To Stack or not to Stack

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To stack or not to stack...that is the question.

That is, indeed, the question. What exactly do I mean by stacking? This is when a person with diabetes takes multiple shots of insulin in a relatively short span of time.

Personally, since I’m still on insulin shots, I typically will wait at least three hours in between insulin dosages. Once that minimal amount of time has elapsed, I can be fairly certain that the insulin I took earlier has run its course through my system.

I try to avoid stacking at all costs, because it seems to do more harm than good. The most common problem it causes for me is lows. If I’m too impatient for insulin to kick in and give myself a corrective dose, the stacking can work against me and make me go from a horrible high to a horrible low.

So I didn’t really want to resort to stacking, but my disrupted schedule on Saturday prompted me to do so. I ate breakfast at 9:30 and left my apartment at school around 12:00 on a ninety minute drive home. Before I left, I tested my blood sugar to see where it was at: right around 180. I took a small dose in the hopes that I would come down to a better number over the course of my drive.

Around 2 o’clock, I found myself at my parents’ house with a blood sugar of 179. Frustrated, I decided to correct for this as well as bolus for lunch, which consisted of some delicious homemade tortellini soup and a biscuit. I was well aware of the carb-y nature of this meal, so I tried to be a little more aggressive in treating it.

No dice. By 3:30, I was on the road to Boston with my boyfriend and our friends for an exciting evening during which we’d view a screening of The Evil Dead, preceded by a meet-and-greet with the cult film’s star, Bruce Campbell. Over the course of the ride, I kept an eye on my CGM and tested to confirm a spiked sugar of 250. At 4 o’clock, I took yet another shot to correct for this high. Note the time intervals in between each shot – 2.5 hours, 2 hours, and 2 hours…which translates to an inordinate number of stacks for this girl.

It seemed as though I made the right call, though. At 4:45, my boyfriend and I were shaking hands with Mr. Campbell and proudly posing next to him in a photograph. We rejoined our friends and decided to go across the street to a bar to kill some time before the movie at 7.

When I tested at the bar, I was much better with a reading of 140 mg/dL with a single arrow going down. But I had to make a choice: do I skip this one chance to order some drinks and a small appetizer in order to maintain a predictable blood sugar pattern, or do I take another shot and compensate for food and drink alone, assuming that my earlier correction dose would bring me down to my desired target of 100 mg/dL? Clearly, it was a complicated decision with multiple variables.

I went with the former and took a shot to cover a couple bites of a shareable appetizer as well as two beers. I found myself relaxing as my CGM did not vibrate once over the next few hours. It felt refreshing to enjoy my time with my boyfriend and our friends, and I felt comfortable with my stacking. I’m glad to say I survived the guts and gore of the movie, as well as Bruce Campbell’s twisted sense of humor as the night came to a close. My last blood sugar reading of the night was 127, much to my relief and satisfaction.

After this experience, what do I think about stacking? I still don’t love it. I think it’s more anxiety-provoking than anything else if you’re consciously doing it. For much of my Saturday, I wondered if I would come crashing down at some point and curse my impatience. On this occasion, though, it seemed to be the right thing to do as it decreased my hyperglycemic readings. Plus, this particular incident did give me a newfound appreciation for my normal insulin regimen. But when it’s all said and done, for me, stacking falls short.

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Mike R
Mike R

I’m very much of the same mind as you.  I avoid stacking as much as I can but sometimes need to make exceptions.  Like you, I wear a CGM but still test my BG the old fashioned way every three waking hours and grade my day based on the number of non-meal corrections that I require.

I just attended a diabetes conference where a surprising number of T1’s with Dexcoms talked about using multiple corrections throughout the day, mostly without a finger-stick.  I can’t decide if they were off-track or I am just need to update my own habits. 

I’m glad your movie-date worked out well.

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