Author: sugarv5bg

Trust but verify. Don’t fail to check up on your CGM and calibrate.

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On March 17th, I relied on a combination of insulin and exercise. My lunch had been light on carbs, so I bolused only 4 units. Then I nibbled a bit more as I prepared dinner and then ate it. It seemed all was fine according to my CGM, but I’d eaten a fair amount and my eyes were feeling twitchy in the way they do when my BG levels are too high. I decided to calibrate and confirm that the CGM was correct. In fact, it reported my levels about 40 points too low. I was actually above my “high glucose” threshold. That prompted me to do elliptical for 35 minutes to bring it back down to around 70 or so. I figured it would rise again as I slept, but I was happy to see that my levels remained level, and even dropped overnight.

Don’t eat until you’re “full”

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It is a truism that some foods have more carbs than others. The more carbs you eat, the higher your blood glucose can climb. If you’re using insulin, you’ll need more to counteract a heavy dose of carbs.

So the counterpoint can also be valid. Low carb foods can lower the amount of insulin you need.

I’ve adjusted my diet since becoming diabetic to do this. It is much easier to manage my levels when I don’t have huge carbohydrate loads to contend with. I can usually fill up on low carb vegetables (which is healthy in its own regard) and rely on fewer foods that are heavy with carbs.

But even if I eat only a seemingly no-carb option, if I eat a lot of it, my sugars will still climb. There is something about being FULL that stresses my system and causes me to struggle to keep my levels low.

Last night, I had dinner early. It had probably been at least six hours before I went to sleep. I was at 113 when I went to bed, and I was a tad peckish. Rather than eating something, I drank some water to fill the “empty spots” in my stomach. I was curious to see how much my levels would climb over night without any long-acting (basal) insulin.

This morning I was at 132. I found that encouraging. It wasn’t a flat line, but it remained within range. Had I gone to bed earlier or had I been better about exercising these last couple days, it might have stayed completely level. That suggests that I’m still producing some insulin, since my nutritionist says the levels would rise rapidly overnight without insulin for someone who has no exogenous insulin production.

The real take-away for me is validity of the old Japanese adage, “Keep your stomach at 8/10th full.” (Hara, hachi-bun me.) Eating too much taxes the system. When I can monitor my blood glucose as I can, I can see the negative, real-time impact of that extra and perhaps unnecessary second or third helping. Eating light is better for controlling blood sugar levels, even if eating no-carb foods.

The trap of bolusing fast-acting insulin, and then exerting myself more than I expected

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No sooner do I post yesterday that insulin and exercise are hard to balance, then I get caught today in that very trap.

I bolused a regular amount for breakfast (5 units of Humalog against yogurt with nuts and seeds, plus two apple cores left over from the kids’ lunches), but had carpet cleaners come over. They moved up their appointment by several hours due to a cancelation, so I needed to immediately start moving the junk on the floor out of several rooms where they would be cleaning the carpet.

I didn’t imagine that it would be a big job, but it was a good hour of shuttling boxes and small furniture in and out of rooms. By the time I was just about done prepping, that frantic feeling of an impending crash was just beginning. Sure enough, the running around had amplified the impact of the insulin, and now I was going too low.

A couple oranges and several tablespoons of peanut butter later, I’m feeling fine, resigned to the fact that I’m likely going to spike here in the next hour. Ah…them’s the breaks. Maybe I can add lunch and an adjusting bolus of fast acting insulin to get me back into range.

Bolus or not after breakfast when planning to exercise?

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I waited too long to order new replacement sensors for my Dexcom G6 CGM (Continuous Glucose Monitor), so when I finally did, it took half a week to get re-authorized with my insurance. Then the order appeared to have fallen into the cracks. My prompt to inquire into status came after another half week. It will take time to ship. In the end, I’ll be without sensors and CGM data for several days, maybe a week or more.

Ironically, as I relaunch my blog posting practice, I don’t have any real-time data nor screen shots to share until my sensors arrive. So I’m back working “old school”, with finger pricks and only a handful of data points per day.

So today was a bit of a surprise. I woke just north of 100, did some stretching and a half hour of meditation, then made breakfast and lunches for the kids, sent them off, and came back home to do the elliptical for half an hour before starting my day. I expected that would have dropped my blood glucose from however high it climbed after breakfast without bolusing, and would then stay reasonably level until lunch.

When I sat down to lunch at noon, I tested before bolusing for lunch, and found that I was at 180! Ah, how I long for the minute-by-minute insights of my personal CGM. I gave myself a slightly larger dose of six units before eating a vegetarian mediterranean plate of hummus, falafel, salad, etc. (These days my standard bolus is 5 units of Humalog for a regular meal. Hummus, falafel and such are pretty “carby” so I expected them to challenge the system a bit more than a non-carry meal. On top of that, I was starting at 180, so that seemed like a tall order for 5 units.) When I checked again after a light bike ride this afternoon right before dinner, I was back down to 95. The 6 units seemed to have done the trick without causing a crash.

What surprised me was the climb to 180 after breakfast up until lunch time. That was a longer peak than I would have thought. Even though I planned to exercise in the morning, perhaps I should have bolused before or shortly after breakfast? I’ll have to keep closer tabs on what I eat at breakfast, and once my CGM is back in action, watch to see what’s going on.

Focusing on Insulin and Exercise

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I’ve been wondering what angle to take with this blog. As you can tell, it has been a long time since I posted anything. The fact is that my blood sugar condition varies greatly from day to day. Last week I went without any insulin. The week before, I couldn’t get enough. I wonder if this is indicative of life-long Type 1 diabetics, but in my case, the fact that mine is late onset, and I’m getting such insulin-dependency swings, makes me believe that my pancreas as not completely given up.

Some days my pancreas seems strong, and seems to produce ample insulin, like last week. Some days it seems weak, like the week before. I guess this is what it means to be LADA (Late-onset Autoimmune Diabetes in Adults), and why this still feels like a relevant topic to reflect on in a public forum like this. I frequently hear of yet another person someone knows who recently became diabetic. So, I reason that there are a lot of us out there wrangling with questions of what do we do now, how do we manage, who do we listen to, and how do we live fully?

The more narrow focus that seems to resonate for me further is also dig into the still highly unresolved topic of how to live an active life and use insulin. As I’ve mentioned elsewhere in this blog, my endocrinologist and nutritionist believe I’m an outlier who held off from using insulin initially for much longer than normal, and who even now, uses much less insulin than most. That said, one area that I do not feel I understand all that well is how to exercise (which causes my blood sugar levels to drop) and use insulin at the same time. My initial experiments in this area result in my levels crashing dangerously low, that led to my not using insulin at all if I planned to exercise. I’m sure there are downsides to this as well. So…all that said…I’ve got some experimenting to do. I thought I’d share here my reflections as I travel down this path.

So here goes…

First day of trip – no job, no insulin

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Well, I don’t really know what to Well, I don’t really know make of this. The day after my last day in the office, I set out on a trip with the family. This is the first time I’ve gone on a trip without the obligations of job hanging over my head. Today, I have no one looking to me to do something. While I haven’t indulged in any high carb feed-fests, my natural insulin response has kept my levels within normal levels after eating. Then my recovery is pretty quick.

Anyway, I’m not complaining. It will be interesting to see how this plays out over time.

First day of trip - no job, no insulin
My family and I took a long international overnight flight with in-flight meal service. This is usually a recipe for blood sugar spikes. It doesn’t appear to be the case for me today. Maybe the lifting of job-related stress is improving my blood sugar control?

A quick swim drops sugar levels

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A quick swim dropped my blood sugar by 100 points.
A quick swim dropped my blood sugar by 100 points.

 

 

I bolused before lunch, but ended up eating more onion rings than the insulin could accommodate.  After lunch my blood glucose level climbed slowly to 180.  Rather than blousing more insulin, I decided to take a quick swim.  With 20 laps in a small pool, my levels dropped from 180 to 80!  It was a great way to minimize ping-ponging between too little and too much insulin.  With the excess sugar out of my blood, my body tends to find its own level back at around 120, probably by drawing from my glycogen stores.

 

 

Stress reduction steadies blood sugar levels

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  1.  The holiday week of July 4 showed a remarkable studying of my blood sugar levels.  Late in the week prior I decided to give notice and  resign from my company. Deciding and then doing so lifted a heavy weight for my shoulders. Over the holiday week I also slept as late as I wanted. What I saw in my blood sugar numbers  was startling. Granted, I was enjoying a decent come out to the activity, but my pancreatic function appeared to respond well as well.  Here’s a glimpse a couple days after the fourth on July 6. This was an insulin-free day. 
My CGM data for July 6 showing quick recovery and steady overnight levels.
Uncharacteristic BG control without insulin on July 6, 2017.

 

 Later in  the week of July 3 I had some fairly stressful follow up to my resignation that I needed to attend to. My blood sugar response on those days is more typical. I guess that’s not a surprise.