Wordy Wednesday – Low? Low…. Low!

If I could just bottle this to use on the days I was running high, it would be worth it.This was my Dexcom G4 view for the majority of the day yesterday. It didn’t start going up until I consumed a VERY carb-filled Italian dinner last night, but even then, it spiked up, then sorted itself out pretty predictably (after a few hours.) No post-breakfast spike yesterday morning or this morning either. What am I doing different? What am I eating different? Nothing out of the ordinary, as far as I can tell. Could it be a new bottle of insulin? Could it be the new-ish infusion set site absorbs better?

This diabetes thing……always confusing. always a moving target, always a celebration around the corner for the beneficial accomplishments, or a curse on those not-so-controlled days.

I Freaking Knew It

You live with type 1 diabetes for close to 19 years, you read tons of diabetes blogs, have d-friends you meet up with on a regular basis and chat about everything diabetic under the sun….you know things.

Like, I KNEW when I went to bed and my blood sugar was hanging out in the 200s (because I had an infusion set site change right after dinner) that if I gave myself a little shot to try to correct it, just a couple of units to get me over the non-absorption hump I was having post-site-change, that inevitably, I would crash in the middle of the night. But did I listen to myself and NOT take the shot? Did I eat/drink a little something more before bed to maybe stave it off? No, and no.

Which led to me being startled awake the other night at around 3:15am by the “Buzzzt, buzzt, buzzt, buzzt” vibrating and beeping of my Dexcom CGM. Bleary-eyed, I look at it, and it just says “Low.” Yeah, not good. Then comes the body assessment. Oh, I’m here in bed, lying in a pool of my own sweat. No joking, it’s an enormous amount of sweat, and I detest sweating, so I pop out of bed hoping the sheets aren’t so soaked that I can’t crawl back into them later.

My husband rouses awake and asks if I need him to go get me something. I just mumble, “No, I’ve got to fix this.” Off to the kitchen I go, with the best-laid plan of only eating about 15 grams of carbs and then waiting 15 minutes to start going up. On the way there, I stop off and check my blood sugar with my finger-stick meter, just to confirm the Dexcom was on the up-and-up (or rather, down-and-down?) Yup, big fat 39. At this point, I’m actually giving myself a pat on the back at how alert and intelligent I feel at 3:15am with a blood sugar under 50.

I proceed to drink a half a cup of 2% Lactaid milk, along with eating a slice of whole wheat fiber bread. I know, not the quickest way to bring up my sugar, but it’s the way I like, would keep me more level throughout the rest of the night, and made me feel like I was controlling the number of carbs and calories like a champ.  While I was waiting the proverbial 15 minutes, the idea popped into my head to document these moments in a couple of haikus. We all know your brain goes to weird places when you’re low. You can see my scrawling here in the picture, but if you have trouble seeing it (or reading my terrible handwriting), here are “My Diabetes Low Haikus” typed out:How low can you go

3am sweating
Must eat fifteen grams of carbs
Steady deflation.

3am sweating (this part apparently was very important to me, since I had to use it twice)
Bread, milk, chocolate cure all
Awake to prove life.

Huh, I didn’t eat any chocolate……yet! Off to the fridge to get a couple of my secret stash of dark chocolate peanut butter caramel salted truffles. Nom, nom. Then, it was like I suddenly couldn’t stop eating. The chocolate tasted soooooooo good. (Side note – I have actually started liking things I *used* to hate, only because I happened to eat them when I had a low. That happen to anyone else? It’s like, the low changed my taste buds, or made them more aware or something.) I think I ate maybe 4 of them. Then I broke out the Samoas – my most favorite Girl Scout cookie EVER that I have to import into NC because our GS troops here don’t use the bakery that makes them. (I buy 6 or 7 boxes in February, and ration them out for 12 months. That’s dedication.) Ate 2 or 3 of those cookies. Uh-oh, I didn’t follow the fifteen-wait-fifteen rule AT ALL.

My lips and tongue started tingling, and I was awash in a wave of dizziness, which usually means my sugar is moving up out of a low. Checked my sugar against the finger-stick meter again, and it was up to 65. We’re only going up from there with the ridiculous amount of carbs I had just eaten, so I took a few units of insulin in a square wave bolus over the next hour in the hopes of staving off the bouncing high I was going to get after this binge.

With the chills now, I head back to bed, but have to change clothes because my PJs were literally wet with sweat. Gross. Woke up that morning in the 200s again. Sigh. I freaking knew it!!

Dawn Phenomenon, Site Change, and Breakfast Spike, Oh My ???

Wow, talking about a trifecta of ugliness that causes a bad blood sugar day…..this particular morning, it was a combination of:

  1. Dawn Phenomenon – no matter what the linked Wikipedia article says, I *do* have to change my insulin intake to manage the spike in sugars that happens in early morning. Over the years, my endo and I have tweaked my morning basal rates to account for it in some part.  And I *do* eat a small snack before bed that has about 10g-15g of carbs and some protein and fiber in it so that my stomach isn’t so absolutely empty by the morning that the dawn phenomenon cranks up my sugar to exponential heights. For me, if I don’t eat breakfast by around 8am, my sugar just starts climbing and climbing no matter what I’m doing or how much insulin I take. Thank you, Mr. Liver for that input of yours. Sigh. This particular morning, I was so busy doing other things, it was close to 9am before I could eat.

    An infusion set, showing the insertion needle.

    An infusion set, showing the insertion needle. (Photo credit: Wikipedia)

  2. Infusion set site change – My pump ran out of insulin at 7am, so I had to put more liquid life into my pump (in the form of Novolog) and change out the infusion set. It never fails – no matter if it’s a new or old bottle of insulin,
    no matter if I’m putting the site on my stomach, my hip, etc, it seems to take a few hours for the insulin from a new site to really start absorbing and working. I sometimes supplement with shots, but that brings on it’s own level of danger since who knows when the pump insulin will start absorbing.
  3. Post-Breakfast blood sugar spike – I have fought this battle for many years, and Metformin has helped immensely with this, but with the dawn phenomenon and infusion set change already hard at work at wrecking my sugar, it was inevitable that breakfast would send me over the edge. (I took the picture of my Dexcom at 9:17am right after breakfast, and then it got all confused at the rapid rise and gave me the ???, but trust me, it stayed up in the 200s for several hours of the morning.)

Ugh.

The good news? By lunch time, the new infusion site had settled in and started working, and my sugars only mildly tanked because I had so much insulin on board from taking a couple of shots in an attempt to avoid the 300s. The rest of the day was thankfully uneventful, sugar-wise. Note to self: in the future, try to think ahead and change out the infusion set at ANY other time than the morning. Of course, we always have the best intentions that don’t always pan out…thinking of and remembering to do every-single-thing-every-day-to-counter-bad-blood-sugars? Good luck!