Monday, 28 March 2011

Variety is the spice of life? Not if you're diabetic...

I've had a week of absolutely shocking BGs. I had a bit of a cold, but no worse than others I've had, and colds don't normally affect me too much. This time, however, I was seeing the high teens at least once a day, even with constant testing and correcting and temp basals. I was starting to get really worried and considering getting in touch with my DSN, or possibly my liver doctor (since the last time my numbers went nuts like this it was a sign that my liver was under attack), when I woke up on Friday with a BG in range, and they stayed like that all day, without need for temp basals or anything.

It got me thinking. I've said before that one of the things that I find most frustrating about living with diabetes is the apparent randomness that creeps in and affects your numbers.

There are so many variables to consider when we see a BG that is higher or lower than we'd expect. Is it a one off, or is it a run of them? If it's a one-off, you start trying to work out why - did you mess up the carb count of a meal? Did you forget to bolus? Have you been doing exercise/sitting doing nothing? Has something happened to stress you out? Is it a bad set? Have you somehow managed to kill you insulin? Is there a bubble in the tubing? What about insulin absorption or the kind of food you had? If it's a series of highs/lows, then a whole other set of considerations come into play - are you getting sick? Is it hormones? Is it a change in the weather? Have you changed weight? What about activity levels? Is there a pattern or is it just random? Basal or bolus? And a myriad of other possibilities.

Then, if you spot a pattern emerging, you have to deal with it. Sometimes it's straightforward - you're rising every day after lunch, you know your basal is right at that time, so you increase your insulin at lunch and that sorts it out. But then there's the other tricky little buggers. The ones where you've notice that it happens when you eat pizza, or do a particular type of exercise, or have a stressful time at work or some such.

So you have to try and sort it out, and the way to do that (like in so much of diabetes) is through trial and error. You can talk to other diabetics to see what they do, you can try altering an insulin dose or use a temp basal, alter carbs, or the timing of bolus. There are so many options, and even within those there are yet more variables - you decide to try a temp basal but how much? and for how long? You try things, test to see how they're working, and then you tweak, or you try something else. It's the only way to really do it, but the cost of making a mistake can be so huge - you end up low or high, and maybe it's only a little bit and quickly sorted out, but then there's the time it goes really wring, and you end up with a low that just won't come up, or you end of with ketones, or something else goes wring and you end up sitting there feeling like crap and wondering why you even bother.

Someone once told me that trying to manage diabetes is like trying to do a jigsaw puzzle when the pieces keep changing, and it just struck me as so true. What fits one day might not necessarily fit another, and we have to do this every single day. Things that other people take for granted we have to think so much about. Going for a wander around town, going to the cinema, having a drink with friends, having a busy day at work, eating, exercising, and a million other things. We do this every day, trying to cover for a part of our body that's gone on strike, that should do this automatically, responding to changes in our body and tiny little signals and information in increments that we can't possibly hope to achieve.

And yet we do it. We soldier on, we do our best, and we go on with our lives and refuse to let this condition defeat us, and (most of the time ;)) we do it without complaining or asking for any kind of recognition, or turning into babbling wrecks rocking in a corner.

And you know what? I think that makes us pretty damn amazing.

Thursday, 24 March 2011

Post-holiday ponderings

Stuart and I were on holiday last week. We spent a lovely week in Paris and then London exploring, eating, wandering around and generally just chilling out. I have to say, Chuck made the whole experience much easier than it has been in the past - temp basals are definitely one of my favourite things about the pump!

I've learned a couple of interesting things over the last week or so. The first is that my afternoon basal rates are very much determined by when I take my steroids in the morning. The first day in Paris I slept a little later than usual, and combined with the time change, I ended up taking my steroids about two hours late. As a result of which I ended up running low in the afternoon (although testing and free-carbing managed to prevent hypos), and ended up spiking to 16.7 by dinner time. I'd suspecting this before, on the occasional days when I'd taken my steroids later, but this seems to confirm it. I made sure I took my steroids at the normal time afterwards, and that solved it.

The other thing I learned is how much I rely on my logs for managing my diabetes. I keep my logs using an excel spread sheet, which I keep on a USB drive and I usually just have it open on whatever computer I'm using at the time and add to it throughout the day. Since I don't really keep a paper log, I didn't have access to this while we were away. I'm quite happy to do the daily stuff as I go along, but I really do find it useful to have a glance over my logs to see if any trends are appearing, what I did last time I had a particular food, or what temp basals I used etc. It also helps me to spot when my numbers are starting to rise, because there have been times when I've been pootling along, thinking I'm doing ok, and then when I plug my numbers in I realise my average has been creeping up and is much higher than I thought it was, and logging my BGs regularly helps me to catch that early.

Plus, I like graphs. ;) And, well, colour coding things and seeing my averages and percentages in range and all those other geeky things that I've manage to convince excel to do...

I also have a tendency to put lots of little notes in the comments column of my logs, and I have my own abbreviations for things like extended boluses, so I'm never sure how much sense they end up making to other people (especially when my notes end up being small explosions of rage or confusion over a result...), but I figure that I keep these logs for *me*, and the most important thing in that respect is that I have a system when I can have all the information I need, in a way that I can interpret. After all, I'm the one who has to make the day-to-day decisions based on these results.

I still tidy them up if I have to send them to a DSN or take them along to clinic though ;)