A New Addition to Team Frank

“What else has happened in your life since diabetes came along?”

“How comfortable are you when you pull out your insulin pump or prick your finger?”

“What concerns you the most about living with diabetes?”

These were just some of the ice breakers as I sat down with a woman who I hoped I would be able to call my new diabetes educator, in a private clinic last week.

After six years of diabetes care in a public hospital, this was a completely different experience. My diabetes clinic-that-wasn’t-technically-a-clinic was situated behind the corner pharmacy store on a quiet inner city street, rather than a bustling hospital campus. My session was in a room on the ground floor, with an open window looking out into the yard behind the building. There was no sense of urgency, nor did I feel that my appointment was being rushed. There were no interruptions throughout the whole hour. I was being spoken to like a person who had diabetes, rather than the diabetes patient. The place certainly didn’t feel super clinic-y, either. Everything just added up to a nice, casual vibe. 

We looked over my diasend uploads, and straight away she picked up on trends of red numbers on weekends. Something my diabetes brain probably should have picked up on sooner. I admitted to cruizy days of weekend eating that were often triggered after a 10am hypo, and she helped me nut out a strategy to continue to cruise through and see a little more green.

I wasn’t really swayed one way or another as I talked through my diabetes management, either, and I wasn’t sure if this was a good or a bad thing. I suppose, like this decision, it was mine. It was diabetes on my terms. No judgement.

As we approached the end of the hour, I was asked how I wanted to proceed after today. I knew how I wanted to proceed. Yet I still hesitated for a moment.

I had spent the whole hour talking over my diabetes management so confidently. The numbers on my diasend report were pretty good, overall. I had reached the hba1c goal I had set myself at the beginning of the year. This session reassured to me how proactive I am in being able to manage my diabetes. Did I need to be here?

After being pushed towards self management for so long at the hospital, it felt strange to have the option there. After all the time constraints of the busy diabetes clinic, it felt super weird to have the choice of when my next appointment would be. I was paying for it, of course. But it still felt strange.

I’ve decided I want a three month catch up with my diabetes educator. As good as I may be, I still need that reassurance. I need that fresh set of eyes that can pick up things that my diabetes brain cannot. I’ll continue to see the endocrinologist at the hospital, and get referrals for all of my important check ups there. Most importantly, I’ve got someone to touch base with inbetween. If the need arises, I’ll be able to call or e-mail, and make appointments inbetween. I already rest a lot easier at night knowing that I have someone reliable at the ready.

Two years ago, I doubt I would’ve had the confidence to be able to identify my needs, to speak up for what I wanted, or to go through with such a big decision.

Today, I’m confident that this is one of the best decisions I’ve made for my diabetes care. With a new addition, Team Frank feels stronger than ever.

Skyrocketing Levels

A couple of weeks ago, I hit a bit of a speedbump with my blood sugar levels. I began skyrocketing after almost everything that I ate. It took several correction doses and hours of temp basal rates to get me out of my mess each time.

This is what I would often witness on my Libre after a meal. My levels would simply climb and climb and climb until they reached the high teens.


My first instinct was that my body was responding to changes in my diet. I have been eating less carbs, and more protein, consistently. If I needed proof, the total daily dose of insulin in my pump history was at its lowest, and most consistent amount day to day. I was still suprised, though. To me, the changes weren’t anything radical. I had been bolusing for my protein. I hadn’t cut out carbohydrates completely, nor was I restricting my food intake.

But it seemed that my insulin was a lot less sensitive than it once was.

My first thought was to revisit my basal rates. I was convinced they might need revising upward. Moreso after reading this article, which told me that the “status quo” for people not on high carbohydrate diets was 50% basal and 50% bolus (mine are skewed in favour of bolus insulin). I was convinced that if I fixed that, my mealtime insulin would do its job properly once again. However after going low during two separate basal tests, I conceded that my basal rates were fine.

My levels were still spiking after meals, so my next thought was my insulin to carb ratios. The spikes were absolutely ridiculous, even with lower carbohydrate meals. I adjusted my insulin:carb ratio from 1:10 to 1:6, and lowered my insulin sensitivity factor by the same proportion.

1:6 was quite a scary ratio to use, because I had such big amounts of insulin on board after eating a meal with only 30g of carbohydrates. The potential to go low from after meal activity was amplified, and pump sites would ultimately need more frequent rotation. Thankfully, it became clear that the 1:6 was sending me too low after meals, and I eventually settled on 1:8.

The 1:8 has been working great, and I have learned a few things about food and my blood sugar spikes since. For instance, on the weekend I ate porridge, which I thought was relatively low GI. Apparently the instant, microwaveable kind, is not. Not even close. And despite accurate carb counting, pre bolusing by half an hour, and a waking BG of 7.9, my levels just climbed. 9.2 an hour later, 14.7 after that, and 15.7 after 2 units of correction. Instantly, bells rang in my head as I recalled occurrences of skyrocketing blood sugar levels after Weet-Bix, potatoes and an overripe Banana.

So, yes, it does seem that less carbohydrates has reduced my insulin sensitivity, or increased my sensitivity to glucose. But it also seems that my insulin to carb ratio is less effective when I eat higher GI foods. And perhaps there were also some stress hormones in play a few weeks back, that were contributing to some of those skyrocketing blood sugar levels.

I absolutely hate that diabetes is forever changing. There’s no guarantee that what’s working today, will work again tomorrow. Or in a month. 

But nonetheless, it does feel good to be somewhat in control once again…and a little wiser…