for forget about it until the morning. I open my eyes and check my sugar. I check it before each meal, before bed, and randomly throughout the day by looking at my phone or Apple Watch. Before I eat anything, I take a check, calculate the carbs/sugar in what I’m eating and when I’m eating it, then think about what and when I think I’ll be eating next. I change work meetings around it. I skimp in some places to somewhat splurge in others. Before I leave the house I inventory my supplies of insulin, needles, alcohol pads, and candies to treat the lows. I consider where I can go out to eat and who I’m with. I’ve trained my closest friends on how to give me insulin if needed.

Short version: it’s on my mind every second of every day for one reason or another.

I’m not a person with diabetes. I’m a person with acid reflux. I take a pill and it disappears. I am a diabetic. There’s just no question about it for me. But that’s not all I am. There are lots of characteristics that make me who I am. I’m Italian. I identify with those roots and the associated customs. It’s obvious every day to everyone around me that I’m Italian. I’m a husband and a dad. Both of those are evident in all my actions. And the list goes on for all the things I am. I love photography. I enjoy taking pictures. That’s a thing I do. I can’t say I am a photographer. In all things we do in life we can determine to what degree these things infiltrate our minds and permeate our actions. And use those determinations to decide if each thing is something we have/do or if it’s something that makes us who we are. I am a diabetic. It won’t go away. I can’t ignore it for a while to do something else.

You or someone you know may have Type 1 and they don’t feel the same way. There’s no unequivocal, objective right answer. There’s just your answer. I have mine. I think it’s important to find yours. It’s how you make your peace with it. For me, if I have diabetes, it’s a thing that’s not part of me, but stuck to me. It’s a cross to bear. It’s something heavy I lug around. But it’s part of me, for better or for worse. It’s just another part of me that lives in concert with all the other parts of me. Together all parts are a holistic ecosystem of moving parts that keeps me living a good and happy and (relatively) healthy life as long as I can.

Pour some sugar in me

In the days leading up to my diagnosis, as I inched nearer to Diabetic Ketoacidosis (DKA), I felt some things like my sugar was high and some things like it was low. Of course I didn’t know what the problem was so I couldn’t associate the feelings with anything. At one point, Linda commented that it sounded like my sugar was high. She was using Dr. Google to figure it out. I was lethargic and weak. I was thirsty. The urination was more frequent than before but not by a lot.

Then there was one key component that threw it all off. I couldn’t stop drinking sugary drinks. I was buying armloads of Gatorades from the hotel shop. When I was too weak to make it downstairs, I went to vending machines for Dr. Pepper and anything else. Every sip was so good and such a relief. Cool sips of clear water from a cold spring with the Mojave at my back kind of relief. I wanted to chug it, but also just sipped it so slightly to get the icy relief.

I told Linda, my sugar must be low that’s why I need this. She disagreed based on the symptoms but admitted that high sugar and sugar cravings didn’t add up. I physically could not stop myself from drinking it. As it turns out, we were both kinda right. Most people don’t understand how sugar really works.

You eat carbs. Over time they break down into sugar, which your body uses for energy. It happens slowly so you have energy for a long period of time. It’s why marathoners load up on carbs. It’s extended release power. On the other hand, you eat candy bars or drink soda and there’s no extended release. Sugar goes right in and you have a sugar high. It gets spend really quickly and you have a sugar crash. But the key catalyst here is insulin. Your pancreas creates and secretes insulin which turns blood glucose into energy. My pancreas was busy losing the great war. I imagine the beta cells in the pancreatic islets were like the Spartan army in 300.

Upon its death, I had no insulin being produced. So sugar wasn’t being broken down into energy. That explains the lethargy. It also explains the cravings. I had no sugar getting to my muscles. It was free floating in blood. And that’s why our BG gets so high.

When I was in the hospital, I had this explained to me. My hospital doc told me that was why it felt so good. What I did made sense, given I was unaware of what was happening. But I was, of course, killing myself. And that, my friends, is when high blood sugar masquerades as low blood sugar. Add that to the list of things I’ve learned about the human body in the last 3 months.

Type 1 is such a prick

One of the most annoying things about being in the hospital is having your sleep interrupted by the nurses asking if you’re comfortable and getting enough rest. Well…I was. Then you came in here prodding me and ruined it. When you’re in the hospital for diabetic ketoacidosis there’s added fun. They stick your finger to take your sugar every 60 minutes. Not only does this wake you in a way you can’t go back to sleep, but it’s generally unpleasant and it’s always a different nurse so they don’t know which finger they hit last. Fun fact: the more you hit the same finger, the less it bleeds. Actually, it’s probably just micro scar tissue making it harder to get the blood out. Sometimes you get a 2-for-1 deal on the finger sticks.

After 4 days of prickly fun I was sent home with a meter, test strips, and a box of lancets so I could mutilate my own fingers, sans sadist nurse. I’m fortunate in that I only had to check it 4 times a day. I know of some people doing it every hour. And I do mean every. Up every hour at night to do a check. For me it was before each meal and before bed. Initially, I had a strict regimen. Eat 30-35 carbs per meal and dose insulin on a scale based on the resulting blood sugar. How do you dose insulin you ask? MORE NEEDLES!

One one hand, these are better because they don’t hit the same small part of the finger tip with a spring loaded “fuck that hurts” surprise attack. On the other hand, they go into the belly, thigh, back of arm, or other fleshy part that’s learned to be hardened to protect itself. With every sugar check, came a correction. So that’s now 6 times I got stuck. Add in one more long acting insulin shot and we have 7 stabs per day. If I wanted to be stabbed 7 times per day, I’d jog in Central Park at 2am with $100 bills taped to me.

What happens over time is you begin to flinch before the needle hits you. Now it’s a game where I see which hand is faster - the one hitting the button on the spring loaded son of a bitch or the hand ready to dart away and live to fight another day. Eventually the first one wins, I squeeze my finger tip like a 15 year old with a zit. I dribble a few drops of blood onto the test strip and watch the countdown. I sometimes silently countdown like it’s New Year’s Eve until I see the glucose number and the judgmental meter telling me when I’m over target and I shouldn’t have even sniffed that french fry, but only when I’m not cursing like a madman at the lancing device.

But just before I developed Tourettes and lost the ability to contain the obscenities, I got the call. I was getting a CGM. That’s a constant glucose monitor, ya pleb! This thing is a game changer. It’s the Dexcom G6 which is a technical marvel. And it’s my first step to becoming a sugar free Iron Man. This things is 3 parts - sensor, transmitter, receiver. You hold what appears to be a 1990s computer mouse against your gut and let the adhesive stick to you. Then you push a button and another sharp bastard jumps out and into your belly. Remove the mouse and voila you have a sensor attached (more on how it works later). Then you clip in a transmitter. And then you wirelessly connect the receiver (in my case it’s my iPhone). Now this sensor senses and the transmitter transmits my blood glucose every 5 minutes. And the trauma of the needle attack? Once every 10 days! I still have the insulin injections 4 times a day but subtract 3 sticks and add an additional 285 data points throughout the day. I now have near constant visibility into my sugar levels. And it’s all BLE (bluetooth low energy). No charging, no wires. Just magic!

Near the end of the first 10 days I started to wonder how this was happening. I couldn’t be dribbling blood. Surely it would soak through the adhesive. Plus I’d have clotted by now. If there was a needle lodged in my gut, I’d feel it every time I moved. What kind of sorcery was this? On day 10 I excitedly pulled off the sensor, and most of the hair it was attached to. Sticking out of the bottom is a 2 inch wire about the thickness of a human hair that had been inside me measuring all that time. With that, Type 1 became just a little less of a prick.

You were born in the 90s

If you thought I was holding a computer mouse

Eating dessert is on a roll

You learn a lot about nutrition after being diagnosed. Life is a day-to-day, minute-to-minute grind of what you can and can’t eat and drink. It becomes almost immediately apparent, which brands and food categories have gotten the sugar free thing right. By and large, the food industry has done a good job. The beverage industry hasn’t come as close. There is still lots of aspartame in things which tastes bad when you drink it and leaves you with an aftertaste reminder for 3 or 4 hours.

Then there’s dessert. Of the categories of food, drink, and dessert, the last of the 3 is the farthest behind in not killing me yet being tasty. I first tried to overcome the ice cream dilemma. Wink Frozen Desserts promised to be the answer to my problems as a purveyor of clean ingredient, keto friendly, plant based ice cream. Unfortunately for me when they printed Sugar Free, Gluten Free, Dairy Free, Egg Free, Nut Free, Soy Free, Peanut Free, and Tree Nut Free they ran out of room to print “and looks like dirty snow but tastes like shit.

Meanwhile this brown slush has the nerve to come out looking so happy.

Stop smiling, you tasteless bastard.

If there’s anything sure to remedy this experience, it’s chocolate syrup! And it’s Hershey’s so there’s no way it can be bad, right? Right? RIGHT?!? To give you some understanding, think of syrup poured onto a spoon. It’s viscous but quickly spreads because, after all, it’s a liquid. The sugar free version coils on itself and sits there like every poop emoji you’ve ever seen… and doesn’t taste much different (I’m assuming). Maybe 2 pieces of shit cancel each other out when mixed. Hint: they don’t.

2 wrongs make a wronger wrong

I was determined to get to the bottom of this. I ordered a book called Keto Sweet Treats. With upwards of 60 recipes, surely one got it right. I’ll go page-by-page and spend the time, energy, and GDP of Bolivia to feed my sweet tooth. First things first - where can I get almond flour and what the hell is monk fruit?

Dessert making take 1 - a giant swiss roll. With 10 servings and only 7 net carbs per serving, half of this giant thing is a meal. I mixed the cake ingredients that smelled just like the Betty Crocker variant and looked close enough. Then bake it into a sheet like this

You better be a fudgey as you look

Then you make what is effectively the filling of a cheesecake. How could that ever be bad?

Then you spread the above onto that chocolate cake slab and roll. Protip: let it cool enough that it doesn’t melt the mixture but not so much that it cracks. Mine cooled just a little too much but here’s the finished product.

I’ve had the same conversation with everyone I’ve spoken to about this.

“Me: It was good
Them: *side eye*
Me: Ok so if I could eat sugar, I wouldn’t eat this. But in the context of sugar free desserts, it’s actually really good.”

Page 1 of the book was a success. I plan to go page by page through the book testing each one. I’ll share the successes here and if you want the recipe, just ask. People I speak with tell me just to skip dessert. Health is more important. Not everyone has a sweet tooth. For those that do, ignoring it isn’t healthy. Physical health and mental health must be in sync. Finding alternatives and giving yourself what you crave is important. There always must be balance. I’m fortunate enough to have the means to search until I find it.

Climbing the diabetic LADA

There are 2 kinds of diabetes, right? Type I is often called juvenile diabetes. It's autoimmune. You're pancreas is DOA. It makes no insulin. You can be irritable and have mood changes and unintionally lose weight. It's autoimmune because your idiot body thinks the insulin producing beta cells are foreign invaders and it kills them. After the friendly fire, you make no insulin.

Type II is developed over time. Your body makes insulin but doesn't know how to use it. Stupid body. We also don't know why we become insulin resistant exactly but there are several potentially contributing factors. Weight is one of them. And you don't unintentionally lose weight with the type of diabetes that often needs you to lose weight. Stupid, stupid body. This is the kind that often costs you your feet...  and vision... oh, and life.

Now you understand how you can have Type 1 or Type 2. But if you're really lucky, you can kinda have both. It's called LADA - Latent Autoimmune Diabetes in Adults, which should by LADiA I guess, but we don't include prepositions in acronyms. Poor, left out prepositions.

Like Type 1, you can't produce insulin. Usually there's a trauma or attack that causes your body to attack itself. SO stupid. Are you seeing the pattern here? And you don't need insulin right away because your pancreas is a scrappy little guy and keeps fighting through it. Unless you're me and you've got LADA for a while. This is why it's called 1.5. It's autoimmune in that the pancreas was attacked by another part of the body until it was killed. But Type 2 in that it presents as insulin resistant since it's not an open and shut case of worky/no worky.

This is why it's hard to diagnose. Doc says "Oh, looks like Type 2. Watch your diet. Take this preemptive medication to help your body use the insulin. Check back in 6 months." This happens all while there's a war going on in your gut. And then one day you look and feel like shit and fly home in diabetic ketoacidosis and barely survive.

In my case, my pancreas was a hell of a fighter. The onset of LADA must have been going on for a long time, and my pancreas fought for survival. Being like Type 2 I was making insulin while my pancreas clung to dear life but used it poorly so I had high blood sugar with the expected lethargy. I also just finished a year of almost 70,000 miles of travel. Of course I was tired. And then when he couldn't hang on any longer and died, it became like Type 1 and I started to drop weight. I was working out and trying to eat better and drinking more water. Of course I was losing weight. And hiding in plain sight was this whole situation, until it was nearly too late. 

Sugar? No thanks! I'm sweet enough

If you follow me on social media, you’ve seen #EatLikeVig for many years. What you haven’t seen is #EatLikeVig lately. There are a few basic tenets to what qualifies for inclusion. It must be delicious. It’s likely unhealthy. If your taste buds support it, but your doctor doesn’t - tag it. Meat, cheese, carbs. Basically a full blooded Italian cliche.

As it turns out, the doc wins and the taste buds lose. I found this out the hard way. In January of 2019, I was kicking off my business travel with our company wide sales kickoff in luxurious Tampa, Florida. Arrived on Sunday and found the first Instagram worthy burger and beer.

View this post on Instagram

Beer. I like this.

A post shared by Jason (@jayvig) on Jan 13, 2019 at 11:13am PST

Monday I attended all the sessions while feeling progressively worse and skipped the team dinner. Tuesday morning I went downstair and was greeted by a horrified co-worker, who so lovingly told me I looked terrible. We found my boss, boss’ boss, and co-founder to say I wasn’t feeling well and wanted to lie down. Before I could tell them, the mimicked the horrified look I saw moments earlier. So I went to lie down. I moved my Wednesday 5pm flight to Wednesday 8am because it was clear I had a date with a doctor. I stayed in bed for the next 24 hours.

I arrived home and went directly to the doctor who told me it sounded like a blood sugar thing. I said it did seem low and I had been craving sugar. So we checked it. The meter came back with a clear reading that determined next steps - ERROR.

Quick digression to discuss blood glucose facts

• Normal - 70-130

• Let’s think about this - 250ish

• We need a plan today - 500ish

• Coma - 1100ish

ERROR means it’s higher than the primary care physician’s in-house retail meter can read. (HINT: It’s above 500). To the ER we went early Wednesday afternoon where their high grade equipment told us it was 850. I was in a state called Diabetic Ketoacidosis (DKA) with a side order of pancreatitis. I thought “I shouldn’t have anything with a leading adjective of “diabetic” because, quite simply, I don’t have diabetes. Or… I hadn’t had diabetes.

First things first. Let’s get the sugar levels down and avoid death. Then we can think through next steps. Between Wednesday afternoon and Saturday afternoon, when I finally went home, we figured a few things out.

• My pancreas quit without the courtesy of 2 weeks notice

• Flying in DKA and surviving is more luck than anything

• There’s such a thing as Type 1.5 diabetic

• I now had that thing

• Odds are high that it’s irreversible (unlike Type 2)

So what happens next? I quit sugar. I mostly quit carbs. I realized that Diet Coke is an abomination. Multiple times a day a spring loaded lancet abuses my fingertips. I Google everything I eat and count up the carbs, do some quick calculations, put back most of the food I prefer to eat, and devour the rest. Then inject myself with insulin and curse at my now defunct pancreas. The needle hurts and the insulin stings, but the good news is that it’s only for the rest of my life.

The greatest challenge is probably avoiding preaching to the general public about how awful their food choices are because I’ve now memorized the carb count of every food on the planet.

You should know that the food industry has done a good job of alternatively sweetening things. They’ve found talented food chemists, dietitians, and chefs. The beverage industry, apparently, has not.

There have been other wild wins and fails along the way and the challenges never stop. Rerouting your thought process of what to eat, when to eat, where to eat, who to tell about this, how much to say, what should you substitute vs just give up, and more is a tricky, tricky process. I’ll tell you all about it as time goes on and share some recipes as I find new ways to live with this. I’m open to suggestions if anyone has them.

In the meantime, when you see me walking around with my fanny pack just remember it’s filled with insulin and sharp objects, not 1980’s memorabilia.