A few days ago, after months of high blood sugar and a blood test to confirm it, I decided to increase my basal insulin levels to try and bring it down. I didn’t change my basal insulin settings; I just set a temporary rate of 120%, and kept it there for a few days, until going to my quarterly appointment at the diabetes clinic yesterday.
I was nervous going to the clinic. I had the worst A1c since diagnosis (7.4%), my LDL cholesterol was down, but not down enough, and my fructosamine test suggested that my blood sugar over the last month was much higher than the 7.4% my A1c reflected (my 517 fructosamine level is equivalent to an A1c of over 11%).
I also wasn’t so sure about what my endo would think about my self-prescribed increase of basal insulin.
My clinic visit started with the nutritionist/diabetes educator. She downloaded the data from my pump and looked at my blood work. She wasn’t my regular nutritionist and she wasn’t happy about my low carb diet.
“How long have you been on this diet?” she asked.
“And you have enough energy? You’re not moody?” she continued.
“Yes, I have plenty of energy and I’m no moodier than before,” I said.
Then she looked at my blood work and told me I needed to eat carbs for my kidneys. I listened politely, and agreed politely by nodding with my head.
Then she got to my blood sugar. I told her the story of my recent high levels and she told me that I was right to increase my basal insulin. Then she went to talk to the doctor.
She came back and told me to come with her to the doctor’s office.
I told the doctor my blood sugar tales and explained what I’d done with the basal rate. The doctor didn’t seem to mind at all. She pulled up my file, looked at my blood sugar charts and started to calculate basal rates. She told me we would be totally changing my basal rates and increasing my total amount of basal insulin from 12.8 to 14.4 units a day.
She was nice, understanding and not at all upset with me.
I told her I didn’t understand what happened. “Nothing has changed,” I said.
“Diabetes doesn’t stay the same. It always changes,” she replied.
When she finished with my pump the doctor took a look at my cholesterol. She wasn’t happy. She told me to talk it over with my GP.
“I want you back here in a month to see if this is working for you,” she said before I left.
So I made my next appointment and went home feeling strangely happy about the visit. I didn’t get scolded much and I was armed with new basal rate. I was also happy because I felt like they actually cared, and although it doesn’t make my blood sugar any better, it’s important, too.