Sunday, July 10, 2016

Week 19: Restoring Tranquility

When I say that I need to "restore tranquility" to my blood sugars, do you kind of understand what I mean? Avoiding having to give correction boluses, which always seem to bring me too low and never fast enough? And then having to guess at what to eat to bring it back up, and thinking that I've waited long enough and eating a little more, but discovering that I perhaps needed to wait just a bit longer and the desired rise in my blood sugar would have made itself manifest? And then my blood sugar is high again and I have to give another correction bolus? And then a meal time arrives and I know I need to eat but I'm not sure where I am in the food/correction bolus pattern I was dealing with for the last three hours? And I wonder why I don't have an eating disorder yet because I'm so anxious about what this new food/insulin bolus combination will do and I experience terror about something as simple as lunch? Then lather, rinse, repeat for not hours, but days?

So last week, early in the week, my husband and I went on a two-day vacation to celebrate our ten-year anniversary. We went hiking on both days, we slept in, and we had a very fancy, very indulgent dinner one night. It's a recipe for blood sugar weirdness. All the kinks probably could have been ironed out within a day or so, except that I think there were some pregnancy-related changes afoot. As a result, it's taken me almost a full 10 days to identify the source of the problem and correct it. Ah, now I remember why I had sworn off traveling in previous pregnancies!

I first did nothing, because I didn't know what to do and we'd been traveling and I didn't want to make any changes for my normal life that were based on not-normal-life-activities. So then after a couple days, and realizing that the wackiness was not going away, I tried adjusting bolus ratios. I increased them (meaning, 1 unit:8 carbs instead of 1:10). The first day I only adjusted one meal-time bolus ratio, but the next day I adjusted the other two, also. I tried to be diligent and wait for three full days before making any additional changes, but my panic was growing because the problem was not resolving. I didn't need three days of a new bolus ratio to tell me that. The basal rate was increasingly suspect. So I brought bolus ratios back to their normal level, and dramatically increased basal rates. My basal rates are so weird that I have never had an endocrinologist or certified diabetes educator fail to raise an eyebrow when I tell them what they are. But the sensor is really helping me keep track of where they should be, and they are only getting weirder.

The changes I had to make to restore blood sugar tranquility were basically widening the extremes of basal rates that I already seem to live with. Before this latest round of changes, my low rates were about 0.35 and the higher daytime rates were about 0.70. But the changes I finally ended up with are as follows. An extremely low basal for the late evening (starting at 11p) and early morning, return to daytime levels smack dab in the middle of the night (2a), increase slightly around dawn and breakfast (5:30a), extremely low again following breakfast (8a to 11a), and then a pretty high basal from lunch through to bed time.

The basal rate I call "extremely low" is only 0.15 per hour. I occupy such territory for about 6 hours of the day. My normal daytime basal is so much higher (1.0 per hour) that I am still tinkering with it a little bit, mostly bringing it down bit by bit. But for now, it is keeping me a little on the low side of stable. That works out OK during pregnancy, because I spend a lot of time in the kitchen and I always have food with me, and now I have the sensor to tell me when I really need to pay attention. It's a little harder to live on the low side of stable than the high side of stable, but I've always supposed this to be healthier for baby, so I'm just going to suffer through it for now. I'm hopeful that, over the next week, the sensor will help me get it even tighter than I ever could with finger sticks.

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