Tuesday, August 01, 2006

I am flumoxxed. Confused. In a dither.

Yesterday, I skipped breakfast for the good 'ol basal test. I looked longingly at the peach on my counter, the oatmeal carton in my pantry, and just said no. I was going to do it. And so I watched as my blood sugar climbed, climbed, climbed. And when it beyond 250 I did a correction and watched it climb, climb some more.

So, this confimed my sense that by bolus rate has been covering (or not) my morning blood sugars rather than my basal. So I drastically upped my morning basal. Didn't know what to do with the continued clib.

Woke this morning at 112. One hour later I was 157. Seeing as I was obviously repeating yesterday's pattern, I gave in and had breakfast. Glorious oatmeal, walnuts, peaches!

Clocked in at 257 an hour later. Corrected. Went nowhere.

Until lunch, when I was a very shaky 100. Suspended my pump. Had some quiche. Was very conservative on my bolus. Came home. Was still 100. Drank a ton of juice and forced myself to wait a half-hour for my much-needed swim. Then I was 114.

Had a yogurt. Am now 260, a mere 2 hours later.

I don't get it. I suspect I should call my doctor, but she'll say -- have you changed your pump? yes. Is your insulin fresh/cool? yes. Have you done a basal test? um...yes? Well, then, just keep increasing your basals until you get. I am, I am, I am. It's not working.


Kevin said...

First, congrats!
You are working toward the right goal: getting your basal rates adjusted correctly. Just relax.

You found out that your climbing in the morning, and you upped your basal rates to compensate. You don't need to test it again the very next day. Pace yourself. It took me a full 3 months to get all my basal rates set appropriately.

Start with your overnight rates and then move on from there. Try only doing two or three tests per week.

A few things:
1) Eating oatmeal, walnuts, and peaches for breakfast will likely spike your blood sugar 1hr after eating it even if you have perfect basal rates set, unless you're taking symlin or have waited a long time between your bolus and eating. And you probably shouldn't be correcting 1hr post meal - you should give your insulin a chance to really kick in and pull your post-meal BG back down.

2) Were you treating that 100 as if it were a low? That seems pretty aggresive. Although, I completely understand that: I used to do it all the time. I would be filled with fear of not knowing whether I was "dropping of the edge of a cliff." So I would reason to myself: "it's not worth the risk", and I would treat anything below 120 as if I was going to die, which was completely ridiculous. I found I stopped acting this way once I had faith in my basal rates.

3) And treating a low with quiche doesn't seem like the best option. Quiche has a lot of fat in it and will have a very sloooow BG effect.

4) And then mixing in the pump suspension, a yogurt, the gulps of juice, AND an exercise bout in there and you have WAY too many variables going on to figure anything out.

Slow down and focus on one thing at a time. Keep up the good work, and you'll get there.

Please note, these are just suggestions and I hope you find them helpful.

Scott K. Johnson said...

I think Kevin has some really good points and ideas.

Take it slow & steady - no need to rush (but I can totally see why - it's exciting to see what's going on and try to fix it!).

Kathleen Weaver said...

This may sound dumb -- because you probably already thought of it -- but did you remember that when you adjusted your basal that you are working two hours ahead?

Meaning that if your blood sugar is climbing at 8:00, you increases your 6:00 basal?

I always forget that when I'm in a panic.

Andrea said...

Nic- I really understand your frustration :o(...

I'm far from the expert on basal testing and, probably, not a good role model when it comes to performing these tests. In fact, I've given up completely on them~ I just felt like I was doing test after test (after test) and not getting anywhere :( .

I know that many rely on these tests to help them determine if something needs to be adjusted in their regimen, but I have found that after multiple tests, I am still having the same problems... mainly my evening and and after dinner readings.

Now despite my poor example, my advice would be to keep at it... I know it's real PITA to do, but if you eventually find the right adjustment that helps to perfect your control, it will be well worth the inconvenience and annoyance.

Hang in there :)

mel said...

I remember my CDE (also certified pump trainer)telling us that doing basal checks, we should hold out on corrections for highs until we've reached a point where we are uncomfortable (for me this number is over 200--I don't want to still be climbing after this).
Once you have corrected a "high" blood sugar, you really can't continue to check your basal rate, unless you are 110% sure that your correction rate is without error. It just adds another variable. A high blood sugar following this could be a result of too low a correction rate and a low blood sugar could be a sign of too high a rate. But they could be linked to your basal as well. Making it a guessing game.

I really hope your doctor offers more than, "keep adjusting your basals." Maybe something more like actually adjusting them for you. I have a great resource outside of my doctor's office, so I don't really know how endocrinologists themselves deal with basals--my "doctor" defers to the NP, who usually trusts the CDE. Hopefully, you either have a CDE, NP or your doctor can offer a little more.

That being said, I agree with Kevin :)


cHoCoMiLkRoCkS said...

when i have probs with my blood sugar like i am at the moment my mum and boyfriend say call the nurse, call the doctor but i won't. they just say all what i already know. sometimes you're just HIGH. I'm doing all the usual stuff at the moment, eating the same etc.... not due on period but i'm always high...........

good luck setting those basals, i so need to re do my over night one.