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The Glucose Curve

In January of 2014, Butterfly, my ten year old Lhasa Apso, was diagnosed with diabetes. We went for monthly visits to a doctor she loved, and did twice daily blood tests and insulin shots, and we seemed to be making progress. But, over the summer, her doctor left the clinic and Butterfly’s sugar started to go up and down like a roller coaster. By the fall, nice doctor or not, we had to go back to the clinic for advice.

Butterfly was not feeling well.

Butterfly was not feeling well.

The doctor who saw Butterfly in October was a per diem, filling in for the day, and he was concerned about her sugar. He made me very nervous, despite his choir boy face and laughing Scottish accent and frequent stops to tickle Butterfly behind her ears, because he said there might be another underlying health problem. He wanted me to do a glucose curve at home: starting first thing in the morning, I would test her blood sugar every hour or two, until I couldn’t stay up any longer, then I should send the results to one of the regular vets, to see if they could recognize a pattern.

But she always loves those ear tickles.

But she always loves her scratchies.

The glucose curve day was, possibly, the best day of Butterfly’s life. Every time I went to take her blood, she made me chase her around the apartment first, and after each test she got another chicken treat. I had to break the chicken treats into tiny pieces to avoid an exploding Butterfly halfway through the day. And, of course, Cricket matched her treat for treat, and attempted to climb the bookshelf to reach the bag of treats when the pieces were too small for her liking.

Butterfly's tail is ready.

Butterfly’s tail is ready.

Cricket's tail is running away.

Cricket’s tail is running away.

Cricket and Butterfly, ready for their treats.

Cricket and Butterfly, ready for their treats.

By the last blood test, at two o’clock in the morning, Butterfly was wiped out and ready for bed, but still willing to grab a last chicken treat on her way down the hall.

We made an excel sheet out of her test results, with comments about her moods, and meals, and exercise, and pooping. The vet we sent it to was duly impressed, but she said she was worried about Butterfly’s very low sugar numbers midday. She wanted us to lower the insulin dose and redo the curve in two weeks.

I liked the compliments – I really love compliments, and I especially like when my organizational skills are noticed and appreciated – but I was hoping for a different response. Anything but “do it again.” The second glucose curve, two weeks later, was closer to normal, and the vet told us to keep everything the same, and redo the test in a few months.

By December, Butterfly’s twice daily blood sugar readings were getting wild again, so I ordered extra test strips and lancets and chicken treats and woke up at 5:45 AM on December 30th and started testing her blood every hour or two, administering an enormous amount of chicken treats to get her, and Cricket, through the ordeal. We stayed up until 2 AM, or I stayed up, Butterfly took a few naps.

Nap time.

Nap time.

When we finally met Butterfly’s new vet in person, she had a theory she wanted to test: that Butterfly’s blood sugar was bouncing up so high as an over-correction to too much insulin, and if we lowered the insulin dose again, maybe things would even out. Two weeks on this dose, and then another glucose curve. This was becoming normal for us.

Cricket sniffed Butterfly all over when we got home, to make sure no extra treats had been consumed, but also to make sure Butterfly was still Butterfly. We’d tried taking Cricket with us to the clinic, once, and she spent the whole time hiding behind my legs and barking at everyone and everything. But still, staying home alone made her disgruntled and suspicious.

Cricket's suspicious face.

Cricket’s suspicious face.

Unfortunately, the low insulin dose skyrocketed Butterfly’s blood sugar levels into the too-high-for-the-meter-to-count range. She was drinking and peeing constantly, in the house and out, so even without a glucose curve, we raised the insulin back up. And, of course, waited two weeks and went through the whole day of testing again, to Butterfly’s delight. And the numbers were still not right.

I was afraid that the doctor would give up on getting Butterfly’s sugar normalized and tell me to accept that she’s just going to die sooner rather than later, and it’s not worth stressing about. But she’s my baby! And I am stressed about it! I was angry that being a conscientious dog mommy hadn’t added up to better health and better luck for Butterfly, and for my carpeting.

“What’s wrong with peeing on the carpet?”

And then Mom came up with a plan (okayed by the vet) to give Butterfly an extra unit of insulin when her blood sugar levels are high, and the regular dose otherwise. I have no idea if this will work long term, or why the doctors haven’t wanted us to try it before now, but so far it seems to be helping.

I just want Butterfly to feel better, and not need to pee every five minutes, and live forever. Is that so wrong?

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Sugar

I love sugar. Well, not straight sugar. I was never a big fan of Pixie Stix, or rock candy, or sugar cubes. But I love chocolate frosting and Nutella and Twizzlers and marzipan. I like candy in every color and shape and size. When I first watched Willy Wonka and the Chocolate Factory, I was pretty sure it was a vision of heaven. I don’t like bitter or sour very much, savory is good, salty is okay, but sweet is my thing. Sushi was a wonderful discovery, because it looked and tasted like candy but had actual food value.

One winter, Mom and I took a series of cake decorating classes. They were inexpensive, and once a week, at the local Michael’s craft store, and once we finished level one, we went on for levels two and three, and would have done level four if it had been offered. I loved making cakes, and frosting, and doing crumb coats, and lattice work. I learned how to make royal icing flowers, and animal characters out of fondant and marzipan, and experimented with Nutella cream cheese frosting. I made chess pieces and roses out of molded chocolate, and white chocolate molded flour pots with chocolate frosted dirt. I tried to make petit fours and failed miserably.

Chocolate music on a flourless chocolate cake.

Chocolate music on a flourless chocolate cake.

Marzipan fruit is just as good for you as real fruit, right?

Marzipan fruit is just as good for you as real fruit, right?

Chocolate dirt, enough said.

Chocolate dirt, enough said.

The trouble with petit fours is, even after you find the right recipe for the cake, so that it’s moist but not delicate, you need a sure hand for the cutting and placing of layers, and then you need to be willing to waste a lot of icing by pouring it over the cakes on a wire rack so that the excess pools underneath. This is where Cricket came in, waiting for the overflow to overflow.

"You can start pouring, Mommy."

“You can start pouring, Mommy.”

Cricket was an only dog during the cake decorating winter, and she made full use of her prominent place next to the table, standing by the edge as the icing dripped onto her head, or jumping as high as she could to reach the counter to inspect whatever was going on up there. She cried and scratched at Grandma’s leg to get access to the mixer as it rumbled and tumbled and created glossy white frosting. She’s not especially dexterous with her paws, so she couldn’t participate in molding marzipan figurines, but she loved to help with clean up whenever something fell on the floor. We all had a great time that winter.

Cricket, after icing removal.

Cricket, after icing removal.

But, my father developed adult onset diabetes by the time he was the same age as I am now. In fact, his brother and father also developed diabetes, and then diabetic neuropathy and strokes, and a whole host of other problems, so it is definitely in my genes. I focus on moderation, and go to doctors regularly, and eat my vegetables, and take the medications I’m required to take. I use a lot of vegetables in my cooking, because I like my food to be colorful: red and yellow and orange peppers, tomatoes in all shapes and sizes, red onions, and French green beans, and perfect heads of broccoli cut into individual trees. But I worry.

I am always being told to cut sugar out of my diet completely, that it will solve all of my health, mood, intellectual, spiritual and whatever other problems I may have, immediately, and I will have the energy of a cheetah.

This, of course, is never true. I try it, I suffer, I keep trying, and then I stop. And whether I’ve tried the diet for two weeks or two months or two years, someone is always certain that if I just tried a little bit longer it would all work out and I would be perfect. I’ve tried sugar free, and dairy free, gluten free, and wheat free, and it’s all terrible and squeezes my brain until there is not even one drop of serotonin left and life is not worth living. Mom tells me that too much sugar makes her feel sick and tired, but I’ve never felt that way myself. I might refuse to notice such a thing.

My father went on a high protein diet, eventually, to try and manage his diabetes and ate mostly chicken and spinach. This would not work for me at all, but it would be Butterfly’s ideal, without the spinach. Butterfly, my ten year old Lhasa Apso, has diabetes too, but her diabetes is more like type one, or juvenile onset diabetes in humans, and is controlled by twice daily insulin shots. She also has a special diabetic-friendly kibble and eats a lot of chicken, though not as much as she’d like.

"Yummies?!"

“Yummies?!”

She doesn’t look or act sick, unless her sugar gets very low, and then she gets maple syrup on her gums and she bounces back. It’s a relief to know what’s wrong with her and how to fix it. For Butterfly, sugar is directly related to how she feels every day; no matter how much she craves things like pizza crusts and pancakes and bread, which were among her favorite things in the world before her diagnosis last year, she’s better off, and happier, without them.

The same isn’t true for me. There is no diet that will fix what’s wrong with me, at least that I know of. And while, theoretically, I’d be healthier overall without sugar, I would not be happier, or even happy at all, with a diet like that. I tend to think, and I know this is not the prevailing view, that a little bit more sugar in our diets might help us like each other a little bit more. Maybe I should try to make those petit fours again, and pass them out to my neighbors. I just have to make sure that the icing doesn’t drip to Butterfly’s level. She’d be licking the floor for days.

Cricket, licking the bowl.

Cricket, licking the bowl.

Butterfly, staying on her diet.

Butterfly, staying on her diet.