So I am on, what, day nine now? Things are going well, although there are a few frustrations.
Post breakfast numbers. Oh me oh my. I have never had luck with this time of day. I am on Symlin, which was supposed to help those post meal spikes, but it is a hard balance between going too low within the first hour and going too high at 2-3 hours. When I was on MDI, first I tried reducing my Novolog like the package insert suggests, then I actually switched back to Regular for meals, then I went down from the recommended 10 units to 5 units when I was still having crazy lows all the time. (See my handy graph below)
Fig 1: An approximation of how Symlin affects my blood sugar. By approximation I mean I didn't use any realy numbers and I did it in Word as a drawing.
I was able to get some improvement, but it didn’t work all the time and it remains the most frustrating time of day. The first few days on the pump I passed the 300 mark with a 2 hr extended bolus. We have been experimenting with combo boluses and shortening the extended bolus, and have gotten it so now I only go to 200, but this is still not perfect. I am always back in range by lunch time, so I am pretty sure that it is the timing of the insulin, rather than the amount that needs fixin’.
4 p.m. Lunch numbers: fine. 2 p.m.: fine. 4 p.m.: 200+. Hnnnngh? Did I eat a cookie while I wasn’t looking? Did I accidentally refill my Nalgene with hummingbird food? I don’t think so- it is just the diabetes fairy and her sick, sick tricks again. At least I have a pattern developing. Can anyone say basal rate change?
3 a.m. Now, Monday through Wednesday last week were fine overnight. Steady. No more than 30 mg/dL up or down. I was thinking, this is good; I won’t have to keep doing these night time tests. Starting Saturday night I started noticing it climb towards morning. Grargh. Why can’t I just sleep through the night like a normal person?
My other problem is the alarm. I sleep through them, no matter if it on beep or vibrate. I do wake up and test, usually after they have been going off for ½ an hour or so. The night before last I woke up at 2:58 a.m. Good, time to test. Only it was my 12 a.m. alarm that had been going off for three hours that woke me. As soon as I tested, Jeeves started beeping again for the 3 a.m. test. I know you don’t like to do it, but a little shouting is in order, my good man. I have the sneaking suspicion that I am half asleep while the alarms are going off, as I keep having dreams in which beeping or buzzing noises figure largely.
So, in summary up to this point: Bitch, bitch, bitch, whine, whine, whine. But really, I am ok. I think the Insulin on Board function has already saved my derriere from bottoming out on a number of occasions.
Me: I am high, I wanna shoot up.
Jeeves: Pardon me, madam, but I think you will find that you have sufficient insulin in coursing through your veins already. Additionally, I think you will find that the correct terms are “hyperglycemic” and “bolus”. Uninformed persons might get the impression that you are a drug addict.
Me: Well hang the lot of them. And I tested a half an hour ago and I was “hyperglycemic” then as well.
Jeeves: I believe a bit of patience is advisable, madam.
*time lapse to an hour and a half later*
Me: Hey look, I am 107!
Jeeves: Miracles do occur, madam.
With regards to the other problems, I probably will never achieve perfection, but I do have more sophisticated tools at my disposal now. The average BG on the meter is coming down, as well as the standard deviation. So if I seem cranky, it's just due to the loss of sleep.
The patterns I mentioned yesterday are still haunting me. See, these are my morning numbers for the week so far (thanks to Kevin for the spreadsheet). Current procedure I am trying for a couple of days 40% up front, with the rest over 1.5hrs. I am flat or am dropping between the time I eat breakfast and when I hop out of the shower an hour later, so that is good (as long as I don’t drop too far), but I don’t like how much I have spiked by the time I get to work. It is starting to look like I need another bolus at 7:30ish. I think I might try calculating and taking the extended bolus and basal I missed during that 15 minute disconnect (~0.6 units) when I reconnect at the end of a shower. Probably won’t be enough, but baby steps, baby steps. Although I am faithful in my own abilities to make wise and careful decisions about my doses, its easier to explain to my doctors when I actually get in touch with them again.
I whine, but at least it is better than last week, when I was taking the whole bolus over two hours to start then moved to a 25% up front/ balance over two hour deal. Yikes! If nothing else, at least they are patterns, and I am not getting a bunch of inexplicably random numbers. Patterns I can deal with.
