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…