Thursday, October 11, 2007

Bouncing Basal Rate

Last week after my 9 mintue run and a swim that I dropped to 60 during my coach gave me 4 days off to analyze my blood sugars without exercise. After two days one of the major culprits of all my lows caused by exercise was basal rates that were completely off!

On Thursday I had my typical turkey sandwich for lunch, about an hour later I was down to the 50s. On Friday the same thing happened - it dawned on me that within an hour after lunch I'd be stuffing my face with unbolused clif bars. Since I was adding so much unbolused food to my system in a desperate attempt to get my bs near 200 I failed to realize that the reason my unbolused clif bar was only getting my bs to 130 or so was because it was treating a low, not getting me high.

I reduced my basal rate and have had great results. On Monday I completed my 40 minute run without a problem, ending with a blood sugar of 100. Tuesday I had a blood sugar above 68 after a lift for the first time in a month. Yesterday was the biggest indicator of all - I tired to cram in a run about two hours before I normally go to the gym when my basal rate is at .25/ hour instead of .15/ hour - blood sugar crashed down to 85 within the first 10 minutes of running. So, I went back to the gym later that night when my basal rate was at .15/ hour for about 3 hours and had turned my pump down to 5% for 2 hours - I was able to complete both a swim and a run! I had to take 10 or 15 minutes off between the two to let the gatorade get into my system but after that I felt like I could have run all day.

This indicates a bigger problem however. For weeks I had been contacting various CDEs in addition to the ones I speak with at the Berrie Center. I asked in each e-mail, what am I doing wrong, why isn't my blood sugar high enough when I work out, why am I having to cut workouts short? I heard suggestions of having an unbolused bagel, turning my pump down to 5% 3 hours before I workout before 1 and 1/2 hours - NOT ONE OF THEM IDENTIFIED THAT MY BASAL RATE COULD HAVE BEEN A PROBLEM. As diabetics shouldn't we be able to trust our team of experts to identify problems before we do? Or is this a fight that we all have to live trusting ourselves and our bodies more than advice we hear based on a few excel spreadsheets?

I simply want to find doctors and CDEs as much as I trust the teams that performed my 4 orthopedic surgeries. The surgeons at the Hospital for Special Surgery have let me live my life as athletically as I wanted - I had reconstructive ankle surgery as a high school junior, I have half my rotator cuff in my right shoulder from surgery my sophomore year in college, post college I've had my left shoulder and right knee scoped. After each surgery I went through aggressive rehab, the doctor's warned of any possible problems but gave me the confidence to pursue my athletic career. Right now, I don't have alot of confidence in any of the diabetic professionals I want to trust that they'll identify the problem long before I do but I'm not close to there yet.

5 comments:

Shannon said...

We never talk to Brendon's endo unless we see her at an appointment, but this is 5 years after diagnosis.

At the beginning, we'd call to present little problems here and there to get their advice. Maybe they can see something we're not catching onto. They would guide us in a certain direction, or make a suggestion on what changes to make, but essentially Jeff and I were the ones making the decisions on what changes to make.

You're still a very recent diagnosis, so relying on your team is a given. You might want to shop around for a new team if you're not happy with their advice.

You'll learn not to necessarily rely on your team for concrete answers. But they really should've suggested testing your rates to see if they were right to begin with.

Anne said...

I agree with Shannon. Adjusting basal rates should have been the first step.
Right now I am changing my diet a little, cutting back on the carbs I was eating to train for Ironman. Even that, without a huge change in activity level, is affecting my basal rates. In fact, I have different basal rate profiles for different activity levels. To me, finding the right basal rates can be one of the biggest challenges while training, mostly because I don't like to fast a lot when I'm working out 2 hours per day.

Anyway, maybe the fitness4diabetics place would be good for you; although they seem a bit pricey. (fit4d.com)

Wingman said...

Thanks Anne - I've actually spoken to the people at fit4d.com and the service they offer is very expensive. Since I already have a triathlon coach I'm not sure they are the right fit for me either and long term I do need to find a new team; just wish I knew of one here in NY!

Shannon - finally posted a comment to a recent entry of yours on your blog. Make sure your son always has that blood stream going!

Scott said...

Personally, I was disappointed in Naomie Berrie Center in part because most of the endos there who specialize in treating type 1 only treat pediatrics and wouldn't see adults (there are a few, but many have a waiting list and appointments must be made 6-8 weeks in advance). But its nice to have everything under one roof, and NYC doesn't have many alternatives (although there are some great endos in town, such Zach Bloomgarden on the UWS, Daniel Lorber in Queens) who are well-known in the diabetes research field and quite well-published.

That's one reason I was really pleased to learn that NYC will soon be getting another diabetes center. The new Gerald J. Friedman Diabetes Institute at Beth Israel Medical Center in Lower Manhattan opens officially on November 14, 2007, which is World Diabetes Day. When fully operational, the new center will have a full-time staff that will include nutritional, clinical and educational experts.

The rule for me is whether your blood glucose levels remain stable after the rapid-acting stuff has finished its peak of activity, and that requires skipping meals sometimes. But if they go up, basals are probably too low, and if it goes down, they are probably too high (similarly, on MDI, adjustments must then be made to your long-acting insulin the next time you dose). But adjustments happen often and can be influenced by seasonal variations, stress and other things, so prepare for the unexpected!

Dying Water Buffalo said...

Scott's comment is interesting. We'll have to plan something cool to do November 14th!

Personally, I am still shocked that here in NYC of all places, their's no fantastic diabetes center... and to think I always thought we were living in a medical hub! Ugh so frustrating.

I think you're doing the right thing by adjusting your basal rate on your own... it seems as though the Berrie center doesn't really understand athletes.