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…

Do Others See My Diabetes as a Weakness?

This year, in particular, my diabetes is more apparent than it ever has been before. I started wearing an insulin pump in May, and intermittently use the FreeStyle Libre to monitor my blood glucose. I more actively manage my blood sugar levels than I once did, which means I rarely leave the house without my meter and skittles. I tend to my diabetes quite a lot through the day, and I am very conscious of it.

Which is why the very first question during last week’s OzDOC chat really struck a chord with me. What are the high lights and low lights of being open about my diabetes in real life?

For me, one of the low points is definitely my perception that others might see it as a weakness. It’s stupid, really, because why should I care about what other people think? Yet those thoughts still sit there, on the edge of my subconscious, every time I need to pause and tend to diabetes through the day.

Every time I swipe my FreeStyle Libre up against my arm. Every time I pull out my pump, staring at it for moments on end while deliberating over a correction bolus. Every time I’ve got my phone in hand at the dinner table (and feeling extremely rude for it), calculating carbs or searching through Calorie King. When I spilled my container of skittles on the floor in the shopping centre last week while I was trying to treat a hypo, scrambling to pick them all up (thank goodness I had a spare!).

For the most part, I definitely don’t feel that diabetes as a weakness. When I reflect on my life, I don’t feel that it is significantly weaker because I live with diabetes.

Sure, it’s work. Hard work. It effects every single activity that I undertake. It’s intrusive. It’s frustrating. It doesn’t always go right. It does interrupt my day. I get angry and sweary and pissed off. If I’m lucky, it will even disturb me while I’m asleep. It’s fair to say we have our moments. 

Yet as strange as it might seem, most of the time it is just something that I have to do alongside eating and sleeping and working. Half decent management doesn’t simply come from accepting defeat.

I guess, naturally, people don’t know a lot about diabetes. Neither did I, in the 17 years before I was diagnosed. I don’t really know how I can change that.

The high point of being open about my diabetes would definitely be its conversational value. It does give you something interesting to talk about. And I do feel a little less “weaker” when the people around me know what I’m doing. 

I can only hope that by being open about my diabetes, I am not feeding those perceptions of weakness. I can only hope that by continuing to talk about it, others will see it as the ordinary that I do.


Making the Leap into Private Diabetes Care

I am extremely grateful for the diabetes care I have had access to over the past six years. The diabetes clinic at my local public hospital has given me access to every kind of service I could ask for manage my diabetes. All completely free of charge. Unless you count parking. Parking is a pain in the ass.

By far, the most amazing part of that diabetes clinic was my amazing Diabetes Educator, Gwen. Yeah, appointments were often as far as three months apart. Yeah, there was a gap in the middle of those six years where I probably should have kept in touch but didn’t. But Gwen was always there. She was always available by phone and by e-mail. She listened to me. She was someone I could rely on. I wouldn’t have wanted anyone else to support me as I began insulin pump therapy in May.

She retired several months ago.

In the last couple of weeks, I feel like I’ve lost my way. I no longer feel like I can achieve consistency day to day. I mean, I know I’m doing all the right things. Writing things down. Trying to take note of patterns. Checking my basal rates. Eyeing insulin to carb ratios. But none of these things seem to add up to consistent trends in blood sugar levels after eating.

I so wish I could call Gwen right now. All I want is someone to talk this over with. Someone who’s brain isn’t screaming diabetes, diabetes and more diabetes.

The high point of last week was a hba1c result that I had worked damn hard for. The low point was the diabetes education that went with it.

I’m a very hands on person with my diabetes management. Okay, maybe even a little too much of a micro manager. But the advice I received last week was very textbook. I didn’t feel that I was being listened to, nor did I feel that the way I choose to manage my diabetes was supported.

To be fair to this educator, it would have been difficult to give advice to someone who she had only met for the first time. Let alone in the space of a 30 minute appointment on a busy clinic day. Gwen was never replaced after she retired, which has meant a revolving door of whoever’s free to see me on the day I come into clinic.

However at the moment, I need better. I deserve better. I need someone who I can build a relationship with. I need someone who has more time for me than a busy and understaffed clinic in a public hospital allows. I need someone who will listen to me, and be supportive of my approach towards managing my diabetes.

The icing on the cake was being told that it would be okay for me to let my a1c creep back up a little, because that’s all I needed to avoid long term complications.

This is something that has weighed on my mind for some time. I have decided that I want to make the leap into private diabetes education.