After a week of waking up with low BG a pattern has emerged. On nights that I exercise I wake up below 60. Not ideal. I am starting slowly and reducing my 4-7am basal for the dawn phenomenon by a hair a mere .05u/hr and see what happens.
We shall reassess the situation in upcoming weeks.
Update 4/3: It’s working; but I am dropping my 4-7am another .05u/hr because I am still waking up too low.
Vacation can be easy at times and more difficult than meets the eye. While sleeping in NYC I am basically at sea level; however, in ski country I am sleeping at around 5,400 feet. The effort difference is huge as you can see when climbing a staircase (the reason many elite athletes live and train in mountain towns). Following it up by skiing at 9,500+ feet is quite a change from East coast skiing where peaks are barely reaching the sleeping elevations out West.
What does this mean for me? While sleeping at elevation I require much less insulin. I am still not certain as to a good rate; but it is far less than what I require at sea level. My body is working harder even when I am shut down for the night. It is rather common for me to awake with lower BGs early in the morning that are stubborn to rise and cause bounces through late morning unless attended to properly.
Moral of the story? Life would be better if I lived at a higher elevation.
What type of diabetes do you have: Type 1
When were you diagnosed: 1988
What’s your current blood sugar: 155
What kind of meter do you use: OmniPod + FreeStyle Flash + basically the entire suite of OneTouch products
How many times a day do you test your blood sugar: 6-12; depends upon the day and activity
What’s a “high” number for you: 225+; I refuse to do a correction until I am over 180 due to glucometer inaccuracies. I have trust issues if you can’t prove your worth.
What’s do you consider “low”: < 70
What’s your favorite low blood sugar reaction treater: Fun Size candy — 10g each = about 35 BG points for me. Tried glucose tabs when I was a kid, tasted like dirt and cost a fortune – no idea why they still make them.
Describe your dream endo: Writes perscriptions EXACTLY the way I tell them to and does not balk when I don’t show my face in the office for a year or two.
What’s your biggest diabetes achievement: I’ll let you know when I get there!
What’s your biggest diabetes-related fear: Loss of vision, organ issues.
Who’s on your support team: Wife-to-be, family, friends. Anyone willing to share creative ideas.
Do you think there will be a cure in your lifetime: Not really, but I wouldn’t turn it down. I think a more functionally complete closed loop is a reality, potentially an implantable. Also, smarter insulin seems much more likely.
What is a “cure” to you: Pop a pill and it’s gone.
The most annoying thing people say to you about your diabetes is: You rode a 120 miles on a bike this weekend? (Answer: Yes, yes I did. And I only didn’t go for a run because it was getting a little dark out and wanted dinner)
What is the most common misconception about diabetes: T1/T2 confusion. It’s not as bad as it once was, but starting to get more confusing with LADA, gestational, and T2 becoming dependent upon insulin; so many are crossing over to my turf.
If you could say one thing to your pancreas, what would it be: You’re busted, dude.
I might have to go down to Coney Island to check these guys out before the baseball season comes to an end. Two type-1 diabetics playing for the Brooklyn Cyclones (minor league). One player uses a pump, the other does not. I really think that is great — they both are using what works well for them.
http://cityroom.blogs.nytimes.com/2010/07/10/sweat-bats-right-slides-left/
http://blogs.fasterskier.com/krisfreeman/2009/12/02/nerves-of-sugar/
As a diabetic I have to balance the “fight or flight response” on my own. I get nervous before a race and release sugar just like everyone else. Unfortunately my regulatory system is broken and I have to give myself the appropriate amount of insulin. This is where things get tricky. How nervous I am affects how much sugar I release into my body: more Nerves equals more glucose . The difficult part is there is no real way to monitor how nervous I am.
-Kris Freeman, 12/2/2009
This post by Olympian Kris Freeman really gets me thinking. How to monitor your nerves to find out how much the natural release of sugar into your body? It’s not just elite athletes like Kris that have this happening, this happens to me all the time on the bike, on boats, or even heading into a big meeting. Your body has a physical response to a mental stimulus.
I personally have found some correlation in the length of time I spend “nervous” – basically preparing and how long/how high the BG can go. In sailing, there is a half hour-to-fifteen minute period to the start where I will spike. When cycling or running, it really depends how long I am waiting around to start. The more time spent standing around, the higher I will go (the more time I have spent thinking rather than doing).
It would be interesting to see if any breathing or relaxation exercises have any effect.
Low carb? Not me. I’m a high carb intake type 1 diabetic. Breakfast is usually a bowl of cereal and milk (not a small bowl, but a bowl that is about 1.5-2 serving sizes). I eat lots of pizza. Cheese and crackers are a fantastic snack (and easy to bolus if you are counting the crackers in advance). Some days I may eat 500 grams of carbs, other days I may eat 100 grams. It all depends upon the needs of my body that day and how hard I am working.
As long as I am not constantly consuming carbs to keep BGs within range (a BG control issue) – I am happy to consume carbs to keep my body energized.
Reading another athlete with T1:
Carbs are not my problem. I take Novolog insulin analog to replace the insulin my body isn’t producing. And as a type 1 diabetic friend once said, “I’m not on an insulin budget.”
If you are working hard and burning energy, you need carbs (sometimes a disgusting amount). End of story.
In my opinion, the biggest annoyance with insulin pumps is the sites and changing sites. It is substantially better with the OmniPod for insertion. However, the biggest problem has to do with pooling of insulin at the site. Basically, eat a big meal, and take a large bolus. The insulin has a tendancy to pool at the site. And if I decide to change my infusion set/pod a short time after taking this insulin — well, most of it is going to fall out.
Even though I give myself the correct dosing, if I decide to change my site after eating, I will go high unless I administer a guesstimate of how much insulin I have lost. A big part of the calculation has to do with how long after eating/how long after giving myself the bolus. Almost impossible to get right.
Moral of the story: never give yourself a bolus right before you change your set. It never works.
There is a downside to every huge upside — something you can prove in life, money and diabetes. It’s called opportunity cost. Diabetes is a math game. A really annoying one where the rules always change.
I wrote about feeding the basal with enthusiasm. However, I forgot to mention a very key downside that hit me recently. Basically, I take more basal (currently Lantus) than I need to keep my BGsat 115 (my target, not my goal). Therefore, if I do not eat, I will go low. Not a problem with exercising (exacerbating the lower need of insulin), I eat and want to eat constantly.
Got home late last night at 8pm with a BG of 80, I proceeded to eat 90g, bolused correctly. I continued to feel hungry, and therefore continued to eat (an unknown amount via blind eating for an hour plus). Falling asleep with a BG under 100, I felt good. However, bolusing for blind eating is tricky, especially so close to bed time – so I made a guess. The guess was wrong — by a long shot. I woke up very early and was very thirsty — the cue to know instantly I am running very high.
The worst part about being high is how difficult it can be to come down. The usual ratios do not work. If you are 1u:60 points when you are 200-275, everything over 275 may take more insulin to bring down. So from 275-350 you may need 1u:40 points, and anything above that may need 1u:30 points. Basically, the higher you get, the harder it is to fall. In my experience, I really hate to do this kind of math when realizing a high BG and just do a normal 1:60 correction. However, in an hour I will see that I am not coming down fast enough.
Given the above situation, let’s say I was 400 and want to get down to 115. I would need 1.6u to get me to 350 (1:30), 1.9u (1:40) to get to 275 and 2.6u (1:60) to get to 115. For a total of about 6.1u — versus about 4.75 that I would take using my 1:60 baseline approach. The difference? 1.35u or about 80 BG points.
Guess what happens when I used 1u:60 this morning instead of my more complicated formula? I was 260 3.5hours after the correction. Makes sense, since 80 points higher 3+ hours ago can easily translate into an additional 65 points over a few hours of higher BG.
Moral of the story
1. Watch what you eat before bedtime. It can really mangle your morning.
2. Feeding your basal has the side effect of giving you lower BGs right now (as does increased metabolism from exercise) but Carbs on Board may not appear till later in your BG. Must have enough insulin to cover.
Nb. These are my numbers — that work for me. Your numbers will not be the same as my numbers.
Nb. Blind eating is a curse for diabetics. It’s something I know I should never do, but I do it. It causes havoc to my numbers, but I doubt this will be the last time I ever do it.
In all reality, not much has changed in preparation of exercising. COB, IOB are still the two items I am always conscious of – just how they get to me changes. While on the pump, I always disconnected before working out for 1.5 hours or less. This would tend to leave me in a basal deficit when I got out of the shower and reconnected and I would be forced to bolus immediately to both fill the cannula and get some insulin on board. However, now using Lantus, I do not have that insulin deficit when disconnecting. On the other hand, I do not start working out with a BG <180, Carbs-on-board and limited Insulin-on-board. I have purchased fun-sized candy that are 10 grams each – one or two candies are usually enough to get a BG <150 into my acceptable pre-workout range (also ensuring limited IOB). On the flip side, using the pump, I could be at any BG, and as long as I lowered my basal far enough in advance, I could raise my BG manually without additional carbs (however, I would end up going into further insulin deficit during the period of disconnect from the pump).
Not having to worry about the insulin deficit from disconnecting is a huge benefit for me during exercise – one reason why I am currently considering the OmniPod for my next pump.
As for the OmniPod in particular, I used a demo Pod for a few days over the weekend and I was somewhat impressed. Although the device is significantly large, it stays in place and has a smooth surface all around, unlike some of the MiniMed infusion sets I have used over the years. However, the inside information is calling for a 40-50% smaller Pod late 2010 or early 2011 (awaiting FDA approval). From the investor relations slides, it appears to retain its distinctive shape in a smaller package.
Since I went on a pump “vacation” back in February, I have been using Lantus/Novolog with decent results. However, one of the downsides has been leakage from the injection site. This tends to happen if you pull the pen away from the skin too early (the pen is still releasing insulin for several seconds after it clicks done).
However, for some reason I feel like I am getting a little more leakage than what is normal and my precision boluses that I used on the pump are getting bumped up 10-15% to cover leakage (this is true to both my Lantus and Novolog).
Experienced leakage woes? Just another part of living life as a diabetic and playing with the numbers.
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