Arrrrghhhh!!! Every once in a while I decide I really do more or less believe that “you can eat anything” business. Yesterday was one. I didn’t really push it that hard. Went to a pub with friends for lunch, and had a cheese & sausage omelet–no harm there–but allowed myself some french fries—about 1/3 of a potato’s worth–with a tbsp or two of ketchup, and–the big extravagance–two glasses of beer. Bolused pretty generously for it, had to guesstimate a bit but not crazy. I didn’t have a slab of chocolate cake with ice cream or anything.
So I spiked up for a while, 234, a bit worse than I expected but I hadn’t been able to pre-bolus so I wasn’t shocked, just did a correction. Then another. Then another… Ever since yesterday afternoon I’ve been correcting and correcting and correcting, and I just CAN’T get it into range even though I haven’t had a single carb since that meal. Pushed it down to 150s at one point last night but then it went ballooning back up to the 190 area at bedtime, 160 this a.m., and 170’s just now as I was setting up for lunch time pre-blousing.
My BGs aren’t usually this stubborn, except every once in a while when they are. I have experienced this before, where it seems to get hung up in the highlands and just will not come down, daring you to do something risky. The meal is long since processed by now, but my BGs are still wandering around up there picking daisies and gazing at the clouds. Which is when the prospect of the rage bolus starts to appear. “I’ve done everything according to the book and you won’t come down! I’ve tried reasoning with you but you JUST WON’T LISTEN! Well we’ll see about that! You think you can resist no matter how many corrections I fire at you? Well try THIS!!!”
Trying to resist that impulse but it’s this kind of thing that makes me squint and look askance when people say that if you have a pump and a CGM and you know your carbs and ratios “you can have anything.” Oh really? Maybe you can, but it’s stuff like this that most of the time makes me say It’s Just Not Worth The Aggravation.
Yeah, the inconsistency of this insane condition is one of the things that can drive you right up the wall. I have taken liberties such as the one you describe, bolused aggressively and been absolutely fine. I have done the same thing on a different day (same food, same amount) and found myself on the granddaddy of all roller coasters.
YDMV doesn’t only mean only from person to person. It sometimes means from hour to hour.
I have the same issues which I think are magnified because I follow a low-carb diet. Sure, “I can eat whatever I want,” but if I do, I’m going to be paying for it over the next 2-3 days when my insulin needs are significantly higher and my fasting levels seem to stay 20mg/dl higher than usual.
Oh, sorry. LOL. YDMV = “Your Diabetes May Vary”. It’s just a shorthand way of reminding ourselves that every case is individual and can behave differently, and that one-size-fits-all rules just don’t work for diabetes.
Bolus is a medical term. In our context, it basically means a one-time shot of insulin whose purpose is to cover a meal, or correct an unacceptable high.
Hey DrBB, when I go through these bought’s your having it is almost always the fried food (in your case FF) that make everything go whack for me. Sometimes that coincides with a insertion site going belly up to really make things interesting. Once a year I’ll punish myself and get a big plate of fried calms or Fish and chips but go through what you are as penance after. Have pretty much sworn off french fries as they can kick it for a lowly potato ( I say this with nose in air) lol. Wish I did not have to.
I agree, most of the time high-carb stuff is just not worth the grief that follows. I explain to people that while I’m not banned from any particular food, I need to watch the portions carefully because larger amounts of insulin behave more unpredictably and might send me too high or low. By any chance did you recently start any kind of steroid medication or have an injection? (cortisone, etc.) I ask because that can cause your BG’s to go through the roof starting about a day afterwards and lasting for weeks. Just asking in case that might be why your BG is so stubborn in coming down. It could also just be the stress that’s causing you to stay high.
I’ve had the cortisone injection experience several years ago, yeah, but no, not this time. My favorite part was how surprised the orthopedist was to learn there were special side effects for T1s. Lasted for about 3 weeks. I was still on R/NPH then, which made it even harder to deal with. Stress is definitely one of things that affects mine, so yeah, could be that, though I suspect mostly that it’s because the weather has been bad here recently and interferes with my primary form of exercise, bike riding. If I fall below about 3 rides a week for two weeks that makes things flaky too.
Really this whole situation is such a familiar part of T1 after 32 years: trying to figure out what happened in retrospect when you thought you knew what you were doing but it didn’t work. The explanations always remind me of the “predictions” of Nostradamus: they only work after the fact, not before.
Guess this is one of those times when I get to feel “blessed” - had an impromptu higher-carb meal last night, taking my son and his fiance- out for dinner and had a very similar spike, took one correction toward the end of the meal – only mine did come down almost as rapidly as it rose, then dutifully flattened out at 85 with no additional corrections in either direction.
Couldn’t repeat that performance, though, I bet!
I know how that rage bolus can seem enticing - but do you really want a roller coaster ride??
I would not blame just the carbs, but the cheese & sausage omelet as well. Restaurant-style meals, including large amounts of protein+fat, take forever to digest and tend to cause stubborn highs that do not seem to respond to any insulin corrections (with a possible exception of Afrezza, which I do not have any experience with). Next time, instead of adding more corrections, try a brisk walk (which is what I’ve learned from @Terry4). I’ve been amazed how much just a 10-15 walk can be effective after such large complex meals with non-trivial amounts of carbs.
But, your bg should not have gone that high in the first place. For such meals, I’d recommend early, high and long temp basals (in addition to a normal bolus for carbs at meal time).
I hate it when that happens. I’ve given many a rage bolus in that circumstance. I have a few thoughts about your experience. The first is prompted by your title, “You can have anything.” You came out of the same R/NPH era I did, where most initial education about living with diabetes emphasized routine eating, regimented meal timing and same size, even the same, meals every day.
When the mainstream diabetes educators woke up to the basal/bolus system, they realized that they could sell it to their patients as a less regimented dosing system that could relieve us of the meal size and timing tyranny. They were right, to a certain extent, and many of us bought it. But there are limits to the number of carbs one can eat and still maintain BG control. This limit varies from person to person but it does exist. Once you exceed it, controlling BGs with insulin is like pushing on a rope. “Carb up, shoot up” is not a good comprehensive strategy.
Your experience, however, makes me think that you developed a meaningful deficit of insulin. A missed basal dose could do this or a deficient pump basal rate and the hourly shortfall accumulates and when it expresses itself, it’s hard to backfill with a normal quantity of insulin. This “missed basal” effect could also be a temporary increased need for basal insulin or even a temporary increased insulin resistance. I’ve even watched the same effect when I came down with a systemic infection and doubled my total daily dose without reining in my errant BGs.
I’ve come to appreciate the good effects that intermittent fasting has on my metabolic system. It seems to immediately moderate my BGs numbers bringing down the highs and not going too low. You might consider missing the next meal if this happens again. I personally think that the occasional treat meal should be a part of a diabetic’s routine. I think it’s good for emotional health yet still challenging to your metabolism.
Finally, as @Dragan1 noted, I’m a big fan of walking. It’s benefits far outweigh the efforts involved. It has a great effect on my blood sugar and walking while rapid acting insulin is peaking is even more powerful in bringing skyrocketing BGs back to earth. Also try to drink more water as high BGs can dehydrate.
Sorry if tactics were the last thing on your mind when you wrote this. I appreciate the rant!
Your description of the historical situation and the transition from R/NPH is spot on. It was just hugely liberating when I finally switched to basal/bolus, not so much “you can eat anything”-wise, but because of having to eat by the clock in such a relentlessly regimented way. It was far more about the “when” than the “what” for me. As far as being able to eat carbs goes, I don’t think I have ever really gotten past the R/NPH mentality on that. Twenty years on it really burned that into me. Which is kind of the background to the rant, which you’ve exactly put your finger on: that when I do decide to step out of the box I almost always end up regretting it rather than feeling all free ‘n’ liberated ‘n’ stuff. My inner R/NPH T1 just looks at me sadly, sighs and says “See? I told you so.”
The insulin deficit thing is an interesting idea. Sundays are really anomalous for me in general so it’s a bit hard to figure if that fits or not. I try to go for a vigorous 45min-1hr bike ride in the late-afternoon/early-evening every day but the weather somewhat unexpectedly skunked me, and I do have a lower basal programmed to account for the exercise BG drop (trying to offset the fact that I produce some endogenous insulin in the evenings which amplifies the effect). So that might be a big part of it. Plus Sundays I just tend to run high especially in the a.m. I’m not sure why; only thing I’ve been able to figure is that it has to do with the stress of public performance (I sing in a choir and frequently solo). So I actually had had a 150%+ basal running until about lunch time to try to keep that down. Combination of the two basals coupled with not exercising probably accounts for the whole mess.
As usual, lots of post-hoc explanations; wish I was better at the pre-hoc!
I came late to this (to insulin, I mean, not to diabetes; in fact I wish I had figured out to ask for it years sooner than I did). So I missed the era of regimentation and exchanges and all that went with that. Can’t say I’m sorry—I missed boiling syringes and sharpening needles, too, and I don’t mind that, either . But freedom and choice is always nice to have. Whether we use it well is, of course, entirely up to us.
As for the R/NPH mentality, I’m not sure about that. I began well into the basal/bolus era so that’s the only method I’ve ever used. Nonetheless I have the same issue: deviations usually end up costing me, sometimes a little, sometimes a lot. So I think that just goes with the territory, regardless of the path we followed to arrive here.
Maybe some diabetics can eat whatever they want as long as they bolus for it. I sure as hell ain’t one of them! I go through exactly what you are describing every. single. time. I eat carbs. I just can’t do them without being punished with stubborn highs for days after.