Photo courtesy of Renjith Krishnan
The June DSMA Blog Carnival Topic: When it comes to diabetes, sometimes it seems things change more than they stay the same. Every so often, we may start to notice things going a bit out of whack and some new blood sugar patterns emerging. Part of being an informed and educated patient is learning to identify these problems. So this month we’d love to hear:
What are the best resources you have used to help trouble shoot?
I don’t believe in just counting carbs and then reacting to the subsequent highs and lows.
Well…after 16 years of diabetes and lots of note-taking and troubleshooting and learning about how insulin works and what factors can influence insulin resistance, insulin absorption, and blood sugars….I don’t usually get confused about my blood sugars. I know that sounds like an arrogant lie but I’m being honest. I mostly get confused about why I couldn’t muster up the motivation or energy to do what I know I needed to do. The overwhelming majority of my out of range blood sugars are due to my own self-discipline issues-which are impossible to always avoid because, duh, I’m human. I try not to kick myself when I choose incorrectly, I just move on. I believe in accepting full responsibility for my actions but showing guilt the door. Anyway, here is how I have arrived to this point. I certainly didn’t get to this place quickly or easily.
Low blood sugars
When my blood sugar is low, the first thing I do is to recall the last time I gave an insulin shot and how much I gave. (I take mental note of the time every time I inject) If it was within the past two hours then I know this low is going down fast. Especially if I’m low and my last insulin shot was within the past hour. So by remembering this insulin info I know whether or not I need more than 15 grams of carbs or not. I really stay on top of these lows since they tend to feel more dramatic and are more dramatic.
If my blood sugar is low and I haven’t given insulin in the past two hours I take my 15 grams of carbs and relax, the low shouldn’t be too harsh.
Usually, when I’m low, I realize it’s because I didn’t eat as much as I thought I might or I forgot to finish something I was drinking which contained carbs. This morning for example, I woke up low and right away knew that it was because I gave too much lantus (basal insulin) last night and yesterday morning I worked out 30 minutes longer than I normally do. I had a light dinner and woke up really hungry and of course, low. I should have known (and usually know) to have a light snack before bed or to give a little less lantus. Either one usually does the trick for me.
High blood sugars
When my blood sugar is high, the first thing I do is to go through a mental check-list that looks like this:
-Am I PMS-ing?
-Did I give enough insulin last time I ate?
-Have I been abnormally stressed during the past few hours?
-Did I exercise within the past 48 hours?
-Did I snack on anything without giving insulin for it? (Even a bite of something turns into a high hours later)
-This is a TMI but, when was the last time I had a BM? (Believe it or not, going regularly reallyyy helps keep blood sugars regular, too)
-How much lantus did I give last night?
-Do I have any active/on board insulin? If so, how much?
-Do I possibly have any infections?
-Am I in any pain?/ Does anything hurt? (Because that can do it, too!)
-Did I overeat during my last meal?
-Have I had any processed foods in the past 24 hours? (this makes it impossible for me personally, to avoid highs at some point in the 24 hours following processed food- and I do mean impossible)
-There are probably more but that’s what I tend to go through when I am high.
99% of the time for me, one or more of these reasons is the culprit. So I don’t usually change my routine or my insulin doses, I just make a mental note for next time and often, I have to work on my discipline. Lately, when I’m high it’s usually because I make a conscious decision to do something I know I shouldn’t do-or I don’t do something I know I should do. Either way, the blood sugar is on me, not on some mysterious phenomenon. But like I said before, and I really want to reiterate, guilt or shame have no place here. We’re human.
Along with plenty of blood sugar checks, this is how I have avoided many lows under 50 and many highs over 250.
After having many of the above scenarios play out, I’ve learned to see them coming and therefore prevent them instead of reacting to them when they happen. Reacting to highs and lows is exhausting and doing it for years really wore me out-much more so than using extra discipline or simply sticking to certain habits that guarantee me better chances.
Taking notes or the journaling trouble shooting method
I really advocate for note-taking. Not just blood sugars but activity and physical and emotional stuff, too.
It’s so important to narrow down the cause for out of range blood sugars. For example, when I’m nervous, I will quickly go from 100 to 300 and then have a hard time going down (and this is without food being involved!). Lately, I’ve been dealing with more anxiety and will soon get evaluated for that because I know I can’t ignore something that is messing with my blood sugars. I wouldn’t be so sure this was a problem without my note taking though.
Sidenote: This really is a challenging area for parents of children with diabetes for all sorts of obvious reasons. The troubleshooting on my blood sugars truly got easier for me as an adult (not to mention I often relayed inaccurate info to my parents and hid emotions from them). So parents, hang in there and never beat yourselves up. You’re in a super hard, outside position for troubleshooting because you can’t feel what your kid is feeling and they aren’t always going to be able to articulate certain feelings and symptoms. Please do not be discouraged. Keep up the amazing work!
Also, I hope no one feels that I’m pushing advice on them. I am compelled to share this info because it helped me SO much and I wish someone had shared it with me long ago. So take it or leave it, it’s brought to you with the most sincere of intentions :)