I went to my endo today and, dammit, my A1c is not good. It wasn't good the last time I visited either. I tried paying closer attention to what I was eating. I started working out but with that comes the fear I'm going to crash. I had a couple of lows, so I'll admit I've slacked off a bit to less intense exercise like walking or biking around town on flat surfaces.
Anyway, being the great endo he is (no sarcasm there, he's good) he reset EVERYTHING including my carb ratio and basal. He reset my basal because I had a crazy number of basal changes during the day. He asked me why I had so many and I had no reason. I think it's just how it's always been since my first pump and my nurse practitioner in NYC tried to keep me on a similar regimen as I passed out a couple of times. Anyway, I just transferred back under his care. He was my endo over 10 years ago before I moved away.
Since I've been gone I've become hypo unaware (hence the passing out) at times, and I now wear a pump. I'm currently hypo aware. Hypos manifest themselves differently: no physical shaking but usually mental slowness, feeling cold, a craving for food, and I can feel my moods switch. I caught one this evening, and I just saw him this afternoon! I went to the drug store to pick up a prescription and stocked up on glucose tablets because I know this is going to be roller-coaster until we start adjusting my doses based on the results I record. I also have to roll back my tendency to freak out during a hypo and over compensate with too much sugar.
I'm just anxious, and I'm not looking forward to the next few days or weeks. :( However, something has to give to get my A1c level down.
Hope you and your endo can figure out a basal program and carb ratio that works for you so you don't have to fear the hypos as much! Keep us posted--how are things going today?
I feel your pain, but hopefully the adjustments can be slow enough as to not make you have severe hypos. When I make adjustments, I usually err on the side of caution and give myself a little less insulin, and then gradually increase the dose until I get my BGs where I want them. I had some hypo unawareness in the past, but got rid of it after a year of eating like crap and running a bit higher....not exactly a good thing, but I got my hypo symptoms back to some degree.
Welp, I just woke up and my blood glucose was...wait, um, was (have to check my pump) 142. Not ideal, but with the bad A1c that I have, probably an improvement.
I did a correction bolus, so we'll see where I'm at when I finally eat. Unless it's something really light, I probably won't eat until lunch as I'm going to a fancy schmancy lunch today.
Yeah, once I got to the hypo unaware stage, I was doing the exact same thing but my doc wants to be more aggressive.
I'm a compliant sort of patient. I just don't do what I'm told, but I err on the side of trusting that my docs know what they're doing most of the time (and, most of the time, I've been right on that point.) I'm going to comply and see how it goes.
I gave my doc my password to my Carelink account, so he can check in too. I'll just have to get in the habit of uploading results more frequently.
The thing that most freaks me out is exercising. I won't go to the gym today but I probably will tomorrow. That's going to be anxiety central.
Today things went pretty well. I held out on eating until my fancy downtown lunch. I failed on the carb count front and ended up with a high post meal glucose level. I check 2 1/2 hours after a meal. I did a correction bolus and had a GREAT glucose level before dinner 90-something. 2 1/2 hours after that my glucose was in the 90-something range again.
Not bad. I'm still concerned about working in strenuous exercise. Today it was just biking to the train station and walking around town. Today was good. I'm going to have an apple for a snack and hope my nighttime and morning numbers are good too.
I'm sure there will be a few bumps along the way (like misjudging lunch carb counts), but that happens to all of us. Sounds like your correction worked pretty well though for your dinner time BG to be 90-something!
As your start adding strenuous exercise back in, think about proactively making basal adjustments. For example if you're going to go ride your bike at 4 pm, you'd want to make your basal adjustment by about 3 pm b/c it takes 60 minutes or so for the current basal profile to be active in your system. When I ride my bike I will decrease my basal about an hour before my ride, and i'll decrease it for the length of time that I'm going to be riding...that way when I get done w/ my ride, my basal will have switched back to normal and I'll be at 'full blast' again. Anyway, don't be too scared about it. Just take it slow and (through some trial and error) you'll find what works best for you!
I feel pretty good about my rates because I am *extremely* boring at eat about the same thing every day at lunch, with only occasional changes (1/2 sandwich, broccoli, carrots, nuts [Planters Pistachio Grove blend, very tasty stuff!], cheese, Propel and my junky mid-afternoon Diet Coke fix. I know the counts and run things pretty tightly, run it up a bit at the end of the day and go run when I get home. A lot of the motivation to have smooth BG is because it makes running more fun not to be bouncing all over the place, so I can 'fuel' it with a few jelly beans PRN and come home and start blasting away at dinner with my insulin pump. One thing my Tae Kwon Do teachers (several of them...) pointed out about exercising is that a lot of times, you may not want to go but if you go and accomplish a goal, you will almost always feel better afterwards? I hope that you can succeed at the gym. It's been a great help for me.
One other thing is that part of the problem I've noticed by being "dull" from a culinary perspective is that rates and ratios still change all the freaking time. I don't get huge BG swings but will see numbers 20-30 points off (sometimes high, sometimes low, I suspect that it may be affected by astrology?) and just nudge the pump settings appropriately. Numbers can be a moving target. Another reason to exercise, so you can catch them! LOL...
REGINA, I highly Recommend reading "Pumping Insulin" by John Walsh. Many charts, easy troubleshooting guides, not hard to understand at all. Chapter 17 is all about reversing hypo-unawareness. I am using the book NOW to get my overnite basals and I:C ratios intact( yes, as Acid said our bodies DO change). I do not wait for my endo to do it. When I was on the pump for about a year and half, I started doing it myself with his and the CDE's approval. It is trial and error with exercise.. I learned to turn the basal rate down by 30% an hour before I exercise and leave it there for another 2, post exercise.. And it depends on the exercise: line dancing requires less of a decrease than bicycling up and down hills. I am not hypo-unaware and only occasioanally(sp?) wear my unreliable MM CGM( another untold story). But I am going to fulfill my New Years resolution to try to exercise, for 45 minutes to an hour, at least 3 times weekly. It really does help with control.
Thanks. That bit of advice made me smile. I'm really nervous about taking something as simple as a spin class. My doctor suggested I do a three hour basal roll back: one hour before, one hour during and one hour after. I'm going to try that and see how it goes.
re dinner with was Thai yellow curry with beef and brown rice, it also means that my carb count was right too! :)
I've already read that. However, I should re-read it. I've been pumping for awhile. :) When I read it hypo-unawareness wasn't really a big problem for me. With all my moving, I'll see if I can grab that from the library as my copy is long gone too! Thanks for the suggestion.
I think that's definitely part of my issue: culinary diversity!
I'm trying new stuff all the time or the same stuff from a different restaurant. :-S I moved back from NYC to the SF Bay Area and there really are sooooooooo many great places to eat.
I don't want to yield on that point, but I might have to if my numbers get wonky after a couple of culinary adventures. :-/
Hey, Regina. I don't have anything to contribute on the exercise topic, but just want to say I'm sorry you're struggling. It sounds though that you have a great endo and that things are starting to come into better range, though I agree with Brunetta that with all the fine tuning necessary it's easier to do it yourself, slowly but surely and monitoring the results. I personally find that having several basal rates (I have 9) during the day is necessary to meet my needs, but again that was through a lot of trial and error and I periodically tweak them. There is some statistic in Pumping Insulin about the number of us who use multiple rates but I'm too lazy to move the cat from my lap and go get it; it's most of us.
As for restaurants....sigh. Going out to the great restaurants in the Bay Area was one of my favorite things to do when I lived there pre-diabetes. Since then, my results are always so mixed, some of it my own fault. Like I went to my favorite Ethiopian place (Cafe Lucci on Telegraph) and a friend and I ordered the vegetarian sampler. I bolused generously because I knew there were lots of grains, but then I picked around the higher carb items, only having tastes. I went low..duh! Conscious eating and talking at the same time are not my forte. After awhile I stopped going out as much, partly because I'm semi-retired and it's expensive and partly because it was so unpredictable. I wondered maybe if I went out more often if I'd get better at it. But now I live in the boonies, out of harm's way. I do, though, have culinary diversity at home. For dinner anyway, I'd hate to eat the same thing all the time and nothing makes me as happy as a new cookbook with interesting recipes to explore. I'm not giving up that pleasure any time soon!
Anyway, hang in there; it sounds like after some fine-tuning you might definitely be getting better results than you were with the old settings.
I've got a Dine About Town lunch scheduled today, so yeah. I also just got a new client and guess what her business is? I high-end restaurant. A let with her, I'll have a direct connection with the chef. That will be good.
Yesterday, I got hit with a bad low right before I was going head off to an evening spin class. Needless to say, I didn't go. :( I'll try to make up for it today or tomorrow though.
Sounds like you guesstimated pretty well w/ the dinner you had a couple days ago! Bummer about the bad low right before the spin class. I have def. had a low hit me right before I was scheduled for a ride or run. Frustrating. I am stubborn and have just loaded up w/ a mix of quick and long acting carbs (depending on my intended workout), given it a few minutes to start working, packed extra glucose and my tester of course, and then hit the road (again, stubborn and probably not the best plan ;) As you are getting adjusted to your basals again I'd probably take your approach and steer clear of doing stuff like that so that you don't have any issues w/ going too hypo, passing out, etc. Best to be safe!
Good luck w/ getting a workout or two in later today or tomorrow!
Direct connections with chefs are always good! Enjoy! And try not to stress to much over manageable highs and lows until you get your numbers set a bit more accurately.
Today was good. The positive distraction of a new client was good. I treated myself to a self-indulgent lunch (not what I ate per se but just the price.)
I had pretty good numbers all day today. No workout though unless you count riding my bike fast for about 1/4 mile to make sure I could catch a bus. ;)
