Yesterday's endo and CDE appointments left me with plenty of new techniques that I'm ready to put into practice. Even though my A1c finally bumped from 7.3% (which I'd been stuck at with the pump for over 6 months) to a 7.1%, I know that I can do better. And despite the better A1c, I'm not seeing the types of patterns that I prefer to see. So here are all the tips that I'm setting into motion over the next weeks.
- First and foremost, my post-prandial numbers are the worst after breakfast. Often I see results like 220 or 260. I tried lowering my insulin to carb ratio just for breakfast, but never could find the right mix. My endo suggested adding protein to my breakfast (something I'm not so great at)...maybe a little yogurt or soy milk. I'm hoping that works, but if not I'm going to try Symlin. I've also bumped my breakfast bolus up to 30 minutes before the meal (currently I do it with the meal).
- I'm also working on getting my Lantus straightened out so my basal insulin isn't as scattered as it is right now. To figure this out, I'm only correcting bedtime blood sugars over 250. With my history of seizures and severe night lows, I have to get this straightened out first without pushing my body too far. It scares me to sleep with a high number (just like it does to go to bed too low), but I'm hoping I can figure the Lantus out soon enough and stop soaring to the 250's in the first place!
- Still on the same page, we've raised my morning Lantus injection by 2 units (which I'm going to carefully watch as I do feel this might be a little too much) as well as moving it up by a few hours. Instead of doing it at 11am or noon, I'm going to do it when I wake up (so about 8am or 9am depending on weekday or weekend). Although I don't always wake up at the same time, those extra hours should help with the post-breakfast highs and move the Lantus peak away from where I see a lot of lows (late afternoon).
- Next on my list of diabetes "to-do" is to get my exercise blood sugars under control. Right now, I'm hesitant to bolus before going into a workout since I'm tired of treating lows with more calories than I expend. But I'm also realizing that working out three times a week leaves me with about six hours of 200 level blood sugars. So anything about 250 (again), I'm bolusing with 1 unit of Humalog to help my body avoid those spikes from weight training.
- The past few months I've noticed the week or two before my period I'm experiencing higher averages than "normal." Although it's not a truly stable trend, it's still something I've been puzzling over in recent weeks. So if I feel the need, the suggestion is to lower my carb ratio that week or two to counteract the insulin resistance my body is so fond of. I'm not exactly positive I'm going to put this into practice (I might continue to watch the trend) since it means computing a much harder ratio in my head and raising my risk for lows if I'm wrong. But we'll see.
- The last big tip on my list is something I'm not so certain about, but I'm willing to give anything a shot to get this A1c down. My CDE recommended using the KwikPen to carry in my backpack and purse instead of my usual vial and syringe. She claims that all the jarring and temperature changes may affect how my Humalog is truly working (leaving me with the erratic numbers that I have now)...so the pen lowers those negatives. I'm doubtful this is truly a problem, but it's kind of nice to take a break from the traditional.
I'm excited to see if these changes truly help my averages. I'd give just about anything to see my blood sugars stabilize (I don't even care if they stabilize at 180, but at least they'd show a pattern!) since everything is all over the place right now. Basically, I want all these tips to ease the burden of managing my diabetes. A little added convenience and a little lower blood sugars (without severe lows) may just be the answer to bumping my A1c down again.
Great to see that you have an action plan and an endo to work WITH. I can also see that you will change the plan as you get more "data".
Keep up the good work!
Fair Winds,
Mike
(aka YOGA O)
Hi Lindsey,
Exercise can be a challenge. For food we can measure, compute, count, etc. Exercise presents a different factor. Do you have a set exercise plan and/or pattern. What I have done over time is test, test and test throughout the exercise period. Meaning bg (blood glucose) before starting the treadmill. After your treadmill time frame take your bg. Stay on the same exercise time frame. Watch was happens after 7 days, 14 days, and 21 days as your body adjusts to the exercise level. Hope this helps and keep on keeping on. It is great to hear a new sense of direction and energy. As always, have a great day.
D2
Hi patrick2~ Thanks for the new advice! I've been watching the rise and falls of my exercise numbers...I started trending higher during workouts so I thought I'd built up endurance. But then I had a few days of lows during my workouts...I'm so perplexed! I can't seem to keep it stable with Lantus!
Hi Lindsey,
I will try to keep this short. I re-start on the treadmill at 10 min. This goes well. Have seen an insulin sensitivity increase over the next 8-16 hours. Day two 10 min ok. Third day the 10 min starts to become difficult. Fourth day the 10 min is hard. On the fifth day the 10 min fly. My insulin needs match the feeling based upon the day. During the second to though the fifth day I find an increase in insulin sensitivity. By the end of the sixth through the next tired period the same cycle repeats itself. Stay the course and remember to test, test test and I use a 15-15 rule. Take 15 grams of carbs and check bp in 15 minutes to see the change. Sometimes I have had my glucose drop and time to slow down. PS this is referred to a peaking for an event. ie. My time and or strength (the example was the fifith day) I can press myself to go longer and the process starts all over again. Hope this view helps and as always have a geat day.
D2
Hi, my husband spikes at midday around 199 to 289.He does 35 lantus in the morning and 35 before bed.He shoots at 9:00 am and 9:00pm.I'am tough on him because he has plenty of problem to control.He likes to sleep in for him that a no no no.He does better if he get up early around 8:00am not 11:00am but we share the time monday thru thru.He get up at 8:00am takes a light walk.His walking is limited.On fri,sat,sun he sleeps in.those days he spikes.We are still working together on this.I beleive if you have the will you can do anything.Keep up the GREAT WORK!!! You will have a great out come.OH for the kwikpens you loves them!
Lindsey Guerin,
Do you know how important your blog would have been to me if it had existed back in 1983 when I was 12 years old? Really important! It took me many years to "get it" where diabetic management is concerned, and just to know that not only others were (and are) going through all the exact same kinds of things that I was (and still sometimes) go through, but also to know that it is so important to really understand how my own body reacts -- those life "patterns" as you put it -- you have written down a very concise listing of things you intend to address because you are paying close attention! I bet you make your endocrinologist's day with each visit.
This is such a good example of diabetic management for all to see, not just because you have identified the items on your list, but also you have shown just how much attention is necessary for diabetic management, as well as your own demonstration of willingness to live life as healthily and as fully as you can.
If you had verbally announced this from a platform and I were in the audience listening to you, not only would have I applauded, I would have jumped up and down gesticulating wildly flailing my arms yelling "Woo-hoo! You GO GIRL!"
I mean, yes, seriously. My throat might hurt the next day from my cheering so loudly, and I might pull a few muscles, but I still would have done it! :-)
I love your attention to the details of your diabetic management. It's like you're a scientist!
dantonyc~Thank you so much for the encouraging words! I LOVE to hear that what I do is actually making a difference, sometimes it can feel like I'm just writing to the wind. I wish these types of blogs had been around when I was first diagnosed, I'm sure my mom could have used it. And going through my teen years would have been so much easier! But I love what I do now, especially considering I hear amazing support like this! By the way, I'm quite analytical so those details are the only way I know how to manage this disease...sometimes it can be my downfall though because I try to find reasons for every shift in numbers.
Lindsey - re: insulin resistance before your period. You will become more insulin resistant after you ovulate (about 2 weeks before the period) as progesterone levels rise throughout the body. You will probably find you become more insulin sensitive a day or so before your period as the progesterone level starts to drop (unless you get pregnant of course!). I find this rise and fall in insulin resistance quite pronounced over my monthly cycle (I am type 1 too).