Monday, January 23, 2006

I finally did it... After putting it off and putting it off, I finally tested my overnight basal rate. Actually, I did it last Wednesday night into Thursday... I've been meaning to post about this (and also some other things), but for some reason I haven't really gotten around to it 'til just now. So this posting will be dedicated to catching up...

First things basal rate. Well, as I've whined, bitched, and complained about...I figured that I just better go ahead, do it, and get it over with. Wednesday, I decided would be the best day to give it a shot. I basically stuck to my regular schedule until about 4:30, when I got out of work.

Instead of going to the gym, as I normally would, I skipped my workout. I tested and I was at a nice level, I believe about 78 (if memory serves me). I was a bit hungry so I thought I would pop over to Starbucks to get myself a little something. I bought a Caramel Light Frappucino (my new weakness) and then decided to stop at Stop & Shop to get something for dinner.

Part of testing the basal, also, in a way, means checking your bolus rates as well. You are supposed to choose a dinner with a known amount of carbohydrates. So you can take whatever amount of carbs are in the meal and use your carb to insulin ratio to balance those carbs out. I decided probably the most simple thing to do would be to buy a meal like a Lean cuisine or Weight Watchers frozen dinner and then make a small piece of salmon along with it. I chose a spaghetti w/ meat sauce meal which had about 49 carbs. I figured that with the salmon would make a nice dinner and would keep me satisfied for awhile.

After my shopping, I went home. At this time it was about 5:30. The instructions for testing suggest eating dinner @ around 6 pm. Well I wasn't quite ready for dinner then, so I decided I would eat at around 6:30- 6:45. I tested at that time and I was at 130. Now this might be slightly above the range where they like you to start, but this was good for me. I continued with the test.
Two hours after dinner was testing time again...this time I came in at about 98. I was nervous that I was going to continue dropping, but that wasn't the case. Later on that evening before bed, my blood sugar reading was 136.

Part of the test also means setting your clock to wake you up during the night. I set my clock for 3 am. However, I woke up a couple times during the night as well. When I tested during the night, my level had stayed in the 130 well as my blood sugar at breakfast time.

However, things did start to change during the morning. My next reading at about 9:30 was just about 200. I don't know if that's from the "Dawn Phenomenon" or what, but I guess I wasn't that surprised. Mornings have been tough for me in the past. Anyway, they suggest to stop the test if you go over 250, but I somehow was able to keep going. At around 11 am, my levels had fallen to 180, and at lunch time, my blood sugar was 144.

I was, actually, very surprised by these readings. I thought for sure I would have to stop the test much earlier, have my Endo. adjust my basal rate, and do the test again. I was quite pleased at how level my blood sugars stayed for the most part. I know it's one test and it's hard to draw conclusions from it, but it did confirm some of my thoughts on the problems I have been having.

The main thing it confirmed to me is that my exercise is causing me problems. After seeing how my blood sugar stayed so nice through out the evening of the test, shows me that my workouts are running havoc with my sugar readings. However, saying that, I am definitely not going to stop working out.

I work out in attempt to try to stay fit and in efforts to keep the weight off. In the past, I thought, it also helped out with my blood sugar control as well. However, lately, as I have described this is NOT the case.

What often happens is I'll test, have a small snack, and then go to the gym. Usually, towards the end of my cardio routine, I start feeling the general uneasiness I get when I start dropping low. Somehow I make it out to my car and test before I start the drive home. The test usually confirms those uncomfortable feelings. If I have something on hand to treat, I'll eat that. If not, I attempt to make the drive home . I know, I know.. a very stupid move, but it's happened- I can't lie.

By the time I get to my place, I either am at the point where I am literally dragging myself into my apartment, or I'm starting to feel better, if I 've treated the low. By this time, it's usually around 6:30-7 pm and I'm usually feeling pretty hungry. So as I'm trying to get dinner together, I do my grazing, and munching on this and that. I know this probably contributes to the issue, but sometimes it's unavoidable.

About 2 hrs post dinner, it's testing time again. I am not surprised to see readings in the 200s, if not higher. Usually, I'll see readings in the upper 200s to even as high as 400. Yeah, I know the grazing doesn't help, but I don't do so much to lead to those extreme highs. It my mind, it's a rebound effect. My post workout lows which then leads to me swinging to the opposite side of the spectrum.

I've discussed this with my doctor and my CDE/dietician...which lead me to the basal testing. They believed that was the true issue. It may very well still be. I don't know how much you can really tell by doing one test. However, they also thought I'd be better off skipping the snack (boo :( ), setting a temporary basal an hour before, during, and an hour after exercise. Well, I've tried setting a temporary basal just during exercise and it never helped. Instead, it just made me high after my workout and then I was even higher post dinner. I'm going to give their suggestion at try, maybe it will work for me.

Also they did make one other small change. My basal rates prior to the test were 12 am - 6 am .5 u/hr, from 6 am to 12 am 1.0. Now my levels are 12 am-3 am .5 u/hr and from 3am to 12 am 1.0. I'm not sure how, but I think they believe that will help with my highs that strike mid morning. So far, I've been waking up low each morning, but maybe I need to give it more time. Who knows? I do know that they need me to repeat the test again to kind of confirm things. Hopefully, we'll get things more ironed out as we go.

Guess I'll wrap this post up... As for those other non-diabetes related issues, guess they'll have to wait for another posting. I think I've rambled on long enough as is. Hope it wasn't too boring :)


Blogger mytime79 said...

Great job doing the basal test. I think that you've inspired me. I always thought I had to do each portion of the test separately, but I'd rather do it all at the same time like you did.

Hopefully now that you know (and your doctor's know)that your base rates are okay, i think it will be easier to figure out what to do about exercise.

Exercise for diabetics is really one of those catch 22s... you have to do it to keep your blood sugars in range and to keep healthy, but really it does affect the blood sugars so much and not only for the time directly following the workout, but hours later as well.

Definitely keep updating us on your working out progress.

9:57 AM  
Blogger Scott K. Johnson said...

Hey Andrea,

Exercise can be a huge challenge. Like mytime79 said, it's a catch 22.

There are so many things that are happening in your body while you exercise.

I play basketball a couple times each week. It's full court, pretty intense exercise. I find that I have to run a temp rate of 25% basal at least 1.5 hours BEFORE I start. Then about halfway through it I need my rate to go back to normal.

It's all related to calories and stored energy. Your body needs that energy to keep moving, and if it can't find any it will start to convert fatty acid. This conversion creates keytones, which for me makes me less sensitive to my insulin, therefore raising my blood sugars.

It's tough to find the point where to make that change, and it's all trial and error (unfortunately).

The way one of my old endo's put it - exercise creates so many more variables, but the benefits far outweigh the problems that are created in control.

You must learn how to deal with those variables because the exercise is so important.

All that advice is coming from an overweight, out of shape, exercises less than I should, long term diabetic - so take it with a grain of salt. :-)

11:03 AM  
Blogger Andrea said...

Thank God for a comments section on these blogs. I can't tell you how much better it makes me feel to read your words of support and encouragement.


Yeah, I'm glad I did the test at least once, but I still have to do my daytime and evening basal. Also, you were right, they want me to repeat the test again, so that's something to look forward to (not). What guidelines do you follow for testing your basal? I use the ones described in my Paradigm 511 Manual.

I agree, exercise is a catch 22. At first, I thought it helped me control my blood sugar levels. Now, I'm not so sure. I truly believe that it does affect your blood sugar even hours after exercise.I know it is beneficial in other ways, so I'm not planning on stopping, but I wish it was a little more helpful to my blood sugars.


YOu make a valid point. I'm sure there's a lot more going on than one might expect to your body during exercise.

It's funny, b/c I don't usually end up high after exercise (ususally go to the low extreme), but after dinner, hours afterwards, I will go high no matter what. But like you both have said, exercise can impact a person even a while afterwards, unfortunately.

I have been trying to play around with temp. basals, as suggested by my Endo, but that doesn't seem to be working either. I have a feeling it might be my carb to insulin ration that needs adjusting. Can't say I like the idea of that, I rather take less insulin if possible, but I guess sometimes it's unavoidable.

Anyways, I want to thank you both again.

Mytime- I'm glad that I am able to inspire you in some way...that's nice to hear. Thanks for your caring and thoughtful response.

Scott- I don't think I need to take what you said with a grain of salt. In fact, I give what you say a lot of merit. It sounds like you really do know what you are talking about. Thanks for taking the time to respond :)

10:12 AM  
Anonymous Tiffany said...

Good for you Andrea! :)

If you don't have it, you should probably run to the nearest bookstore and get "Pumping Insulin" by John Walsh. It gives great information - much better than Minimed's guides - and tips on testing a lot of the variables in pump management.

Have you tried eating a small snack of complex carbs/protein/fat before your workouts? Sometimes this is helpful in controlling both post-exercise lows (which I would agree you seem to be rebounding from) and also suppressing appetite. Combining that with a temp basal would hopefully decrease the frequency of your hypo's and subsequent rebound highs.

Since I don't want to turn this into an essay, I'll leave it at that. Good luck and keep us updated!

11:11 AM  

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