It’s been one crazy year – and a very different kind of crazy than 2013 was. Since January of this year, I’ve been working a new job in the medical device industry and it has re-defined “busy” for me. My work hours are nuts. I can have meetings scheduled for 8:00 AM – on the other side of the state. I cover Oregon, Washington and Alaska, so some days can include commute times of 5+ hours by car or plane - and that’s before the workday even gets started! I’m all over the map (literally), often working early mornings, late evenings and sometimes weekends – wherever patients and doctors need me.
I love the job and the company, but it’s easily the most challenging job I’ve ever had and the long hours can make taking care of my diabetes extra difficult. But if my husband and I want to start a family soon, I need a lower A1C than I’ve ever had, so my diabetes management can’t go out the window just because I’m busy. So how do I stay on top of things when I don’t even know what state I’ll be in the next day? Read on for some of my personal tips.
Choose Low-Carb Food Options on the Road
“Treat your diabetes with some of the focus and intensity as you do your paying gig, and everyone wins.”
First, when choosing food on the road, low-carb trumps low-fat. If I’m catching a plane and stuck with the fast food options of most airports, or on the freeway for the next three hours, it can be really hard to eat healthy. Yeah, yeah, I know what the experts say: “If you really care, you won’t eat fast food, EVER!” But tell me that when I’m starving in some remote corner of Washington state that doesn’t even have a traffic light, let alone a grocery store with fresh produce. If my only option is the gas station convenience store, I will pick up beef jerky, a string cheese, and a packet of almonds and call it lunch. Sure, it isn’t a low-fat or even a low-calorie option, but it’s low carb and will have a minimal impact on my blood sugars.
If I’m on the road in a remote area, it’s a high likelihood that I’ll be sedentary for the next few hours while driving out of said remote area. I’d rather take minimal insulin for minimal carbs than trying to bolus for a banana/apple/low-fat muffin or anything else with lots of carbs that’s likely to run me high and then crash me low if I over-bolus. Small amounts of carbs mean small amounts of insulin, which means small mistakes.
Keep Up with your Exercise Routine
Second, get used to exercising ANYWHERE. And I mean anywhere. If you like running or walking, perfect! You can technically do those in any city, any time of year. But in the states I work in, that can mean rain, shine, sleet or snow, depending on the day. So no matter where I’m headed, I pack my usual workout gear plus one layering thermal shirt and one tightly packed travel rain jacket (same one I used in Asia!). That way, I’m ready for anything and can go for a jog wherever I am.
Don’t know the city? There are apps you can download and use to find pre-drawn routes just about anywhere. Or, pick an out-and-back destination that’s safe and recognizable by most, like a mall or a high school. If you get lost, people will be able to help you get back on track quickly. Sometimes, if I’m working out in the morning, I’ll jog to a nearby coffee shop and walk back to the hotel, instead of doing the in-room coffee.
If running and walking is not your thing, you can try to book hotels that have a gym, but those rarely get used for a reason: they’re not very inviting and are usually super limited in their equipment. I say have a little more fun by getting creative. I have taken conference calls while climbing the stairs at a hotel, and I’ve done squats and tricep dips while watching company-mandatory training videos.
The rule for exercise and travel is: doing something, however small, is better than doing nothing. Exercise will help you sleep better in a strange city, it will help clear your mind from a stressful day, and for us folks with the 'betes', it will have an overall glucose-lowering effect in the moment and for hours to come. Even 15 minutes can help! Don’t get caught in the trap of, “Well if I can’t do a full hour, why is it worth it?” It’s worth it because SOME is better than NONE when it comes to exercise.
Use CGM to Monitor your Blood Glucose Levels
One of the scary parts about being on the road/in a plane/in a hotel is the fear of having a bad low when you’re all alone, or worse, while driving. If you’re not on a CGM (continuous glucose monitor) and you travel a lot of work, it’s time to get one. Seriously, get over it and see if your insurance will cover it. CGM is the future of diabetes management for a reason: it allows proactive behavior instead of reacting and “fixing” things after the fact. Before and during a three-hour drive, I’m checking my CGM to make sure I’m in safe range. If I see the arrow starting to tick down when I’m say, 85mg/dL, I can have one or two glucose tablets and never even get into the dangerously low range. Same goes for highs. And the alerts on a CGM will wake you up when you’re sleeping alone in a hotel room, something you and your partner will be grateful for and sleep better knowing.
Always Be Prepared with Treatments for Low Blood Glucose
This leads into my next tip for hectic work weeks, which is to have something to treat your lows EVERYWHERE. Go to the nearest drugstore and get about 10 tubes of glucose tablets. Then put one in the car’s center compartment and one in the glove box. Put one in your work bag and one in each of the travel suitcases that you use. Then grab your laptop case and zip one in there. Get that rain jacket you packed and stuff one in a pocket. Seriously put them everywhere. Why? Because there’s nothing worse than it being midnight after working an 18-hour day, being ready to fall into bed and realizing that you have nothing in your hotel room in case you go low. If you put glucose tablets (or whatever your go-to is) everywhere, you won’t have to have that moment. Trust me, there will be a day when you go, “Thank goodness I put one there.”
Track your Diabetes Management Progress
My final tip for gaining good control amidst the craziness of a demanding job is to track your progress. If you’re working a tough job, chances are you’re constantly being evaluated, whether it’s about hitting sales goals or getting reports filed on time. We’re all beholden to the numbers these days - and the numbers don’t lie. If you feel like you’ve been gaining weight (which can lead to insulin resistance), check your total daily units average on your pump. I like scrolling through the records on my Omnipod insulin pump at least once a week to make sure my total daily units are consistent. If I see a pattern of them creeping up, I know it’s time to lower my carb intake and squeeze in some exercise.
When I download my CGM and look at my 90-day average, I can usually guess when my A1C is within 0.2 of a percent. Tracking and recording allows us to see patterns and places for improvement, and they don’t take much time or effort to do – simply knowing the numbers is half the battle. If you don’t know how you’re doing, you don’t know how much more you need to do to meet your goal.
When I set my goal of an A1C under 6%, I realized that translates to an average blood glucose of 120 mg/dL. This became my new target number and it made things so much easier than simply saying, “Do better, get that A1C down.” The goal of averaging a blood glucose of 120 was a measureable and specific goal that I could shoot for, and as a result, I’m happy to say that I’m finally at that goal, despite what has easily been the most intense work situation of my life.
It’s not easy to pay attention to diabetes when you feel pulled in a million directions by a super-demanding job with long hours and high-pressure goals. But the bottom line is that if you don’t take care of your diabetes, you won’t be able to keep up with that kind of a job for very long anyway! Treat your diabetes with some of the focus and intensity as you do your paying gig, and everyone wins.
One of the main benefits of an insulin pump is that it takes away the regimented schedules of multiple daily injections.