I’ve been doing a lousy job of getting enough sleep this week. So, as I’d expect, my levels are more insulin-dependent than they might be if I were well-rested. The profile from yesterday shows that I needed to match bolus insulin to carb intake to keep myself in my target range.
I did walk on the treadmill as I computed in the late morning. That kept my blood sugar level.
Walking helped keep my BG level. My bolus pattern was pretty standard. My dosage of basal insulin before going to bed was good. I might have even gotten away with one fewer units?
As I prepared for bed (lights out at 1 am…), I took stock of my overall condition and decided that basal insulin overnight would be a good idea to keep my levels even. I injected five (5) units. Seeing how the levels declined overnight, I might have been able to get away with just four (4) units and maintain the level even. But because the levels didn’t drop too far, five (5) was probably the right call.
Yesterday I was under deadline pressure and didn’t exercise much. I took the easy path and bolused around each meal to keep the peaks low. I did try adding a little burst of exercise along with the insulin to see how that continues to work. So far, so good. It worked at lunch and dinner. For lunch, I walked on the treadmill for 30 minutes after eating, and then I used the elliptical for 20 minutes in addition to insulin to bring my levels down quickly before going to bed.
Blood sugar levels drop faster if I add a little exercise along side the insulin. The overnight profile looked encouraging as well.
A novel wrinkle was that I had to change CGM sensors shortly after finishing my 20 minutes on the elliptical last night before going to sleep. I inserted another, but there is a gap in the data of about four hours. It is possible that my levels dropped low as I slept because of having insulin on board and exercising, but I don’t know and I didn’t wake up in sweats. At least the long tail looked good. When the data returned, I was within target range and even for the duration of the night. This is strategy may hold promise. There is more to learn about this.
Yesterday’s data tells me two interesting things: 1) My new insight into bolusing AND exercising carefully to rapidly drop my blood sugar levels is paying dividends, and 2) Not going to be early may be hurting my blood sugar control. Let’s start with this second point.
Staying up late may have signaled to my body that I was in trouble, and caused my levels to rise.
I didn’t hit the pillow before 2 am last night. You can see the blip in the climbing level that indicates where I took my shower just before bed. As my body detected that I was not going to hit the hay, and it drew on stress hormones to keep me awake, my blood sugar levels started to rise. That trajectory continued throughout the night at a remarkably even rate.
My mother always campaigned that the hours of sleep before midnight were worth twice the hours after midnight. My wife recently heard from a friend that the restorative energy of the body is given to repair if the body is asleep by 10:30 pm or so (in adults). If the person is not asleep, then that energy that would have gone to repair is redirected toward staying awake. The upshot is that the body misses that day’s repair. I can only imagine how much deferred maintenance I’ve accumulated over the years. It may be a large contributor to my having become diabetic in the first place. I don’t have any proof of that, but I’m suspicious that it might have played a part.
The first point I found interesting was to see how a little exercise (as in five (5) minutes) with insulin could bring my levels down much faster than just insulin alone.
My BG dropped much faster with insulin and only five (5) minutes of elliptical exercise as compared to insulin and no activity. This image shows both scenarios in the same 24 hour period.
You can see on the left how quickly my levels dropped with only five (5) minutes of elliptical. It was just enough to feel myself start to get a little warm. The next morning, I was not physically active at all. The result was that there was a latency in the effectiveness of the insulin of about an hour, and the rate at which it dropped my levels was much lower. I’ve inserted relative angle sketches to emphasize the contrast.
There is also likely a difference between gradual walking and an intense burst of exercise. I’ll have to do some experiments between those two scenarios to see what conclusions I might draw.
Saturday and Sunday were good blood sugar days. I’ll surmise that getting more sleep on the weekend than I do during the week may have had a hand in what I witnessed in my CGM data.
On Saturday night we went out to an indulgent dinner at a Chinese restaurant. I didn’t eat any rice, but the starch in many of the sauces, the dumplings, and the green onion pancakes are all hard to resist. So I bolused six (6) units as dinner began and watched how high I climbed. To my surprise, the six (6) units held a blood sugar spike at bay. I hovered in the high 160’s/low 170’s after dinner. That wasn’t bad given my indulgence.
What I found surprising, however, was that at about four and half hours after initially bolusing, my sugar levels dropped down into target range without any further insulin or exercise. My overnight levels stayed even, and even dropped Sunday morning as I got up and started moving around.
The data suggested that more sleep translated into better blood sugar control.
I found it additionally interesting that this continued into Sunday night when we had a family dinner at the in-laws. There was food, but there was also homemade desserts. I’m not sure why I didn’t bolus in preparation for that, but my levels stayed remarkably even after dinner given that my belly was full. Detecting before going to bed that I still had much more digesting to do, I decided to bolus a catch up dose that would bring my levels into target range, and add basal insulin as well to keep those levels even throughout the night.
Dinner on Sunday night, though it included dessert, did not spike my BG levels. In fact, they dropped a couple times of their own accord before I decided to bolus before bed.
What I don’t understand is how my levels rose then fell of their own accord before injecting insulin at bed time. Could sleep have been the only factor.
If I could just get my act together and put myself to be earlier each night, who knows what I’d find…?
Last night was a successful attempt to match how much I ate of what things, my general wellbeing, and my insulin. I had a big dinner that I counteracted with insulin, but then I watched to see how quickly my levels climbed back up after the three (3) hour window of effectiveness ended. Then, based on the rate my level rose, I gauged how much additional bolus insulin and how much basal insulin I should inject. Happily I hit it right. My levels stayed constant overnight, and within target range.
I successfully matched my insulin usage to my dietary intake.
This is an interesting example of how eating light and staying active allowed me to avoid insulin on Friday. When I woke in the morning, I was within an acceptable range. I ate for the first time at 11:30 am, and indeed my levels began to climb. Rather than going for the insulin, I went for the treadmill and continued my computing while walking at my treadmill desk. This brought my levels back down, and they continued to drop for the rest of the afternoon until dinner.
Light consumption coupled with moderate exercise allowed me to avoid insulin for the whole day.
I like the idea of adopting a vegetarian (vegan if possible) diet, but I am still struggling to see how I would do that without relying on lots of insulin. So many vegan dishes are heavy in carbs. Wednesday the 20th was a day to explore how I’m doing in general related to a vegan diet. I attended an event that served a vegan dinner. Prior to arriving, I snacked on nuts and cheese to make sure that I would not be too hungry. That didn’t lift my blood sugar materially. Then, as dinner was served, I bolused 6 units, which is how much I currently use if I’m expecting a carbo load in what I’m intending to eat. This brought my levels back down into the 120’s briefly, but as the bolus (fast-acting) insulin began to wear off, my levels climbed back up into the 170’s-180’s around the time I planned to go to sleep. I decided to inject another bit (2 units) of bolus (fast-acting) insulin to bring the levels down, and then went with four (4) units of basal insulin to carry my through the night. I didn’t want to inject too much insulin right before bed because then I might crash as I slept, which is always risky business.
How many carbs I eat before bed will impact how easily I maintain my BG levels overnight. The more I eat, the more difficult to maintain low levels.
The four (4) units were not enough to keep my levels even overnight. I crept back up, waking up around 170’s. If I had it to do over again, I would have used five (5) units of basal (long-acting) insulin.
I found interesting to be reminded that sleep is the state where sugars rise. Without eating anything, I finished the morning routine and then rode my bike to school with my son. By the time I finished the morning thrash and I returned from a short ride (5-10 minutes each way), my numbers had dropped back down into the 120’s.
Getting the kids out the door for school and taking a short bike ride was enough to bring my numbers back down into the 120’s.
The takeaway here is that how much carb load lingers in one’s system impacts how quickly the system can recover to healthy levels of blood sugar. By 9 am, I didn’t have much source of blood sugar remaining in my digestive track, so mild activity was sufficient to bring my levels back down.
I had a weird day when both my CGM was acting a little squirrely and my blood sugar response to exercise was different than normal. I had a low carb dinner, but then some desserts came out. I decided to see how well I could handle them given that my levels had been so consistent for several days running. At first I couldn’t believe how steady and low they remained (150’s) despite some sugary goodness. Then I started getting suspicious. I decided to calibrate and discovered that I was reading at least 30 points too low. Now I was in “high glucose” alert range. When I exercised for 30 minutes later that evening which would normally bring me right down, I was surprised to watch my levels not drop as much as normal. They stayed stuck around 120’s even though I’d been at it pretty hard for a full 30 minutes.
My CGM was off, but so was my response to exercise. My levels weren’t dropping. 20190320-0036
When I checked in the morning, my levels were higher than I like for an overnight read. The CGM said 150’s! Drat. “I should have used some basal insulin last night!” I thought to myself. But then I decided to check, and discovered that the CGM was again off, but this time in the opposite direction. It was reading 30 units too high, rather than 30 units too low. When I adjusted back to correct that number, I was in the 120’s overnight. That was fine, as far as I am concerned.
The CGM read too high, rather than too low, as it had just the night before. 20190320-1024
Suffice it to say that there was something odd going on.
I stand by my belief that adhering to a low carb diet makes it easier for the body to keep things in balance. Piling on a bunch of sugar, even though you have insulin to help you out, will make it hard for the body to adjust and level out at a good spot.
Later that day, I appeared to have cleared out whatever gunk was clogging my endocrine system. After a breakfast of nuts, seeds and yogurt that would typically have required 5 units to keep balanced, I tried bolusing 4 units only to have my levels drop farther than I expected. Some more food and a little more exercise afterward balanced it all out.
Once I’d cleared out the sugar in my system, I was more sensitive to insulin than normal. 20190320-1853
After fasting for most of the day, I had a light snack of mixed nuts mid afternoon and then a light dinner of a spinach Indian dish called Palak Paneer. With 5 units of Humalog, my levels dropped lower than their standard 120. Perhaps it was too much insulin? But after it wore off, the numbers climbed back up into the 120’s and stayed steady throughout the night until breakfast the next day.
Another steady low-carb day.
I decided to keep the low-insulin experiment going. Though my numbers had climbed after breakfast, I decided to see if I could walk off the blood sugar. It turns out that I could with an hour’s walk on the treadmill as I did computer work.
A walk on the treadmill brings my numbers back down into range.
My BG levels stayed level throughout the night. When I got up and hit the hour where I might have normally eaten breakfast, my levels rose slightly more. This was probably a stress response. I keep up my fast until four pm. Overall, my day was steady. This was interesting because I’d thought I needed to eat regularly. I’ll experiment with fasting more to see how I respond under different scenarios.
An acquaintance mentioned that some health fad has advocated for fasting. I hadn’t given it much thought, but this experiment leads me to believe that I could look into it. Fasting was not a catastrophe. My levels stayed steady.
