Comment by Brian (bsc) on August 31, 2011 at 7:24am

One thing I've wondered about is the number of corrections you use. Not all pumps properly handle insulin stacking. Do you think that might be causing a problem? Has anyone checked your pump settings, like duration of action? Just some thoughts.

Sometimes you just have these sorts of days. You can't let this get you down. You are putting in the effort. Remember, every new day is a fresh start.

Comment by Jen on August 31, 2011 at 9:45am

Hi BSC, thanks for the comment. I really am trying to take the "Tomorrow is a new day!" thing into practice.

I've checked my duration of action with Apidra and found it was two to two and a half hours, but I kept my pump set at three hours which is the same as it was when I was taking Humalog.

Comment by Bug74 on August 31, 2011 at 9:49am

I have learned to step back a few steps and dial down the intensity of my reaction to all of it. Not saying this is what is happening to you....but I found my reaction to all the ups and downs caused a lot os stress and my bg was pretty sensitive to the stress. I know it is easier said than done.

If you repeat the CGM in the docs office make sure you have someone who is really good at interpretting the results. When I did this the CDE and I spent about 3 hours just digesting and analyzing the data. We made a few small changes that really made a big difference. I kept a log of every thing I did, ate, bolused. EVERYTHING.

Comment by Brian (bsc) on August 31, 2011 at 3:28pm

John Walsh (of Pumping Insulin fame) suggests that you set your duration of action (DIA) reflect the amount of time that insulin will be working and that often people have their DIA short. Here are the symptoms he gives for a short DIA setting:

•Causes “unexplained” lows as the bolus calculator recommends larger boluses than are really needed.
•Leads to incorrect insulin adjustments as basal doses are lowered, and carb and correction factors raised to compensate for the excess boluses.
•Causes you or your physician to lower (strengthen) carb and correction factor numbers to offset the missing basal.
•Causes more hypoglycemia when large carb boluses are given for high carb meals.
•Causes highs when meals are eaten late or skipped due to the low basal.
•Makes you override or not use your bolus calculator

Perhaps something to think about and talk over with your doctor or CDE.

Comment by Jen on August 31, 2011 at 4:49pm

Hmm, this sounds like the opposite of what I get. I do get lows but most are attributable to exercise or other factors (hot weather, hormones). It's the random highs that drive me crazy. I woke up low this morning as well as yesterday morning so lowered my basal by 0.05 units an hour, but now I've been 200+ all day today, so I think I'll put it back up. But then, today I'm also having issues with allergies and stress from work starting again after the summer and it's day two of my infusion set which usually only lasts two days, so that could also be the cause. At least today I'm consistently high instead of the usual bouncing around everywhere.

Maybe if I had the time to track in detail the 10-15 things that I know affect my blood sugar I could figure it all out ...

Comment by Jodil on August 31, 2011 at 4:53pm

Hey Jen, I have the same issue although not on the pump. My endo calls it "labile" or "brittle" diabetes in which despite my best efforts my sugars are all over the place. Like you, I can go to bed with one number and all things being equal always waking up with a different number. It is a pain in the -ss disease in which my son, my father, my brother and myself suffer from so you are not alone :)

Comment by Holger Schmeken on September 1, 2011 at 5:09am

Have you ever considered to take Metformin? It will moderate the glucose release of the liver down. I am assuming that your liver is changing its output according to your hormonal cycle. Thus a moderated release might help to get the erratic behaviour under control. Katherine has combined Insulin and Metformin with great success.

Comment by Jodil on September 1, 2011 at 6:37am

I was actually on Metformin with my insulin for many years and due to my development of gastroparesis I stopped taking it. While it did help to lower my blood sugar I found that I had a hard time treating a low as the metformin stops your liver from producing glucose which you need when trying to bring your sugars up from a low. It is also VERY hard on your stomach. I am actually glad to be off of it and since I lost 30 lbs due to the gastroparesis I did not have a hard time this time when trying to stop the metformin. However, I agree with Holger that for women I believe hormones, stress, etc...plays an important part with blood sugars as I always have better reading at the beginning of my cycle and my insulin must increase as the month goes on. My father and brother and son have much better control with their blood sugars. Just to note that when my son was diagnosed last year, my sugars WERE CRAZY HIGH especially on days I was stressed and was freaking out as they were in the 400's some mornings when he was first returning to school. Good luck

Comment by HowToDiabetic on September 1, 2011 at 10:19pm

First off, I'm sorry you're having all these problems :(. There's been many times over the years when I've felt the same way - university+football+diabetes = STRESS! Perhaps that's part of the problem for you too? Stress can do all kinds of things to your body and your blood sugar. If you are concerned about each and every blood glucose test you do then that may actually be the root of the problem. Instead, maybe just experiment with consistency. Try consecutive days of eating the same foods, doing the same exercise, performing the same tasks - whether it be work or otherwise. Just get into a routine and remain optimistic about the outcome. Eventually with some trial and error, you should be able to find out which days (food, exercise, tasks) worked and which ones gave you inconsistent numbers. Good luck!

Comment by Jen on September 3, 2011 at 10:45am

Hi Alan. Usually when I have a low I will eat about 8 Skittles (1g each) and then test 15-20 minutes later to see if I'm still low, and repeat if I am. I actually use Skittles instead of glucose tabs, though maybe glucose tabs would be faster.

When I am high, I will correct and then correct again 1-2 hours later if I'm still high. Since I have a pump, my pump takes away any insulin on board from future corrections so, as far as I know, it makes it so I can't stack corrections unless I override the pump (which I don't). But I do think Apidra does almost nothing to my blood sugar for the first hour or so, so maybe I need to always wait two hours before testing again and doing another correction if I need to.

The past day or two have actually been much better, though. Sadly, I find I have two months of total CHAOS every month, and two months where things are relatively smooth. The graph I posted was of my chaotic portion of the month, and that's also when I get really, really frustrated at my blood sugar. I am not sure how to deal with that but the people who mentioned metformin below have a good idea, so I will look into whether that might help.

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