Friday, January 18, 2008

Basal or Bolus?

Over the past week and 1/2 my lunchtime blood sugars have been running out of control. Each day I essentially have the same thing for lunch, turkey and roast beef with cheddar cheese and mayo or mustard on some sort of multi grain bread. For nearly my entire short diabetic life I have been able to bolus this meal with a carb ratio of about 1 :15. On really active days I'd bring the bolus units down to 2.8 but on less active days never higher than 3.2. But for the past 10 days at 1:30 pm an hour and 1/2 after eating my blood sugars have started to creep into the high zone. On both Tuesday and Thursday my blood sugars closed in on 300. On Wednesday I increased my basal rate by .05 units and reduced my carb ratio to 1:11 but the results Thursday were similar to what they were with the old settings. Pretty confused as to what is going on so I'm going to try and not eat lunch today until 2pm to see if it is my basal rate that is screwing things up - wish me luck and I chew on my arm out of starvation!

The reason I'm pretty stressed out about this change is it has wreaked havoc on my workout routine. To get in a hard swim or bike ride on the trainer I need carbs and I need lots of them. As I shoot myself up with insulin to move away from an unstable 250 and get rid of a killer head ache I know I'm going to need to get my bs back up to 200 again soon. However, the 250 caused by weird events and the 200 that I intentionally hit feel totally different. Due to all the corrections I have had to give myself the past week or so after lunch my IOB is killing my bs during workouts - for example last night I could only bike for 20 hard minutes - it was a great workout but not close to as long as I need to build endurance. If life occurred in a vacuum, ceteris paribus as my old economics professors used to say this would be alot easier to figure out; I'll do my best and let you all know how it turns out though.

Update - Seems to be the bolus and not the basal - in fact the reset basal may be too high. I went low today (44) after breakfast as I over corrected for under bolusing the muffin I had - wasn't in the mood for egg whites this morning and vainly thought my abs looked better than usual so figured what the heck :). Some glucose tabs got me back up to 97 at 12 but by 1:45 I was down to 68 and had a lamb scwharma pita - we'll see how the bolus holds for that. Confusion continues!

6 comments:

Shannon said...

Diabetes is a pain in the ass that way. The variables can be the same from day to day, but the outcome can be totally different each time.

Managing diabetes is an endurance sport in and of itself.

Anne said...

My vote is for basal! :) I'm interested in what you find...

Although with your training, which, I assume has been increasing as of late, it seems a little strange that you would need more insulin.

Carol said...

Definitely frustrating. My guess is that you may have been honeymooning a bit up until now, thus getting by with less insulin. Only time and testing will tell. You're doing all the right things to figure it out. Hope your arm survives the basal check!

Anonymous said...

I agree with Carol. How long has it been since your diagnosis? I just had my 2 year anniversary and am an avid mountain biker and gym rat. The first 9 months were really easy (I remember freaking out when I hit a "high" one morning of 133) but the next 6-9 months were very challenging as my insulin needs began to change. I think I am finally through the transition phase and have had more stable and predictable readings.

I dealt with the same frustrations and confusion...hang in there. I am not a pumper, but don't be afraid to increase your basal. I've been told and read, that it is normal for your needs to change drastically for the first 2 years after diagnosis.

Shannon said...

My first thought is what Carol said about you honeymooning and maybe now the honeymoon is winding down.

The diabetes detectives are on the case ;)

Cara said...

You know, just when we think we have the diabetes figured out, it does something crazy. The one thing that I always find to be true, it that diabetes is almost never predictable.
Good luck with getting everything back in order!