Diabetes Self-Management Blog

This week marks one year since I started writing a weekly blog entry for DiabetesSelfManagement.com. That’s 51 articles (almost 40,000 words!), or blogs, or missives, or whatever you want to call them, about what it’s been like for me (for the most part) living with Type 1 diabetes. This week, I’d like to share some modified portions of an e-mail I sent to a friend a few days ago as a response to her asking how the diabetes was going.

To answer your question about the diabetes, I went to the endocrinologist yesterday for my three- month checkup, and everything was fine. My hemoglobin A1c (a three-month blood-glucose snapshot that’s one of the major ways of measuring diabetes control) was 6.0%, which is actually lower (better) than it was three months ago—although three months ago it was 6.7%, and thus still under 7.0%, which is what you want to be under to drastically limit your chances of diabetes complications. There’s no reason for me to try to get it under 6.0%, because the benefits from an even lower HbA1c are negligible, if any, while the chances of dangerous bouts with hypoglycemia if I try for tighter control increase dramatically.

The 6.0% yesterday, however, is slightly odd. But it isn’t odd. Not necessarily. It is a really good thing, actually, because I’ve let up a bit on my mental rigor in managing the diabetes, and yet it seems as if I set pretty good groundwork in year one. So, well, that’s comforting to know. There’s nothing out of the ordinary with anything, and all seems to be well. I’ve gained about 15 pounds in the past three months, but the doctor said that’s not a problem. The reason for the weight gain is simply because I haven’t gone to the gym nearly as much and instead choose to be out in the garden. I’m sort of the opposite of most people: Instead of losing weight in the summer, I put some on and take it back off with hours indoors at the gym in the winter.

Do you want more? The one thing the endocrinologist pointed to as something that I might work on if I wanted to (and he wasn’t advocating working on this; he was just saying) was that I bring up my daily percentage of basal (baseline) insulin rates relative to the percentage of insulin I bolus (take for meals). Right now, my daily basal dose is about 36% of my total daily dose of insulin. Ideally, I’d be getting about half of my insulin from basal (the steady trickle administered by the insulin pump) and half from the bolus for meals.

But, again, these numbers are not a huge deal.

But, me being me, I want to improve it. So I adjusted my rates by a measly .05 units per hour overnight, and at 3 AM I woke up with a low blood sugar. This is the first time—yes, the first time I’ve encountered a low enough blood glucose to rouse me from sleep. I woke, stared at the clock, then felt a bit of the symptoms of a low and convinced myself to go check and see what my blood glucose was. It was at 55 mg/dl.

Seventy mg/dl is the high end of a low range (I target 120). Once it starts to dip, it can drop fast, and as I was standing there checking, middle-of-the-night by the oven light, I began to get sweaty and clammy and start trembling. In those situations, however, I need only about 30 grams of carbohydrate—about one container of fruit-on-the-bottom yogurt.

I quickly ate the yogurt, getting to the compote berry mixture on the bottom by burying the spoon into the vanilla without mixing it up. The thing here is, however, that I’m supposed to wait 15 minutes or so after that carby-ness until I check my blood glucose again. It will take fast-acting carbs about that long to kick in. During that time, though, my brain, which needs glucose as its fuel (its only fuel) is telling my body that I’m starved. I’m ravenous. I want to eat any food that’s in the house.

It takes most everything I have to not eat what’s in the fridge, to down three or four large Gatorades, to eat a loaf of bread, to scoop out the entire contents of the extra-crunchy peanut butter. Because that would only send me spiking the other way, and then I’d enter into a blood-glucose roller coaster with numbers that aren’t healthy at all.

Instead, to keep myself munching, I ate half a bag of (mostly carbless) baby-cut carrots. I tell you what: I’ve never tasted the sugar in cold carrots before. But when your body is needing that, or thinks it’s needing that, there’s nothing to compare to how sweet a vegetable like a carrot can be. These helped me until I was able to make it back up to around 120 mg/dl, around 3:40 AM, at which point, for good measure, I ate a piece of whole-oat toast (slower-to-absorb carbs to get me through the night) and went back to bed.

Yep. You’d think a disease would be easy. Sheesh.

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Comments
  1. Dear Eric.

    What a wonderful blog. You could put my name and the story would still be true. With the exception that I can tolerate most of my insulin as basal 45U Lantus/30 hours, yes weird in my case the Lantus last more than 24 hours in some people much less. This works out to 36U of Lantus/24 hours. To this I add at most 15 Units of Novorapid. More is better for a low HA1C but a disaster for weight gain. Intensive diabetes treatment= constant extreme hunger. I wonder if this is the fundamental equation of tretment with insulin. I have in desperation tried adding Metformin to the mix this drug upsets my digestive system and makes me generally feel unwell but less hungry.

    Do everything that it takes to not gain 15 pounds in the hope of lossing them later. As you grow older these will become more and more difficult to shed and at some point impossible.

    Posted by CalgaryDiabetic |
  2. Eric, I would be interested in knowing if your Endo gave you some kind of plan or strategy to bring your basal up from 36% of your TDD to closer to 50%?
    My basal is also in the 32% to 36% range. My Endo hasn’t said anything about it,but John Walsh (Pumping Insulin) told me at the recent DESA Meeting in Toronto last week that it should be closer to 50% for better control. He gave me a few ideas and suggested reading his book as a start and then fine tuning as necessary.
    I use an Animas 2020 with Apidra and I’ve been pumping for 1 year out of the 41 that I have been living with Type 1. My A1C is in the 5.8% to 6.5% range and I am feeling good.
    Florian

    Posted by Florian |
  3. > That was a brilliant self mangement skill and
    > quite detailed.

    Posted by winima |
  4. Eric,
    thank you for your frank discussion on living with type 1 diabetes. It’s hard for us non-diabetics to imagine what you go through, but reading your blog is very enlightenin.
    If you are having satiety issues and continued weight gain you might discuss adding Amylin with your endo.

    Posted by skiqueen |
  5. I’m amazed that you have only woken up once from low blood sugar especially with an A1C as low as 6.0. I personally find it difficult to go a week without having to get up at night to treat a low. There are so many factors that change the balance of metabolizing glucose that make it incredibly difficult to always accurately dose.

    -Brian

    Posted by boulderb |
  6. You’re dong a fantastic job, the most important being the actual measuring of BG. I wonder, With a BG in the 50’s, the point is to eat something that does not need to get digested in order to get a quick increase in glucose values. drinking 4 oz of a Coke or other sugary drink can raise them quickly, Also, do you eat a snack before bed? I know that the basal affects those lows, and that the body naturally may go low at those hours. And yes, that desperately hungry feeling is awful, but the consequence is, as you said, a roller coater of BG levels. I carry sweet tarts with me, pure sugar! 23 of them equals,12g carbs and raises BG 36 points in 10-15 mins. 50+36=86. That 86 can sure tolerate a slice of toast with a little p’nut butter and will make you feel a lot better. By 7 when you get up and start over again, I would think about high fiber foods throughout the day.

    Posted by Millie |

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Disclaimer of Medical Advice: You understand that the blog posts and comments to such blog posts (whether posted by us, our agents or bloggers, or by users) do not constitute medical advice or recommendation of any kind, and you should not rely on any information contained in such posts or comments to replace consultations with your qualified health care professionals to meet your individual needs. The opinions and other information contained in the blog posts and comments do not reflect the opinions or positions of the Site Proprietor.


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