How much stress matters: A CGM tale

Type 1 and LADA
#1

So I’ve always heard stress can raise your BG. Heck, even my dentist brings it up when I have to have a “procedure.” And I always said, nah, not really a problem, at least I never noticed it being one.

But then I got me a CGM…

Background
1: The last couple of days have been exceedingly stressful at work as I crank through one of the annual tasks that I feel the least confident about, and that my boss makes the biggest stink about (and believe me, she can make a very painful stink).

2: Back in April I got a CGM to help with managing time-zone changes for a trip to France. Since then I’ve been paying a lot more attention to post-prandial spikes and whatnot, trying to learn the technique of pre-bolusing sufficiently to control them, particularly at lunch time which is the one meal where I usually indulge in a few carbs.

These things came together yesterday in a way that really opened my eyes. I was busting my butt on this report I have to get out, deep under the gun, when my pre-bolus reminder came up. Went through the routine–I find unless I’m below 120 I have to give it quite a bit of lead time in order for the down trend to get going before I actually eat. So I bolused at 11 for the expected carbs, noticing that my BG was riding kind of high compared to normal at this time–like 140 or so. Meanwhile, I go in for my first meeting with my boss to go over my spreadsheet, and it turned up a bunch of problems (she has a laser eye for this stuff, which I do not). So I dived back into it for the next hour, keeping an eye on my CGM for the down curve to start. By 1 pm, I’m still waiting. In fact, even though I’ve bolused like 8 units two hours earlier, it’s still edging UP.

In fact I kept working to fix the problems in my report and never actually ate lunch. BG finally started to turn around later in the afternoon, and by the time I got home for dinner around 6 it was an unremarkable 90. But that 8 units I’d taken at noon basically did nothing but keep the stress effect in some kind of check. I can only imagine how high I would have gone without it (I think I peaked about 170)—but I’m fairly gobsmacked to have had that much IOB without eating and ending up just in normal range hours later. Without the CGM I probably wouldn’t have skipped eating (would have been afraid to, not that doing so was a good thing particularly) and I probably would have ended up with a pretty high number pre-dinner probably without any clear idea why (miscalculated the bolus maybe). Having the CGM data going the whole time really was like lifting the veil–stuff that’s probably been going on all along but I never was really aware of it.

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#2

Yep. While I never had the particular experience you recount, I also have found that a CGM makes it obvious, for me at least, that my BG just doesn’t follow the simple model one assumes it will. Take insulin & BG drops … but not always. Eat a certain amount of carbs and your BG rises … but not always by the same amount.

CGM can give an entirely different slant to the quip “Your Mileage May Vary”. This is something one always kinda, sorta knew from experience over the years. But the CGM brings it into much sharper focus and removes a lot of uncertainty.

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#3

There’s a lot of variability in this game we play. Insulin doesn’t absorb the same way each time. Food doesn’t metabolize at the same rate each time. The exact same exercise produces different results from day to day. And as your example shows, stress can play a dominant role.

I love all my quantitative formulas I use, but I’ve gained a new respect for the power of the CGM to expose and enable participating in the dynamics of the moment. I keep thinking about Ponder’s Sugar Surfing. He makes the point that static thinking and formulas are not the definitive answer. One has to be willing to act in the moment to produce good glucose control.

Good on you for resisting the habit that you had to eat because you dosed!

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#4

Good thing your dexcom helped you. I would never be able to take a large amount of insulin and skip a meal, unless something really major was going on. But then there are other times I do hours of careful corrections with no drop for hours and then I crash. I noticed when I was at the dentist last month, I had eaten before going there and had iob, that I was dropping and I dropped a lot more with novacaine so I shut off basal. I’ll make sure not to have any iob if I need novacaine again.

#5

Stress absolutely destroys my blood sugar, seems to render my completely immune to insulin.

Had to run a workshop today that I hadn’t properly prepared for and was worried about the outcome. Things started going bad when I went to bed at 1am and couldn’t sleep properly, started at 4.8mmol(86), creep up to 12.5(225) overnight. When I woke up I rushed to work to do some last minute prep, I didn’t have breakfast but my bgl climbed rapidly until the sensor maxed out at 22 (396). When I tested with my meter I was 26(468)! No matter how much insulin I took I couldn’t get it to move downwards until the afternoon when the workshop was over and I could come home and have a drink :beer:

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#6

Public performance is another sure-fire BG elevator for me too. I sing semi-professionally and have a weekly Sunday a.m. church gig. For years I wondered, “How come my BG is always way up there by lunch time on Sundays?” Should have been obvious I suppose, but it was being able to watch it angling up on my CGM as the time to sing approached that really brought home to me what was doing it.

#7

and sometimes it’s GOOD stress that makes mine go up. I always wondered why it seemed mine went up up up on days when I have Quilt Guild. The anticipation of spending time with friends? All the activities, conversations, stimuli, artistic inspiration, running around and seeing everyone? Could it be the lovely leisurely drive through the beautiful farms and hills of the lower Hudson Valley, gorgeous any time of year?

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#8

Pleasure can be stressful too! :wink:

Whereas in spite of my dentist’s concerns I never seem to have any problem from getting my teeth drilled.

#9

whenever i go to the dentist for a “procedure” i make certain to schedule my appt. around my IOB. afraid of going low while the dentist is working on my mouth, i check BGs before the procedure and if in a normal range, i take a glucose tab just to relieve my anxiety. then i place the dexcom receiver on my lap. this way, if i should feel/hear any alarms go off, the dentist, and i, will see it and stop immediately so i can re-test my BGs and take another tab immediately so he can go back to work.

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#10

so if you have a cgm, can you find ways to relieve stress in the moment, rather than waiting for the stressful moment to be over? has anyone done this using a cgm to see if the stress relieving strategy actually worked to lower blood sugar? at a museum near my house there is an exhibit where you can hook yourself up to a blood pressure monitor and see it fluctuate in real time. i found when i laughed my blood pressure went down. don’t know how accurate that was. for you guys with a cgm, do the old stand-by deep breaths make a difference? i know the cgm is lagging behind your actual blood sugar at the time, but can it help you pinpoint how to reduce stress in the moment?

#11

As far as I can tell the BG elevation seems to persist far beyond the situation that precipitates the stress. My latest work stress was pretty well cleared by mid-afternoon but I was struggling to get my numbers to come down all evening.

#12

research has been done on how to reduce hot flashes with slow breathing right when the hot flash is beginning, and that seems to work. it seems that we would have to catch ourselves starting to have a stress response and do something to dampen it before it builds up to some critical level. as an extreme example, if i’m worked up about something in a public forum and i want to raise my hand to speak out, i can feel my heart start to pump hard. other times stress is much more subtle. people who are ‘nervous’ or ‘sensitive’ by nature (like me) already have their work cut out for them.

eating low carb has made a difference in my mood, making it more even, so i assume it has enabled me to handle stress better. my chinese father-in-law swore by qi gong, which i never learned, but which seems to have helped him. unfortunately he was hit and killed by a truck crossing the street in flushing, ny. since it was a possible vehicular homicide, they did an autopsy. my father-in-law was in his 70s and the coroner told me he had very little atherosclerosis.

i found a website that has some interesting ideas:
http://www.helpguide.org/articles/stress/stress-relief-in-the-moment.htm

#13

I’ve had a very similar experience. Who goes through that? I do. gotta love it.