Thanks for that reminder, Jen. That’s a very nice 6-hour line! After all your challenges yesterday, you deserve some feedback that all your efforts do count.
So, I want to recall some of what I’ve been through in the last 20 hours or so. I went to a doctor’s appointment early yesterday afternoon and sunshine provided a nice yet cool day. After the appointment, I headed for a Starbucks and decided to get a pastry with my coffee, a rare treat for me. I took two doses of 4-unit Afrezza, one immediately after eating and another 30 minutes later. Well, it’s clear my timing and dose amount was off as the post-snack BG topped out at 197 (10.9) and then took a dive.
I planned to meet my daughter for dinner out and I changed my infusion site at 4:40 p.m. I didn’t bolus for dinner until about 15 minutes before arriving at the restaurant. As we walked the few blocks to the restaurant I could see and feel my BG diving, so I took one glucose tab. Turns out I underestimated the low and it persisted for about 45 minutes, even as I tucked in to a serving of early french fries.
I accepted that I made a few bad calls leading up to the low but I figured the usual post meal rise would even everything out. Diabetes had other plans as my BG marched ever upward. At 8:45 p.m. I took a 1.5 unit pump-delivered correction followed by another 2 units at 10:30 p.m. and finally 2 more units at 11:00 p.m. I felt a little leery going to bed with all that insulin on board but I figured my CGM would wake me up.
The CGM did wake me up at 2:00 a.m. with a 300+ (16.7) reading. I was tempted to just throw some more pump insulin at it and roll over to sleep but I remembered the infusion site change of about 9 hours prior. That would have been a serious mistake. I knew I had to get up and change sites.
I placed another site and pulled the bad one expecting to see blood or a kinked cannula. There was nothing obviously wrong with the failed site. Then I knew that I had to add a heap of insulin to bring my BG back down. My experience with failed sites is that you need to add insulin to correct, more since it’s so high, and also backfill for the hours of basal insulin that I missed. I inhaled 8 units of Afrezza and delivered an 8 unit IM shot in my arm. I also drank about 12 ounces of water.
I did over-correct, but not by much. My Dexcom woke me up to a sub-65 (3.6) around 6:00 a.m. but I was able to turn it around with a single glucose tab.
I’m not sure what lesson to draw from this. I suppose I could conclude that the afternoon pastry was a mistake but I’ve done that before without bad results. And I sure couldn’t avoid a site failure, they just happen. Oh well. things have settled down with my BG ranging from 68 (3.8) to 126 (7) over the last 5 hours or so.