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Location: Minneapolis, Minnesota, United States

Diagnosed with Type 1 diabetes in April of 1980. I recognize the incredible mental struggle of living with diabetes. I hope to share my struggles, my successes, and everything in between.

Monday, March 06, 2006

More Set Change Stuff - Or Is It...?

I'm still fighting my set changes. This is something that has been a thorn in my side for a long time, and it's been hard for me to pound out all the variables and get some steady consistent testing figured out.

This is another good example of that.

I woke up around 1:50am last night (this morning?) and did a test. Didn't feel anything weird, but was up to use the bathroom and thought I should just do a test to see where I was at. I was 191. I took a correction bolus of 2.6 units figuring I'd wake up with a nice, close to target blood sugar.

But when I woke up I was 211! I can't think of any real good reason for me to be high. Where would I be if I hadn't taken that correction bolus last night?!

It was a scheduled set change day. I'm trying a combination of suggestions from kind commenter's here. I've left the old site in (to avoid any leakage), and took a bit more extra insulin on the new set than I should have needed. In fact I took a whopping 4.3 extra units right when I did the set change.

Then I had breakfast, which was the following:

- 1 slice whole wheat toast with a bit of butter and jelly (17g & 13g)
- 8oz skim milk (13g)
- 1 serving sugar free nestle quick chocolate powder (7g)

As Wil & Kevin have suggested previously, this is still pretty high GI (glycemic index) stuff, which probably has a lot to do with it - so that's another area that I need to nail down a bit and do some testing.

About 1 hour after all this, my blood sugar was at 399. Off the frickin' charts! Damn. Now I'm down to 287, so it is coming down (so again, I'm confident I'm not having set problems). But boy am I sleepy!

Looking at this, I'm thinking that there may have been something other than just a set change throwing a monkey wrench into the mix today. Especially since I woke up higher this morning than I thought I would - even after a correction. Maybe I had some air bubbles or something (I was near the end of my cartridge) - but I've never had problems with that before (or maybe I just never paid close enough attention?).

I kind of feel like I've been half assing the testing of strategies around set changes. As I've talked about before, it seems that I have trouble keeping track and paying attention to things every third day when I change the set.

Yes, I've tried a few different ideas - but have I really eliminated the variables around those? Did I eat the exact same breakfast those days? Maybe it was something as small as not having the same bread that morning as I did the previous set change? I just don't feel confident that I'm setting up a stable test environment. I think there are still a lot more variables than there should be.

I do think that I need to do something different for my breakfast - but just didn't plan for it very good this morning. The breakfast I had is a pretty habitual breakfast, and seems to be something I fall back on when I don't have anything better planned.

There was also a suggestion from Jay to take my breakfast bolus on my old set prior to changing, followed by an extra unit bolus on the new set after changing.

I think that I started taking my bolus after changing sets based on another suggestion from a diabetes educator I spoke to a while back. I think her philosophy was to give the new site a nice big breakfast bolus to give it a little "kick start" on the absorption.

Again, it really seems like a YMMV thing (Your Mileage May Vary), and I'll have to try it both ways and see what works best for me. It seems like there are many different approaches on similar problems, and a lot like the exercise adjustments, it's trial and error until you find something that works well for you.

I also have to pay attention to whether I've played basketball the night before, because I feel when I play in the evenings that it does have an effect on my mornings much different than when I play in the afternoons.

With all this going on, I'm thinking about keeping a set change journal, where I can detail the different things I try, and the surrounding circumstances.

I would like to stress what I perceive to be a very difficult thing - to pay particular attention every third day. My brain just doesn't work like that. If it was every day, or even every other day, I think it would be easier. This whole every third day thing throws me for a loop! So, I'm hoping keeping the set change journal will help ease that pain. I've been trying to keep good track in my logbook, but I find the "Comments:" section too small - I've got more to say then space to say it!

So, the game plan is this:

- verify my basal rates.
- verify that this same breakfast doesn't spike me so high on non-set change days.
- start a set change journal.
- list the ideas or possible solutions - things to try.
- eliminate variables as best as possible (this is key).
- look at lower carb & lower GI breakfasts.
- diligently record things tried, variables in the mix, and results.
- trial and error my way through until I find something that works for me.

For right now, I'm going to sit here and close my eyes for a precious few seconds. Maybe I'll be lucky enough to avoid any interruptions for a bit...

***edit*** - 7 hours after my set change I was back down to 86. So again, I know it's not a problem with the set. It took a solid 5 hours before I got down under 200, and the rest of the day is sailing along just fine.

4 Comments:

Anonymous Kevin said...

Hey Scott,

It sounds like you have a great plan laid out for yourself. A lot of it is a pain in the ass, but once you figure it out, well, then there'll probably be something else to figure out! Man, this sucks sometimes, huh?

I feel your pain particularly regarding what you said about taking a correction bolus in the middle of the night and waking up HIGHER than when you tested. This happens to me somewhat regularly, and I haven't been able to figure it out either.

The questions that have been bouncing 'round my head on this issue are: Do boluses at night not have as great an impact because I'm sleeping and the insulin is not getting absorbed the same as when I'm up and relatively more active? What did I have for dinner the night before? Was it high in fat? Often, I feel like I'm full when I lay down to bed if I had a big dinner. If I feel full when I'm going to bed, I just know that my blood sugars are going to climb overnight. Even if it's been 3+ hours since I ate dinner and I'm going to bed with a good reading, I have climbed up over 300 by morning many-a-night.

This "fullness" feeling, of course, has me fearful of gastroparesis issues, but I'm not sure whether that's an issue or not.

I've just started experimenting with taking a square bolus at bedtime if I feel full, but I haven't figured it out yet.

Keep up the hard work on figuring out your site-change problems. Like I said before, it sounds like you're starting off with a great plan.

As always, keep us posted...

2:08 PM  
Blogger Megan said...

Maybe taking your breakfast bolus plus an extra unit via a shot these mornings would eliminate the spiking and give the new site more time to start working?

7:05 PM  
Blogger Shannon said...

Here's another thing to try: There was no protein in your breakfast. How about having an egg (or two) or maybe yogurt along with what you ate. It'll help with the blood sugars.

I know they have white whole wheat bread, so try the whole wheat as well, this way it won't be so high GI.

Is anything happening with your 100 days. March 1st has come and gone ;)

7:13 AM  
Blogger Scott K. Johnson said...

Kevin -- Like you say, there will be something new to figure out! What's that old chinese saying - "may you lead a long and interesting life"? hehe!

Megan -- You know, that's not a bad idea. I'm curious as to whether it's a timing thing or a quantity thing, and this might be one way to find out. I'll give it some thought.

Shannon -- Good idea here too. I'm not too big on the eggs, but I could certainly do a yogurt or something. And the 100 Days streak is alive and well at 6 straight days so far. 7, 8 & 9 are pretty much automatic as I've got basketball lined up for those days. It's my non-basketball days that are the challenge!

9:00 AM  

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