Interpreting Bloog Glucose Values

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1

OK. I'm a little confused by my BG trends lately. I'm learning there are many seemingly hidden variables to diabetes which frustrates the hell out of me as I'm sure it does you too!! Some days they're not so hidden and I can identify why I am high or low. But other days I can't find an answer to why I'm trending the way I am. Will my ability to figure out my BG values before they happen get better with time?? I'm beginning to think not.

I've been reading a lot of new (to me) diabetes blogs since my introduction to them from Blog Week 2014 and I'm reading that some T1D veterans experience the same thing. I don't know if that fact is frightening or reassuring. Is it always gonna be this hard to anticipate what a meal or a walk is going to effect my BG?? I was hoping it would get easier but I'm not going to hold my breath waiting!!

I've recently started to pre-bolus after seeing an old recording of an interview of Gary Scheiner, CDE of the year, 2013, by TuDiabetes' Emily Coles in which he recommended getting a handle on postprandial (after meals) high BG's by bolusing for the amount of carbs in an anticipated meal by 15 or 20 minutes. This helps improve the timing of when your insulin starts to work with when the carbs (carbohydrates) from the meal are absorbed, hopefully, preventing that dreaded spike. I've had some successes but I failed miserably tonight and I can't figure out why.

Bear with me as I rehash what happened with you in the hopes that one of you may be able to help me by figuring out what I did wrong... Twenty minutes before a usual dinner of spaghetti, meatballs and a slice of garlic bread, I bolused for 66 carbs (the usual amount I always bolus for and have had success with.) The spaghetti was weighed out, so I know it was the same serving size and the garlic bread was pretty much the same size I always eat give or take only 2 or 3 carbs. Just as I was finishing up, I started to get really sweaty all of a sudden. I didn't think I was low. How could I be?? I usually get high at this point in my spaghetti dinner.

I didn't treat for the feeling, nor did I check Dex. (It was in my purse and I was too lazy to go get it!) I was certain I wasn't low!! It had to be a result of the suddenly warm New England day of 80 degrees with some moderate humidity. Only when I broke out in a full sweat and started to experience that ravenous hunger only associated with a low, (even though I had just eaten a whole meal!!) did I actually test...results?? 41!!!! How could that be?? I hadn't had any activity before dinner. As a matter of fact, the day had been largely sedentary, so activity wasn't the cause. I couldn't figure it out and still can't! It was such a scary low this time that now I'm afraid to pre-bolus if it means chancing feeling like that again!!! (I treated with my 4 rolls of Smarties and quickly felt better, but it was definitely hard to consume those Smarties as I was very full after my delicious meal!)

I think if I had to describe what is most frustrating to me about my T1D, I would have to say this concept of doing exactly the same thing from one day to the next and getting two completely different BG values and trends, is it. Can any of you D veterans tell me if this gets any easier??

I am very thankful to have Dex and my BG meter to identify when these things happen. (I don't always have low symptoms and usually I don't get symptoms until I've dropped below 50 and they come on fast. )Back in the day, this wouldn't have been possible and I would have had to wing it. If I had to become a PWD (person with diabetes) then getting it now in the new millennium is definitely better than the mid 1900's. Technology has come so far in thirty years. I'm excited to see what is coming in the near future in D tech!!

I guess if we're trying our best with what is available to us at the time, then we can't ask any more of ourselves. (But I think we all do!!)

Remember, Check! Don't Guess!! See where my guessing got me tonight??!!

2

To some degree yes. But then you throw in the other factors like temperature, weather, stress, whatever else your body maybe fighting something even if you don't even feel ill, or even the season and no not really.

As for reasoning about the low...could be weather, could be timing of the bolus, could be size of dose, could be how the different elements in the meal's timing kicks in at different points (the sauce kicking in sooner than the pasta etc). Your level before taking the bolus for example, if you were edging low before maybe, taking the bolus and then having a food with a slow glycemic index thus coming in a further 40-60mins after eating it, will give a low since you only have to sauce in the system first. But unfortunately it's pretty much a stick the tail on the donkey game at the correct time on something like that as to when to inject.

As for the concept of doing the same thing day in and day out...don't. We learn how to correct for things, we go out and do anything and everything we can. No rules other than we think out what numbers we need to use. We can still ignore the same thing every day and go eat and do anything we want. No boundaries, we have the tools, we learn how we work and what needs to occur to allow it, we go and do it!

I think we get better at dealing with the variables over time, if not necessary being able to prevent the swings from them (since they are out of our control anyhow). We also learn how different foods effect us, and also as and when we'll get the food coming into effect and when the insulin does also. But we learn how we work better through doing things, and testing.

3

If I need to bolus early I do it 10 min. before. I use Novalog.

When making corrections pick ONE thing to change not several. That way you can see what is really the culprit.

While it is very frustrating to deal with this, Know that you are not alone. We all deal with the same problems and we survive and grow and have good days and bad days and a lot more days that are in between.

We each need to learn how WE work (in the diabetes sense) through trial and error. What works for me may not work for you and vice versa. This does NOT mean you made a mistake. Something happened that you weren't expecting or prepared for and, through trial and error, you will learn what happened and how to prevent it in the future.

You have a great attitude and your already working towards your solution by using this to remind you to check your glucose levels rather than "winging it" so you'll be ok and you are doing just fine.

4

not only are we all different but each day is different too
sometimes
same thing happened to me & i survived
have had t1 77+ years since 1936
i was not yet 3
hugs & keep smiling

5

Some lows I feel, some I don't.

As soon as you think you know all the variables, a new one pops up, much like life. Hang in there.

6

Pre-bolusing is always a good thing ... except when it isn't!

I find one of the variables is what is my BG trend before I pre-bolus? If I am at or slightly below target (100, for me) and I am mildly trending down (steady arrow on Dex, but still falling numbers), I might not pre-bolus, or I might pre-bolus 5 minutes rather than 15.

If I am slightly above target and mildly trending up, I might pre-bolus 25 - 30 minutes before the meal.

FWIW, when I have pasta, I like to use a dual wave bolus, with about 1/2 of the bolus upfront and the remainder spread out over 3 hours.

Of course, I then pay close attention to what the Dex, my body and the meter are telling me.

As you say, testing not guessing is key, and yes, every day is different, sometimes slightly, sometimes enormously.

7

As a rule of thumb, reaction rates for many reactions double for every 10 degrees Celsius increase in temperature. This also means that the upper layers of the skin have better blood circulation and the insulin will separate more quickly from the complex insulin hexamer structure it has in the vial. Furthermore your body is consuming more energy to keep your temperature. These effects can explain why the insulin has unfold its activity much quicker than you have anticipated. Next time you will think of the temperature as an additional factor. With trial and error you will get better...

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Thanks u, Holger. That's very interesting!

9

yes
very interesting & true
heat & cold affects many things

10

The first thing I learned from cgm was that I was going low after eating. Who would have thought or tested. So I stopped pre bolusing. I’m very careful with pre bolusing now. It feels good to have the insulin and food matabolise together and avoid a BG spike. But that’s such an ilusive goal.

11

you have to know your body
if i'm high i bolus first
if low i start eating then bolus
i also split the bolus
half before & the other half after the meal
i have gastroparesis with irregular digestion

12

Nyadach, what great advice!! Thank u!! I'm learning that I need not to be so afraid of the variables I can't control. I'm also learning I'm a little bit of a control freak which I need to let go of. Like life, diabetes is my daily guessing game & as time goes on, I'm getting better at it!!

13

Thank u, halford!! That's why I've taken up writing this blog, to conect with others and to know I'm not alone. We all can effect learning in each other in ways those without diabetes can't. Thank u for reading and commenting!!

14

Shoshana, u stated it perfectly!! We all r different. That's what makes life so interesting!! Thank u for ur comments and for reading!!

15

Thanks, Mike!! When £ first heard of prebolusing, I thought it was THE answer.Now, I'm learning I need to go with the flow and just payingmore attention to dex and my trands and figure out when and if to prebolus!! I appreciate ur reading and ur comments!!

16

Aaron, I'm slowly figuring out that getting rid of postprandial spike may indeed be an ilusive goa!!! Thanks for reminding me and for reading & taking the tims to comment!!