Stress Basal?

Diabetes Technology Insulin Pumps
#1

I'm only half kidding. I'm just wondering if anyone has any tried and true methods (or just some hare-brained ideas too!) for dealing with the highs that come with stress. I work as a counsellor so I find I'm great with coping with the emotional side of stress, yet I seem powerless to translate that into keeping my sugars in line.

For example, today I gave a talk to a group of stroke survivors. I know enough to get plenty of rest, test frequently, eat my normal meals, engage in meditation and mindfulness... all of those things helped me to feel confident and relaxed. I was thrilled with how the talk went. But nonetheless, my numbers, which have been great the past couple of weeks, have been persistently and resistently high all day. (Had been averaging in the 6-8 mmol range, today more like 14 to 16 even with correction boluses galore!).

As much as I'd like to say it's just coincidence, this "coincidence" of high sugars happens whenever I do something that is stressful for me (and as an introvert, public speaking is way up there).

So I am partly venting, partly hoping someone has some strategies they use for the actual insulin dosing and numbers game. For the record, I am Type 1, on a pump, generally testing 10-15 times per day.

Thanks!

#2

My basal profile is set to deliver more insulin to tackle weekday mornings. When I need to get the kids out the door, and in a great mood for school :) It was funny to me when I finally pin pointed the source of the high BG. I do childcare and consider myself a very patient and generally relaxed person, just not first thing in the morning!

Now dealing with unpredictable or prolonged stress is more challenging, I find my BG can be quite variable. I just test frequently and correct when needed. I have experienced prolonged stress in the past and changed my basal pattern (increased my basal 20%).

#3

Hi Crystal -

I will bump my basal up 20% for "mild" stress and have pushed it up as much as 60% when I had to give a deposition. Even with the 60% bump, I was high reaching about 200 (11) before corrections started to get it down.

Once I'm over 200, I will usually increase my basal by 40-60% for a few hours to help the correction work and will turn the heat down once I hit 150 or so. You take the risk of a mild low 4 or so hours out but that can usually be handled with a small snack.

Maurie

#4

Fortuity I have a CGM, I just do small corrections when my pump starts predicting
that I'm going to go over my High target. I have been at this game along time and I don't
think you can predict how much insulin your going to need for a stress related high that
may or may not happen.,,JMHO

#5

Hi Crystal, Have you tried doing a temp rate with raised basal when you do the public speaking or other stressful things? I have noticed I can either go up or down during that type of thing or with any stress so I tend to just let myself run a bit higher then because I prefer that to a full blow hypo in that type of situation. Sometimes it also has no effect on bg. I never know why for sure.

#6

There is a difference between a transient stress and a constant stress. If you work all day and find it extremely stressful you may find a basal change or temp basal is an appropriate way to deal with it. But just giving an hour long talk, while it may be extremely stressful, that is a transient condition. You may not want to deal with that as a basal change.

Here is the reason, a basal is delivered at a measured rate over time. It can take up to several hours to ramp up the circulating basal to the selected rate. And this delay means that it isn't responsive to transient stress. If you know that you will be speaking for an hour and that you blood sugar skyrockets under those conditions but settles down afterwards you would be much better served by doing a bolus. We have been told that we bolus for the blood sugar rise from meals and we correct "highs." But in truth, if we really want to mimic what our bodies do we should bolus for any conditions which cause our blood sugar to rise. For instance I bolus for weightlifting because it is such a stressful activity and it is transient.

ps. And as Maurie notes going over 200 can induce insulin resistance requiring more insulin for correction. Your pump is programmed for a specific correction factor and doesn't account for this and it may in fact keep subtracting out for insulin on board.

#7

Thanks to all for the comments and letting me know what you do and what works for you. It sounds like, for others too, transient stress (thanks for that term!) is not likely to be predictable. Which I knew, I suppose, and I try to remember that frequent checking is my best bet in that case.

I feel a little sheepish to say this (after 20 years of this disease, there are so many things I think I *should* know), but I didn't know about the insulin resistance happening with highs - that is such illuminating news. It doesn't happen a lot but sometimes I find it incredibly vexing that the highs can be so persistent despite all the boluses I'm throwing at it. I will be google-ing my little heart out tonight to learn more, but please share any links to more info about that.

TGIF!

#8

I find that "busy stress" doesn't affect my BG's much, but emotional stress like you described does really impact me. Sometimes if I've just had a good cry, I will give myself a half-unit bolus on my pump. It may not totally cover any rise, but will usually help keep it out of the 200's. It's not your imagination...stresses of any kind stimulate a release of various hormones like cortisol and adrenaline, which can cause BG to rise.