The Bigger Diabetes Picture

After months of struggling with my Minimed Continuous Glucose Monitor Carelink settings, I’ve finally done it. I’ve figured out how to upload all of my CGM information to the big Carelink cloud in the sky. And I’m uploading that information every few weeks, so that I, and my Certified Diabetes Educator, can look over all the pie charts and line graphs and color-coded calendar icons and make changes to my basal rates and carbohydrate ratios on a more frequent basis.

I should be proud of myself, and I am — to an extent. This whole baby-growing-in-my-diabetic-body thing kind of forced the issue, so I finally committed myself to spending an hour and a half on the line with Minimed’s technical service team. Some poor soul named Aaron patiently walked me through the wonky process of tricking Java into working on my home computer’s operating system (it’s a long, nerdy story), and for the first time since I’ve had the CGM, I felt like a full-fledged diabetes robot.

The first few uploads were thrilling, as ridiculous as that sounds. Here was my entire diabetic life, recorded in detail and illustrated in full color, ready to share with the world. Unfortunately, it only took me a few weeks of uploading and reviewing to realize: here was my entire diabetic life, recorded in detail and illustrated in full color, ready to share with the world — and that picture isn’t always a pretty one.

Skiing, anyone?

I call it “Still Life with Dead Pancreas.”

During my first pre-natal visit to my CDE, she brought out several weeks’ worth of printed records. The lines on the graphs peaked and plummeted, jerking up and down according to those diabetes variables we all know and love: food, stress, exercise, baby-building hormones. A devastatingly narrow green rectangle ran the length of the chart, representing the range that those lines should have been confined to. Instead, they were dancing all over the place.

“What do we think’s going on here?,” my CDE asked, gesturing to a mountain range that spanned the 6 p.m. to 10 p.m. landscape of the chart.

“I’ve been low a lot in the late afternoon,” I guessed. “I think some of this may be me over-treating the lows right before dinner. And I had pizza a couple of those nights.”

She pointed out a few other trouble areas, and we made some small changes to my afternoon and overnight basal rates — no big deal. But ever since then, I can’t look at my 3-hour or 24-hour CGM display on my pump and not imagine how it will look when it’s printed out in a few weeks at the Mayo Clinic.

It’s not particularly healthy, but I’d gotten used to viewing my blood sugar fluctuations in tidy little easy-to-swallow snapshots.

This never happens, by the way — which is why I took a picture of it.

The ridiculous thing is that this is why I signed up for this CGM adventure in the first place — to get this vulture’s-eye view of how diabetes behaves on a day-to-day basis. It’s just that now that I have it, I miss my days of relative ignorance.

Diabetes is just one of those things that’s infinitely easier to deal with when you take it one niblet at a time. If I woke up every day thinking about all the blood sugar checks it’ll take to keep me on track for the rest of my life, I would never get out of bed. It’s the same thing with these graphs, even though they’re retroactive. I look at those lines and that little green rectangle and, even though I’ve been doing this for 21 years, I think, “Wait — this is my job? I’m supposed to control this shit? Every day?”

Yes, the graphs are useful — even the Pac-Man pie charts that show you how much your management sucks or succeeds on any given day — but each one challenges the “A1c is just a number!” mentality of self-forgiveness I’ve worked so hard to cultivate.

The perfect response here, I understand, is to view this information as motivating. After all, it’s there to help, right? I need to remember, especially now, that even though everything’s not completely within my control, I’m lucky to have the technology it takes to kick diabetes’ ass, no matter how unattractive the big picture is.