I have an analytical background and used to believe that math, equations and sheer determination could figure out anything. Then I ran into Diabetes and I don’t believe that anymore.
When I had high and low blood sugar, I would obsess with determining the reasons why. With high BG it must be because I made a mistake counting carbs, I was sick, anxious, bad injection site, bad entire bottle of insulin, etc. Same with lows. It could be any of these things and more but it may be something totally out of our control.
Currently, we assume our liver produces sugar systematically and try to offset the sugar with doses of insulin in the right amount and at the right time. Thus, the development of “basal rates”. Generally, our basal rates change during the day. It is our educators and our guess as to the amount of sugar that our liver is producing at certain times of the day that we try to offset with insulin delivery. And bolus rates are generally the amount of insulin we give ourselves before eating a meal to offset the rise in BG from eating carbs.
Unfortunately, we generally have no control over our liver and when and how much sugar it produces. Thus, we could be doing everything right, by the book, and still end up with a very high or low BG. It could be that for whatever reasons our liver decided to produce more or less sugar that we could not have anticipated. That could be the sole reason we had that high or low BG.
We were taught this and it is still the right thing to do until we come up with something better which is where these closed loop pumps are heading. Until then, stop always blaming yourself for unexpected and unresolved highs and lows. It may be out of our control and the best we can do is react to them.
While this is true, I believe many causes of live glucose secretion fluctuation can be addressed. A big one for example is the cortisol level. It increases naturally in the morning after getting up. This is called the cortisol awakening response. Lack of sleep can make it worse by extending the duration of this response. Stress also drives cortisol way up. Furthermore, a basal rate that is too low can actually drive up insulin resistance by provoking the increased production of ketones (fatty acids can sort of “get in the way” of insulin attaching to the receptors).
So, if you see that your insulin isn’t working so well, and that your BG keeps rising, then perhaps what can help is to do a high carb diet with very little fat and protein, plus increasing the basal rate. That’s where temporary diets like the oatmeal come in. High carb food that doesn’t kick in quickly. The idea is that this forces the body to become more insulin sensitive. As for the increased basal rate, it is there to counteract the ketones. Doing so with bolus isn’t ideal, because the ketone production is going on constantly. So, by increasing basal, ketone production is dialed down, and the insulin resistance goes down.
But overall, yes, the main problem I think is the lack of control over the liver’s activity. One thing that would be a great help is some kind of medication that completly shuts off the extra glucose secretion in the morning. It may have been a useful tool sometime in our evolutionary past, but I doubt it is these days. Non-diabetics don’t need to care, we do. Without this trouble at the morning, BG management would be a whole lot easier I think.
Some things are outside our control, for sure. Control what you can. For me, Law of Small Numbers, smaller amounts of carbs and smaller amounts of insulin, keep things more manageable.
Adequate sleep, exercise, can all help as well.
This has helped some
“Big inputs make big mistakes; small inputs make small mistakes.”
You’re right that there are so many factors that contribute to your ultimate blood sugar control. As much as those of us who like to think our understanding of math and science will provide all the secrets of our glucose metabolism, it is more complicated than that. Hormone driven systems, like the human body, are more sophisticated.
In my n = 1 experience, however, I experience great results using a low carb way of eating coupled with an automated insulin dosing system and helped by daily exercise and attention to good sleep hygiene. Now I realize that my positive experience may not be replicated by everyone with diabetes but I suspect that many could find improved glucose metabolism using similar tactics.
I think this sentiment is important to all of us. We can’t control everything and need to absolve ourselves of soul-crushing responsibility. We need to extend kindness to ourselves; that’s important for overall success.
That’s been my gordian knot solution for dealing with the multi-factor, multi-failure-point mare’s nest that is insulin dependence: the less you have to take, easier it is to deal with.
So true!
Yes, I agree with all of this, but when one fully understands the low fat plant based diet, and that means studying the info on Mastering Diabetes, you will understand that low carbing is not
the only way to go. I started following Dr. Bernstein long before it was mainstream and ate 30 carbs a day for 11 yrs. I have been a type 1 for 60 yrs.
I now eat 300 healthy carbs a day and only take 23 units of insulin. I have no working beta cells.
A vegan life style isn’t for everyone, I love being able to eat fruit, root veggies, rice and potatoes. I have never been a big fan of eating meat.
Of course it doesn’t eliminate what stress can do to glucose control. I will still throw a high glucose level when I am stressed.
But at 68, I am at a perfect weight, and my health is very good. I try to spend an hour daily at the gym.
Just a shout out to another way of eating.
I will agree that most times, there is an answer that can be figured out for most sugar fluctuations. If we are completely honest with ourselves, it is one of the many things that can cause a blood sugar variance. Adam Browm at diatribe has listed 42 of them. And all it takes is the timing of your insulin to be off by a few minutes to mess your best laid plan.
But there are times, you’re just like WTF happened! Dr. Polonsky calls them the “sugar fairies”. And while that name does cause me to smile and also want to throw the meter across the room, the reality is we will never be a true pancreas. The hormone landscape that is our body will never be controlled with the equipment we have right now. That liver can be a life saver for some and a nightmare for others.
And there are some drug studies happening that are trying to see if a drug can stop the production of the liver to try and close down that blood sugar rise that can happen. Of course if you do that, it might not be there for that emergency rescue that some of us have been blessed to have happen.
I hope the main take away from this topic is that we need to stop beating ourselves up over blood sugars. We will never be perfect. As smart as many of us are, we can’t be the human body that has all its systems working together. So, relax and enjoy life. Don’t sweat the small stuff! A blood sugar of 300 in the big picture is a small thing that can be corrected. Please just keep fighting the fight and do the best you can with the tools you have!
I am now trying an alternative to Low Carb. I call it “smart carb”, or “safe carb”. That is: No real limit on carb count, so it can be 300g of carbs for example. But - these must be “safe” carbs, meaning that these are carbs I know well how to bolus for. This implies little to no estimating, and instead careful weighing and calculating. Plus, these are preferably high quality carbs. So, less candy cheap white bread and pizza, more rice, polenta, quinoa, good quality bread etc. No empty carbs. Carbs with nutrients.
Result: Fewer hypos and hypers, without a strict limit on carbs. Low carb reduces likelihood of BG swings by reducing the carbs. This reduces the likelihood by leaving out the more volatile carby foods, like pasta and pizza. Or, at least these are reserved for special occasions - which is how it should be for everybody actually, diabetic or no.
Type 1 for 60 years. I am pretty impressed.
Love your last paragraph. Wished I had used those exact words.
Thank you Joakim. I must say that I am pretty impressed with 60 yrs too. I haven’t felt this well in years.
You give me hope. My name is Amy. I was D’d at 22 months of age. I jusr turned 5o. I had open heart surgery and a brain injury; I am back to normal now but it has been hard–so impressed that you are doing so well.
Oh Amy, you have been through so much. I hope the coming years will be much kinder to you. Wish I could give you a big hug.
Funny we can see self driving cars in the future but perfect BG control I don’t think so. The problem is that diabetes is so multivariable and more important many variables cannot and/or are not measurable, Also the action we take injecting under the skin has the finesse of trying to hit a fly with a sledge hammer. If we could inject into the portal vein that would be better and not sure what to do about getting the insulin to calm over excited alpha cells.
That works for you and 23 units on 300g would mean you aren’t insulin resistant and quite insulin sensitive. As you say, you are injecting on a very accurate carb count, from the foods you know. A lot of processed foods have at best an estimate of carbs and the labels allow a large variance. Doing a 300g intake on these foods or needing 100U to cover them, could end in tears
Yes, that is why I seldom eat processed foods. Eating a very low fat plant based diet has greatly increased my insulin sensitivity.
I’m thinking you meant insulin sensitivity. Am I missing something?
LOL. Thanks Terry! That is what happens when I post before 7:00 am.