Posted by on Friday, 9 April 2010

Too many variables

I've booked an appointment to see a Consultant at the hospital. Well first I went to the most diabetes-savvy GP at my practice with a list of issues, concerns and proposed changes to insulins and/or pens who immediately said, "This is a bit out of my league really, you need to go and see a Consultant".

So since then I've been keeping a detailed diary of bg readings, meals, doses, activity, post-meal readings. This isn't something I've done for many years, but I can certainly recommend it. I had a good few days to start with. Things felt quite under control, and where they didn't I had good information to look back at to compare and contrast different days and attempt to work out what had caused that high reading... why I went hypo there...

If you are interested, here's a link to the grid I made up which allows space for date, premeal bgs, estimated carb and dose, 2 post meal levels (say 1.5 and 3 hours) and any notes about level of activity etc. You can print them back to back on A4 sheets then cut the sheets in half lengthways and fold/staple to make a little booklet. I tend to carry all my diabetes gubbins in a pencil case, and it's small enough to slip in with everything else.

I've got another two or three weeks before I see the Consultant and boy do I need them. If this new push towards tighter control is showing me anything it's that there are too many variables. After the first few good days I've launched into a bizzare period where for every errant reading I have at least 6 different possible causes.

Every day is different.

I have a cold (this can sometimes push bg levels up). It didn't for the first week (when I felt worse), but now I'm coming out of it my levels are often higher than expected. Is that it?

It used to be common for me to wake up low - this week it's 10.something (dawn phenomenon*? overnight hypo rebound**?)

Recent 1.5 hour post meal readings have ranged 2.7-16 (!)

Over correction for a hypo?

Pre meal level variations?

Post meal spikes†

Mis-guessed meals/doses?

Dose-splitting††

Ambient temperature?

Stress? (often pushes bgs down for me, but I gather up is common too)

Easter (and no I didn't eat any chocolate eggs, the unusual/celebratory meals were plenty to muck me about)

I've not been to the gym for a week or so too which probably isn't helping


Not a good day for me today. I got so frustrated this morning I had two hot cross buns for breakfast (instead of the usual high fibre cereal/semi-skimmed). Something I'd been denying myself in an attempt to 'be good'. It's feeling like the harder I'm trying, the more chaotic and inexplicable my levels are.

On the plus side I have got rid of a LOT of hypos since I've been writing everything down, but now I'm drifting high way too often and my current HBA1c (average levels over the past 2-3 months) would be terrible. At least a few low level hypos kept my averages down!

Glossary of confusion:
* Dawn phenomenon is the body's natural 'fire up the burners' routine in the morning where glucose levels tend to rise as dawn approaches. It's more pronounced in some people than others. Strictly speaking I don't think it can be this since I'd expect more consistently reliable high levels, but I'm not ruling it out. Maybe I have it one day, but not others.

** Somogyi effect suggests that if you sleep through a nighttime hypo your body has the capacity to dump glucose into the bloodstream from the liver as a defence which means you can rebound into hyperglycaemia.

† Relatively high levels of fat in some foods (pizza is a classic) can significantly delay the absorption of the carbohydrates, meaning that it kicks in once your bolus dose has pretty much run its course. Ironically I perfectly judged a chipshop blowout the other day, while getting something far more straightforward hopelessly wrong the following day.

†† I've been having quite a lot of success in tackling post-meal hypos by splitting the insulin dose. Rather than injecting all at once I'll delay some of the dose until an hour or two later to spread the insulin activity over a longer more even curve. A little like being my own very crude insulin pump. Unfortunately some times I've underdone the first injection and ended up with a bg spike at 1-1.5 hours (rather than a hypo at the same point). Bah!

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