The summer of 2013 was the first summer I ever had to think about food and drink consumption and activity levels. After 37 prior summers of “absolute carefree freedom,” it was eye-opening, mind-numbing, and so many other things. Early in my diagnosis last year, I began to see that you can’t control what you don’t know, so I implored my endocrinologist to sign off on me getting the Dexcom G4 CGM—all just prior to summer—knowing that it would enable me to have better blood sugar control and less fear of lows brought on by summer’s extra levels of activity.
Some of the daunting things I had to learn about were how to “bolus down” or “carb up” for summer’s activities. I learned how to “bolus down” if I was going to go for a family bike ride or mow the lawn just after dinner. I learned how to “carb up” before spending a couple hours swimming with our kids at our local swimming pool or run a few miles. Our kids love going to one of our local ice cream stands on the particularly hot, sticky days of summer, so I quickly learned how to estimate the carb counts of the various ice cream treats. I learned how to count and dose for s’mores that our family enjoys around our fire pit. When we would go to the area’s festivals, I would try to plan advance which “fair food” would be easiest to bolus for. The our kids wanted a special treat such as a funnel cake, I learned how big of a piece I could have for each unit of insulin that I wanted to dose. If I wanted to share some of the fair’s fresh-roasted glazed almonds with my husband like we’d done carefree for so many years, I had to try to bolus a few minutes ahead of time and take a stab at figuring out how many carbs with half of the container was. If I happened to guesstimate wrong, the CGM would clue me in so I could either have more carbs or dose more insulin after double checking with a fingerstick reading. Yet I began to learn that while walking around the festivals all evening, I had to be extra cautious about over-correcting with insulin because of the effect that sustained mild physical activity would have.
What shocked me the most was how truly unnatural it felt to live with a chronic condition such as type 1 diabetes. The innocence of sipping a few glasses of lemonade or sharing popsicles with the kids was gone. Even sharing an all-natural treat with them like fresh apples sprinkled with cinnamon took so much thought and calculation. I had no idea what an obscene amount of forethought would have to go into these nostalgic and previously enjoyable activities. I became familiar quickly with a myriad of dosing-based scenarios such as knowing things like which direction blood sugar levels were headed and what anticipated activity levels were going to be. And one of the most frustrating things was learning that I could eat the same, bolus the same amount and timeframe in advance, and have the same activity levels two days in a row, yet have entirely different blood sugar results. This again reinforced how essential a tool like a CGM is when trying to manually control a process that our bodies lost the ability to do.
But what I learned last summer in living with type 1 diabetes that I plan on building on this summer and many more summers to come, is that while type 1 diabetes is absolutely not a normal way to live, so many good summer memories can still be made with it. Most importantly, I learned that my husband and I could still have unlimited summertime fun with our two little boys—it just takes more foresight and planning, but I’m hopeful that in the years to come, the technologies that become commercially available to us all will make the summertime pleasures more like what they were prior to the attack on our pancreases.