As I got ready for bed around 10pm on a Tuesday night I prayed that my blood sugar would behave itself at least until I start my overnight fasting basal test. I really didn't want to put it off any longer. My sugar hasn't been great lately. I've fallen off my work-out and healthy eating wagon and I desperately wanted to climb back on it again. I mean I wrote a book about this stuff - you'd think I'd follow my own advice! Just proves how difficult dealing with diabetes is, and how being a "good diabetic" 100% of the time is an almost impossible feat.
I checked my sugar and was thrilled to see a 107 flash on my meter's screen. I would next check it at midnight followed by every hour on the hour until I leave for work at 8am. I knew my sugars were higher at night then I'd like as I would often find myself waking up to use the bathroom, then checking my sugar and seeing it out of range. I need to put a stop to that ASAP. I need a good night's sleep! Though I certainly wasn't going to get one tonight.
When my alarm rang at midnight it took me a second to realize why I set it in the first place. I was groggy and unhappy to be woken up, but I dutifully checked my sugar to discover a fabulous reading of 89! At least I didn't have to stop the test to treat my sugar and could continue with the experiment. I fell back asleep content and anticipating the next wake up call.
At 1am my sugar was at a very comfortable 91. I was less comfortable having to be woken up again, but I kept telling myself this is going to let me sleep through many nights once it's over - and that helped...a bit.
At 2am the meter read 98. "So it's creeping up slowly", I thought. But it was still a very good reading, so without a worry I curled up under the covers and was greeted by Morpheus once again.
When I woke up at 3am my sugar had reached 127. Hmmmmmm, I thought. That's quite a jump of about 30 in one hour. This wasn't boding well but I had no choice - I needed to let my body do what it normally does. I was simply observing and recording the results. So back to sleep I went.
At 4am I woke up before the alarm. I had to pee! I checked my sugar - it was 161! In four hours it climbed by 72mg! This wasn't good. At all! Was it dawn already? Had the Dawn Phenomenon, as it is known, reared its ugly head? I was tempted to correct but stopped myself. "Only three more hours to go!"- I thought. And there was a chance my blood sugar may drop of its own accord. So I waited, and tried to go back to sleep.
I must've fallen asleep eventually because the 5am alarm clock startled me. I fumbled around for my meter and with my eyes practically closed I checked my sugar. It read 147. So it had dropped a bit, but it still was a bit too high for my liking as an early morning sugar reading after many hours of fasting. But I still had a few more hours to go.
At 6am the sneaky sugar crept up again to 151. Not a big change but I worried that, not only did it not go down it actually went up a bit.
I basically napped the hour I had left to wake up and at 7am my meter read 134. Well, that's a bit better, but not the number I'd like to wake up with every day. Especially if I go to bed with a 89 reading.
I knew my 8am reading would be higher. I knew this because that's the Dawn Phenomenon kicking in. It doesn't have to be dawn exactly, mind you, but whatever time I wake up, if I do not bolus and just go about my day, my sugar rises. This is why I always try to bolus a tiny bit as soon as I wake up. Especially if I'm not having breakfast right away. This time I couldn't do it. I had to wait until 8am to finish my test.
At 8am my final reading of the overnight basal test revealed a 143. It had gone up from 7am just as I suspected. At this time I finally bolused and ate breakfast: plain full-fat yogurt with ridiculously expensive organic blueberries and similarly over-priced raw cashews, with a few left-over goji berries (which I'm sure have expired by now - if only I would know what expired goji berries taste like, but apparently I can't taste the difference).
By 8:15am I was out the door and walking a mile to my job at the hospital. In my mind I was already devising my plan to tweak my overnight basal rates. At this time they don't change much from the time I go to bed at night to the time I wake up in the morning. In the evening: from 6pm until midnight my pump administers 0.6 units of insulin per hour into my body. From midnight all through 7am it gives me a bit more: 0.65 units, and then it drops to 0.55 units from 7am 'til 10am. Now I realized I may need to gradually raise my basal over night. Seeing as it rose from midnight until 4am, with the biggest changes between 2-3am, and 3-4am - I would need to raise my hourly basal starting at 1am - as experience has taught me that it takes a while before the basal rate change actually kicks in. Perhaps raising it to 0.7 from 1-4am will do the trick. Then bring it back to 0.65 as normally my sugar drops on its own after that. The Dawn Phenomenon of my sugar raising after I wake up would still need to be dealt with manually, as I don't always wake up at exactly the same time (on weekends for example, or when even two snooze alarms can't get me out of bed for work!).
That's settled then. My overnight test is done, and even though that's the easiest one I'm still happy my sleepless night is over! I can't make any changes to my basals yet, however, as I need to get a big - 24 hour - picture of how my sugar fares when no carbohydrates or extra insulin stimulates it. And for that I would need to do fasting tests between 8am and midnight. Keeping in mind I have to have my last meal/insulin bolus at least four hours before the test starts (that's 4am). So I can either try to brave it and pretty much fast for 24 hours, or break the test up in two sections: one day fast from 4am(or midnight) until 4pm, and the other from noon 'til midnight. How will that turn out and what will my sugar readings tell me? You'll have to keep reading my blog to find out ;)