Insane

Tonight I downloaded my pump data and captured exactly what it is that drives me so completely insane about my diabetes:

Graph of blood sugars

That's the past two weeks. The first week is extremely consistent, not perfect but at least very consistent so that I could work on it. Then just like that things turn to total chaos and the past week I have no idea what is going on, I'm just trying to hold on for dear life (or so I feel).

It is like this every few weeks. Have a couple of consistent weeks where I feel like, okay, I can work on this ... and then suddenly the chaos hits and I feel like I'm going completely crazy and all the rules are out the window.

And I know that it will only last for two weeks or so and then go back to normal, but if this happens every month then no wonder I can't get my A1c down! I already jack up all my pump settings significantly during this period and still have so many highs and even ketones very easily if I'm not on top of things. Drives me crazy.

I think part of the reason I'm reluctant to jack settings up even more is that this ends just as suddenly as it begins. I'll do something like go to bed and randomly wake up at 35 at 3:00 AM one night ...

Anyway, I just had to vent. I feel like I vent on here a lot but I rarely ever vent to people in real life so this really helps! I was high all last night and then finally got down into range earlier today and thought I was good, but am back to being high (and ketones) tonight. I just get so sick of this crap sometimes.

I know how frustrated you must feel. A scatter graph of my glucose readings looks like a shotgun blast - from 382 to 39 to 287 in 10 hours yesterday alone. If I could get mine withing a 30 mg/dl band for just a couple of hours I'd be ecstatic.

One cool thing about great reporting tools like your Animas graphs and my Minimed CareLink system and continuous glucose monitors is that now our doctors can see that despite our best efforts controlling blood glucose is no simple matter. For years I've been annoyed by hearing a doctor tell me "you have to do better." Now with these tools I can show them that despite doing what they tell me, my body is going to do what it is going to do.

All we can do is do the best we can and with more data our care providers can see how tough living with diabetes can be.

Do you adjust your bolus ratios, along with basal rates when you are running higher? It seems like there's a regularity to the higher read thingies?

Yeah, my endo either acts like I'm just not really trying OR like diabetes is just "like that" and there's no point in even bothering ... I need to find an endo who's more in the middle.

I do change everything on my pump: basal, I:C ratio, ISF. For example, so far this time my basal went up by 0.2 u/hr, I:C ratio went from 1:10 to 1:7, and ISF went from (using mg/dl) 36 to 25. That is usually what I do each time but I think I need to adjust even more because I still run high.

Can you relate any of those random highs to the changes in hormones from your monthly cycle? I have been learning so much since joining TuDiabetes, even though I have been T1 for 13 years. I just read a couple weeks ago that those hormones can definitely cause changes in bg. I noticed it just this past week, but I'm going to have to test my theory next month, as this month I was also using some bad Apidra that didn't help matters any. I was in the 180-250 range and couldn't get down for anything--although I don't take too much extra insulin just to come down for fear I'll drop too fast and have a low.

Just a thought!

I am sure it's hormones ... I have been tracking it and it definitely seems to have a cycle around hormonal changes. It's just so frustrating because I work so hard but end up with such lousy control for 50% of the time.

I don't see how this could possibly be helpful unless you correlate it to a log of precisely what you age (time, food, quantity, carbs) and when/how much you exercised...?

I mean, unless you're fasting for a few days (don't!) then the only way to make sense out of these numbers is to look at the food, too, right?

Are all those readings at 12.5 and above just random spikes? Or spikes as a result of eating more carbs than your insulin could cover? Or uncovered protein that was converted via gluconeogenisis? Or meals with more simple carbs and not very much fat to slow absorption (quicker absorption, bigger spike)? Or...?

LaGuitariste, she probably does keep track of food and exercise too, but just posted that graph to show how wacky things looked.

And Jen, I'm there with you! It feels like the harder I try, the worse I do! In reality, I'm sure it's the harder I try, the more I feel like a failure when I'm not "PERFECT"!

But the thing is I eat pretty much the same food every day with virtually no variation. Unless I eat out, which isn't very often (and lately when I eat out I stick to salads and look u the nutritional information before ordering so I know how to bolus). If I'm eating at home or packing food to go, it's pretty much identical (down to weighing/measuring the serving sizes). Same thing with my schedule ... I exercise for 30 minutes every day after dinner except for the odd time I'm out (usually the same night I eat out ...). Some of the after-dinner highs are due to this exercise ... I haven't quite figured out how to start out at a normal level without ending up low at the end, so I'll often start out a little high.

The highs on the graph are sometimes after eating (especially for that first week), but for the second week they are after eating, sometimes fasting, sometimes before meals. I do wonder about protein sometimes, but I already calculate carbohydrates so meticulously that the idea of having to calculate protein as well just makes me shudder ...

I think my big frustration is that if things stayed like the first half of the graph I would be able to work with it and refine things. But I'm finding I'm never able to "refine" things when I keep getting interrupted every two or three weeks with a period of craziness before it goes back to being consistent and "normal" again. I feel like I have to start over from scratch every month. (Sort of like how before I got the pump ... I'd wake up high EVERY morning no matter what I did, and I'd be high for hours and by evening would finally be getting things under control and feeling good ... then I'd go to bed and wake up high and have to start all over again battling highs for hours the next morning. It's kind of like that but on a monthly basis now.)

I do use Diabetes Pilot which keeps track of my food and everything .... I just didn't post it because it's pretty much identical every day and I figured people would not be interested in reading through a long Excel file!

You will note, I didn't ask any questions about your records, I have found your records super detailed and way better than mine!

If it is related to the hormonal changes caused by the menstrual cycle you would need to look at 1/2 to one year. This should reveal the pepetition of 6 to 12 cycles. The question is: can you identify some valuable information in this analysis? With valuable I mean: at day 10 after the menstrual bleeding you will need to increase the basal for the next 10 days by 20% or something like that. I fear it is all much more complicated...

Oh Jen, I so share your frustration. My body is fighting menopause every step of the way. The inability to get any kind of pattern identified is so frustrating. I'll do really well for a couple of weeks and think "I've got this now"...then bam! everything changes again.

Making it worse is that I don't have predictable cycles any more. I'll skip one or two or 3 months and then have one. When I've skipped 3 or 4 months, that's when my bg really skyrockets. So I crank up the insulin. But, like you, I'm afraid to crank up those nightttime basals too much for fear I'm going to come crashing down when this stretch comes to an end or changes...as it always does.

I thought for a while maybe it was my dinner meal or the I:C ratio or protein, just as you said. But the same thing happens when I'm fasting. I do really well during the day most of the time so I've been trying to eat a decent lunch and for dinner eat only scrambled eggs or nothing at all so I can get these basals inched up.

Last night I was up 4 times correcting and trying to see when the different rate changes need to kick in. How I wish for a nice dinner and a good nights sleep...with good fasting a.m. nummbers.

Good luck, Jen, I hope things get easier for you. You're doing a great job though considering the irregular fluctuations! And know that you're not alone. :)

??? No I don't. I'm sure BCBS will only cover one? I have had 4 I think? One in high school, one after college for a very short time and then got back w/ endos in 2008 and moved. I'm not sure which rant I mixed something up in but I only have ever had one at a time.