Posted by on Wednesday 16 June 2010

Living on the edge

My control has been, in recent weeks, really pretty good I think. Certainly it feels significantly better than it has been for several years, and it was never really bad even then. A change of insulin, adjustments my approach to my basal (Lantus) delivery and a slightly more focussed attention on carb:insulin ratios are all paying off. All those peaks and troughs are being evened out.

I'd tightened up quite a bit before the switch from NovoRapid to Humalog, but even so I think the change (and the time/date dose memory of the Memoir pen) have been hugely helpful to me. In a quick, thoroughly unscientific compare-and-contrast of a fortnight's figures on each insulin here's what I've found:

I am now having
30% fewer low-level hypos (my warning signs are significantly improved as a result)
28% fewer results outside my target range of 3.9-9.0mmol/l
80% fewer fbg (pre-breakfast) results outside target range

So it feels very much like the effort is paying off, and while I do catch myself smiling an occasional smug smile these days I also recognise that these closer-to-normal figures bring with them their own set of peculiar problems.

If you are happily spiking away into the teens after every meal you have a degree of slack while your insulin chugs away before you might dip into hypoland. With my new tighter range I'm spending far more time at or near 5.5mmol/l - which, while good, is also just on the edge of going hypo. A few weeks ago I'd miscalculated breakfast and was 10.0mmol/l before lunch. Slightly annoyed, I decided not to eat straight away, but to stroll to the supermarket to pick up 4 pints of milk. The walk is level and takes about 6 or 7 minutes each way at a fairly easy pace. When I returned with the milk I tested again to find I was 4.0mmol/l. This was just what I'd hoped for, but at the time I was struck by the size of the drop, over the short space of time, with the very little effort expended. To drop from 5.5mmol/l to 3.5mmol/l is all too easy.

Living life at or around 5.5 basically means, for me, that I need to take a little short-acting carbohydrate whenever I walk anywhere or do anything, in order that I don't dip low. There are some days when you overdo it slightly, which is a bit annoying. And days when you don't allow quite enough - I slightly underdid the compensation yesterday for a late evening walk. Went to bed at 6.2, but fbg was 3.5 this morning so I was obviously trending downwards last night.

Much as I'm still fairly pump-averse it makes me envy pumpers with a CGM (continuous glucose monitor). Now that would be a life changing bit of kit.

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