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Practice makes near perfect at bedtime

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October 21, 2016
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Omnipod Patterns and Concerns

It’s been two weeks since I first came down with a cold/cough and I am still fighting a little bit of it that seems to be lingering. Overall, I’m feeling much better though in that realm but struggling with the D this week. Sometimes I think the more attention I give my diabetes, the more it decides to play tricks and confuse the heck out of me.

After my endo appointment last week, I bought a new planner in hopes that it would make me log my blood sugars since keeping my usual logbook at home didn’t seem to work. I’m old-fashioned when it comes to a calendar and like a book in my hand to pencil items in rather than logging onto an online calendar to keep track of meetings and life. So a new planner seemed like the treat for myself that would make me write down these pesky blood sugars and figure out what’s happening.

So far, I’ve been doing well with the logging. I’m only tracking blood sugar levels but know I need more data to truly see information. The Omnipod, of course, tracks all carb counts and boluses but there is so much more to these ups and downs than numbers. I need to know how food is affecting my blood sugar. I need to know when a site change may be the cause of a high. Or when a change in schedule sets things off.

Just looking at this week alone, I’ve bounced all over the place. I’ve had highs in the 280s and lows in the 60s with some beautiful “in betweens” like 122 or 111. But I’m not sure what’s causing this as the patterns don’t seem to add up.

Morning highs are my biggest challenge right now. I just increased my overnight basal again from an increase on Sunday evening. When looking at my insulin delivery history, I am very high on boluses and disproportionate on basal delivery amounts so I am hoping to even that number out a little more by increasing my basal slowly and decreasing the need for bolus corrections (which comprise way too much of my overall bolus deliver).

My other overnight issue is a suitable number for sleep. Given my history with seizures and overnight lows, I am always hesitant to see a “lower” number on the meter right before bed. But it appears that when I eat a snack to bring that number up, I undo everything I’ve worked for in a suitable fasting blood sugar. To give you an idea:

Sunday night, I went to bed at 279 with 2 units of correction/carb coverage. I woke up at 269 so only a slight dip. Monday night, I was 122 at bedtime so I had a glass of chocolate milk with no coverage as there was still IOB from dinner. I woke up at 286, yikes. Tuesday night was 194 with a correction bolus to bring me to 150 (my overnight target). Yet I woke up at 197 on Wednesday morning. Last night was a repeat of Monday with a bedtime number of 135 with IOB, applesauce for a snack and a Thursday fasting number of 259.

Ick. So I’ve just increased my basals overnight this morning in hopes that I can curb these horrible spikes. The Lantus was working well in bringing the overnight numbers down and keeping me steady all day. I used the last bottle though so the doctor is ordering a new prescription but I’m not sure what I plan to do with it. Do I want to continue taking a small dose of Lantus to act as an addition to my basal or do I want to try to make these basal rates and the Omnipod work?

One thing I am very curious in is watching spikes around site changes. In my Medtronic days, I learned to keep my old site in (even without insulin delivery) for a few hours post site change to prevent any site change spikes. I’m curious if last night’s jump from 135 to 259 is because of the site change. With pods, I generally pull the old one immediately since it’s bulky and takes awhile to remove the adhesive from my skin. I like to do it timed with a shower.

Lots of ideas to consider to get these numbers into control. I am not quite ready to let them run into range for a 6% A1c even though I know that’s what I need by next year for pregnancy planning. Right now, I just want to drop into the 7% range and keep working from there. Slowly but surely.

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