Are you asking what a rage bolus is?

In case you are, it’s the act of giving insulin, often much more than you need, when you’re really angry at a high glucose reading that you can’t immediately explain, or one that refuses to come down.

If you read any diabetes blog or forum enough, or have it yourself, you’ll know that for many people with diabetes, in all its incarnations, it’s a 24 hour job to look after it. Yes, even when you’re sleeping you have to make sure before you rest your weary head, that you have calculated and mashed together, to the best of your ability, food, insulin, activity, stress and more, so that your blood glucose won’t go low or high overnight.

There are very few things in life that you can’t take a break from – even for one day, let alone a week or two of blissful holiday. Diabetes is with you 24 hours a day and it has to be managed 24 hours a day.

So now and then I get cranky with it. Even though I know a lot of the science, on occasion, diabetes doesn’t behave as expected.

I probably under report every last bit of the bad stuff here on this blog, but tonight I’m sorely tempted to put some very raw feelings on the screen.

It’s more than annoyance and less than outright anger – somewhere in between. Let’s see if I can contain myself.

Here’s the scenario:

Dinner: BBQ
Food: Hungarian cabbage salad (oil, vinegar and a tiny bit of Splenda – a scant teaspoon for a whole cabbage), steak, tomato, cucumber, avocado – just with salt, half a corn cob (as a treat) with some butter.
Drink: Water and some diet mineral water.

Easy to bolus for? Supposedly! On paper, other than the corn, it’s lowish carb. I’ve bolused for this kind of dinner a gazillion times and been fine. Hadn’t eaten for many hours before.

I calculated about 30gr carbs, figuring that I would probably have maybe 1.5 loosely packed cups of cabbage salad (I could eat that stuff all day long!), half a tomato, the half cob of corn (definitely not low-carb), 3 slices cucumber, plus I also bolus for protein and fat and a few extra carbs for the diet soda (the one I drink has 3g carbs per glass). It would easily be way less “carbs” if I didn’t add in 50% of the protein and 10% of the fat (TAG bolusing).

My BG was were I expect it to be when I’m not eating – perfect. Total already bolused for today 20gr carbs. Am happy with that.

I entered the carbs into my pump, went for a combo bolus of 2 hours (very thick steak with fat) and thoroughly enjoyed my dinner, with the steak rested well before I started eating.

I really thought I did everything right. Apparently not…

At 2 hours I checked my BG and it was fine – just inside normal and the combo bolus was just ending so the insulin should still be working and keep working for another 2-3 hours as the rest of my dinner hit my bloodstream.

At 4 hours I should have stayed within normal range yet I was way higher, totally on the wrong side of normal. Not too much but enough to make me cranky. Diabetes you are not behaving tonight!

Did I underestimate the carbs? I didn’t think so but I probably did – it was probably the steak that I didn’t calculate properly. I thought I did a small overestimate on the total I should bolus for, but thinking about it and checking some nutrition info, I’ve probably under-bolused for the steak.

Insert expletives, because I don’t want more fat-promoting insulin. More expletives because I must have screwed up. More expletives because I don’t want to be dealing with this right now. Rage bolus coming up!

At midnight, my angry fingers dialled up more than what my pump suggested.

Two hours later (2am) and I was back inside normal but not where I usually am. Technically I should have gone low.

Hmmm… more expletives. Another rage bolus, but this time more rage than bolus. It’s now 3am and I’ve stayed exactly what I was at 2am! What the bleep?

So what is it? Insulin not working? Pump site not behaving (it’s behaved fine the last 48 hours)? Total screw up on the carbs and how long they would take to hit my bloodstream?

It’s easily 7 hours since I’ve eaten. Seven hours for a steak to keep working? I’m not so sure about that but in case it is… holy cow (pun intended)!

So now I’m faced with changing out my pump site and going to bed. Never a good idea! It’s much better if you hang around awake to make sure the site is working and that you have a stable blood glucose before you hit the pillow. Or do I have another rage bolus? Maybe it was all that swearing that caused the stress that caused the BG to stay up. We all know how the just the tiniest amount of stress sets me off.

Don’t know what I’m going to do yet. I still have hope that all the insulin I’ve taken will do its job or the dinner I had won’t keep repeating the BGs I don’t want!

It occurred to me today that I’ve only ever physically met two other people who wear an insulin pump! The first was a young man who was visiting Byron Bay and who showed me how his pump operated, not long before I got mine. His demo was a great experience for me. The second person was my Animas pump-start rep.

Now that I’ve moved to a more populated area, I’m hoping I’ll meet more pump users. While the Diabetes online community (DOC) is teaming with pump users, and I’ve come to know many of them over the past couple of years, talking face-to-face with others seems to be quite a different experience.

I was a bit worried about getting a new Diabetes Educator up here. I’ve known about one DE who is in private practice in this area. I wasn’t sure I could afford appointments with her, but since I’ve made further enquiries, it seems I can. I’m really excited to be seeing Deb Foskett from Insulin Pump Angels. She not only comes highly recommended but has won awards as a DE. I’m not sure when I’ll be seeing her yet, because I need to get some referrals from my family dcotor, but I’m hoping it will be soon.

So that’s one worry about being in a new area, organised and solved!

I’ve also had an endo recommended to me, so I’ll give him a go too. Apparently appointments take a while. No problem – I’m not so eager to see an endo right now.

Being up here has played some havoc with my diabetes. I have no idea why. I’ve had to increase my basal by a quarter of a unit for about three quarters of the day! Yet, I seem to be more active here! I’m still going to have to tweak the basal a tad. It’s not quite right yet.

I’ve been in the pool nearly every day, and I’m still working out how to avoid higher BGs when I get out, despite exercising in the pool. I must say that with all my aches and pains, I’m feeling ever so comfortable swimming and floating around weightless and cool. It’s hot here – so far, not as hot as it can get, but hot enough. (Read: too hot for me.) The pool is a godsend!

The winters here, like Byron Bay, will be glorious! Few more months before that though.

Annoyingly, I’m getting raised BGs after some very low-to-moderate exercise in the pool. Really, there’s hardly any effort at all in 30 minutes of swimming, floating and walking in the pool.

What usually happens to me is that the first lot of increased activity for the day raises my BG and the second lot (if there is one) lowers it.

I’ve not yet experienced this amount of swimming on a pump, so it’s an experiment in itself to see how I’m going to manage it. So far, I’ve only been in the pool once per day. It’s such a hassle to peel off that miracle suit (which doesn’t work because I still look like a beached whale), shower the salt water off (yes, it’s a salt water pool) and then wait for the swimsuit to dry again before wriggling and struggling my way back into it. A second swim will have to wait for a second swimsuit! Those suits are hard enough to get on when they’re the right size. I think mine is one size too small! Maybe time for two new ones?

I’ve tried eating a small amount of carb before I get in the pool, taking a bolus and then taking my pump off for the 30 minutes. It didn’t work so well. I’ve tried doing nothing. That didn’t work well either. Next experiment is just a small bolus without any carb. Two hours after swimming, I’m still not going any lower and I always have to bolus.

I’ve only just ordered replacement parts for my Animas that will ensure it is waterproof. They should arrive in the next couple of days, so I’m not worried about managing all this without the pump on for the swim-time. I will pay closer attention when I get the parts and I can wear the pump while swimming. That will mean no break in basal insulin and I’ll get a better idea of what my BGs are doing both in the pool and a couple of hours later.

I haven’t gone anywhere near the gym yet (which is right next to the pool). I’m hot and sweaty enough and that gym looks like pure torture! I’ll leave the gym to the cooler days/months.

A change in lifestyle often means a change in insulin regimes and a learning curve to figure out what’s right. That’s on top of seasonal changes in insulin needs. I’m hoping that Deb (the new DE) can give me some help as well.

My right hand is doing ok. Still can’t fully straighten the middle finger, but I’m sure that will come. My stitches come out on Tuesday. Shortly after that, we move across a state line and into a different life.

I am so sad to be saying goodbye to the beautiful, peaceful, alternative place I’ve lived for the last 11 years. I have truly loved it here and wish I could stay. I wake to the sound of birds and go to sleep to complete silence or the sound of the sea.

I go into town and it’s all about relaxing and getting your life together the natural way. Massage therapy on every corner, naturopaths, chiropractors, alternative medicines, organic food, interesting restaurants, incredibly talented buskers on the weekend, monthly markets and weekly farmers markets and best of all, healthy fresh air, untainted by diesel, crowds or horrendous honking-horn traffic.

We have no buildings over 3 stories and no traffic lights.

A beach is never far away – either in the bay or seaside. We live two streets from the beach and sometimes I can smell the sea air amongst the sub-tropical gardens of the beach house I’ve just sold.

There are a list of reasons a mile long that explain why we’re moving. I’m not going to bore you.

We’re going soon and I can’t afford to have any regrets. I just know I’m very sad to be going and I’m not looking forward to what amounts to ‘big-city’ life again.

Know how people sometimes ask… if you could do anything you want, live anywhere you want, what would that look like? I’ve been living that dream for 11 years. I never thought for a second this would end.

It’s a case of circumstances beyond my control.

They say that moving is one of the most stressful times of your life. It probably is. Moving and the death of my best friend in the same year… more than I bargained for. I think this whole year has been one big stress for me in so many ways.

Moving and diabetes doesn’t necessarily go together. The spurts of activity play havoc with blood glucose levels. It’s imperative for me to test more than usual at the moment.

I’ve had the move planned for a while and I was adamant that I didn’t want to do all the packing in the last week. Over a couple of weeks, I packed about 30 boxes before my hand op. That was great and fairly easy. And yes, I had some near hypos. I also had trouble getting up off the floor where I sat, packing. I feel so old!

It’s also too soon to be taking down artwork or leaving myself with nothing to wear or cook with. So I’m taking it easy on the packing front and getting caught up with all the phone calls and other things I have to organise.

My movers have been engaged to do the last bit of packing for us. There will be a good few hours left with a few packers.

I’m a list maker by nature and for the past several years, I’ve made those lists on my computer. Now, with my Macs (desk and lap), iPhone and iPad, those lists go with me everywhere. They get checked off one by one and added to on the fly. Making lists for a move eliminates about 50% of the stress, I suspect. Or is this the calm before the storm?

The one thing I really feel is my lack of energy of late. Don’t know what that is. Maybe just age, as I said.

I may be able to take it a bit easy this move, but diabetes never takes a holiday. With activity increasing over the next week and my larder getting more and more empty, I will have to be even more careful about lows and not eating well.

I would love to hear how others manage moving house with being on insulin or other meds. Did you find you had lots more lows than usual?