30 Grams

I haven’t been able to stop thinking about a really enlightening article I read at Diatribe in recent weeks. Cherise talked about a glass ceiling that she had for the number of carbs she entered into her pump, and explored why she was hesitant to declare the actual number of carbs that she was eating.

I’ve lost count of the times where I’ve subconsciously entered 30 grams of carbs into my pump, even when I know I’ll probably be eating more.

30 grams is the number I’ve been conditioned into thinking is the ‘right’ amount of carbs for a meal. Many corners of the diabetes community send out messages that less insulin is better, and even worse, demonise food choices.

Today, my mentality has evolved to eat as much as I need to meet my own needs and not some unrealistic ideals of what is right. However, I can’t think of too many times where I will enter more than 30 grams into the bolus calculator of my insulin pump. It’s more of a wait-until-my-blood-sugar-starts-going-up until I’ll top up with more insulin.

30 grams also feels like a safe number. Even moreso after weeks of nasty hypoglycaemic episodes caused by a combination of hot weather and correcting extremely stubborn blood sugars until I’ve over-done it. You know, the ones where I have to stop what I’m doing completely because I can’t concentrate and I feel yucky.

My time in range has been suffering, for a while now. It was definitely a contributing factor to the fatigue that led me to take a pump break over Christmas. But even now that I’m comfortably settled back into pump life, that problem is still glaringly obvious.

50, or 60% at best, does not reflect my best effort. I know that I’m not supposed to judge myself on my numbers, but I feel guilty at seeing so much yellow and red on my Dexcom Clarity reports. Not to mention that my diabetes just feels so much harder to manage.

One of the hardest things about managing diabetes is that the dynamics are always changing. There are times where I need less insulin because it’s hot and I’ve been more active than normal. Then there are times where I need more because I’ve been ‘slacker’ than usual. You always have to stop and think about what’s going on, and what to do to fix the problem.

The lockdown that much of Western Australia was plunged into earlier this month, quite honesty, came at just the right time. It was just the perfect chance to take away some of those distractions – that background noise that comes from the daily grind – and just give my diabetes a little bit more love and attention that I can’t always seem to muster.

I think Cherise’s post couldn’t be more accurate, especially in the context of my own hesitation to go beyond 30 grams – and it will definitely be a focus for me going forward.

The Rule of 10 Percent

A few days before I was planning on ending my pump break, I pulled my pump out and reviewed my basal profiles. I have, I guess you could call it, a ‘base’ set of basal rates. These are the tried and tested rates that I know work for me most of the time, given that my lifestyle and activity levels have been largely consistent over the past couple of years.

It has also been so hot in recent weeks. I am so sick and tired of this heat. Even after dinner, I end up regretting going for a walk when it’s still 32 degrees outside at 7 o’clock. Yuck.

So yeah, as soon as I resumed pumping, I quickly found myself going low after almost every insulin dose. My insulin sensitivity was epic. Was it due to the heat? Or the fact that I’m feeling far more relaxed after Christmas? Or did my pump break give me a natural reset to my insulin sensitivity? I suspect it was a combination of the three.

Whenever something doesn’t feel right with my diabetes, I go by something I like to call the rule of 10%. In this instance, I simply went through my basal profile and dialled my basal rates back by 10%.

Likewise, I suspect that by late April or May I’ll be upping my base basal rates by 10% as the weather gets cooler and hibernation gets a bit more tempting. Ditto for those periods when I’m feeling a bit more stressed, being less active or facing whatever else is going on in life.

I’m not saying any of this is easy, or that I’m completely on top of all of this. But 10% saves me the stress of having to think about every single basal rate, every single increment, in every single time block of the day. My basals still follow the same pattern, with a typical elevation from 1am, an increase around the time I wake and then a holding pattern for the rest of the day. So it makes sense that an increase across the board will help plug the leaks.

If only there was some kind of golden handbook with answers to navigating sick days, stressful periods, relaxing periods, hot weather, cold weather, active days, lazy days and everything in-between.