RRRRRRRR I don't know about some people!

General
1

Ok I was recently refered to a new group of health professionals to help me deal with the fact of having so many low's which happened very fast and often. So in the team of professionals is a women that is supposed to be a diabetic pump trainer/nurse. and she keeps wanting me to upload all of my results for her to review and she would get back to me about changes that should be made. so i uploaded on the weekend and sent them to her and when i finally didn't get an email back by 12pm today i decided to call(i was upset and i just want someone to really help me put myself back together) and when i was talking with this women she keeps talking about using temp basals and how to adjust them and how to only give so much of a bolus before doing an activity, then she informed me that it is all trial and error. well i took it into my own hands and this morning i had a plan to get up and do a workout before breakfast if bg was good but of course it wasn't it was at 3.9(70.2) so i had breakfast which was only a bowl of special k red berries (2 cups)and 2 ex lg coffee and when carbs were figured out i was only going to give for 50 carbs but gave for 35 carbs to have a bg that was a little high but no bad, but when i tested again oh was i ever wrong about it cause now my bg is at 24.1(433.8) i can't believe this and i have no idea what this women was talking about with the temp basal's and she doesn't make any sense to me so right now i want to give up and say to hell with it all and just crawl in a whole and die. right now i don't care if it comes down i'm just mad, upset and very fustrated and i'm very sorry to all of you but thanks for letting me rant.

"If it were true that we are what we eat, them I am fast, easy and cheap" -- Barbara Johnson

2

 

just for an update when i tested @ 3:10pm my bg was 4.4(79.2) and don't know if it's normal to drop almost 20 points in a little over 2 hrs and i really just want to throw in the towel and right now i guess.......

3

CJ -

You've done basal rate testing?  You know that you're basal rates are correct or no?  I'm not sure why you ate 50 carbs but only bolused for 35?  Did you go workout after eating?  

4

 

hey jaco,

haven't done any basal testing and don't know how and have no idea if my 1 basal rate is correct or not and no one is helping me to get the answers to these questions because when i was put on a pump the trainer just imput my #'s and that was it and now that i'm having all of these problems with basal's, temp basal's and everything i don't know how to make adjustments or test all #'s. and the reason that i had 50 carbs and only gave for 35 is @ 9am when i tested my bg was 3.2 and so i didn't want to give for the full 50 carbs cause then i would have just gone low again.

But hey the starting point to finding all of my #'s is to find out my TDD but when you work on a pump and use a sliding scale to adjust for different amount of carbs per meal.

jaco if you can show me how to caclute my TDD and teach me how to do this cause the new pump trainer started bringing up all of this but only gives verbal instructions and no practical instructions(which i need to understand)

sorry if i'm sounding harsh i'm still trying to get back to norm after the high and sudden drop in bg

 

"If it's true that we are what we eat, then I am fast, easy and cheap" -- Barbara Johnson

 

5

I believe basal testing is key and why your trainer or endo has not tested your basal rates is beyond me.  You can look things up online and buy books to better understand the pump.  But to start I would test your early day basal rates.  (I don't know your daily routines or schedules so this is just an example).  Stop eating or exercising by lets say 10pm.  Then if you can wake up once in the middle of the night to test and document your bs (do not correct unless over 275)(do not eat unless lower than 70).  Then document your bs when you wake up then continue to fast until about 10am.  You want to see what your sugar is doing without the influence of food, boluses, or exercise.  (you might want to do this for a day or two).

The next step is do basal testing for the day to afternoon - so it's the same concept - eat breakfast (try a low carb breakfast that requires a slight bolus). Don't exercise then fast until say 2pm.  Document your sugars and see how they run during this time of day.  Again don't make corrects unless you're really high and don't treat anything lower than a 70.

Then you can move on to the later hours - eat a light breakfast, eat a light lunch then fast, don't exercise, etc.... document your sugars, etc....

So if you're sugars are going low during these times your basal rate is too high and if it is going high then your basal rate is too low.  Once you have a good idea what your basal rates are (they will be different at different times of the day) then you can start in with figuring out the accuracy of your carb ratios, your sensitivity, the effect of exercise on your blood sugar, what type of carbs you can eat at what times of day (i.e. I can't eat any carbs in the am.  I'm too resistent and it's just easier for me to wait until about 10am to eat a real breakfast - I wake up at 5am). 

I have to go right now - but I've made myself clear and understandable - if not I'll be happy to clarify and help you out in anyway possible. 

Just start with the basal testing first.  This will take a few days/weeks (depending on you and your schedule) then you can go onto the next step.  But playing around with temporary basal, etc... without knowing if your normal basals are correct is not going to work.  Good luck and let me know how your doing.

-Jane

6

CJ it's definitely tough to adjust with exercise.... I've found the best thing to do is plan exercise 4-5 hours after my last bolus, so I don't have to worry about it kicking into extra gear and causing a low. What exactly led to the bg of 24.4? Did you actually have 50 grams and only bolus for 35? If you give me more details I might be able to help you sort it out 

7

CJ,

Duuuuuude.  I am so sending you an air hug right now.

I also don't know why your endo hasn't had you do basal testing.  It totally sucks - I always hated doing it - but once you can figure out all of the math, you'll feel so much better with numbers more in range.  The suggestions above sound right to me.  You're basically letting your body do it's thing, without food or bolus amounts getting in the way.  The idea is to know what your body does, left to it's own devices, so to speak (which, right now, is that one basal rate you have.)  You will need to do these tests a few times to know for sure that there is a pattern, and it wasn't just a one-time fluke.

Figuring out T1 AND exercise sucks.  I totally get that.  (Sidenote: I'm doing my first half-marathon this Sunday with a girlfriend of mine, who is not diabetic.  When I explained to her what a typical routine is for me - testing, timing of carbs, types of carbs, IOB - in order to be able to have a successful run without going low, her response was, "Wow, if I had to do all of that just to work out, I probably wouldn't work out at all."  Um, yep.  That's how I'd like to feel about it too, sometimes!)  If I can recommend a book, this one has helped me tremendously in figuring out what certain types of exercise do to my body, and what I can do to prepare and sustain my energy and BG levels:  The Diabetic Athlete's Handbook by Dr. Sheri Colberg. 

Everyone's body is a little different, but here's a general guide that works for me, specifically for when I run. 

1.  No IOB.  If I have bolused in the last two hours, I will drop like a rock in my first mile of running. 

2.  I eat a snack about 45 minutes before I start exercising, with no bolus for it.  I eat about 20 - 25 carbs, with some protein.  Clif bars work well for me.

3.  After I'm done running, if I do nothing - my blood sugar will spike.  Once I've transitioned from running to walking/cool down, I take the bolus I would have taken for the snack.

This is what works when I'm doing less than an hour's worth of activity.  I hope this helps.  Feel free to ask questions - I'm happy to help where I can.

8

 

Jane, I want to thank you so much for your explation of how to test my basal rates(i'm going to see if i can print off your response to have a guide). I have no idea why no one has ever tested my basal rates before this point and no one has ever metioned it before this either. You have no idea how you have started to help rebuild me!!!! And if it's ok I will be bugging you as I go onto the next step if you up for it, and i'll take as much help as I can get from everyone.

And Justin, the reason that I only gave for 35 carbs at bkfs was because I was only at 3.9 @ 9am so i didn't count the 15 carbs needed to help bring up mg bg a little.

 

"If it's true that we are what we eat, then I am fast, easy and cheap" -- Barbara Johnson

9

Thanks so much Kim, I'm really starting to feel the love from here and I'm going to have to get the book that you suggested. I'm going to start testing my rates tomorrow and I'll let you know how it's going and what the results are!!

And sorry I said justin and it should have been dylan, I'm really sorry

10

No problem!

Also - with a BG level of 433, I think we can let a few typing errors slide.  :D

11

Thanks Kim :-) I'll work on the errors!!! LOL

12

CJ, The advise you have been given here is right on track. The testing isn't going to work perfectly, but I don't think there's any "perfect" way to do it. It's all trial and error, using educated guesses when possible. Another good book is "Pumping Insulin" Fourth Edition, by John Walsh and Ruth Roberts. John is T1, uses a pump, and is a physician's assistant.

Tom Beatson

dx 12/1942 with 100,000 miles on my bicycle since 1978

13

It will also be a good idea for you to become familiar with the different aspects of the pump - temporary basal rates, different boluses, etc. You can pull out your pump manual and read through the instructions and play with the different features. This will help you feel more comfortable with it, and (hopefully) you can rely less on your endo and pump trainer. Because they aren't very responsive to helping you out, you might have to do some experimenting on your own.

 

Good luck!

14

Sorry to sneak in....but what is IOB?

15

insulin on board (how much insulin is still acting in your body after you bolus)

16

CJ - 2 cups of coffee?  Did anyone ever tell you that caffeine itself raises your glucose?  I am an avid coffee drinker, so I know!  Also, you may find that in addition to planning your exercise around your last bolus and last snack, setting a reduced temp basal for an hour before as well as an hour after your exercise session (as well as during) should help you prevent your lows.   Fire your trainer and file a complaint against her.

Good luck

17

I don't have anything new to add, really - jut one more person here to support you through basal testing. Let us know how it goes!

18

Good point Nannimae - I forgot to mention that I also remove my pump for an hour before I begin exercise.

19

Hi--I have a son with diabetes--so i feel your pain-from a mom's perspective--this disease truly makes no sense sometimes--the rules keep changing day to day--one thing we had tried that may help you get a handle on the fluctuations with blood sugar is a continuous glucose monitor--you wear it similar to a pump and it gives a reading every 5 minuts--it is very nervewracking at 1st and my son hated wearing it so we havent tried it again but I think it may be helpful--not to know every 5 minutes but to get information to see what the trend is over a 1-week period--maybe ask you dr about the monitor==they may be able to do a trial for a week to see what sets off the changes--just dont give up--I feel that frustration every so often and my son definitely feels the rage along with it--he is 9 and was dx in june--diabetes seems to be a constant demander of attention--the second we relax a little the numbers go sky high or low and I know the feeling of just wanting to forget the whole f888ing thing and just live your life--fortunately that feeling passes--the blood sugar comes back up--or down and we go on happily til the next incident.  It is however getting a tiny bit easier and I have hope of my son living a wonderful life that happens to have diabetes in it but not overshadowed by it--I hope this is helpful--just know other people out there do feel the way you do and apparently lots do quite well with this disease--dont pressure yourself to be ok all the time--its a marathon--not a race..peace

20

Jane..you explained the basal rate testing very plainly and clearly for anyone to find the rates they need at each part of the day. Thats a real bonus of a pump!!

The pump & CGMS still blows me away... I go back to 1958 with one syringe & needle a year!

God Bless modern technology!!

~Annette~