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Posts tagged ‘high blood sugar’

Not A Single Decent Number.

“Huh.  223 mg/dL.  Still.”

This was the mumbled mantra of our vacation to Maine.

Aside from the long drive to Bar Harbor (six hours, plus coffee stops and bathroom stops and “Hey, look at that lobster!” stops), the time we spend in Maine is usually very active.  As a family, we did the hike around Jordan Pond (about 3.5 miles), the hike up South Bubble Mountain (with a stop at Bubble Rock), and spent hours walking through downtown Bar Harbor.  The lure of blueberry ice cream was enticing, but I tried to avoid the sweets and instead downed buckets of iced coffee instead.

And yet my blood sugars were complete shit while we were traveling.

I wanted to blame my infusion set, but I changed it once while we were in Maine and my blood sugar numbers remained crap.  I wanted to blame the bottle of insulin but it was the same bottle that worked just fine at home (and it wasn’t like we microwaved it or let it bake in the car).  I wanted to blame my own actions but I was exercising, checking my blood sugar, pre-bolusing for meals, correcting highs, and sticking with reasonable carb intake.

So I blamed diabetes.

The graphs over the four days we were in Maine were gross.  When I wasn’t high (which was the majority of the time), I was erring on the side of high, teasing the edges of 160 and 180 mg/dL all day long.  Why?  No clue.  Hesitant to up my basal rate in the face of constant walking, I just watched the graph ride the mustard for a few days.  Not convenient, because blood sugars running higher means more water, more “Hey, it feels like someone put cement in my sneakers,” more teeth sweaters, more bathroom breaks.

“Mom, do you have to go potty?”

(Fun when the four year old is asking me, instead of the other way around.)

Sometimes the numbers don’t make sense, and this time, I choose to roll with it for a few days.  There are probably six dozen different things I “could have done” to take a bite out of the high blood sugar trend, but I didn’t want to the micromanagement of diabetes to eat up my brain on vacation.  Instead, I did what I was willing to do and thankfully, now that we’re back at home, my Dexcom graphed has settled back into a more forgiving pattern of Pac-Man dots.

I prefer mountains in the landscape, not in my Dexcom graph.

 

 

The Art of the Pre-Bolus.

"Fucking frost on my eggplants."  Batman tries to wait patiently for his bolus to kick in.“So it’s a Wednesday night … what’s the chance we might not be seated right away?”

“Are you talking to me?” Chris asked, pulling the car into a parking spot near the entrance of the restaurant.

“Yeah.  Sort of.  I’m trying to decide if I should bolus now, because I’m 200 and I don’t want to be high all night.  Or eat ice for dinner,” I responded.

The science of a pre-bolus makes sense to me.  Take your insulin before you eat so that it’s active in your system when the food hits.  Or, in smarty-pants terms:  “A bolus of rapid-acting insulin 20 min prior to a meal results in significantly better postprandial glucose control than when the meal insulin bolus is given just prior to the meal or 20 min after meal initiation,” states the conclusion of this study from 2010 examining the influence of timing pre-meal boluses on post-prandial blood sugars.

I put this theory into practical application during the second and third trimesters of my pregnancy, when insulin resistance was constantly on the climb, as were my actual insulin needs (thank you, hard-working placenta).  Around the 22 week mark, I needed to pre-bolus approximately 25 minutes before a meal.  Around the 30 week mark, I was upping that time frame to 45 minutes prior to eating.  And now, without a baby on board, I still try to bolus at least 20 minutes before I eat.

Making the decision to pre-bolus is a precarious one, because the success of that decision rests in the quiet of variables.  (What, too esoteric?  I wrote that sentence from a cloud.)  Pre-bolusing only works when nothing else gets in the way of eating.

Exhibit A:

Yesterday morning, I woke up to a shiny 218 mg/dL on my glucose meter, so I wanted to make sure I pre-bolused for breakfast, since morning highs tend to stick with me well into the early afternoon.  (Little jerkfaces.)  I took my correction bolus and my meal bolus in combination with one another for my meal (eggs, avocado, and a slice of toast do not judge me for eating toast), and set about playing with Birdzone until it was time for breakfast.  Only the best laid plans of this PWD were derailed by a phone call, a frantic search for Carrots (Birdy’s stuffed rabbit, who happened to be in the dryer, a la Knuffle Bunny), and falling down the email vortex for a spell.  End result?  I skipped the toast and ended up chugging some juice with my breakfast.

Exhibit B:

Before dinner out at a restaurant, I decided not to pre-bolus in the car, assuming it would be some time before we were seated.  But (of course), we were seated and eating within 20 minutes of arriving.  Even though my blood sugar was in range when I sat down, I had a post-meal spike that looked like a rocket ship taking off.

Timing is only part of the art of the pre-bolus.  For people dealing with gastroparesis, trying to predict the absorption of insulin and food is tricky.  For kids with diabetes, the art is more Pollock-y, because who knows what a kid will eat/won’t eat/might lick and then hide in a plant?  The blood sugar number you’re starting from makes a difference (or at least for me), too.  I’ve found that if I’m high, I need to wait until I see a downward slope on my Dexcom graph before I can start eating; otherwise, I start high and end up higher.  And the time of day matters for me, too.  A breakfast pre-bolus definitely needs more time to kick in than a dinner one.

Pre-bolusing, for all of its variables, is one of the most useful things I’ve done to help lower my A1C.  Keeping my post-prandials lower helps my overall control, and every time I see my endo, she nods in agreement when I mention pre-bolusing.  (She also warns me about lows every time, because she’s a doctor and also extremely smart and always has cool sneakers on /digression)

Do you pre-bolus? 

 

Taste Test.

Since it’s December now, I hope it’s okay to revisit a video that includes a festive ol’ tree in the background.  This video is about how awesome coffee is … and why it matters that the order is RIGHT.

(See also:  Now I put my own fake sugar in the cup, instead of playing coffee roulette.)

 

 

Ketchup and Mustard.

Blood sugar excursions are one thing (little trips to the grocery store, short flights to Canada … those sorts of excursions are fine) but the long-haul ones are not okay (BOS -> MEL).  I can deal with a sticky high of 180 or 200 mg/dL without getting fired up, and lows are less frequent these days, so I’m not as irritated by them.  Issues seem weekly rather than daily, which is a lovely change of pace.

Except for yesterday.

Holy shit, Yesterday.  You sucked.

The day began with a low alarm in the morning – not a deep one, but a shallow low, easily managed by turning down my basal rate for 45 minutes and popping one glucose tab.  Before breakfast I was 107 mg/dL.  After breakfast, I was 302 mg/dL.  The eff?  I have a breakfast bolus recorded in my pump, but it clearly didn’t make a dent (either that, or the stress of the morning sent me cruising up into orbit).  My goal of bringing my blood sugar down within a few hours was thwarted by a thorough combination of a bloody infusion set (was that why my breakfast bolus didn’t register?), insulin that may have been borked (my pump cartridge was a potluck of dregs from older bottles), the regular stress of work coupled with exacerbated stress of having a high blood sugar … it was gross.

It wasn’t until about 2 pm that I was back down to the 200′s, and that was after pulling the infusion site and taking an injection.  And it wasn’t until about 3 pm that I saw a number under 100 mg/dL.  Which started the second half of my day, spent trying to bring up a low blood sugar that wanted its own bedroom.  I bounced between highs and lows for hours, not able to properly correct at either end of the spectrum due to a magical combination of user error and pancreas error.

When I looked at my Dexcom graph last night, it was way too much ketchup and mustard (aka “highs and lows”) and not nearly enough time spent in range.

“Damn hamburger Dexcom,” I muttered.

A normal day with diabetes doesn’t wring me out, but yesterday did.  Concentrating on work was really difficult, because my high-brain was too sluggish and too thick to let synapses fire.   Writing was impossible.  Sitting at my desk for more than twenty minutes was impossible because I kept having to take breaks to get more water and then to pee.  (I went for a run and a mile and a half into it, made the wise decision to turn around.  A good idea since, by the time I got back to my car, the need to pee was amazingly all-consuming.  Oh hydration!)  My whole body felt like it was submerged in Jell-O, and I tried to swim through it for the majority of the morning.  Instead of making beds/doing laundry/cleaning dishes/writing/answering emails/phone calls, I wanted to climb into bed and sleep off the blood sugar hangover, but that wasn’t an option.  Life doesn’t wait for diabetes.

I made lots of mistakes yesterday – should have pulled the site/taken an injection earlier, should have assumed my blood sugar would rise more after turning down the basal, should have checked an hour after eating instead of two.  So many things I should have done, or done differently.  But my brain isn’t very clever when it’s on the glucose roller coaster.

Oh yeah, and diabetes.

This morning, my fasting blood sugar was 104 mg/dL, a welcomed change after yesterday’s 398 mg/dL, 42 mg/dL, and all the numbers in between.

“Don’t mock me, you little jerkface,” I said to my meter.

If the frigging thing had a tongue to stick out, it would have.

 

The Price of Being Stubborn.

“Huh.  Still in the 200′s.  That sucks.”

But I’ve been stressed out and was on a train at the time, so I laced in a quick correction bolus and barely noticed that the site felt a little sore as I was sitting on the Acela.  Later that day, still in the 200′s.  But again, stress?  So I went to dinner with a few more units on board and anticipated a drop.

I should have pulled the set.  It took a whole night ‘in the yellow’ to remind me that it’s not always my pancreas being the prick – sometimes it’s the infusion set that’s gone rogue.  Sure enough, after pulling the set this morning and watching blood pool up where the infusion set had just been, and then inspecting the cannula to find that it had, in fact, gone full vampire on me, I realized being stubborn doesn’t pay.

Here’s twenty minutes after a correction bolus from a new set:

Stubborn Kerri pays the price of being stubborn with sweaters on my teeth and a high level of grouch from hearing the Dexcom going off all night.

Despite Insulin …

The Sparling household has reached a frenzied pitch of stress this week, with a big project for me reaching the finish line simultaneously as a big project for my husband begins.  Overall, we manage our family circus (… could Billy ever get anywhere without leaving a trail of dashes in his wake?  Gross.) without stepping into the ‘unhealthy’ zone, but the last few days have been an exception.

For me, stress usually leads to higher-than-normal blood sugars, even despite insulin.  (Or “to spite insulin.”)  And not in that, “Oh, I didn’t bolus enough, so I’ll just correct this high,” sort of way, but in the “What the EFF – I just rage bolused the hell out of that blood sugar and it still won’t budge.”  This week has been all sorts of that, with fasting blood sugars as the only ones I’m comfortable keeping.  For the last few days, it’s taking 150% basal to keep me even close to range, and my insulin:carb ratio has been tweaked to accommodate the exceptionally busy week.

That 233 mg/dL?  All emotional, no other influence.  Insulin is good, food wasn’t introduced yet, basal rate was solid, and no I’m not pregnant.  I was 108 mg/dL an hour earlier.  This high was the product of stress.  It always amazes me to see how tightly woven my blood sugars are to my emotions.

The bad news is that my meter average, with which I was very comfortable last week, has gone to absolute shit.  I feel more tired and the highs are making me feel grumpier and shorter-tempered than normal.  (Which, if you’ve met me, is sadly saying a lot, because my average fuse is the length of a whisper.)  I’m not able to parent the way I’d like, because these highs are sapping me of my funergy (energy for fun).  I hate when diabetes derails time with my daughter.

The good news is that I know the cause of these diabetes radar blips, and I know things will be much more manageable in a few days.  Until then, I need to do whatever it takes to coast.  Testing more and correcting while taking the insulin-resistent instigation of stress into account?  Trying hard not to consume coffee as though it’s a necessary and actual basal rate?  Moments like these make me thankful for the CGM, because I can respond to trends, and I get a head’s up when I’m over- or under-compensating for stress.

For now, I’m in “just keep swimming” mode, hopeful that the highs will abate and leave me the hell alone in a couple of days.

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