Wednesday, November 01, 2006

Art or science?

Some days, despite the 6-8 shots I take, it's easy to forget I'm diabetic. It's easy because I feel better than I've felt in years (maybe even ever), because my blood sugar stays in the tight range where I don't have any symptoms, because managing my diabetes is more like a science than an art right now. Then, a day like today comes along. For various reasons lunch was delayed, so my blood sugar was in the lowish range when it was time to eat. That's just my body, not any lasting insulin effects. It had been that way at least 30 minutes, so I was getting a headache and feeling cranky. Then some distracting things happened, it being Halloween. I forgot to take my second lunch injection, 30 minutes after the first one. By the time I remembered, it was 20 minutes late. My bg had gone up 100 points in about 25 minutes. This hardly seems fair since I read that you can only lower bg at a maximum rate of 3 mg/dl a minute. It took three hours to get it back down to the "safe" range.

Since I'd had a big lunch I wasn't that hungry for dinner. We stopped and got bubble tea instead. I can't have it very often because it doesn't fit into my (personal) meal plan unless I skip a meal. It was delicious and I was sure I'd counted it correctly. My bg was within range for 3 hours, until I got a 45 point spike. This only happens with fatty meals, right? Right? I ignored it, because it was in the "ignore it" range - I figured it would go down enough with time. Two hours later and it's up another 20 points. I took a half unit correction even though I wasn't in correction range yet, because I'm afraid of what will happen if I go to bed with that number. Normally I wouldn't be, but things aren't acting like normal. I don't have an explanation for the spike other than most of the insulin wearing off. Which could mean that the profile for the carbs I ate was different than it's been. The other explanation would be a basal problem, which is too tricky for me to contemplate right now. Usually I can expect at least a 20 point drop if I start out in the "ignore it" range and wait a couple hours. But I can guess how this might sound to some of you.

The thing is, I'm just not ready. I put all this effort into management because I get consistent results. Today I spent several hours with my bg out of the "safe" range and as a result I'm completely wiped out. "Safe" range is safe from chronic fatigue. But for a couple weeks now, I've been getting unexpected basal numbers. Not diabetic range, but unexpected. I don't know if my pancreas is having a party lately (it has good days and bad days), or if this means my basals are finally going. I'm not ready for that. I so wanted to get on a pump before it happened, so I would have all the programming down. I don't know if Lantus would work - I definitely have daily patterns and I know what all of them are. Some have advised me that my pancreas would back off on insulin production if I took Lantus, so I wouldn't go low. Yet it's hard to believe that, though, when without intervention I have hypoglycemia every day - caused by my pancreas. My only real option would be to live with higher basal rates skewing things at certain times of day, and I can't handle the thought of being already near the top of the "safe" range just from basal problems. That means I'd have to overbolus for meals to fix it, and that is a dangerous game. I've never had a severe low and I've always put a significant amount of effort into avoiding any situations where I'd need assistance because I can't count on getting it.

I'm not ready for my diabetes to be an art and not a science. I'm especially not ready to go into the endo's office with artsy-type data instead of sciency-type data. I can tell her what my patterns are, but why would she believe it if there are now confounding factors? I need to have a strong case and every unexpected number weakens it more. If this wasn't enough to worry me, I'm waiting to get my labs back (and they hadn't yet ordered the ICA!) and I can't see the endo until the 29th. Now this entry is long and broody but I guess it explains the title of my blog.


Kerri. said...

I can empathize with your struggle. The peaks and valleys of blood sugars oftentimes don't correlate with anything concrete. Diabetes, though I wish it were a science at all times, is most frustrating when it's being "artsy."

I don't have any words of wisdom or advice on "why", but I can say I understand. And you aren't alone with this.

Lili said...

Kerri, thank you.