A few days ago, I had settled into a certain level of comfort with my insulin pump settings. After a week of relentless hypos, I was close to nailing my basal rates at work. I successfully rocked a temp basal rate on Saturday while I was in the kitchen cooking lunch, and on Sunday when I was gardening.
On Sunday evening, I went out for dinner. I thought I had been fairly sensible – two slices of pizza for entree and a steak with steamed veggies on the side for main. I was bolusing insulin under the table as I was going – thank you for your convenience, Mr. Pump. I’d estimated 30g for the pizza and another 10g for the veggies on the main dish. All was good.
When I returned home, I was 14.2. No problem. I entered my reading into the pump, and administered the recommended correction bolus.
By the time I was ready for bed, my glucose had jumped to 18.8 (insert your favourite swear word here!). I gave another correction bolus. It was nearing 10.30pm, and my lower overnight basal rate was about to kick in. I decided to set a +30% temporary basal rate for 2 hours to help get things moving along.
I was trying to be cautious with the use of my temporary basal rates, not wanting to overdo it and go low. The rest of my night was spent checking my blood sugar level, swearing at the result, correcting, setting another temporary basal rate and setting the alarm on my phone to wake myself in another hour to check.
After trialling an hour without a temporary basal rate, I woke up at 4am to discover my BGLs had skyrocketed. I finally decided that I could safely go to sleep with a temporary basal rate switched on for the remainder of the night.
When nothing had changed 24 hours later, I began freaking out. I’d changed a perfectly good looking site, suspecting possible insulin absorption issues because it was too high up on my stomach. I’d checked my temperature, which was a perfectly normal 37 degrees. I checked for ketones that weren’t there. Stressed? Not that I was aware of. Sick? I felt fine. Change in activity? Nothing out of the ordinary.
I was correcting with very little effect, and temporary basal rates were creeping up to very abnormal levels. In a moment of anxiety, I reached out to the Twitterverse to find out if there was anything that I could have missed.
The first one was dehydration. It has been absolutely freezing cold this week. When I think about it, I don’t think I’ve drank a lot of fluids that didn’t contain caffeine these past few days.
The second one is that perhaps I’m coming down with a virus, and my glucose levels are responding before I am.
The final one was lack of physical activity, but I ruled that one out because my job is quite an active one.
Today, not a lot has changed symptoms-wise. But I’m confident that a 30% temporary basal rate across my entire day is enough to keep me somewhat stable. I’m trying to drink lots of water, and pre bolus as much as possible to avoid blood sugar levels from going out of control after meals. I’ve talked it over with my diabetes educator over the phone, and I feel somewhat reassured in my thought processes.
I hope I’m not going to have to start all over again with basal testing. But for the time being, I’ll just have to wait it out and see what happens…
If only all the problems of the world could be solved with coffee.
I don’t know how large the steak was or how much fat the pizza had but it could also (at least partially) be attributed to the high protein/ high fat content of the meal. Protein digests much slower than carb/glucose, and some will turn to glucose over the course of several hours (I often have this happen with large steaks). High fat and high protein can also cause insulin resistance. This is why I personally struggle with chinese food so much for example. I don’t pump but many have figured out things like extended boluses etc. to help with high protein high fat meals…
Thanks Maria. I’ve heard about the insulin resistance issue before from others, but it seems to be lingering around a lot longer than normal. I don’t think I’m eating much differently than normal, but I’ll keep it in mind.
I’ve had a few days like that but on each occasion it has been a viral infection of some sort. Do you use square and dual bolus? Either way don’t give up, it gets easier but it is no full proof system. Can’t wait for the bionic pancreas. Once i had a system failure, took me about 24hr of sheer frustration to realise it was the pump not me. Ugh
No, just using normal boluses for now. Bionic pancreas…I can only dream!