Work continues to be insane. One thing I realized is that I think over the past year or two I've been letting myself run a bit higher at work. I'm reluctant to take full corrections or bolus too aggressively because I might go low. I work doing direct assessment/teaching, usually one-on-one with people or at most in small groups, so it's impossible to discretely test and treat a low, so I try to avoid them completely.
I am trying to figure out how to deal with going low while I'm working with clients. Right now I tend to just wait it out which is just asking for trouble. A few times I've been in appointments and started to feel a bit low and just left it, knowing they'd end in 20 minutes or so, and when I test I'll be 3.1 or 3.2. It's frustrating because the lows seem completely random to me, although some are related to mistakes I made myself. The other day I bolused for a sugar-free drink thinking it was 20 grams. It turns out the people who made it didn't put any milk in it (I just assumed they had), so it was actually zero grams. An hour after bolusing I started to feel SUPER low and a client was literally on their way up to my office at that moment. I tested and was at 3.3 but must have been dropping really fast because I had a few units of insulin on board. My lips/tongue were numb and my ears were ringing and I felt super weak. Usually for a low at that level I feel almost nothing. I scarfed down about 30g of glucose tablets and was totally panicked knowing I had to look functional in 30 seconds and probably wouldn't be able to test for two hours unless I did so in front of my client (I was doing an assessment). Thankfully, the client was delayed getting to my office and I felt a bit better by the time they arrived, but I feel like it's irresponsible to feel that low and not tell someone or something ... but I'm also on probation at work so don't want to make it seem like I can't do my job ... My supervisor knows I have diabetes, but when I told her she was like, "Have you ever needed to eat emergency sugar?" as if it's something that happens rarely and not multiple times per week! Two hours later I tested at 14.4 (259 mg/dl), so either I over-treated or I rebounded or both.
I also have been following my "food rules" including trying to get nutritional information for everything I eat, including work luncheons and such. So far it's been pretty successful and my blood sugars have been pretty good. I still have to figure out how to pre-bolus a bit because I've found with things like luncheons I start out in range, then spike to 13-14 for an hour or so, and then come back down by two or three hours. So it's not the insulin dose, just that it doesn't kick in right away that's the problem.
Overall my blood sugars are pretty good as long as I keep on top of hormonal changes or whatever it is that causes my insulin requirements to change drastically every few weeks. For some reason I've also found I wake up some mornings extremely high. I went to bed in range last night and woke up at 4:30 this morning at 17.7 (319 mg/dl). I think part of it is pump sites, they seem to die completely after two days and once two days has passed I shoot up really high and often get ketones. I am going to my allergist on June 29 and will probably ask him about infusion set allergies as I think that's the problem (the sites get itchy within hours of inserting them), even though I am using Tegaderm and changing more often. I was using needle sites for a bit and it may be that I have to go back to them, even though I don't really like them, better than high blood sugars.
I am really, really hoping a CGM comes to Canada at some point in the foreseeable future. I think a CGM would make things so much easier. I'd be able to be more aggressive at work because I'd be able to just check the CGM to see where I was trending (I know it lags behind somewhat, but it's better than having no clue), and I'd be able to have it wake me up sooner when going high instead of spending hours sleeping through it.