The Insulin Experiment, Day 6.5: The “What if”s of Diabetes

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It has been mere hours since I last blogged about my week-long experiment with my boluses and basals, but today was so confusing I thought I’d write a follow-up. First, after kicking things off right with a morning of high blood sugar, courtesy of my banana and peanut butter, I ate a lunch (1 tortilla with cheese, 1.5 cups strawberries) and watched as my blood sugar soared to 248. I tried to hold back on giving myself a correction (I’m trying to minimize variables during this experiment and wanted to let the insulin run its full course), but by 4:45pm with no sign of dropping, I was frustrated. So I took .5 of a unit for a correction — hardly a big dose.

I tutored for an hour, checked my blood sugar, and it was still hovering around 230. Went to my kickboxing class from 6-7 (during which I disconnected my pump) and, what do you know? By the time it was over an hour later, my blood sugar had dropped to 134. I don’t know how to interpret this. Does it mean that if I’d added .5 of a unit to my lunchtime dose, I would have been fine? Are my basals too low in early afternoon and too high when I exercise? (Right now I have the same rate all afternoon.) It brings up a constant question I have about diabetes: I know from experience that I respond really strongly to exercise, even if it’s been hours since my last bolus. Does that mean I should let myself run high after meals, knowing that I’ll drop once I start moving? Or that I should raise the mealtime bolus and drop my basal? If so, by how much — and how should I manage it on the days when I don’t exercise? And also, even if perfect solutions exist (which I doubt they do), how am I supposed to figure out exactly when to use which one?

It all gets back to a recurrent thought I had during last week’s workshop: I am sick of the “What if”s of diabetes. An example: we learn the basics of carb counting. Once ounce of bread, for example, has roughly 15 grams of carbs. If you’re using a 1:15 insulin-to-carb ratio, then you’d take one unit of insulin for each one ounce of bread. Easy enough.

But then . . . what if you’re eating that slice of bread in the morning instead of in the afternoon instead of dinner instead of before bed? Your reaction will be different. What if you’re eating it in the morning and you exercised vigorously the night before? Your reaction will be different. What if you’re sick? What if you’re tired? What if you have your period? What if you walked up the stairs to your office right before eating the bread — or were lazy and took the elevator instead? What if you had a lot of coffee (boosting your adrenaline) or took Sudafed (ditto) before you ate that slice of bread? What if someone cut you off on the freeway? What if you’re on vacation? What if you ate the bread with cheese melted on top? What if you’re planning on exercising after you eat it? What if that exercise is aerobic? What if it’s weight-lifting? What if the bread is high fiber? What if the carb count listed on its label is actually wrong? What if your pump set isn’t properly attached to your body, so whatever insulin you end up giving yourself doesn’t actually make it into your body? What if your tubing has an air bubble and you don’t notice it? What if you accidentally didn’t give yourself the entire bolus? What if you decide, half-way through eating the bread, that you don’t want to finish it? What if you catch a stomach bug and throw the bread up?

It’s enough to make you not want to eat the goddamn bread. And it brings up why I always feel so exhausted at the end of diabetes workshops: there is no perfect answer for anything with diabetes. There’s plenty of textbook information out there and we’ve all heard it before — but when it comes to applying that information to our bodies, everything gets screwed up. (To their credit, the nutritionists and diabetes educators I’ve worked with all recognize this – I would think it’s particularly frustrating from their standpoint.)  I never liked my science classes, but I did learn that if you’re doing an experiment, you need to control the variables. And if diabetes has taught me one thing, it’s that the human body is not a good place to do a controlled experiment.

For now, the best I can do is continue keeping track of my food logs and push myself to maintain this level of self-control till my check-in appointment on Friday, when I can see what explanations the doctor might have for these fluctuations (I was going to call them patterns, but they’re too unpredictable for that!). Today at the gym I did notice one small benefit of writing down everything I eat, though: I appear to be losing weight. Granted, at this point I’d prefer to just know how to manage my blood sugar when I eat a bowl of strawberries. But at least it’s a small upside.

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Laura G.
Laura G.

Thank you SO much for writing about all this, on top of doing all the work! It’s so interesting to see how this level of precision works in practice. I always feel guilty about guessing, tweaking and changing everything all the time and wonder if there’s an expert CDE out there that could teach me some consistency, establish fixed ratios, test my basals for good…Probably not. If my body ever adheres to one stable I/C ratio for all food or keeps a basal pattern for more than five days running I’ll know I’m dead… Do let your readers know how… Read more »

Matt M.
Matt M.

This all sounds incredible frustrating. There are obviously limits to transferring what works for someone to another person, but I exercise a lot (commuting by bike about 13 miles a day), and for me, I definitely drop my boluses significantly if I plan on exercising within the next 60 or 90 minutes or so. If it’s the afternoon, I will  also turn off my basal about an hour before  I plan on starting. (In the morning, I don’t usually eat before exercise, and I’m usually fine with leaving my basals as is, even though they are higher at that point… Read more »

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