The 'Art' of Blood Glucose Management

Reading the blog by edenseffort "Nerves AND Exercise - not a good mix" blog. Sort of inspired me to document this.

As I commented there, I love it when we can nail the ART of blood glucose management.

I had a small victory myself yesterday and an alarming failure this afternoon.

Yesterday before breakfast was time to change my infusion set and sensor. I decided to try an experiment. I tried my thigh last week with the CGM, and that worked out OK, so I decided to try the other thigh with the set.

All went well, bolused and ate breakfast, just as I got done eating and got a 'delivery failure' alarm. Well..that's interesting.

The pump infused less that half the bolus...wonder why it waited so long to tell me? Did my troubleshooting no blockages in reservoir or tubing. Gave myself a manual bolus for the remainder.

All good. On with my day. Waiting for the two hour 'warm-up' on the new sensor.

Started feeling a little odd a short time later and with no active CGM I did a finger stick. 248! That is super high for me. Figured a bent cannula as I don't have an overabundance of fat on my thighs (one of the few places on my body where I can say that).

So I got a new set in w/ reservoir, new insulin etc. just to be safe. I did another finger stick and was at 289! OK here is the 'art': How much of a bolus to give?
The pump thinks I have all my previous boluses on board still.
How much of what I did bolus actually get absorbed?
So I made a guess: Not quite a SWAG, more of an educated guess and gave myself another manual bolus - hoping I did not just overdose.

With that done I went to remove the set from the thigh. Pulled it off and was covered with a spray of blood! Well there's a first time for everything and it looks like Sunday was a twofer.

By the time I got a cloth to staunch the blood flow, it had already soaked my leg, my sock and the inside of my shoe! Thanks Asiprin, Plavix and Xarelto!
I finally got it stopped and bandaged. Discovered a hematoma about the size of half a golf ball!

Since the CGM still was not active I began checking BG every 15 minutes for the next three hours expecting the inevitable crash from the unknown amount of absorbed insulin.

Ended up with a 100 without crashing. Woohoo! I love it when a 'guess' works out!

Now on to today. I been suffering from an URTI, compounded by a severe reaction to a steroid nasal spray, combined with not being able to take my Metformin do to a CT scan the other day, so I've been running with a 150% temporary basal since Friday afternoon.

Well, this afternoon after showering I sat on the bed to put socks on and this, apparently, was the precise moment my body 'recovered', very rapidly, from the increased insulin requirement. The next thing I remember clearly was sitting in my truck at the stop sign exiting our neighborhood. Had my meter in my lap and a test strip ready to go in one hand, two empty bags of gummies and one half-eaten oatmeal raisin cookie in the other!

I do not remember getting dressed, getting the snacks, going out to the truck and driving the mile or so to the stop sign! Best I can recall it was about 15-20 minutes from the time I got out of the shower until I found myself at the stop sign.

My BG was 58 by this time.

I've never blacked out before, and I've had some pretty low lows. Lots of 40's and a few 30's. I have no idea how low it really got.

The CGM registered between 73 and 90 during this time period. :-(

That was about 3.5 hours ago and as I write this, my BG is 90, and I'm back on my 'normal' basal rate (I seem to recall canceling the 150% temp basal at some point) and consumng abut 55 grams of carbs at the stop sign!

The scary part is that after 'waking up', I went ahead and drove off to where I was headed - my grand daughter's school. The trip is a little hazy as is picking her up...however by the time I got her buckled in her car seat, I was fully with it and my BG was 90.

I suppose the take-aways from today are #1 to check BG before I shower - perhaps I was already falling and could have caught it.
#2 Don't trust the CGM! Remember it's delayed about 15 minutes and cannot capture extremely rapid changes in BG level that are a recurrent theme with me. (Friday, when I had to increase the basal rate, I checked my BG before leaving the house for a DR. appointment, it was 90: While sitting in the waiting room 30 minutes later, my pump alarmed - BG was 170! Finger stick confirmed BG of 178.
#3 test more frequently when on a temp basal and/or when sick.
#4 I'm not really sure how to combat this one due to the cognitive issues that accompany hypoglycemia, but - Don't Drive when low!

Hypoglycemia has, thankfully been very rare since starting on the pump three months ago. Counting today, I've only had 4 excursions in that time. Compare this to the four weeks prior to starting on the pump where I had something like 45 or so moderate-severe lows!

I really love my pump and CGM, they have probably saved my life. Or at least made it possible to actually live it!
I've been able to maintain my A1c at 6.0 - 6.1.

But the CGM is not, by any means, infallible. The past couple days have made that even more apparent.

I just reread your blog, thanks for writing it. Your experiences were appalling, especially the part where you wound up driving after a low, without really meaning to be driving after that low. Diabetes calls for art and science both, with a little good luck thrown into the mix.