Those who have followed anything I've posted in the past know my struggles with highs.
I've been on the pump since May of 2011 and a CGM for a few months now.
Since then, my A1Cs have come down almost 3% and overall I've changed. I am being more active and eating considerably lower carb.
With all these positive changes, I've quickly gone back to hypo unaware, which is what caused my years of highs out of fear to begin with.
I've only been waking up or catching the lows last second when the CGM alerts that I'm dropping too fast or hit my low range.
I had the paramedics called for a 41 out of nowhere on Tuesday.
Tonight, I had a mid 300s drop to 80 in a matter of 90 minutes and had to race to the ER because even glucose gel didn't stop the plummet.
The ER doctor was kind. She simply stated the obvious, that my lifestyle choices require me to turn down my basals. I get it. I know it. But I have a massive guilt/fear complex of turning them down because I don't want to return to the high A1Cs.
To complicate matters more, I'm in a fairly new relationship and this week we moved in together. He's not taking it well. He had an angry/blaming reaction Tuesday night. And a "I wasn't prepared for this/scared" reaction tonight. I fear losing him because I'm such a burden as usual in my relationships.
I feel like I'm doing everything I'm supposed to and despite this, feel like a failure and completely defeated.
That's all. Needed to share.
I hope you know, we are all really proud of the progress you have made. All those feelings which drove you to keep your blood sugars high, the fear and anxiety, they don't just turn off. It takes time and effort to bring all of those feelings under control and make rational and logical decisions about these things. It is important to take life as a journey. We take one step at a time and only by looking back can we see what progress we have made. Anytime you have a setback, it can really help to look back and see how far you have come. In the scope of things, one step back doesn't reverse how far you have come. Think about it.
A 3% improvement is fantastic and you should pat yourself on the back for being proactive and accomplishing it.
As for the rapid drops, it may help to try to set the emotions and frustration aside for a moment, look at the data, and try to analyze what caused it in each case. Logging and perhaps a 3rd party's help (a CDE or another PWD ?) may help figure out whether there are some adjustments that need to be made to stabilize things. Look for patterns.... was it an over bolus (off carb count, wrong ratio ?) , too much physical activity without a corresponding adjustment to basals or a snack ? , etc...
All of us have mysterious things happen we can't explain once in a while, but if it happens a lot, there may be a pattern that can be discovered and an adjustment made to stabilize things.
The good thing is you now have the technology to help you discover what is going on and reach a point where less work is required day by day.
You've made so much progress... focus on the positives. You are not a failure.
3% rocks!! Way to go!! Sorry about the paramedics' visit though, I know that's no fun. I haven't had one for a couple of years but they are always a drag.
If the 41 "came out of nowhere" in that it was fasting, I'd agree w/ the doc and turn the basals down. The thing that still amazes me about the pump is how much small adustments to basal or bolus ratios will change numbers. If you hit 41 and had a very small amount less insulin, you'd have been at 80-90 and probably "fine" or close to it!
To figure out where to make adjustments, particularly when things seem out of whack, I look at the CareLink "pie charts" that show the time of day (I think they are "modal" reports...) and what %age of numbers are within range and make adjustments to maybe an area or two that seem to have the most lows (or highs for that matter...). Sometimes, there's what I refer to as "spillover" in my head, where an off basal can "pollute" a bolus or an off bolus ratio can push down what may look like a basal issue. In your scenario, while the low was the "big problem", the solution might lie with getting rid of the 300. I am much more inclined to take risks to get rid of a high since, if my BG runs down, I will eat some jellybeans which doesn't bother me all that much.
While it's alarming, the 41 isn't that far off and may have stemmed from "attacking" the 300 a shade too much. Neither result is a total disaster and, by nudging it a bit in the right direction, perhaps you can continue your efforts to feel better while knocking your A1C down a couple more points.
Good work on lowing the A1C!
Could this be emotional? It is almost Christmas, the most stressful holiday. Plus you are entering a new relationship, which has a whole nother group of emotions tied to it. If you are taking leave next week, there is the stress ofgetting things done, so you can be off.
I would make one suggestion. See if you can talk to a psyhcologist about your fears, problems, etc. There are some out there who only work with people with chronic illness, and if you can find someone who specializes in diabetes, even better. Talk to your doctor about a referral, or better yet, a CDE.
I did this a few years back. I found it really helped me see the reality of what was going on.
Until retirement, I was an adult educator (trainer). When I first got my pump, I created a Quick Reference Card for my husband that tells him how to quiet alarms, suspend the pump, even turn it off. He keeps one in the nightstand and carries one in his wallet.
I had some foot surgery and a sedated dental procedure and gave both docs the QR card, just in case. The dentist actually used it, as my glucose level when high during the procedure, so he could turn the CGM alarm off.
It actually helps others, as well as protects me.
We have been maried 47 years, so he is well versed on how to treat lows.
I was talking about that same stuff to my brother yesterday. When we were in our twenties we were so much healthier and the highs didn't make us feel so crappy so we tested less and stayed higher.
Now the highs make me feel sooo poluted. I try hard to stay in range and commend anyone else that does it too. It is tough; I can't sleep deep when I'm high and a low in the night can be catastrophic; the CGM helps but is not always accurate.
All I can say is keep fighting. Maybe your significant other sees things that you don't or maybe he doesn't understand; if he's worth being with he will love you and stand beside you.
It can get frustrating watching a significant other that doesn't take care of themselves, hopefully you don't fit that category.
The only comment I would offer is not to overcorrect on the insulin/food too fast.
The body is dang slow and better to undercorrect a bit and slowly.
When one over corrects and too fast; one ends up cycling low and high from overdriving things too fast.
I was there before - most painful.
How low carb are you? When I eat carbs, almost at all, my blood sugar is so much more unpredictable. When I start feeling out of control -- like I'm bouncing back and forth between correcting for highs and then go to low -- I can usually pull things back into balance by going way down in my carbs, like between 10 and 20 g a day (usual just from green leafies, cheese, eggs, cream). Dr. Bernstein talks about the law of small inputs: big inputs make big mistakes, small inputs make small mistakes. And I've found this to be so true. If you're only eating tiny bits of carb, you only need to do tiny bits of insulin and you end up staying within a fairly small blood sugar window.
The other thing about eating this way is that I can protect so much better against lows, if that is my priority. There have been times that I've decided it is more important to avoid lows than to keep my blood sugar in some small range, and when I've done this, I've been amazed to go weeks at a time without lows, which I hadn't thought would be possible. My b/s also doesn't tend to go very high either, though, since I'm doing the small inputs thing.
I'm sorry about your guy feeling freaked. I can't imagine that made you feel great. I've been with my husband now for 23 1/2 years (20 with diabetes) and he has had a few moments of freaking, but truthfully, it is such a small thing in his life. It really has hardly been a blip on his radar (let's hope I can say this in another 20 years!). I'm sure there're a dozen things about me that bother him more than my diabetes. I think your bf will adjust and be okay with it.
ETA: This is just out of curiosity... I'm sure that everyone's experience of blood sugar is different, and even my experience of a 60 on one day can be very different from how I'll feel at 60 on another day, especially if it's plummeting. But I'm wondering what was going on for you when you needed the paramedics at 41. Were you conscious? Do you have times when your body just can't absorb sugar fast enough? Were you alone and scared that your self-treatment wouldn't work?
Alone and scared and in the storefront business that I run in a rough neighborhood. I was 41 with double down arrows on my CGM and active insulin on board. I've since changed my ISF from 65 to 70 and so far it's helped a little.
Wow! A 3% improvement is phenomenal! I had to do a lot of trial and error when starting back on the pump a couple of years ago to figure out how much my basal rates had to be turned down during exercise. I had quite a few sudden drops as a result of not decreasing it enough, and a few highs because I decreased too much. Just be systematic about it and find what works. A few highs here and there are not going to ruin all your hard work. Believe me.
As for the relationship, the only advice I can give there is to educate your boyfriend in as matter-of-fact a way as possible. Don't expect any immediate turnarounds. He has to want to be a supportive partner. If he can't be that, then he's not the person for you. I've dated a lot of people and for every person out there who sees T1D as a huge burden, there's another person who is supportive and understanding.
Thank you. He's trying :)