To test, or not to test...

DSMA Blog Carnival Question: What types of decisions and frequency of diabetes related decisions do you make in any given day?

My man, Shakespeare (or Hamlet), had the question phrased right even though he missed my topic. There are so many questions that role around in our minds all day long. Especially as a diabetic, the questions seem like they never end. I don't think that it's ever "noble" to choose laziness or indecision over responsibility or action but I can't say that I always represent myself as Queen of my diabetes...

I had a professor in my Freshman year of college tell me that computers are dumb machines. You tell it what to do and that's exactly what it does. So if it's malfunctioning, there's a good chance the problem lies between the keyboard and the chair (aka you told it something other than what you meant to). Whenever I think of decisions, I think of that little snippet of wisdom.

Making diabetes decisions isn't as nearly as easy as writing a computer program (okay, that's pretty difficult sometimes). I can't say if this crazy number appears, then I need exactly this much insulin to fix it (even though I wish I could). I constantly have to keep track of all these extra variables (sleeping, eating, exercising, etc) and my simple little if-statement blows out of proportion with extra clauses. If I ate, did I eat more protein, more carbs, or more vegetables? If I bolus, did I account for how long it takes my body to break down an apple versus pizza? Did I remember to subtract some for all the extra exercising I'm planning? Is it enough aerobic exercise or is it anaerobic and am I going to need more or less insulin? AND how do all of the answers to these gigantic questions come together?

The toughest decision I make is the one I run into most often. Should I test my blood sugar? Do I ever really want to test? NO. It's really that simple. But without knowing that little piece of info, it's like wandering around in the dark without knowing anything about where I am. Yes, sometimes I'll treat based on what my Dexcom (aka my blood sugar etch-a-sketch) says, buzzes, or screams at me. I don't feel good about it, but gosh darn it, it's a whoooooooole lot easier. I wake up every morning struggling with that decision. It plagues me at lunch when I realize I left my tester at my desk or in my car, and I really don't want to go wait any longer to eat. It nags me at night when I haven't checked, but I'm already tucked into bed. The way I understand it (and explain to everyone else too), I'm SUPPOSED to test:

• Whenever I wake up (yes it can happen more than once if I nap) [Let's guess once for this example]
• Whenever I go to bed
• Before I eat (Between 3 and 6 times a day) [That's why eating 6 meals in CRAZZZY but good for you nonetheless]
• 2 hours after I eat (Between 3 and 6 times a day) [post-prandial test. I despise them]
• Before I exercise
• After I exercise
• Before I drive my car
• Anytime in between when I feel "off"

So for anyone keeping track, that's a minimum of 10 times and a maximum of 16 times I "should" test everyday assuming I don't feel low or high all day long and don't drive. If I sleep for 8 hours, that means I’m testing about once an hour if I divide that maximum number up evenly. Do I ever test that often? Sometimes. Everyday? I'd lose my mind. Usually it's between 4 to 7 times a day that I stab my cute little fingers. I really can't stand doing post-prandials unless it's in preparation for a snack or I feel off.

For brevity, I won't talk about the decisions revolving around food or actually bolusing insulin. They occur way more than 3-6 times a day (somedays it feels like I’m hungry every second of the day). I won’t talk about the decisions I make in fear of low blood sugars (like drinking an extra swig of juice), high blood sugars (why, yes I’ll treat those double up arrows even though I know my continuous glucose monitor will be nose diving in ten minutes), and glucose roller coasters (how long can I go, eating nothing but vegetables and drinking nothing but water?). AND we really won't discuss my aversion to changing my infusion sites or sensors (REALLY REALLY hate it) and the decisions that those devices add to the situation (yes, I should put those extra supplies in my bag even if I'm going out on the town).

What makes diabetes really overwhelming is that I can't pass some of those decisions along to someone else (like when I tell my roomies to decide what our plans are for the evening). These silly diabetes decisions stick to me like glue. And when I decide to do nothing or be lazy, I end up paying the price with a hyperglycemic-hangover or a hypoglycemic-slump.

If I could build a little decision making diabetes robot or some sort of awesome diabetes-centered Magic-8 ball, then I would in a heartbeat. I'd save my decision making power for more important life and fun decisions. I'd instantly forget about how many silly Diabetes decisions I have to make every moment of every day and instead, spend more time deciding how big my smile should be or the minimum amount of sunshine I need to soak in a day to appropriately fuel that grin.

This post is my October entry in the DSMA Blog Carnival. If you’d like to participate too, you can get all of the information at http://diabetessocmed.com/2011/october-dsma-blog-carnival/