The Top of the Mountain

Everything was going great. I felt like I was FINALLY achieving control of my diabetes and started making strides instead of incremental positive changes. I just left my endocrinologist with a rave review and my first 6.1 a1c in maybe ever. Soon after that appointment, my wife and I began caretaking a ranch in eastern Montana. The abrupt change in my routine sent me into a two-month rollercoaster ride. Diabetic burnout was setting in HARD.

My wife and I are both working remotely for the stretch of this caretaking gig. On top of getting ahead of day jobs, our volunteer duties include watching over this property, acting as a resource for hunters who had permission to hunt this ground, and being friendly neighbors for those working the land around us. The cherry on top is hunting season, and living on the ranch cut our fuel costs to and from productive hunting grounds in half.

I noticed I started losing weight about halfway through the archery season, which is normal when you’re lugging a heavy pack in rough country day in and day out. The Control-IQ settings on my Tandem t:slim X2 seemed to be making overzealous corrections that would send me plummeting on hikes when I was trying to keep some carbs on board for an extended mission looking for elk. When I tried to have enough carbs on board with a reduced bolus, my sugars spiked upward more aggressively than usual.

The author has a low blood sugar while packing out pronghorn quarters on the prairie. Photo: Jordanne Kemper

The Burnout Balancing Act

The balancing act of diabetes is exhausting. When the management needs of my diabetes change, getting back up to speed can be brutal. Little inconveniences mount and build into an everpresent diabetic burnout. Subsequent road bumps are enough to make you want to quit. If you have diabetes, you likely know this feeling well. If you’re newly diagnosed, these frustrations will come over your tenure. Don’t let the disappointment weigh you down long. This, too, will pass.

Sometimes, we all need the reminder that we’re not immune to those angry, frustrating days–no matter how long we’ve been diabetic. Even the most experienced diabetics get burned out and have days where all they want to do is scream at the world.

Two weeks ago, it was time to refill my insulin prescription. It’s the first insulin script I’ve filled since starting my new insurance. When I placed the order, I went back and forth for a week, trying to get the script through before discovering that I needed prior authorization for the prescription. I’d heard the term “prior authorization” before, but I never knew what it meant in practice.

The pharmacist informed me that insurance companies prefer certain medications you can use. Using a different form of medicine requires a notable exception from your doctor and a specific reason why you need a different medication instead of the one insurance prefers. After using the type of insulin I’ve used for over 18 years, I was astounded that a company that did not know about the day-to-day of my diabetes could tell me what I could and could not use. After aggressive ups and downs over the last two months, introducing a new medication while being 6 hours from my doctor was the last thing I wanted.

Go Towards the Light

More often than not, you have to roll with these bureaucratic punches. I wasn’t happy about it, but I figured I’d get the script, let my numbers further implode from what was great control only three months ago, and have a reason to go back to the insulin I’ve used since I was in fourth grade. I was exhausted and tired of being jerked around.

What happened next shocked me in the best way possible.

STABILITY. For the last week, I’ve felt I could cruise through my day without rage bolusing, going for a walk to bring down a high, or interrupting my workday to smash a pile of fruit snacks. I’ve had three consecutive days of 90% in range. It’s a strange feeling.

I know it won’t last forever, and diabetic burnout ebbs and flows. But maybe this new insulin is what my body needs. On principle, I’m still pissed about the insurance company’s fingers in my business, but I’m grateful there’s a light. Whenever I feel like giving up, there seems to be a light just when I need to see it. Be patient. Keep fighting.

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