Thursday, July 29, 2010

Not very confidence inspiring....

I submitted a boatload of logs and Dexcom graphs to my CDE yesterday, including the horror show from the bridal shower. Our exchange:

CDE: Looks good, let’s try to fix that persistent later day low…what are your current carb ratios?

Me: We're currently at 12:00a - 11, 12:00p - 10, and 5p - 12

Also, could you take a peek at the hourly trend Dexcom report? At 7am, my median is 90...and from 8am to 9am it's way up around 132 and 139 and then it drops again. It's the highest my median goes and it's driving me bonkers - I get this spike every weekday, but I'm not eating anything, it's not from unhooking for a shower, and it doesn't happen on the weekend. I'm assuming it's a stress reaction to rushing around to getting to work, so it probably can't be eliminated, but I wonder if you have any tips to manage the spike? Currently, I do a .3 pre-shower bolus and then put my temp basal on 112% for an hour when I hook back in 20 minutes later. This morning, I had to do an extra .6 bolus after my shower...and I still went from 71 at 7:30am to 146 right before 9:00. That's a 75 point jump! I'd consider that a failed meal bolus, so I'd love to wrangle it down. Any tips you have would be awesome.

CDE: Ok, change the 5 pm to 11 as well…I think this is driving those lows!

Me: shouldn't I raise the ratio to 13 if I want to do less insulin?

CDE: Oh geez, I meant 13!

Looks like I need to just suck it up, read my Pumping Insulin book, and start making my own changes. I don't want to do this on my own, but people just don't quite seem to be listening or paying as much attention as I am.


  1. Oh, my.

    And I'm assuming she didn't have any suggestions for your morning high?

  2. You're assuming she even noticed/thought about my question about morning highs! She didn't mention it - just the one sentence back. SO. AGGRAVATING.

  3. I've been in your situation before. Sounds like you may be right. Try to do the techniques in "Pumping Insulin" and see how it goes. I did and it helped TREMENDOUSLY. But, that's competely up to your own judgement. I would let your CDE know you're doing it though.

  4. That is frustrating, whenever any of your medical professionals don't seem to be listening. I've had some that operated like that, and we didn't stay a team for long. Anyhow... Morning spikes are normal. The body does it's thing and that's natural. Mine are much higher and dramatic spikes, typically from the low 100s in the morning to the mid 200s if I don't do anything. My morning basals are a tad higher for that reason, and now that I've reverted to MDI for a few months, I've been just injecting a couple units about 8:30a to prevent those spikes. Seems to do the job. Another item to think about is any caffeine you're drinking, which has an effect. I blogged about my thing a while back. But anyhow, good luck on your end with those morning spikes and other Lows!

  5. My guess (assuming she read it) is that she does nit consider your spike concerning and dismissed it. It is, however important to you. Just reading what you do for your shower, you seem to have a great handle on things and I bet you know better than anyone the best way to handle the spike.

    I would go to Caleb's Endo with questions like these and not be thrilled with the response. Like how to handle post breakfast highs that came down by lunch. They were happy with it coming down by lunch but I wasn't. So I came up with my own solution. They seemed to have bigger fish to fry.

    So the good news is you're doing great. I bet someone in the DOC has a great piece of advice to help.

    Not that I have a clue, but what time is your shower? Would a bigger bolus at that time on work days help?

  6. Yeah - I imagine a median BG of 140ish doesn't freak anyone else out, but if I'm trying to get under 6 it's a big deal. Every point counts.

    I think I'm going to need to start tweaking how much I'm bolusing pre-shower. I'm just nervous about too big a bolus on a 70s fasting BG and then getting a crashing low on the subway commute into work. Maybe I'll keep upping it by a tenth and see what happens. Freaky how we have to experiment to figure this stuff out!

  7. Oh sheesh!!

    I noticed there was no answer to your question for tips regarding the spikes!

    And I need to get that book I think!

  8. Sounds like your CDE is not particularly good at his job. I fired mine a few years ago, never bothered to find a new one. I do it all myself by reading and trial and error, because regardless of what school a CDE had, they don't live in my body or know how it works as well as I do.

    If I were you I'd try stuff out on weekends that way you don't worry about dropping on the subway. Lows suck, but they suck harder on the subway.