Thursday, June 07, 2007 | 5 comment(s)
I know what makes diabetes so difficult:
Today I did a basal rate test.
And it clearly showed that I could acheive near normal blood sugars for a decently long time... if only I didn't eat anthing.
It's been about a year since I tested my basal rate settings. Before then, I had been on an insulin pump for almost 5 years and had practically the same 2 (TWO!) basal rates since the day I first started the pump. My endocrinologist at the time urged me to do some basal rate tests when I first started, but I always wimped out.
I tried, honestAfter 20-some years of living with diabetes and having to eat each-and-every meal, often in exact time increments, and to be force-fed snacks in between meals, the whole concept of fasting was completely foriegn to me.
I tried a few times, but I would break out into sweats and get what I would describe as symptoms of hypoglycemia even though I was coasting in around 180 or something ridiculous like that.
Before going on my pump, I was told how much better my control could be with it. But rather than improving my control, it actually got worse when I went on a pump (and I attribute at least part of that to the inaccurately set basal rates). I certainly liked not having to take 4-6 needles per day, but I was pretty non-plussed about the lack of improvement.
When I upgraded from my Minimed 508 to the 515, I was looking forward to taking advantage of the built-in bolus wizard. This meant that I REALLY needed to get all my basal rates figured out first. I knew that I needed to start with a solid foundation (i.e., a base) before I could even try to figure out my carb ratios. Without this base in place, even if I were to figure out some carb ratios, they wouldn't be exactly right because they would potentially (i.e., very likely) be incorporating some over- or under-coverage in my basal rates. Without this baseline of insulin coverage personally tailored, I don't think one can get nearly as much out of a pump as they should. This is the one piece of unsolicited advice that I dole out rather regularly when I meet (most likely via email) someone who is about to start on a pump. Getting your basal rates set can be tough, but it is very important to put in the effort and do 'em. It took me over 2 months to figure it all out. A lot of fasting and testing and retesting. I remember feeling frustrated when I would go low during a basal rate test because I knew that meant that I would have to start all over again in a few days. But there was also a bit of twisted relief because then I could eat!
Intellectually, I knew what I needed to do. But sometimes there is a significant gap between theory and implementation (and this just so happened to be one of those times). To help me bridge that gap, I decided to work with Gary Scheiner at Integrated Diabetes Services. In case you don't know Gary, he is great. He's a CDE and works remotely with clients to help them with their diabetes management. To be able to work with a fellow diabetic who was always an email or phone call away with assistance to help figure out my basal rate and carb ratio settings was remarkable. Really, I can't stress this enough. The current structure of meeting with an endocrinologist once every 3 months, for 20 minutes (max) is just ridiculous. That's not enough time. If you're feeling like you can't figure out something specific with your treatment plan, I highly recommend working with Gary to help out. It wasn't very cheap, and it wasn't covered by my insurance, but the benefits were huge, and it's hard to put a price on the long-term effects better control will have for me. While I still haven't gotten to my goal of an A1c reading below 7 (or 6.5), I do give him a lot of credit for helping me get as close as I have to that goal (one of these days I'll get there!).
After working with Gary for about 3 months, my 2 basal rates were replaced with 8(!).
Over the past few months, however, I've been noticing my blood sugars take a pretty significant drop on a semi-regular basis right before lunch. I knew that the first place to start in figuring out what is going on was to retest my basal rates (I've been putting this off for a while now).
But this morning, I woke up at 115 mg/dl (which was exactly where I was when I tested at 2:15am as well), and I decided at the spur-of-the-moment that I was going to do a basal rate test today. I biked into work so I didn't have to worry about trying to shower
Sleepy LogicUpon waking up, I thought this was a good thing. What I didn't realize was that I wouldn't be able to pull off any sort of awkward shower at work, and so I would be kinda gross at work. And to make matters worse, I rode my bike home from work last night and didn't exactly shower before going to bed. I was, what Megan likes to call, a dirty bird today.
Oh well. I stayed in my office and didn't eat lunch with others (I was fasting, see?) so I shouldn't have offended too many people.
My blood sugars stayed rock solid from 2:15am through 3:15pm. I was thinking I would hold out as long as I could without eating, but I finally broke down and had to eat something before biking home. The spike that came after eating was impressive. I under-bolused a little for what I ate because I knew I was going to be biking home while my insulin was peaking. Just as I planned, though that exercise knocked it down into range in no time. I'm pretty proud, actually. It's 9:30pm, after a rather unhealthy dinner of a PB&J, and I'm sitting here at 122 mg/dl. To quote Col. John "Hannibal" Smith: "I love it when a plan comes together."
If only we didn't have to eat... life would be so much easier.