I spent 4 hours at a deposition today and I'd like some feedback on my insulin management.
I woke up at 155 this morning which is very unusual for me and took .8 unit of correction (my usual ratio is 1:75). An hour later I ate my usual breakfast adjusting my bolus for a still elevated bloodsugar and insulin on board. I also bumped up my basal by 25% for the first two hours.
Two hours later I was at 115 which is normal for me. I corrected down to 95 as usual ( correction = .3 units) and started a temporary basal of about 1.05 for the next seven hours.
One hour later I was 166 and corrected with .5 units. Another hour later I was still at 166 and took another .6 units.
The deposition ended an hour after that. I walked about 15 minutes to the subway and took the train to my office. An hour later - two hours after my last test - I was at 170 and took another .8 units.
In the last two hours I've taken an hour walk and retested 3 hours after my last bolus and was at 137. I've just corrected with .6 units and bumped my basal by 20% for two hours.
So my question is how much more should I have bumped up my basalwhen I was at 115 and looking at 3 hours more of questioning. My total corrections total about 2 full units. I'm not inclined to add all of that to basal since I would be running at about 200% but maybe that's the trick.
Unfortunately this isn't just a theoretical question. I'm scheduled to be a witness in the same case next Thursday.
Thanks in advance for everyone's ideas and help. Hugs are also welcome.
Sometimes you just can’t figure it out and you can drive yourself crazy if you think every blood glucose excursion has a discernible reason and can be prevented. In a situation like this, the last thing you want is to go low. So you probably need to be conservative, correct as best you can, and just be thankful that you don’t have to deal with depositions every day.
Thanks. While I was out walking I was thinking that it might be better to over correct and if I end up at 55 just take a couple of glucose tabs and call a time out. I don't drive for events like these.
Caution is probably appropriate but running high for 4 straight hours of testimony really softens me up for the attorneys.
When I do basal adjustments, I crank it up to 200% and wait for it to start to drop and turn it off. The 200% worked really well for steroids and usually does the trick, although if I'm way off on a prior carb count, it may take an hour or two to smooth things back out?
I got grilled long and hard for "practice" by the lawyers supposedly on my side before hand and that was more stressful than the deposition.
Still in some of the most intense real deposition cycles I was rocking in my chair so yes it is pretty intense.
I did pretty well bg wise in the actual deposition but the practice session did drive me right off the charts. I was like at 350 after 11 hours of practice. May have been a good practice because the sedond day of my deposition it went 12 hours for real. But I got lots of breaks and did a good job tweaking during breaks.
I've also been a witness in the court room and in some ways that was harder for me. Not the intensity, but the uncertainty in the timing. For my depositions I show up at a given hour and we start. But because other witnesses are in the courtroom before me they have me on standby for hours before I actually start.
I don't have much practical information for you, Maurie, as I've never done temporary jacked up basals. I'm assuming you did them 2 hours in advance? I also haven't seen the effect of stress on my bg...mainly because I don't have much stress in my life, but I do tend to get anxious about things and haven't seen any impact on my bg when I do.
But with your coming down to normal then popping back up I'm wondering if there aren't other factors and you're just attributing it to the stressful situation? When that happens to me (correcting and then going right back up) it's been either an absorption issue (with the need to switch sites) or a set issue. Did you check those things?
So with that little bit of input, I definitely offer the cyber hugs. Does not sound like fun! I'm sure you get the same input from your wife, but do whatever you do to soothe and relax yourself for next Thursday. I hope it (and your blood sugar) goes smoothly. If you are high, though, don't add to it by stressing over that. It happens and you are normally well managed so it won't hurt you.
In my experience, my body's response to stress is predictably unpredictable. :) Usually stress will make my blood sugars rise, but it is never by a predictable amount and never for a predictable amount of time. Sometimes stress one day will make me run high that whole day and sometimes into the next, even though the stress is gone by that point. Sometimes it won't. And, sometimes stress makes me go low, so it's a total guessing game with me. Hopefully it won't be for you, but to me it sounds like what you're doing is the best way to combat it. Lots of testing, and lots of correcting. I think everyone's body is different, and responds differently to stress, so in cases like this, you will probably be able to answer your questions about how much to increase your basal the best through trial and error.
Thanks everyone. I was feeling sorry for myself but Tim your 12 hour performance on a second day puts things in perspective. I'll just treat today as trial prep and move on.
AR I'm just not bold enough to pump a basal to 200% but we all know you are fearless :-).
I also try to avoid stress Zoe and being self-employed helps in that regard. I don't think the stubborn high was site or insulin related since things have finally settled down and I was thrilled to see a 67 2 hours after dinner. How sick is that?
Erin, your point about stress sometimes pushing you low is very helpful and supports Lathump's advise. I think I'm going to bump up my basal about 20% for the trial but I'll continue to rely mostly on corrections to try to keep under control.
For me, stress can be a very tricky thing. While it does make me go high, if I correct too much, I will come crashing down a few hours later. Generally, if I know I'm about to do something that is stressful and causes a predictable rise in blood sugar levels, I will increase my basal to 0.7 units per hour. This is my magic basal rate for stressful events and it works if I dial it up ahead of the stress.
HOWEVER, if I find myself in a stressful situation and my BG has already increased, I generally do about half the correction I'd normally do for a high attributable to something else and simultaneously increase my basal rate by about 50% for several hours. I learned this by trial and error (emphasis on the error).
But we are all different, so you have to find what works for you. I would never correct a 115.
I only correct at 115 2 hours after breakfast. I've eaten the same meal about 1300 times over the past 4 years and I know that I tend to go up over the next two hours as the carbs battle past the peanut butter and hit my blood stream.
Your 150% basal plus 50% corrections sounds like a plan. It may not work but it feels right.
I like the basal plus correction idea, that sounds like it's a bit more sophisticated? I'm not that fearless, but the steroids were really pushing me up. 150% didn't quite get me where I wanted to be but 200% worked ok. I also have the CGM so, when I am hitting a "tactical correction" w/ a basal adjustment, I only do it until it starts to work on the CGM, assuming the CGM is behaving itself. I've discovered that jumping rope makes the CGM run up but my BG run down, which seems sort of odd, maybe the repeated bouncing or something like that?
Just an update. The trial was today and I ended up using a temporary rate of 160%(the highest available on the Cozmo) and correcting every hour or two down to about 110. I still ended up around 185 for a couple of hours but I was down to 110 about 2 hours after I left the courthouse.
I thank everyone for their suggestions and support.
Glad it went well - I saw this too late - I work for the county attorney's office and was going to say attorney's shouldn't make you stress- they all just seem mean to cover their insecurities-
but good job working with it and rolling with the punches
