When a non-D hears about my diabetes, they will often think many injections every day is the worst of diabetes. It’s your frustrating story, however, that typifies what most of us with diabetes see as the hard part of diabetes. You play by the rules, do everything right (or almost everything right) and you’re rewarded with out-of-range BGs and a puzzle.
As you well know, diabetes is not simply the interaction of insulin with glucose. There are many other factors that drive any outcome. I suspect that the main driver of your trouble is morning insulin resistance. Perhaps you need to change your basal profile instead of relying on a temp basal fix.
Insulin pump settings are not a set-it-and-forget-it scenario for most of us. Your body changes from day to day and month to month. Changing metabolic needs are not an exception but a rule. This forms the thesis of an interesting book published a few years ago, Sugar Surfing.
Written by T1D and endocrinologist, Stephen Ponder, he puts forth that diabetes is a not a static disease but a dynamic one. The formulas that we program into our pumps or that inform multiple daily injection therapy can only work on an average day. Metabolically, we don’t live with a parade of average days; instead we live with days both a little and a lot above and below average. Ponder encourages us to respond to those changing needs in a timely way so that we can counteract a BG trend determined to rise or fall out of out target range. He describes his method as sugar surfing.
The key to figuring out your problem will be to change your overnight basal rates to counteract your rising BGs. I realize that that is easier said than done. You could use Gary Scheiner’s basal testing protocol to discover your current basal needs. This involves skipping a meal and observing the BG effects of the basal rate only for three or four multi-hour segments per day. People often start with the overnight period since we don’t usually eat overnight. Using this protocol requires some persistence as sometimes the initial set-up fails and you need to scrub the full test and try again 24 hours later.
If you successfully complete a basal testing regime, it doesn’t mean that you’ve discovered your perfect basal profile that will never need changing. I’m sure you’re aware that diabetes doesn’t make anything that simple! I see basal test as putting you in the right BG neighborhood so that sugar surfing will allow to move your blood glucose to a desired level for that time and that day. Just as every wave varies some for surfers, our dally blood glucose moves in a similar varying pattern.
I apologize if all this seems too complicated and all but impossible to employ in your life. While we all recognize the wisdom of “your diabetes may vary,” there are enough repeatable underlying glucose patterns in a person’s metabolism to make this, in most cases, a solvable puzzle.
Many of us have faced very similar circumstances as you and found a way to successfully deal with it. Maintain hope. This is a solvable puzzle. Unfortunately, today’s exact solution may not be tomorrow’s exact solution. Our daily blood sugar patterns may not exactly repeat themselves, but they do often rhyme.
You have the rest of your life to figure out how to handle diabetes. And you can get better at this game. Learn something about diabetes every day, keep a healthy attitude, and persist. Remember to cut yourself some slack when you fail. None of us get this complicated dance right 100% of the time. Learn from your failures. Good luck!
