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.
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.
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.
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?
The 21st was my second to last day of work, and I can feel the coming peace. I bolused my typical amounts at lunch and dinner, but my response was stronger than I expected. I opted to forego the overnight 8hr insulin. Happily my overnight level stayed level.
Higher insulin response correlates with less stress.
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.
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.
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.
I spent years after my initial diagnosis of Type 1.5 diabetes striving to limit my blood sugar for the purpose of not using insulin. That is a nuanced objective that tripped me up for a while after my exogenous insulin production finally dropped (after 8-9 years) to the point that using insulin became a requirement. I had to make the psychological shift from striving to “not use insulin” even if my short term numbers might rise higher than I would like, to keep my overall blood sugar low.
I wouldn’t have expected that this slight shift in objectives would have a massive impact on my behavior, but it did. I’ll dive into the specifics of that impact in other posts. For the moment, I wanted to point out simply what the impact is of NOT practicing portion control.
For those of us who come to using insulin later in life, it can mean many things. As I allude to above, one thing it meant for me was self criticism. (“I’ve failed! Now I must use insulin! Drat!”) Once I got over that, it became a liberation. “Yippee! Now I can eat what I want! All I need to do is bolus enough insulin to compensate!” Well…it’s not so simple.
I’m a father, and last Sunday was Father’s Day. The extended family gathered for a meal, and the dads were allowed to be lazy. We could eat and drink without reprimand. Good thing? Bad thing? It’s a mixed bag.
Yes, I loved the indulgence, but let’s look at what behavior that invited.
I knew I was going to indulge, so I bolused in anticipation, then I bolused more to keep up with my indulgence, then I crashed (almost), then I climbed right back up to where I had been.
This is a readout of the prior 12 hours, with insulin boluses indicated by squares on the line plot. We arrived at my in-laws around 4:30 pm (16:30 military time). [As an aside, I keep my watches/phones running on military time, hence the double digits.] the eating began around 5:30 pm (17:30). I knew there was a bunch of delicious goodies to sample, so I bolused 4 units of Humalog – fast acting insulin.
The packaging for Humalog says that it acts over a four hour time period. I find that it takes about a half hour to kick in, and then it runs for only 3 hours for me. Everyone should gauge this for themselves because your milage may/will vary. You should also watch it in real time, because other factors like sleep, stress, illness will all impact that performance.
Within about an hour and a half, it was clear I had overdone it. Even with 4 units, I was already hitting my upper limit of 190. So I did what I rarely do, and bolused an additional 3 units!! (Don’t try this at home! That’s too much! 7 units all at once when I never have more than 4 is risky business. I must have thought I had really overdone it with the gluttony.) Despite that user warning, my numbers started to drop. You can see clearly in the graph that from my second bolus at 7 pm (19:00), the levels drop, and continue to drop almost exactly 3 hours.
The drop so successfully that I start to approach the lower limit. Happily I didn’t go any lower than I did. But then, at the three hour mark, they start to climb again. From 10:30 pm (22:30) on, I am still digesting the food and drink from the evening’s splurge. The levels rise again, climbing steadily to 4 am (04:00) when they cross back over the high alarm limit. My CGM sounds the alarm. I wake up. (So does my wife! She was on pins and needles as I flopped into bed at 10:30 pm (22:30) because I had drunk too much as well. She wasn’t sure what was going on, but hoped that my CGM would alert her if I went seriously sideways.) I go into the kitchen. I bolus another 3 or 4 units (I can’t recall), and go back to bed.
Father’s day had been super hot. I worked out in the yard before meeting with the extended family for our evening feed-fest, and I suspect I had not drunk enough water during the day either. The night was hot. I had fitful sleep. My FitBit told me my heart rate was much higher than normal overnight. I was a bit of a mess. But all’s well that ends well. By morning, I was a bit hung over, but blood glucose levels were normal again and I was on the mend.
The moral of this silly story is PORTION CONTROL. If I eat too much, and it can be too much of very low glycemic index foods like vegetables or cheese, it overloads my system somehow and taxes my blood sugar levels hours after eating.
This is an area where I need to develop greater personal discipline. I’m usually pretty good, but I still have my weak moments. What have you found helps you control your impulse to mow down the entire buffet? What do you think contributes to your having more self-control on some days, and less self-control on others?
For Type 1.5’s like me, for years I managed to avoid medication and insulin because I still had some insulin production. So long as I didn’t overrun my system with carbohydrates, my blood sugars would not spike. A common go-to snack was nuts or cheese. Neither seemed to move my blood sugar numbers by much. My feeble insulin production was enough to manage that.
That said, I quickly bored of nuts and cheese. Early on, I remember howling to the cosmos that, “I was sick and tired of nuts and cheese!!!”
Even though I do use insulin now, 10 years after my original diagnosis, I still have the inclination to eat the rough equivalent of a South Beach Diet that is generally pretty low carb. I do very well with a cup of tea and a couple spoonfuls of peanut butter.
But how good can that be for me? While sufficiently filling, I’ve begun to wonder whether or not the same thing day and out is bound to leave some nutritional holes that might cause problems over the long term. So I was susceptible to a prime product placement close to the Whole Foods check out line: Garden of Life’s whole food and certified organic Shake and Meal Replacement!
On the face of it, this option seems ideal. The ingredients purport to be raw and organic, so there seems nothing to cause any concern. It has all sorts of ingredients listed, so there seems little chance that I would create an inadvertent nutritional hole.
This label seems too good to be true: raw, organic, non-GMO, etc.
The best part of this option is that a single serving appears to have less than a gram of sugar. The rest of these carbohydrates are fiber, which are low glycemic and typically won’t kick up my blood sugar.
This carbohydrate breakdown suggests less than a 1 gram of sugar per serving.
What I found was that even with insulin on board, my sugars spiked faster than how they normally rise on a relatively low-carb diet.
Anticipating my blood glucose would rise, I bolused 3 units ahead of time.
Notable to me is the rapid rise after the shake, and then the equally rapid drop after the insulin kicks in.
That behavior seems logical for something with more sugar than the ingredients suggest are in the single serving of this meal replacement.
As I thought about it more, I had a short night of sleep the night of June 13th, so I repeated the experiment the next day after a better night’s sleep.
This reaction was much less sever than the day before, but so too had I slept better the night before.
The 3 units of Homalog insulin kept the peak lower, but the following blood sugar drop is also more abrupt.
So this was a promising result, I kept up the meal-shake-as-breakfast routine for several more days. In the end, my muscle and joints became creaky during the same period as when I taking the powder, so I need to do some more investigations to see if there’s a connection.
Does anyone have a recommendation for a nutritious and well-balanced snack that can double as a meal?
