Highs and lows

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.

Lows at work are hard. I do mostly computer work and presentations but even with computer work, when I'm mentally focused on something, the low can sneak up on me.

You're absolutely right about the cgm though. I keep it on my desk or in my pocket and at least I have an idea where I'm trending. It's a life changer in my opinion. I hope you're able to get one soon.

I'm very dull at work and pretty much eat the same stuff every day. It helps my BG stay flat so I can "bank" a lot of 8 hour "flatlines" but it also keeps my wits about me. W/ all the exercise stuff, I run into periods where I have a "wow, nice weather on Sunday!" and I'll do a 20-30 mile bike ride for fun on my "day off" and then on Monday I'm completely wiped out but I always have stuff to eat and, given how dull my diet is, I just add in some extra carbs and enjoy them. Last summer, w/ the extra running, my cholesterol drifted up but I switched to veggies (mostly broccoli and carrots, I'm a lazy shopper too...) and my bad cholesterol went back down to 86 *and* I felt that I was recovering better from runs so I figured, regardless of diabetes, my mom was right, eat your vegetables! Bolusing for a zero carb coffee drink seems pretty risky, despite my risk-friendly lifestyle. I stay away from that crap and just drink black coffee.

Obviously, bolusing for the no-carb coffee was a mistake. :) The coffee was just expresso and ice blended. I thought it was like a frappuccino because it tasted like one, so assumed it had milk in it, when it was really just coffee and water. About a year ago I quit lattes; now if I get coffee I either get a misto (just brewed coffee and steamed milk), or else an iced latte which is just expresso, milk, and water. I try to justify why I'm spending $5 on just coffee, milk, and water, so I think that might be ending soon, too ...

The crazy part is that I also eat the same thing every day. The only meal that varies at all is dinner, and even that is usually the same food groups, just changed up a little. Lunch sometimes varies by about an hour time-wise. Otherwise my time and schedule is identical during the week and even most weekends. For some reason even with that my control is weird. If you use 80-140 as a target range, only about 30% of readings for the past three days actually fell within that range. My only goal right now is if I could manage to avoid going low or going into the teens every day, that would be great!

I woke up at 16.1 (290 mg/dl) this morning so I am thinking my basal rates are all off somehow. I just lowered part of it because I've been going low in the afternoon a lot. I am not sure why I'm going so high, but I hate waking up high. I'm going to have to set my alarm for a few times overnight, I think.

Couple things I've learned recently that show in your experience... 1. It's not often how much you eat any more than it's what you eat that can change your glucose levels by a large amount. And, 2. The "feeling low" part comes just as much from a dropping BG than an already low BG. I've felt low at 150 mg/dl before. Turns out that I was moving downward quickly, still would have been a hour or two before getting to 70 mg/dl or lower, but the movement downward caused the all to well known shaky feelings to start early.

Oh... and I should have included stress. Your "work continues to be insane" comment made me think about that. Stress burns a LOT of carbs, but not at predictable amounts. Plus stress makes you eat more too, so if the two get out of balance, so does your BGs.

In regards to the stress, at least, work is insane but it's SO much less stressful and SO much more enjoyable than my old job. I am so happy I switched. I used to have intermittent high blood pressure that I was pretty sure was due to stress, and since I've started this new job my BP has not been above 130/80 once (and I check it almost daily), and is usually more like 115/75, which is awesome. I do know stress has a huge effect on my BG, though; my endo used to be able to tell days I wrote exams just by looking at my logbook ...