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.

April 18, 2022

Yesterday was Easter Sunday.  We had a nice family Sunday brunch at home, and then dinner at my in-laws’ house later in the day.  Like it or not, holiday meals often include more baked goods than normal.  I don’t eat a lot, but I like to have bites and small pieces.  

At brunch, I ate portions of several pastries.  Knowing this was part of the menu, I bolused 5 units of fast acting insulin, and dropped my BG level down to about 100 mg/ml.  This was only a temporary drop.  As the rest of brunch continued to digest, the level rose back up to about 140 mg/ml.  
At 3:00 pm, I set out on my bicycle to ride to the family dinner.  This brought my level down directly to about 70 mg/ml, and it then rebounded to about 90 mg/ml, but continued to taper off until dinner at 6 pm.  

I avoided the rice at dinner, but did indulge in the bundt cake (lemon!) and whipped cream, so that kicked my levels back up to the 160’s.  The bike ride home brought it back down, and then it stayed down as I went out for two short walks around the block.  The level rose back up to 140 mg/dl after my last walk, so after completing the evening routine, I opted to go to bed rather than exercise, and I bolused 2 units of fast-acting and 5 units of long-acting insulin.  It used to be that 2 units when I was at 140 mg/dl would drop me to around 90.  Last night the impact was greater, dropping me to 70 mg/dl.  

My natural equilibrium system appears to have kicked in and kept me right at 70 mg/dl over night.  The fact I was able to skirt above the low-BG alarm level was great, though I’m not confident that I can always achieve that.  
I have a friend who is my age but has been a pediatric Type 1 diabetic since the age of three. She hovers between 50-70 mg/dl between meals, which is an amazing degree of control, but she also has no exogenous insulin production of her own. I apparently do have some continued insulin production, and it varies day by day.  

Targeting 70 mg/dl overnight would be laudable, but it feels a bit dicey and out of reach for me as a daily target.  That said, I’ll take it when I can get it.

April 17, 2022

I had about an ounce of pecans in the morning and then had a long two hour phone call.  The pecans didn’t lift my BG level.  Around noon I had lunch, and then my levels began to rise.

I knew I had to run an errand, so I decided to bike 20 minutes there, and 20 minutes back.  My levels dropped in a step-wise fashion with each leg of the trip.  Then they continued to smoothly drop until the evening when I went out walking (for about an hour) to pick up a take-out dinner.  

I had one to two ounces of peanuts on the way, which picked my levels up a tad.  After dinner, I decided to bolus 4 units, but then worried that I might have over done it; so I nibbled a bit of chocolate to make sure I didn’t crash.  I didn’t.  The level stayed even.  I would have wanted it to drop a bit.  

I bolused 1 unit of fast acting and 5 units of long acting before going to bed, and hit the hay – no exercise session.  You can see the gradual decline in the BG level over night, waking in the mind 90’s by morning.  That was a perfect landing.  What I find curious is the sawtooth pattern of the level over night.  It rose a bit, then dropped a bit, then rose, then dropped, etc.  

I wonder what causes that pattern.  The mysteries of BG persist….

April 15, 2022

Yesterday I started the day with a modest bike ride before having breakfast that flattened my “Dawn Rise” BG curve.  When I did have breakfast at about 10:30 am, I bolused alongside, and then launched into a busy day that culminated in attending a friend’s memorial service.  At the reception, I had a half glass of the prepared fruit punch and a bite off the buffet, but was very reserved.  This small amount did start lifting my BG curve about 30 points up until dinner.  Dinner was also carb light with cauliflower, chicken sausage and some tomato sauce with super greens, then followed as I was doing dishes by some Chinese leftover dry fry green beans and a couple ounces of veggie stir fry.  

Then I started an hour-long elliptical session that pulled my 135 mg/dl level down into the high 80’s, leveling off in the 90’s.  I think my body is becoming accustomed to longer workout sessions.  It seems that my liver must be generating more glycogen as I start to exercise to enhance my endurance.  That is a double edged sword because on the one hand, it will allow me to have longer workout sessions.  On the other, it will become more difficult to quickly pull my blood sugar down from a peak by hoping on the elliptical for 20 minutes.  

The gap in the data that starts at about 2:00am is where I changed out the sensor of my CGM.  When I do that, it requires a 2-hour warmup session before it again starts publishing data.  I’ve experienced that it is common after swapping a sensor that the initial readings will be lower than actual, so if I had bolused after working out, and dropped my levels to the 70’s, it might think I was in the 40’s and start sounding the alarm at 4:00 am.  
Given that the whole day had been well-controlled, and that my food intake had been modest and low carb, I decided to risk running a tad high over night, so that it was less likely to trigger a false low blood sugar alarm.

As it happens, my overnight level stayed remarkably steady on its own, so the sensor turned on at 4:00 am with my readings at about 100.  It then gradually declined to about 90 mg/dl until I got up at 6:45 am.  You can see the last 1.5 hour it is climbing slightly as I get up and face the day, make lunch, nibble on scraps, etc.  I’ll grab an actual breakfast shortly, and the cycle will start again.     

April 15, 2022

The insulin at breakfast brought my level down to about 110 mg/dl, and then stayed relatively level.  A small 5 g at lunch didn’t impact my levels much at noon, but then a mid afternoon (~2:30 pm) Chinese pork bun and several tablespoons of peanut butter were probably 40 g of carbs in aggregate.  I knew that would lift my levels, so I bolused 4 units.  

It is always a moving target.  In this case, the 4 units of fast acting insulin were not enough to keep my BG level.  It continued to climb to about 180 over the next three hours.  But then oddly, after the window of effectiveness should have closed, the BG levels began to drop gradually until dinner back down to about 140 mg/dl.  I’m not sure what to attribute that to.
Dinner kicked me up to about 160 mg/dl, where I stayed as I worked through my evening.

When I was done with the evening’s activities, I had a choice to bolus and go to bed, or exercise.  I was tired, but decided to exercise and see what happened.  To my surprise, I dropped down to 80 with only 30 minutes of exercise.  It then climbed back up to about 110, but then leveled out at around 100 for the rest of the night.  That was a pretty good outcome, in the final analysis.

April 14, 2022

“BG” stands for Blood Glucose — and Beer Garden! A dinner at the latter made for a tricky night with the former.

I started the day by bolusing 3 units with breakfast because I knew I was not going to take a morning walk.  That brought my BG curve down to about 120 mg/dl, and it gradually declined until early afternoon when I had something as a light light lunch.  I think it was peanut butter.  Because lunch was not carb-heavy, I reasoned I could either slip out for a walk or I could bolus, but I did neither.  My BG level rose gradually from there until it was time to make dinner for the family.  

I decided to bolus then because my BG level was high already and I was snacking on the the ingredients I was using to make dinner.  That was about 4:30-5:00 pm.  The level dropped slightly, not much.  I then went out to meet a friend for dinner at a beer garden.  I knew I was going to have a beer and a bun, so I preemptively bolused 6 units, and then ordered.  I could do that because my levels after prepping dinner were still pretty high, like in the ~150’s.

Six units carried me through a carb-heavy dinner for just about the anticipated three hours.  Then around 9:30 pm, the three hour window for fast-acting insulin closed while my digestive system continued to pump glucose into my bloodstream from the beer and bun.  At about 190 mg/dl, I jumped on my elliptical machine to seek to bring the level back down.  
Often when I exercise for more than 30 minutes, my BG levels drop into the 70’s, and then I’m left trying to avoid a crash.  It will often for-shorten my workout session.  Last night, the extra carbs in the system kept my levels high at about 120, even after an hour-long workout.  

After stretching, I looked at my level and strategized how I might respond with insulin.  I knew I had consumed much of the BG in my bloodstream and I was not likely to still be digesting.  So I settled on 1.5 units of fast-acting and 4 units of long acting at 2:30 am.  (I really need to sleep more because sleep probably has a huge impact on my glucose control.)
As I turned out the light, I saw that my level had risen to 144 mg/dl.  I just had to roll my eyes.  “Well, I hope I’m not having some crazy spike, but if I am, it’s not the end of the world,” I had to say to myself.  Then I went to sleep.

Overnight the operating system on my phone updated, so there is a gap in the data.  What I found, however, was that in that window, my BG levels plummeted to about 70 mg/dl.  So, it was a good thing that I did not panic when I saw the level climb to 144 mg/dl.  In the end, I woke at about 98 mg/dl, which is pretty much my ideal target.

Takeaways: 

• Knowing myself well enough to know that I probably didn’t have a lot of carbs in my system after an hour long workout, I chose a conservative dosage of overnight insulin.  
  
• Knowing that I was going to eat a carb-heavy dinner, I bolused a large amount by my personal standard (6 units), but then had to be aware of the fact that I would continue digesting after the 3 hour window closed.  I could have bolused a second dose of post-dinner insulin at 10:30 pm.  Because I was able to exercise, I did that instead and used my high BG level as a buffer to allow me to have a longer workout session.  

April 13, 2022

I woke up to find myself in the 130’s, and bolused three units when I had breakfast, because I knew I wasn’t going to be able to squeeze in a walk first thing in the morning.

Then I went for a quick walk to run an errand and started nibbling first at lunch and then had a couple of small snacks over the course of the afternoon.

At dinner I figured I would not be able to squeeze in an exercise session in the evening, so I bolused to bring the levels down. That brought me into the 115 mg/dl level that I maintained throughout the evening. All things being equal, I would have bolused some long acting insulin overnight, maybe four or five units, but I got lazy. In the end my level rose about 20 points to 135. That’s not the end of the world, but my A1C will do better overall if I could keep my overnight level closer to 100.

April 12, 2022

Yesterday: a decent day of BG (blood glucose) control, all in all.

My breakfast contained enough carbs that I still decided it was prudent to bolus three units after a long post-breakfast walk.  This dropped my level into the sub-100 range where even a light nibble around lunch did not lift the glucose curve.  Then some initial nibbles before dinner, including some unsweetened peanut butter, lifted the curve slightly.  When I had the veggies in curry for dinner, the curve shot up rapidly, and I decided around the time that I hit 170 mg/dl to bolus 3 units since I knew I couldn’t squeeze an exercise session into my evening.  That brought it right back down to about 90.  I nibbled some roasted cauliflower around 10 pm, but that didn’t lift my glucose curve dramatically.  In the end I decided to see what my overnight levels would do on their own, so I didn’t inject any basal, long-acting insulin.  Indeed the level rose gradually overnight to 125 mg/dl by the time I woke.