Before we leave on our little trip, there are a few travel terms that everyone needs to understand. The story is crazy enough as it is - best if you know the road signs.
Basal: that is the insulin that is continuously trickling into my body from my pump. It's set at a rate (which changes depending on the time of day) that takes care of my body's insulin needs when I'm not eating anything. If my basal rates are calculated properly and if, for some crazy reason, I didn't eat anything all day, my blood sugar levels should stay relatively steady all the time.
Bolus: that is the insulin I take when I'm going to eat some carbohydrates or when my blood sugar is high and I want to bring it down. It's like a burst of insulin rather than a trickle.
The same type of insulin is used in both examples, it's just the name that we give it and the role that it plays at that moment that differs.
Ok, let's go!
Yesterday was run day. Ten kilometres was the distance. 4:15pm was the run time.
I ate my perfectly ordinary lunch at 12:00pm (small serving of pasta with shrimp, yogurt and pineapple) and took the regular bolus for that amount of food.
At 2:30pm, I had two things to do:
- Change my basal insulin rate. When I'm running more than 45 minutes, particularly in the afternoon or evening, I reduce my basal rate to 40%. That has to happen 1 1/2 to 2 hours before the run because insulin lasts a while in your system and the reduction wouldn't actually be noticeable until a few hours later - just on time to run at 4:15pm. With me so far?
- Check my blood sugar. It had been 2 1/2 hours since I ate so it should be somewhere around 8-9. It should then continue to slowly drop down to about 5-6 by the time I'm ready to run. I take a gel, a date or two and run for an hour.
That, my friends, was 'the plan'.
Enter crazy rabbit.
I checked my blood sugar and it was 13.8. Unexpected and rather disheartening.
Here's the problem. If I take a bolus to bring that number down, the bolus will still be active in my system when I head out for a run at 4:15pm - increasing my risk for a low.
If I don't bolus, I'll stay pretty high and, since I just reduced my basal insulin, I'll probably climb a bit.
So I took a baby bolus of one unit (instead of the 2.8 that my pump said I should take) hoping I would drop down to 10 or something.
I checked again at 3:30pm (one hour later) and it was 12.2. Ok, that's good. I can live with that.
At four pm, I packed up my work and did one final check before going to change.
It was 15.8.
Now we're getting into the dangerously high zone where one really shouldn't exercise for risk of ketones and other fun things. Running for an hour no longer seemed like a very good idea.
But I had high blood sugar (exercise helps bring it down) and I have already reduced my insulin so it's only going to keep climbing. What to do??
"How about a bike ride?" asked my wise Doug
Well, I haven't been on my bike in months but it's a lot less stressful on the body than running and since I shouldn't really head out for an hour run with crazy sugars, perhaps I could head out for a ride with him...
So, I looked at all the variables. Cycling has less effect on my blood sugar than running so I would not normally have set the 40% basal rate for a bike ride. That means my blood sugar won't drop (much) on the ride unless I give it a bit of insulin to help it along...so I took one more unit. Not much but enough, hopefully, to at least stop the upward trend.
We headed out for an hour ride and the rule was we were going to stop and check every twenty minutes.
Check one: 14.4. Ok, I dropped from 15.8 but that's not too drastic or too fast of a drop. Carry on.
Check two: 7.7. Ok, I dropped from 14 to 7 in twenty minutes. This is NOT good. Do I eat? Do I not? If this trend keeps up I'll be dead in ten minutes so it was a pretty easy decision. I ate one bag of fruit chews (20 carbs) and we headed home.
We got home at 5:15pm and I checked: 5.9
Ok, it's still dropping but not as fast. Should I eat something else? I've gone from 15.8 to 5.9 in one hour. That's not good...
"YES!!! EAT!!!!" screamed the crazy rabbit.
NO said my brain. Just wait and see what happens.
So I waited and checked every twenty minutes for an hour.
And that's when I said the hell with it and had dinner.