It’s amazing how something as simple as a conversation has given me some much needed clarity in recent weeks.
For several weeks, I’ve been giving corrections to stubbornly high glucose levels in the afternoons after I’d finished work. Highs that have made afternoon tea difficult to manage. Highs that have made my dinner time insulin dose less effective and pre-bolusing a complete waste of my time. Highs that have often carried through to bedtime and even resulting in a disappointing waking number.
I didn’t think that there could possibly be anything wrong with my afternoon basal rate, because I knew that it was fine on non working days. I thought maybe I was disconnected in the shower for too long. I thought maybe I was eating too much at lunch. I thought maybe it was time to give up the toasted sandwiches slathered with butter, and cheese oozing out of the edges. Maybe buy those addictive donuts from Woolies less often?
When I recently sat down with my new diabetes educator and my Diasend logbook, she instantly pointed out a recurring pattern of red readings in the afternoons. I knew that afternoons had been a problem area. I can see the afternoon ascent in my Ambulatory Glucose Profile.
Yet in all these weeks, I had never really stopped and thought twice about it.
It took my educator’s small suggestion of increasing my basal rate in the afternoons for me to finally make sense of all of this. Could these afternoon highs possibly be an after-effect of my physical activity at work all day? Could my body be responding with extra glucose as I put my feet up in the afternoons and breathe a sigh of relief that the day is over? A quick google search confirmed that this indeed, could be a possibility.
The most incredible thing is the positive flow on effect that this small change has produced in the past two weeks. Since increasing my afternoon basal rate from 2-5pm on work days, I find that my BGLs stay in range through the afternoon. My dinner time insulin dose is far more effective, and I no longer receive frustrating highs after an accurately carb counted dinner. Overnights have also been looking much healthier, which will ultimately account for a large chunk of the hba1c result I am chasing.
As my educator reminded me, I can easily be doing this at home as well. I have the tech that is capable of uploading my data to the computer. I have Diasend, the software that compiles all of my data into one easy to read report.
Judging by my Diasend report that is now looking a little less red, I really need to be making the time to do this more often.
Yeah I get that pattern. My basal more than triples from about 6pm when I finally sit down and stop running around for the day.
Glad you sorted it. Its crazy how earlier things in our day can have such an impact.
I also go into the 20’s immediately after exercise which is so frustrating. Theres nothing I can do to prevent it because I drop during exercise so cant give insulin until I’m done.
It is a puzzle that never seems completed, and if it is completed it is quickly undone. I say this because I imagine your insulin needs will change drastically many times in your life. I once took about 150 U daily and now use less than 70 U and many days am less than 50U. I have found such incredible differences as I age and gain and lose weight.
By the way my diabetes is for sale, but I am not willing to pay more $1,000 (US) to sell it. Do you know any buyers?
I have an interesting phenomenon that my BG goes lower at about 4.30 pm. I usually go for a 30-60 min walk about 5.30 and then watch my level go back up as the liver does its thing…then later when I take my shot ( basal) the walk kicks in and lowers my level faster- thats on a good day… Glad you sorted this out .
Frank – Don’t forget that high GI foods will drive your BGL soaring. One of the best things I find to control my BGL is food choices, and eating a meal with carbs when my BGL is above 8 means that it will be tough to bring it under control until several hours after eating. Eating an apple has a very different effect on my BGL compared to say a banana.
Adding lemon juice to a rice dish for example (basmati rice is low GI) makes for more flavour but also drastically reduces the glycemic index of the food and lower BGL peak.
A really cool thing that you can do when your BGL is high is “super bolus”. Take a correction bolus to bring your BGL down to your target and then take another bolus equivalent to your basal rate for the next hour – and turn your temporary basal rate to 0% for the next hour. This will bring your BGL down quickly but not drive you down to a hypo. In effect you have used the same amount of insulin over the same period of time- but brought it to effect sooner. It is very effective – experiment and see how you go. Using a CGM or freestyle libra will really help you work this out.