Tip of the Day- Basal Checks

So here's the diabetes tip of the day. Make a basal check a standard procedure every two to three months. Like I've said before, I've been struggling with blood sugars all over the place but mostly up. My first thought is always to my site failing or my pump not working properly.

But rarely do I figure that maybe its my basal rates that have overstayed their welcome. The last time I checked or changed my basal rates was at least six months ago. I keep thinking that nothing has really changed since then so why change my basal rates, but when I really sit down to think about it, a lot has changed.

I have gone from working full time to ten weeks of an amazingly relaxed summer vacation and then back to work again. I have begun working out again and made some huge advancements in my overall aerobic fitness. My stress level has dropped since my kids are now going to the same school I teach at so I no longer have to fight thirty minutes of traffic while preventing fights and major meltdowns in the house and the backseat and worrying if I will make it to my classroom in time for the first bell of the morning.

And the biggest factor in all of this, my thyroid is closing in on being back at a normal level. After three years of being totally out of control, it is responding to the meds and mellowing out. Its amazing the effect it has had on my basal rates over those three years. When it was at its max my nighttime basal rates were reduced by fifty percent while still fighting off constant lows.

Now I have hesitantly brought it back up to pre-thyroid levels and even a little higher since I was in much better shape before this whole ordeal started. For the first night in weeks, last night I had a good blood sugar night. Nick didn't wake me once and the clarity of mind I have found today from quality sleep is terrific.

The worst part is that I should have figured this out months ago, if I had only done a basal check. So now along with my quarterly A1C check, my TSH, T3 and T4 check and my five minute conversation with my endo, I will be performing a basal check. -

Managing Diabetes On Board

BREAKFAST

As I get closer to launch day for my sailing trip, I have been focusing more on my diabetes management plan. One of the things that I have been concentrating on is my breakfast. It has always been one of the harder meals to get right because of the different hormones that circulate in the body and bring you from a sleeping state to a fully alert state. Most of these hormones make the body less sensitive to insulin. The result is that you usually need more insulin to cover the same amount of food eaten at a later time in the day. The other problem I have is that I love breakfast foods. I would eat them for breakfast, lunch and dinner if I could (and sometimes I do).

I’ve changing the ratios of my breakfast foods and have achieved some degree of success lately by making breakfast a low-carb, high protein meal. This has lowered that morning spike in my blood sugars and also leaves me feeling fuller. After four weeks eating the new protein based breakfast and finding much success with it, not only in better controlled blood sugars, but, also with the bonus of weight loss. SOME RESEARCH

I came across a study published recently. It was a study of type 2 diabetics (different from type 1 diabetes, I know, but interesting all the same). In the study, the researchers gave the patients a high-protein, low-carb breakfast and found that it lowered their morning blood sugars, which should be obvious.

We have all known that carbohydrates have a far greater impact on blood sugars than proteins do. But what they also found out was that the meal caused their body to replenish their glycogen stores with the sugar instead of storing that sugar as fat.

So the way the body reacted to the sugar changed in addition to there being less of it. If the carbs were later added to a morning snack the patients did not see the same blood glucose spike as when they ate the carbs as their first meal of the day.

I always have to laugh when scientists spend thousands of dollars and hundreds of hours of time to figure out the same thing I figured out in two weeks with my own body. It is nice to have real evidence to back me up, though. And, of course, they can publish their work and make safe recommendations to other people based on their science. I can only change what I am doing, knowing that every diabetic is different and may not react in the same way I did to changes in their diet.

PROTEIN IN THE HEAT I want to continue this high-protein breakfast on my trip, but it presents some slight problems. One of my main morning proteins is eggs. Eggs, however, are very hard to eat if you don’t have a stove or any source of heat. I am all about protein, but I am not going to go Rocky-style and down them raw. I tried that once when I was eight and never will again. I could do a protein shake but after consuming those for breakfast and lunch for four weeks, I have found them very hard to swallow without gagging. So, I have settled for a cheese stick wrapped in turkey slices as my plan for now, but I don’t know if that will work in the long run and I’m not sure that sounds too appetizing first thing in the morning. LUNCH AND DINNER My other meals will certainly include carbs. I am in no way opposed to carbs; as an athlete, there is no way I could be. I will just have to include some of those high-carb breakfast foods I love later in the day.

SITTING STILL One of the other morning issues I will be facing is one that I have more experience with in long car trips early in the morning than I do with sailing. Sailing involves a lot of sitting around. Your body becomes more or less sensitive to insulin based on how active you are throughout the day. I have found that if I take a long car trip starting early in the morning, my blood sugars will race up very high and stubbornly stay put no matter how much insulin I give as a correction bolus to bring them back down. Once I get out of the car and start moving around for an hour or two this problem is quickly remedied. To fix this, I simply have to put in a good workout before getting in the car, and stop every two to three hours for a quick five to ten minute burst of exercise.

PLANNING FOR ACTIVITY While in the Keys, I will have to work-out each morning before I take off for the day. Most days I will go for a quick three to five mile run. When I stay at Fiesta Key for the second night, I get to use their Olympic size pool to put in a quick mile swim. One of the rules of the trip is that I won’t stop until I reach port each night, so I will have to find some way of doing those ten minute bursts of exercise on board. I won’t be able to run or even be able to walk around much as the cockpit on a 22’ Catalina is only about 6 feet long and has the boom of the main sail about 4 feet off the deck.

As a result, I am stuck with calisthenic type exercises that can be done in very little space. To maximize the effect of each exercise I will need to use the largest muscle groups and use as many as possible in each exercise, all while holding onto the tiller so the boat does not go spinning in circles or run aground on one of the many sandbars lurking just below the surface of the water. Included in my workouts will be squats and lunges, which recruit a lot of the larger muscles of the body. Adding to the exercise schedule will be calf raises, which will round out the lower half of my body. I may be able to pull off some push-ups on the seat of the cockpit while holding the tiller still with my foot. EVENING WORKOUTS To round out the exercise regimen, I will need to get some activity in after I dock for the night. This shouldn’t be much of a problem since I will be in search of a warm meal and a view of the old Keys, Florida as it used to be.

Even with all of this physical activity, I will still have to make some adjustments to the basal rate of the insulin, constantly supplied by my pump, to take care of normal bodily functions. The first day I will try a bolus increase of 125% and adjust as needed. FINAL ANALYSIS Each night I will go over my blood sugars and my maintenance plan and will reassess for the next day. Hopefully by the end of the trip, I will have developed some sort of protocol that I can use in future sailing trips, so I won’t need to use myself as the living guinea pig. WHAT'S NEXT As you plan your next adventure, you might want to do two things. First, analyze what you do at home and figure out how that will change as you take off to new places. Second, make a plan to keep your activity level and food roughly the same so you can avoid those whoops! moments while adventuring.

Multivariable Equations

As any good scientist knows, if you want to find out what effect any one part of your experiment has on the outcome, you change only one thing at a time. Diabetes is much like an experiment that I conduct on an on-going basis. Recently it has all gone haywire and after months of not being able to catch up with it, I went a little ape-shit. I decided to change nearly all of it and hope it comes out alright. Some of the changes came at my own hands and some were dealt to me.

A month ago everything was stable: relatively consistent diet, workouts getting progressively but slowly longer and higher quality, and everything else in life just humming along. And then I got sick. Sickness, I think, is the ultimate diabetes enemy.

It makes it so you can't workout, which will change insulin needs. It makes it so you sit on a couch and sleep all day, which will change insulin levels. And then your appetite gets all funky and you get hungry at weird times and nauseous at others, which of course changes insulin needs.

So, after being knocked out for a week, I slowly rebounded and began training again. And then I got hit by another cold and was back on my butt. As soon as that was over I was gearing up for my son's surgery- 3 days in a hospital room with a crying child who just wanted to go home and not be in pain-10 days with not more than 20 minutes of sleep at a time and the other 23 hours of the day constantly tending to his needs. The needs of a four-year-old with two casts up to his groin are abundant and frequent. So my overall stress level changed in an instant. Which, of course, would make it the perfect time for my doctor to change the dosing of my anti-thyroid meds. More insulin change.

Now with all this change, one might think I would naturally shy away from more self-inflicted change, but, alas, I am not that smart. I decided to do a complete overhaul on my diet to try to discover what has been going on with my blood sugars and to finally get a leg up in the two-year battle with the pounds my funky thyroid has strapped to my ass.

And, of course, there was the addiction to way too many diet sodas a day to mention. I don't know how I got so addicted to a food that isn't actually a food, but a product made in a lab somewhere. I figured I would need to go cold turkey on that stuff for a while until I got a handle on my blood sugars.

So Monday morning the changes started. Monday was rough. Tuesday was worse. By Wednesday the headaches were throbbing. Thursday the blood sugar patterns were still undiscoverable.

On Friday I decided to cruise through a website that had invited me to blog for them called asweetlife.org. And I stumbled across something that I learned in that hospital Diabetes 101 class, but had failed to recognize in my wild sugars. I had been fighting frequent, random lows for almost 2 months and then huge swings up to the 300's after. It wouldn't matter how little sugar I gave myself to correct for a low, it always jumped right to 300 after. I read a blog on the 'dead in bed' syndrome , which I have to say is a far too cutesy name for such a horrific, life-shattering event.

I have always done well with my nighttime blood sugars, which is nice because if you can consistently have good nightly blood sugars you have conquered one-third of your daily routine without having any brownie cravings, or extra time on the bike trainer or a movie marathon on the couch messing you up. It's fixed and it's easy.

Well, in the last two months, overnight has been anything but easy. I either wake up low and rush downstairs to get some sugar and then, usually, a few hundred calories to follow up, or I wake up high. There was no in between. I was afraid to turn up my basal rate for fear of getting too low and dying in my sleep, but I couldn't turn them down because then my highs would be higher.

My nighttime basals have varied between 0.45 and 0.5 for the last 13 years that I have been on the pump. It is one of the few basals that hasn't really changed at all over the years. In comparison some of my other basals have changed from 0.8 to 1.6 over time, so the nighttime consistency is nice.

That is when I was reminded of the Somogyi affect and realized I might not be going about this the right way. The Somogyi affect is this weird thing that I always struggled with when I was on shots because my nighttime insulin needs are so much lower than my daytime needs. I would take a shot, but it would be too much and drive down my sugars. I would be low and asleep and not wake up from it. My body would get pissed off after a while at being so low and pump out a series of hormones to counteract it and let my liver release some stored sugar to counteract the low.

I would then wake up high and think I needed more overnight insulin, thus worsening the cycle. The insulin pump fixed the problem back then, but now my inability to listen to my body was forcing the same affect. Even though I figured this out, I was still pretty stubborn about it and didn't want to lower my basals for fear that I might be making myself go even higher.

But hearing a phrase like 'dead in bed' for the first time shakes off the stubborn attitude real fast and finding the research they are doing on what causes 'dead in bed' was even more alarming. There are studies out there that say that overnight low blood sugar can alter the way your hearts electrical system works and although more research is needed in this area, the thought of messing with my hearts beating was enough to scare the living daylights out of me.

After reading the second study, I promptly took my hand off the mouse, lowered it to my belt and grabbed my pump. Those basals never saw what was coming to them. Low, lower, the lowest they have ever been. Later, after sitting on the edge of my bed convincing myself not to be afraid, that I would probably wake up tomorrow like I have done for decades already, and very appreciative that I get to sleep next to my husband who would probably notice if I began to convulse with a low blood sugar and be able to rescue me, I laid down to sleep.

And God smiled down on me with the first night in three weeks without a low. I woke up at 6 refreshed and alert and not feeling like crap like I had for weeks before. When I laid down to sleep the night before I was 125. My glucose moniter registered at 155 that morning.

After this great night of sleep, I realized a few things. When I sleep through my lows, or even if I wake up (typically it's after being low for an hour or more) my body is more resistant to insulin for at least 12 hours after. Which makes the whole day a battle against my body.

On top of that, I wake up feeling hung-over and hazy and grumpy and unfocused, which is not a good combination for dealing with a classroom full of fidgety, talkative, well-meaning 6th graders for 7 hours at a clip.

So with my new basals in hand I guess changing up everything all at once wasn't such a crime. Although I think I could have come to the same conclusion if I had only cruised around on the internet a little earlier and not been so afraid to try something new. Now let's see if a happier, more well-balanced body will let go of the extra padding it has developed in some sort of hibernation preparation.