Replies to This Discussion

Permalink Reply by Melissa M. on January 27, 2013 at 5:45pm

Hi Bethany- are you on an insulin pump or are you taking shots?

Permalink Reply by John on January 27, 2013 at 5:49pm

Not easy to answer without details.

1. How recently have you checked your basal rates? Mine have changed as I have aged, and I have distinctly different needs work days, weekends, and vacations now than when I started on the pump 15 years ago.

2. Are your insulin/carb ratios the same now as they were when you started pumping? Again, my ratios have changed as I have aged.

I would start by reexamining these two elements. Then, take detailed logs of food, exercise, health, activities, sleep, emotional state, etc. Look for patterns.

I have found that my BG is dramatically impacted by activity (physical and mental), illness, the amount of interaction with others in the workplace, the weather, etc. the more relaxed I am, the higher the BG. Weekends, I go high. Vacations, I soar (350 to 400 or more). When working, I tend to stay consistent.

Good luck.

Permalink Reply by MikeU on January 27, 2013 at 6:34pm

Before starting on a pump, it was a big help to work with a CDE to make sure my basal (Levemir) was correct. At the time, I was on a sliding scale, so we also worked to get the scale right.

Other than that, these things helped me avoid the roller coaster:
- use only glucose tablets to correct lows
- exercise regularly
- reduce carbs (although, I did this more for weight loss)

Even with the Dexcom & a pump, I still see a big swing if I listen to the cookies calling my name when I need to correct a low.

But, overall, I think wearing the Dexcom was the biggest help.

Good luck,
Mike

Permalink Reply by Biomuse on January 27, 2013 at 6:37pm

As John's excellent post already said, getting your basal and carb ratios right and adjusting to activity patterns is very important.

I also find that regular, scheduled exercise evens things out overall. Try to make that a part of your routine.

Also, in general: try to get a sense by watching the Dex of how long it actually takes for your corrective actions (bolus when high, sugar when low) to work. Some of that wild ride can come from chasing your own tail.

Permalink Reply by runningtheriver on January 27, 2013 at 7:21pm

All good advice before me.

Personally, I have struggled with this issue for the 14 years since being diagnosed, but have only really been aware of it for about 2 years, since getting on the Dexcom. Even more, it has really only become especially pertinent to me in the last year about dealing with the spikes and drops. I understand that dramatic swings can be some of the most damaging part of uncontrolled blood sugars, so I have recently tried to tame it.

I am not endorsing any particular diet, but I must say, a significant change in my carb intake was mindblowing for me. I decided to do a paleo diet (no grains, refined sugars, or dairy) about a month ago. No joke, my first week I had the most STABLE blood sugars that I have ever had in 14 years. I am not using nearly as much insulin. I feel better overall, and my sensitivity to lows has dropped from the low 80's to the mid 60's. I have been challenged by cutting out carbs (cravings, temptations, etc.), and I have not succeeded 100% of the time, but I can honestly say it has had the single greatest impact on my blood sugar control. Definitely worth a try to see if it works for you.

More than happy to discuss it further ... good luck!

Permalink Reply by HPNpilot on January 27, 2013 at 7:37pm

People have said most of the good suggestions:

1) First test and fix (If necessary) your basal rates, by time of day
2) Adjust the I:C and correction ratios. You may need different numbers by time of day.
3) Consider a lower carb diet. Carbs are one of the biggest cause of spikes and every spike can lead you to a crash with over aggressive corrections. I haven't bought into Bernsteins 30 g of carb a day, but I definitely believe that small numbers lead to smaller errors. If you eat smaller amounts of carb, the swings will be smaller.

I can flatline for 12 hours on the Dexcom some days.... haven't quite done 24 yet, but others on here have. The Dexcom ia a great tool for insight into how to correct things.

The fact that you can see things now is step 0 to making things better!

Although frankly, from your numbers ,you are doing a good job...

Permalink Reply by Ed on January 27, 2013 at 8:40pm

One thing I do while trying to iron out the basal and the boluses; I try to do the same static things for a few days. I work in a cubical so its easy for me. I start by eating the same meals at the same time. I know this is incredibly boring but; you can keep your food static and then adjust your basal and insulin to carb ratios around that.

If you are not sure if its carb ratio or basals you can try to skip a meal when your numbers are close to normal and watch what happens to your ##s if you tapper off then your basal maybe too much; if you climb maybe you need to turn it up a notch.

I find for me that my level of insulin resistance is higher in the morning; so I could eat what I would normally eat for dinner for breakfast and have to take more for it than if I ate the exact same meal for dinner that evening.

Good luck!

Permalink Reply by icuski2 on January 28, 2013 at 7:32am

Thank you everyone so very much for your time and sharing your good ideas. I am going to take some of these suggestions . . . checking and adjusting my basal rates first, then confirming my insulin to carb ratio (realizing it may be different at different times of the day), and really try to get more physically active on a consistent basis. I am not quite sure I could do the paleo diet, although I am sure it would be very beneficial, but may at least try to limit my carbs! I'm still open to more suggestions so please keep them coming.
I really love and appreciate this community. Certainly makes me feel like I am not alone in all of this! Thanks.

Permalink Reply by MikeU on January 28, 2013 at 1:08pm

You could start small with carb-reduction. Replace half of your servings of bread/pasta/potatoes with salad/veggies, etc. Replace pancakes/waffles/cereal with eggs/bacon/sausage. When eating out, substitute low-carb sides for high-carb sides. If a menu item has some high-carb food mixed-in (like fries on a salad), ask for the carbs on the side - then let someone else eat the carbs or request a low-carb substitute. If you don't mind eating something out of a wrapper, there are some low-carb and low-glycemic-index bars available.

Hopefully, your doctor's office has a Certified Diabetes Educator who could also help.