Wednesday, June 8, 2011

One Step Forward, Two Steps Back

The insulin pump battles continue.  A few weeks ago my sugar went sky high for a few days and seventeen became the most commonly seen number on my glucometer.  Not a fun place to be.

Once I eliminated all other variables that could be causing the highs (illness, stress, infection, faulty tubing, air bubbles and faeries), I decided to adjust my basal rates.  I mentioned that, whenever I do this, things tend to get worse before they get better.

I may want to consider changing my career to fortune-teller. 

Before I go on, here is a quick lesson in basal insulin.  Basal insulin is the insulin my body needs for all its metabolic activities.  Basically, a small trickle of insulin is constantly entering my body from the pump and that’s the basal insulin.  In contrast, bolus insulin is the insulin I take when I want to eat something or if my sugar is really high.  It's the same insulin but it's used in two different ways, hence the two names.

Basal needs can change throughout the day and I have several different basal rates – from midnight until 3am, 3am-7am, 7am-11:30am and 11:30am-5:00pm and 5:00pm-midnight. These rates are calculated through an interesting combination of mathematics, years of research, trial and error and witchcraft. 

What works today may not work tomorrow and, when I begin to see consistently high (or low numbers) at certain times of the day, I’ll adjust the basal rates.

And that’s what I did.

I gently increased all of my basal rates by 0.1 unit/hour.  For the next few days, my blood sugar readings were lower but still not in their happy place.  I was still hanging out between 11 and 14.  So I increased by another 0.1 unit/hour.

Then I started having lows around 1am - which meant that I was taking too much insulin in the evening.  So I lowered my evening basal back to what it was before this all started. 

Then I started waking up low and having lows after breakfast.  So I lowered my overnight basal rates back to, you guessed it, what they were before.

Now I’ve started having lows after highs.  In other words, if my sugar is 15 and I take a correction bolus to bring it down, I go down too low.  So my correction factor is off.  I’ve adjusted that so I’m taking less insulin when I correct.

Things are slowly stabilizing themselves again.  Ironically, by the time I will have worked out all the kinks, I will probably be taking less insulin than I was before I started playing with the numbers.

So to recap – my sugar starts to skyrocket which means I’m not getting enough insulin.  I increase my insulin and my sugar drops. I reduce my insulin to the point that I am now taking less than I was before. 

Good news is that less insulin means less pump changes which means less cost overall.  Not by much mind you but enough to, perhaps, go buy some chocolate... know, as a treat to celebrate my good control.

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