Overnight Number = Very Important
It is always hard to start the day off with a crappy number. Lows I can deal with Ok (most of the time - IF I can avoid the rebound thing), but highs seem to start me off on an especially sucky note - which I fight with for a good portion of the day.
Not to mention being high makes me very sleepy, more prone to snacking and just generally gives me the blues.
Your nighttime BG value is where you are for around 1/3 of a 24 hour period - and it's a pretty easy number to maintain - you're sleeping! Some variables still exist - carryover from your evening activities, but the number of variables is by far much less than during the course of an average day.
What other 8 hour period of the day can you avoid stress, eating, bolusing and exercise?
So another thing I'm going to focus on is going to bed on target and waking up on target.
If your basal rate is good, this should almost be automatic! A problem for me with this is that I'm eating a meal and going to bed pretty close together. I think it was Keith who once said that going to bed with food in his stomach and insulin on board is usually not a good situation for him. With my routine I'm barely an hour into my food before I'm hitting the sack.
I think I'll need to start bringing lunch AND dinner to work on my long days. I just want to try to have everything all flushed out before I go to bed. If I eat earlier (and don't eat once I get home) I think I can pull it off.
Planning is the key.
Not to mention being high makes me very sleepy, more prone to snacking and just generally gives me the blues.
Your nighttime BG value is where you are for around 1/3 of a 24 hour period - and it's a pretty easy number to maintain - you're sleeping! Some variables still exist - carryover from your evening activities, but the number of variables is by far much less than during the course of an average day.
What other 8 hour period of the day can you avoid stress, eating, bolusing and exercise?
So another thing I'm going to focus on is going to bed on target and waking up on target.
If your basal rate is good, this should almost be automatic! A problem for me with this is that I'm eating a meal and going to bed pretty close together. I think it was Keith who once said that going to bed with food in his stomach and insulin on board is usually not a good situation for him. With my routine I'm barely an hour into my food before I'm hitting the sack.
I think I'll need to start bringing lunch AND dinner to work on my long days. I just want to try to have everything all flushed out before I go to bed. If I eat earlier (and don't eat once I get home) I think I can pull it off.
Planning is the key.
posted by Scott K. Johnson | 10:08 AM
8 Comments:
Scott, that sounds like a good plan.
Though, another thing to think about is the choice of foods for that dinner.
We've found that, even if Joseph has an early dinner, if it's pasta or pizza or something really high protein (like a big 'ol burger), he still goes high overnight. Thus, we're still trying to come up with just the right combo bolus for these foods... often feels like we're trying to solve a perpetual mystery.
You're on to the clues, then a whole new set enters the mix...
Hi,
My overnight numbers are actually the toughest to keep standard and what Sandra said, it's all about what I ate for dinner.
If I have a high fat meal (pizza, fries, something heavy on the cheese, or any typical restaurant meal that isn't grilled fish or chicken), I can be low to normal at bedtime and spike high in the night. I also tend to eat later, say, around 8-9ish, and go to bed around 11, so it's not like the food's out of my system by bedtime.
Good luck with it--I always sleep better when my sugars are good through the night. When they're not, I'm wide awake, often sweaty, and bolusing aplenty til they start to come down. This can take a few hours, which generally leaves me tired when I get up the next morning.
Nice writing on your blog, by the way. First time poster, longtime reader.
Absolutley important and a great place to focus! BTW, how is the 100 day thing coming?
Sandra & Lyrehca -- Yes, those dang dinners. I tell you, my BG's would be perfect if I never like, you know, ate anything...
JB -- I'm on day 3 so far. Tomorrow will be the big test, as I don't have any basketball lined up.
For me personally, the time period between when I eat dinner and when I go to bed has absolutely nothing to do with my morning bg. My morning bg has everything to do with WHAT I eat at dinner. What works best for me in order to have a normal bg in the morning, is to eat whole foods like brown rice, millet, corn, peas, beans, lentils, and lots of veggies. I have been a vegetarian for 15 years. I never eat any meat/flesh foods and only eat dairy rarely. When I eat refined foods like pasta, pizza, or anything made with white flour and/or sugar, it makes managing my bgs much more difficult. Eating whole foods slowly raises my bgs and I don’t get that rebound effect of a high bg many hours later. However, just like everybody else, I also love pasta, cookies, chocolate and all those other refined, high fat, sugary foods. But I now choose to eat those foods once in awhile and when I go out to eat.
A typical dinner for me would be 1 1/3 cups of cooked brown rice, 1 veggie patty on top of the rice (no bread), and steamed broccoli and green beans. I take 4 ½ units of Humalog for that meal and 16 units of Lantus at bedtime. Guaranteed normal bg in the morning. Like you said Scott, it takes planning. I have recently started to keep a list of foods and whole meals and how much insulin I need to cover them. This way I don’t have to remember how many units to take for those foods. Like I had mentioned in an earlier post, the carb amount on food labels do not always help me. It is a starting point, but I always need to make some sort of an adjustment. It comes from experience, that is, eating the same foods and meals time after time and determining what works.
So you might ask, how is it possible for me to eat this way. I have gotten to a place where I not only think about my diabetes, but I think about my health in general. I already have diabetes complications. I have been legally blind for 25 of the 40 years I have had type 1 diabetes. I don’t want any more complications and I don’t want other diseases like heart disease, cancer, and osteoporosis. I certainly get part of my motivation from fear of more complications, but I also spend a lot of time educating myself on leading a healthly lifestyle. I truly believe that being a vegetarian, eating whole foods, and exercising is what keeps my A1Cs in the 5% range. In addition, it also keeps my lipids low with no cholesterol lowering drugs. A couple weeks ago when I had my lab work done, my A1C was 5.4%, my total cholesterol was 138, HDL 44, LDL 87, and triglycerides 35.
I am not saying that I never have high bgs, because I certainly do. You cannot have type 1 diabetes and never have high bgs. For example, on Monday, I went out to lunch with a friend. I had a hummus (bean spread) sandwich with home fries (thin slices of potatoes which are baked but probably have oil on them). Before the meal my bg was 77 and I thought I made a good guess at how much humalog to take. However, 3 hours later my bg was 379. Definitely a miscalculation. So I took 5 units of humalog and brought my bg down to 92 in 3 hours.
This all takes a lot of hard work and Scott, you need to decide if you are willing to do it. I have concern for you because from reading your blogs I can tell that your diabetes and you yourself are out of control. You are also in denial about your diabetes. But I don’t believe that you see that. I have wanted to say this to you from the first day I started reading your blog. It may sound harsh, but like I said before, I have been where you are and I have paid for it dearly by losing a lot of my eye sight. You don’t want to go where I have been. You need to understand that consistently having A1Cs of 9% or higher are not acceptable. You don’t need to manage your diabetes the way I do, but it’s time for you to make some drastic changes.
Great comment Theresa, thank you for taking the time to write it.
And you know what - I feel out of control. Like you say, not just diabetes wise, but general health too.
I do also agree that it has a lot to do with some form of denial. It makes me angry and I think I often rebel against it. That rebellion often comes in the form of reckless eating.
I tell myself that I am willing to make these changes, and that it's something I want to do, but then I'll get upset about something and start eating bad again.
I don't feel very knowledgeable about nutrition and what different foods are out there, or what these good foods do for me, so that is another area that needs some attention.
What was the transition like for you? How did you learn about all the different vegetarian friendly food options?
I look at this situation and often feel overwhelmed by the perceived size of it! What is the first step? How do I lay down a game plan for it?
I asked my wife about it, and she said that I often try to make these drastic changes overnight - then get frustrated and throw it all out the window when it doesn't work as I thought.
I really do want to change - I just don't know how I should attack it!
Scott,
I am by no means suggesting that you should become a vegetarian. It is a very personal decision to do that. You also have to remember that just because someone is a vegetarian, does not mean that they are eating a healthy diet. Here is how I got started. I first started learning about nutrition and vegetarianism by listening to a local vegetarian radio program where I live. I then started buying books on vegetarianism and cooking, but I did not become a vegetarian for about 5 years. I started out by adding a lot of vegetarian meals to my food plan. I then went to a local vegetarian meeting and I was asked if I wanted to join the vegetarian society. As I completed the registration form to join, there was a question which asked “Are you a vegetarian?” I marked yes and never ate flesh food again. Although once I became a vegetarian I greatly increased the amount of vegetables I ate, I was still eating a lot of refined foods. In the last few years I have been concentrating on mainly eating whole foods. So you can see that this has been a long process for me.
You said that you are going to a therapist. You need to ask yourself a few questions. Is she really helping you? If not, then you need to find a new therapist. Or is the problem with you. When you go to see her, do you actually listen to her? Do you absorb what she is saying? Do you utilize what she is saying to you? Does she ask you to do certain tasks away from the session and you never do them? I vaguely recall that you said in one of your posts that you go to see her and then once you leave, you don’t think about anything she said. If that is true, then that would be a good place for you to start. She is there to support you and you need to listen to her. You should write out a game plan with her because managing your diabetes is all about changing your behavior.
Another thing you could do is keep a journal of what you eat. After you have eaten, write down what was going on before you ate: a) where were you b) who were you with c) time of day and most important d) how were you feeling. Then write down how you felt after you ate the food. This is a good tool to use to examine why you are overeating and why you are eating all that junk food. However, in order for it to help you, you have to do it. Has your therapist ever asked you to do something like this?
Did you ever go see the nutritionist? Didn't your endo give you the name of one?
I understand. The only reason I look at the vegetarian thing (which I don't really know much about) is because I don't like meat.
I am working with a therapist, and you recall correctly about not giving much thought about what she said during the appointment. So the problem is definitely with me. I brought that up with her in my last appointment, and we are working through that. I'm doing a weekly check in over the phone with her to build in some accountability with the action items I'm working on. I've also stepped up the frequency of the appointments because I felt we made some very good progress last session and I want to continue that.
I'll try the food journal thing. No one has suggested that yet, but I think it would be very valuable. I know most of my eating is triggered by things other than hunger, so, like you say, this might help identify some of those triggers.
I've got an appointment with the nutritionist on 3/15, so it's right around the corner.
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