So. It’s my seventh full day of counting every carb, and I had a minor breakthrough: I decided to follow the advice of Pumping Insulin and run a little basal test. After dinner last night, I didn’t eat again until 12 noon. My goal was to figure out whether my recent mid-morning highs were a result of under-bolusing for my breakfast, or basal rates that were too low (in which case I’d have expected my BS to creep upwards despite the lack of food). I was a little worried that my body’s own stress hormones might make my blood sugar go high from hunger, but since this experiment was the most controlled plan I could come up with, I stuck with it.
The result? After waking up around 100, I spent the morning hovering in the 90s and stayed there till around 11:45. By that point I was getting a little light-headed (note to self: do not decide to fast on mornings when you have phone interviews scheduled — that was a bad idea!). So I ate a handful of walnuts — almost no carbs — and held out till noon. My blood sugar stayed constant. My conclusion? To manage diabetes, I should never eat again!
Just kidding. My conclusion is that my morning basal (which I think is .45/hr right now) seems to be okay. I then ate lunch, deliberately having more carbs than normal (50 something grams) just to give my insulin something to work with and took the 1:12 ratio that I’m supposed to be trying out. Then I spent the whole afternoon hovering around 250, unsure of whether I could take a correction bolus or if that would mess up my experiment — and wondering whether I should try the same experiment tomorrow, except skipping lunch instead of breakfast to try to identify what the problem is. It sounds masochistic, but I kind of feel like I should. I’ve never been this successful at maintaining the self-control necessary to even try this kind of experiment to begin with (my poor husband asked if we were ever going to eat out of the house again) — so I figure I might as well ride it while it lasts. In fact, I was feeling all proud of myself for my newfound sense of self-control when I realized that I’m taking Symlin, which suppresses your appetite and is probably making this process easier to stomach (as it were). But whatever. I’m going to congratulate myself anyway. Right now I feel like I need all the affirmation I can get.
I’m also wondering whether this afternoon’s high might have had something to do with the fact that I spent approximately an hour today on the phone with Blue Shield, trying to get a vacation override for my prescriptions while I’m traveling, and also working out some of the intricacies of my insurance plan. I was getting curious about my out of pocket maximum. I thought it was $5,000, and having just written out a check for $1,200 for CGM supplies and another $800 for prescriptions (and I’m a freelance writer — yikes), I was curious to see when I’d reach that limit. So I added up everything, took away $500 (since my deductible doesn’t count toward my max, mother fuckers), and was confused to discover that the total listed in my account didn’t appear to include any of my prescriptions. So I called Blue Shield, and discovered, guess what, that I don’t have an out of pocket max. I have a copay max. That counts doctor’s visits and, apparently, CGM sensors, but not any prescriptions. Test strips, insulin, Symlin, syringes, everything else? No limit. And since, as you all well know, there are no generic insulins or test strips, I’m paying 50% of everything out of pocket.
Needless to say, this did not make me very happy.
But I’m trying to take solace in the fact that I can have breakfast tomorrow, and that when I do, I am going to raise my insulin-to-carb ratio and see if I can solve the existential challenge of how to eat a banana without screwing up my blood sugar. A bold goal, I know. But I’m hopeful that I’ll be able to figure it out.
In the meantime, many thanks to all of you who have left supportive comments and suggestions to my previous posts. It sounds cliched, but it’s really nice to know that there are other people out there going through the same thing. And I will say that, while this process is very frustrating, I do recommend seeing a CDE (certified diabetes educator) or endocrinologist to try to help you sort it all out. It’s tough enough right now with the support of a professional medical team. It’d be even harder if I were entirely on my own. (And if you are and don’t have alternatives, check out Pumping Insulin. That book is great.)