Basal Rate Redux!

A few months back I wrote how my basal rate seemed to be continually climbing. In the days preceding the Ironman my basal rates were around 6 units of insulin per day, around Christmas my basal rate shot up to around 16 units of insulin per day. After 2 months of marathon training and getting back to my training diet my basal rate has been reduced to 11.5 units of insulin per day.

The magnitude of the swings due to diet and exercise has been striking. During the first semester at Darden my eating patterns were sporadic, workouts infrequent and stress was at an all time high. I would regularly skip lunch, get take out from Chipotle or take in a free lunch provided by a company hosting an information session. The stress level of the case studies caused me to sleep less and travel to interviews took up a ton of time. The combination of all that took away from the consistency needed for good blood sugar control and added 13 lbs to my frame from the 183 I weighed right before the Ironman. A quick Google search suggested that children require about .5 units of insulin per pound; using this logic, my 13 lbs weight gain probably accounted for about 5 units of my basal rate gain.

The rest of the basal rate increase was probably due to the higher fat content of the food I was eating and the slow down in my metabolic rate due to less workouts. This has really made apparently how cumulative diabetes care is. What we did yesterday affects our blood sugar rates a week from now; I now view diet and exercise as a glucose management bank. Increased exercise allows a few more "cheat" meals without having to do with an insulin resistant high; while a healthier diet makes insulin more effective in general. My new endocrinologist - Dr. Kirk at UVA is doing empirical research on physiology and insulin transport. One of the things I have learned from her is that 6 to 8 hours after exercise your insulin sensitivity is increased dramatically. Therefore, the more exercise you put into that glucose management bank, the more affective insulin is going to be. This is no way in saying that exercise is going to eliminate the need for insulin since Type 1's produce it - the glucose management bank is just another tool in our quest for a healthy A1c.

Is The Honeymoon Over?

My first semester at Darden is finally over so now I have a chance to focus on my internship search, marathon training and diabetes. Last week was hell with 5 consecutive days of 5 hour exams; not a good time by anyone's calculations but thankfully the stress didn't throw my blood sugars out of whack as they were kept pretty steady over those 5 days. However, in general I've been having a much harder time locking in my basal rates.

Over the past three months I've been playing with my basal rates on a near weekly basis; while getting my blood sugars to spike prior to a workout has been much easier. I'm pretty sure the honeymoon is over and the fight in my last islet cell has been won by diabetes. In a way that will make life easier in terms of knowing how my body will react to exercise, food and basal rates. But in another way that kind of sucks since there was a time period when I could eat pizza with just a moderate bolus.

I've been working out consistently for the past two and 1/2 weeks but have not had the reduction in basal rates that I expected. I have encountered more lows over that period than I had when exercise was less consistent due to class work but I still haven't had the blood sugar reactions I expected. Although it does seem like the overall trend in my basal rates is changing; at night I've had to increase my basal rate by a huge amount as I woke up a few nights it a row with blood sugars above 300 at 4 am; but then I would hit consistent lows around 11 am. To get all this corrected I'm going to have to keep detailed notes over the next few weeks to identify the trend and figure out exactly when my basal rate errors are occurring - consistency is the key and I just need to get back to that.