For Wil "PrintCrafter"!
I love this post, but it was chickensh** of you not to post a graph with your BG on it.
Come on, a blank graph???"
He has a good point, I truthfully didn't even think about it, or avoid it on purpose, I just wanted to convey a sense of how narrow our target range is. I chuckled out loud reading this comment - I just love Wil's sense of humor, and I think it "jives" with mine pretty good. So, Wil, this post is dedicated to you!
The first image here is a picture from the computer of the last couple of weeks of BG's. This is not a completely accurate picture for a couple of reasons. I use a Cozmo pump, which has an optional CoZmonitor, which is a freestyle meter that clips onto the back of the pump. I love having everything I need for testing all in a small belt pouch. Very convenient. Any tests that are done with the CoZmonitor are automatically stored in the pumps memory, and can then be used to calculate meal and/or correction boluses.
I do, however, still use other meters for many of my tests. Those typically only get entered into the pump when I need to calculate a correction. There are a couple reasons for this. When I play basketball it is more convenient to use a separate meter than it is to pull my pump out and test. The CoZmonitor units are also especially sensitive to moisture, and I sweat like crazy. So, I keep the CoZmonitor in my locker. I also have many many many unused test strips for some of these other meters, and I figure that I will use them up. So I basically only use my CoZmonitor when I'm out and about. So in this picture, you are only seeing the blood sugars that were in the pump's memory.
The pictures that follow are images from my handwritten logbook. I've started using My Other CheckBook. The manual, empty notebook style was good, plenty of room to make notes and write - but I couldn't analyze it at all. Couldn't see any patterns or trends, nor make any sense out of the data. To be fair, I haven't been using the MOCB log for long, and haven't flipped through to see any trends or anything yet - but having the line graph is nice in seeing how fast things are heading in one way or another.
This is a basketball day. My exercise is indicated by the shading near the top of the page, shaded from top to bottom to indicate that it was intensive exercise (versus a brisk walk, which might be shaded up to 1 or 2). This day had 13 tests between 6:30am and 8:00pm. I consider this to be a better than average day. I attribute that to basketball, decent will power for eating (well, up to bedtime anyway), and starting off with a "not too bad" 179. There's that spike near the end of basketball - could be due to many things (temp rate too low, or too long, or both, high caloric burn resulting in ketones resulting in insulin resistance, too much Gatorade). Haven't got that nailed down yet, but for the most part am very pleased with my ability to do pretty good during basketball.
This is from a non-basketball day. This is also a day of most excellent blood sugars. If I could have every day like this, I'd be in A1C heaven. One thing I notice looking at this, is that I didn't eat anything worth much. It's mostly all crap from the vending machines (Peanut M&M's, Microwave Popcorn, etc.). All stuff that is pretty easy to bolus for, and the portions are controlled and clearly labeled. For the record I got sloppy with my snacking and counting after dinner, and had a 269 for the first test of the next day. This was also a day that I was basically stuck sitting at my desk at work all day - not much activity to deal with, and a pretty stable day all around.
This is yesterday. A basketball day, and a set change day. I started out high in the AM because (once again) I was sloppy with my snacking and counting at night after work (can you see a pattern here?). I took a correction bolus right away, and you can see the BG drops nicely. At 7:30am I did my scheduled set change, and notice what happens - I haven't eaten anything, but after that AM correction bolus is out of my system I start riding the updraft of a set change. I have suspicions that this happens a lot, but I haven't nailed it down yet. At this point, I'm wondering if I'm spilling what the pros call "starvation ketones". Basically it's been a long time since I've eaten, and my body has to get energy from somewhere, so it's been burning fatty acids (a side effect of which is ketones). I tested for ketones and was negative. I started basketball at 11:30am, and my BG comes down a little, but is still unusually high - remember, I haven't had even a gram of carb yet today. I played ball from 11:30am to 1:00pm. This is high intensity full court basketball. I'm working my tail off, but my BG hits a low point of only 158!? There are a lot of things going on now, adrenaline, lots of fatty acid being burned, etc. - but I was still surprised to only hit a low of 158. I usually need to run a temp rate of 25% normal basal rate AND drink Gatorade to keep the BG up. I did not even run a temp rate. I'm out there working like crazy running at 100% basal rate!! I was pretty dehydrated most of the day, which contributes to the strangeness, but also means I wasn't able to check for ketones until many hours later. They were "trace", which means very little amount. I would have expected more I guess. Sometimes diabetes is just weird. Doesn't always follow the rules, which makes it frustrating to try to manage it sometimes.
I am however, confident that my set is working Ok, otherwise I'd be through the roof with heavy ketones much earlier in the day. The fact that I'm 5 or 6 hours post set change and still Ok, helps me attribute the slightly high readings to factors other than a bad infusion set.
There is a meter (one of the Precision line I think) that can test your blood for ketones, which would be nice - but I can't afford the test strips (they are about $7-$8 per strip). Testing urine for ketones is about as useful and accurate as testing urine for sugar used to be. But, again, the tools are dictated more by the finances and insurance than I would like. Being able to test my blood for ketones during basketball would give me a better idea of when I need to adjust my basal rate back up to offset that insulin resistance.
I had my first "meal" of the day (fries at Burger King - yes, I'm a health nut) after basketball, and a big BG spike (c'mon - "lunch" was only like 156g of carbs - what do you expect?). I came down Ok, had a bit of dinner and went to bed at 152, which I considered to be Ok. I woke up this morning at 73, which is a tad low, but overall not too bad.
I can't help but wonder what all I'm missing though, looking at these compared to the graphs that Wil shared from his monitor. There is so much more that is happening behind the scenes, and I would love to get a picture of what all is happening all the time. The technology will be available and affordable for many of us within the next couple of years I believe. It's hard to wait though.