Dare I Believe?

Since I last posted the saga of the morning blood sugar numbers has continued. My CDE/pump trainer and I continue to tweak all aspects of my pump routine, but those post-prandial bg’s remain Public Enemy #1. I tried going off the Symlin for awhile and doing straight boluses. I still went high. I am not saying that perhaps I might not have been able to work it out. I didn’t change my insulin dose, for instance, and I assume that would need some more insulin without the Symlin. I might have continued to work things out, except for two problems: 1) I am pretty sure that I needed to wait 20 minutes after bolusing to eat to avoid peaking, but that doesn’t work with my autopilot routine and the bathroom usage schedule we have going on at my place and 2) I was hungry all the time. Not just, hmm, I am a little hungry I think I’ll have a snack. I mean, my stomach actually growling by 10 am. Was I really that hungry all the time before the Symlin?

So I went back on, but at 2.5 u, thinking that it would help me avoid those lows at 7:30. It did, but I still had bounded up to 200-250 by 8:30. Thinking it was an issue now of needing more insulin, we made the change from a 1:15 carb ratio in the morning to a 1:10. Surely that should make an impact? Ennngh. My numbers didn’t change one bit. That was almost the last straw: I increased my insulin by 50% in the morning and my numbers didn’t move? Here are the numbers from Tuesday to see what I am dealing with:

6:15 -> 137. Take 6 units in a 40/60 combo bolus, plus 0.75 u for a correction, plus the 2.5 Symlin. Eat my bowl of Kashi with skim milk and a banana.
7:20 -> 112 Check to make sure that I haven’t gone low before I hit the road.
8:30 -> 227 Crap.

As I said, these patterns were beginning to depress me. Yesterday I woke up the same as always, with little hope that this day would be any better bg wise.

6:15 -> 140, take the 0.7 u my pump suggests as a correction. Then take my Symlin and eat my Kashi and banana breakfast. After I have thrown the dishes in the sink I then bolus, maybe 15 minutes after I would normally do so.
7:15 -> 173. A little higher than I want. I am expecting this to rise still further by 8:30, but at this point, I am resigned.
8:30 - duh, duh, duh 114! 114? It couldn’t possibly. I whip out the old Fastake that lives in my desk at work as an emergency backup and test again: 127. Hungh? The number is real, so what happened? Nothing was different except for the timing. I shrug and go about the rest of my days with surprisingly good numbers given I didn’t have to recover from that morning high.

This morning I cautiously tried the same routine of bolusing after I ate. The result at 2 hrs post-prandial? 135! Have I accidentally hit on something that will work? I am too skeptical at this point to believe in complete success until I get some more data under my belt, but this is very, very encouraging. While I am restraining myself from doing so outright, there is a little happy dance going on inside me.

Morning blood sugar blues

Guttentag. I finally made it onto the O.C. list, thank you Allison!

So my CDE who is overseeing my pump start is on vacation this week, and I can’t get a hold of her substitute. I also need more insulin, seeing as I never got a new prescription for Novolog when I started my pump, and my 1-a-month prescription that I filled two weeks ago is almost gone. I am calling as soon as I finish this post.

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.