April 30, 2022

Yesterday was a day of direct correlation.  For every bite of carbs, the levels increased.  For every unit of insulin, the levels dropped.  

Dinner was an indulgent meal of Chinese take-out, which has a fair amount of carb in the sauces even if one avoids the rice.  I bolused six units of fast acting to counteract that meal.  It is usually my high end.  Not everyone typically uses those amounts of insulin.  Others might use more for a large meal.  It depends on one’s insulin sensitivity.  

The amount seemed about right for me because it brought my levels right to about 100 mg/dl.  I bolused five units of long acting insulin for my overnight, and went to bed.

What I found when I woke was that I must have still been actively digesting dinner because my levels rose to 144 overnight. That is not an alarming amount, but more than I expected because five units of long acting will usually keep my level overnight.  

This highlights why having real time feedback is so valuable in blood sugar control.  It is a dynamic system with inputs and outputs that are always fluctuating in ways that are hard to anticipate and quantify.  Dynamic reaction to what is happening in the moment is valuable.  

As for my overnight levels…meh.  No biggie.  I’ll keep this pattern in mind the next time I’m going to bed without a workout after a large, yummy meal of Chinese food earlier in the evening, and perhaps consider giving myself an extra unit of long acting insulin.

That me, Managing It at Sugar vs. Treadmill.

April 28, 2022

I’ve got screenshots of two time periods over the last 18 hours.  The first is from the 24 hours up to 9:00 pm last night, and the second is of the 24 hours up to 11:00 am today.  Of note is that yesterday showcased two long steady climbs from the low end of my range to the high end of my range.  I didn’t intercede as perhaps I should, to have keep them levels from getting so high, but eventually I moved to bring them down from the 170’s.  

This second screenshot is from 11:00 am today.  You can see that the curve starts high on the left side – around 175 mg/dl, and then drops.  That is the peak of the curve from around yesterday noon.  

The level resets to about 115 mg/dl, then starts to gradually climb again.  My walk just before 18:00 (6:00 pm) may have kept the levels from climbing faster from my snacks at that hour, but the still climb faster than before eating.  

When I sit down to have dinner, I over react to the fact that I’m starting dinner around 175 mg/dl, and bolus more than I need.  The drop starts so quickly, that I realized I over compensated for the high start point and the food of dinner.  A bit after dinner, I eat some chocolate and sweets to curb the decline.  It works, the levels flatten for the duration of the three hour window of effectiveness, and at the end of that window, they stat to climb again.  

They top out at 130, and then began to hover in the high 120’s.  As I went to sleep, I decided to take the edge off with a single unit of fast acting insulin and four units of long acting (for overnight).  That kept my overall levels under 130 mg/dl until around 06:00.  

Under normal circumstances I would be revving up to start the day around 06:30, but I slept in this morning because I had a lazy morning and a chance to recharge my batteries.  My levels stayed relatively level throughout the morning.  I take comfort in the fact that I’m still producing enough insulin on my own to stay relatively level if I’m not eating anything…most of the time.

That’s me, Managing It at Sugar vs. Treadmill.

April 27, 2022

Yesterday I started the day off with a decent BG level from overnight after working out for an hour before going to bed and not bolusing any long-acting insulin.  I decided to repeat that experiment last night and see what transpired.

My levels rose as I got up and prepared for the day, and they continued to rise after breakfast.  Because I planned to do desk work rather than head out and about, I bolused three units after breakfast and brought my pre-lunch levels back into target range.  

My lunch was fairly ambitious and a decent quantity, so I ate, and then went for a 30 minute walk.  When I got back, my levels started to rise anew, so I bolused another three units of fast acting insulin.  That brought my levels down temporarily, but lunch had been big, so I must have still been digesting.  The levels started to rise again after the insulin wore off.

Dinner was relatively low-carb, but it did not change the trajectory of my increasing BG levels.  They continued to rise.  I didn’t bolus because I planned to go for a walk after dinner, and didn’t want to get stranded out, away from the house with my levels crashing. The walk at 8:00 pm brought my levels down to about 140 mg/dl or a touch higher.  When I got back, they started to climb again.  

The fact that the curve from 8:30 to midnight rises and then falls suggests that I was finally done digesting dinner.  To bring the levels down to my target range, I could exercise on the elliptical, so I did.  (Had I not been able to, I would have bolused in order to bring the level down into my target range.)

As a separate matter, I’ve noticed that aches and pains start to crop up after a couple days of not exercising and stretching.  So not only does the exercise bring my BG levels down, the sessions help my overall wellbeing.  For that reason, I decided to see if I could take the session to an hour long, rather than stopping just as my BG level reached 100 mg/dl.  

Unlike the night before, I did not crash into the lower bound of my target range and start sounding alarms on my CGM.  The level dropped to about 70 mg/dl.  Then it started to climb.  I went to sleep as it hit the 90’s.  I wanted to see if it would steady there, climb overnight, or drop.  

Turns out it continued to climb.  Luckily, it did not climb so rapidly that I exceeded my target range.  Instead, I woke around 125 and it then quickly climbed to 135 mg/dl.  

I could speculate on what might be the reasons for that difference between last night and the night before.  The most likely reason is that I didn’t sleep as long last night.  I would do better to get more Zzzz’s.  So there you have it.

I’m Managing It at Sugar Vs. Treadmill.

April 26, 2022

I started the morning just above 100 mg/dl.  With breakfast, my levels rose.  Just before lunch time, I was faced with the reality that they had not dropped of their own accord.  I could try to work the BG off, or use insulin.

 Because the pre-lunch level was about 150 mg/dl, I decided to have an early lunch and bolus insulin to help offset the morning rise as well as the blood sugar that would come from lunch.  I chose four units to bolus.  You can see my BG levels immediately start to rise, and then the insulin kicks in and they gradually decline.  

That took me to dinner in the 90’s, which was a great soft landing for the early afternoon.  As I start preparing dinner, I nibble and snack, and my levels start rising again.  Dinner itself is relatively low carb, so it doesn’t cause my levels to spike, but neither do they come down.  By the end of the evening, I’m still above 140 mg/dl.  I can see a gradual reduction beginning, but I’m higher than where I’d like to be before going to sleep.  I’m faced with the choice to bolus or exercise.  It’s the Sugar vs. Treadmill choice.
Instead of just exercising like normal, I decide to try an experiment and extend beyond the 30 minute period to 45 or 60 minutes, and even cause my BG levels to drop below the alarm level.  After an hour, my levels drop to 55 mg/dl, but they bounce right back up as soon as I stop.

My query was whether they would rise softly back to a reasonable level, or would they spike up to over compensate.  Rather than bolusing a long-acting dose as I normally do before going to sleep, I decided to bolus nothing and see what happens.

Last night, I was interested to see that they rose slowly to the 80’s, and then they flattened there. (It doesn’t always happen this way.  That’s what is so dynamic about managing BG levels.  Things are always different.  Rather than assume things will be the same as always, I have to remember that they will always be different.)

In the middle of the night, the level dipped low and bounced up and down a bit, ending by morning just above 100 mg/dl.  As far as soft landings, it was a pretty good night.

I’m Managing It at Sugar Vs. Treadmill.  

April 25, 2022

Sunday’s food intake was more consolidated than it had been on Saturday.  We stayed home most of the day, running only modest errands and doing projects.  

Breakfast was a good match of insulin to food.  Lunch was not enough insulin, resulting in the levels rising without dropping.  After dinner, they rose further, so then I over bolused with five units.  I then watched my levels start to drop quickly.  To fend off a crash, I ate some chocolate and slowed the rate of BG dropping. 

The most interesting feature of yesterday’s data is that I swapped sensors at about 1:30 am.  When sensors swap, there’s a two hour obligatory warmup period when the CGM publishes no data.  Because I usually swap my sensor before I go to bed, that gap usually happens in my sleep.  The catch is that the first hours of a new sensor can also be erratic.  I see this in last night’s data.  It was high then it was low.  It is unlikely that my actual BG levels were doing that.

 By the time I woke at 6:45, it caught its stride around 120 mg/dl and started leveling off.  That seems credible under the circumstances, so I think it is reflective of my actual BG level.  We’ll see tomorrow morning in the recap on today if I am/was correct. 

April 24, 2022

During the day on Saturday, I let my levels linger near 140 mg/dl.  That’s not great.  It was largely the result of grazing/snacking during the day.  I was moving about, but also snacking, and as a result, there wasn’t any specific exertion that brought my levels down.  The fact that I didn’t eat a big meal meant that bolusing some fast-acting insulin might bring me lower than I wanted, especially if I started exerting myself in an unscheduled activity.  Weekends are unpredictable, so that was always a possibility.  

Then we decided to walk to a friend’s house in the evening, so I didn’t want to set out on that excursion with insulin in my system because it would cause me to crash, so I held out a bit longer.  In the end, we ran late and drove to within a 10 minute walk of our destination.  So my walk there at about 8:15 pm and back around 11:00 pm were both shorter than I thought probable.  

The upshot was that I decided to jump on the elliptical when we got home, drop the BG levels, and then consider what might be the right amount to take me into the night.  Doing that I dropped to 80 mg/dl, and then as I was getting ready for bed, I bolused four units of long-acting insulin.  That allowed the levels to rise slightly, but then drop to about 100 mg/dl for a soft landing.  The estimate for that worked out.  

I would have clumped my eating into single meals if I could do it over again, but then I’d also certainly wonder how much to hedge in case I were to do something active during the day that I hadn’t planned (given that it was a Saturday.)

April 22, 2022

Today’s data is an illustration of an overnight soft landing that differed slightly from yesterday’s.

In brief recap, I bolused at breakfast, dropped into the 80’s as I headed to lunch with a colleague where I had some running around to do before lunch, but not enough to call it a workout.

Lunch was a kale Caesar salad with chicken, so it was relatively low-carb.  My levels climbed but stayed well within range.  I snacked as I started preparing dinner, and then we had veggie burgers with 2g of net carbs per patty.  I ate some broccoli, salad, and other condiments.  It was a relatively low-carb meal, but I could see that the curve was climbing fast, so I bolused three units and went for a walk around the block.  It took a while, but eventually the BG curve started to turn down.

At about the 3 hour mark, the downward curve leveled out.  As I went to sleep, I didn’t want to drop the curve too quickly, so I bolused only the long-acting insulin (5 units).  The night came in with a soft landing, ending in the 80’s by the time I woke up.  Most of this is interesting as compared to yesterday (see prior day’s post).

April 21, 2022

So yesterday, I’ll admit it — when lunchtime came, I was lazy. Lunch was a bowl (about eight ounces) of peanut butter.

Dinner was a cauliflower/parmesan cheese bread replacement, a sausage, a slice of cheese, some salad and about eight ounces of roasted broccoli.  
So what really stands out to me about the curve in my CGM data is that it so clearly shows the difference that different types of carbohydrates can have, even in the same quantities.  I didn’t plan this demonstration, it just turned out this way by chance, but here you can see that the peanut butter hits me slower and lighter than my other “low carb” choices at dinner.  

One main difference between the two might be the amount of fat.  There’s more in the peanut butter I expect than there was in the olive oil I used when roasting the broccoli.  

The back end result of that is also pretty interesting.  I was able to pretty quickly bring the level down with exercise alone.  Within 30 minutes I was just about at 100 mg/dl, and 15 minutes later at the 45-minute mark, I was getting an alarm on my CGM that it was about to go into the danger zone.  
In point of fact, because I didn’t have insulin on board, I could likely have withstood a dip, even far into the danger zone because my liver would have produced the necessary glycogen to keep me from going into a low blood suger-induced coma.  But if I went too far in that direction, it might have over-compensated, and caused me to rocket back to a peak.  Then dealing with all that, especially when I’d rather be sleeping, is a drag.  So rather than push to a 60-minute exercise session, I cut it off at 45 minutes in the hopes that the correction up would not be too extreme.  

In the end, as went to sleep, I saw that it had climbed back up to 111 from its low in the 70’s.  It might have flattened out on its own, but I decided the curve was gradual enough that I would not try to change its trajectory abruptly with some fast acting insulin.  Instead, I decided to bolus five units of long acting insulin and go to sleep.  

That appears to have been the right call.  The curve gradually crested and turned back towards a low number.  By the time I woke, I was in the 90’s.  That was an excellent soft landing.

April 20, 2022

Yesterday morning started as is common, with my BG levels rising after I woke, and then having breakfast.  My standard fare is nuts and yogurt.  With three units of fast acting, the levels dropped back to the 90’s-100’s, before climbing slowly again.  Lunch was low-carb, so it didn’t disrupt my BG trajectory in any significant way.  

Dinner was also low carb, but I ate a lot of broccoli, so even though that is relatively low-carb, the sheer quantity of it started to take my levels higher.  I overestimated how many carbs I had eaten, so when I decided to bolus, I over reacted and used four and a half units.  (I know that isn’t many units in the grand scheme of things, but for me, it has a strong effect.)

As you can see, the levels started to drop quickly, and within an hour and a half, I was headed into a zone that is too low.  So then snacked on a sliver of bunt cake that someone had left on the counter in the kitchen.  I had a bite or two of something else as well.  

Now I could see that my levels were starting to shoot higher again just as I was hoping to go to sleep.

That is always the challenge with BG control at the end of the day.  It is never completely clear what will happen in the night because my natural insulin production varies from day to day.  

In the end, I opted to bolus just one unit of fast acting insulin so that I didn’t cause another crash, add five units of long-acting to get me through the night, and a decent dose of hope that it would all balance out in the end.  As it turns out, it was a good bet.  The curve started to turn down, but didn’t plunge.  The long acting then allowed that trajectory to continue throughout the night to a soft landing by morning.  I woke in the high 70’s.  
All’s well that ends well.