"What just happened?"
As many of you know, I play basketball a few times a week. Usually about an hour and a half or two hours at a shot. Great exercise. Great fun. Great challenge in managing blood sugars.
You would think, that after playing routinely for a while, that I would have things pretty well figured out. Well, that's just not the case. I do my best, and most of the time that works out relatively well. Let's take a look at a day from a few weeks ago:
A little trouble after breakfast, but I evened out nicely during basketball. A pretty "low maintenance" afternoon on the court. Again some trouble trying to prepare for another (yes, I know I'm crazy) session of basketball later in the evening. You can see that as I started basketball, both times, that my blood sugar went down. The drop in the evening was farther and steeper than I'd like. The point is, basketball = drop in blood sugar. Most of the time.
I am aware of the whole adrenaline thing, which can in some cases make your blood sugar go up. I'm also aware that the presence of ketones can make your blood sugar go up. There is a delicate balance between the exercise and insulin, which drop blood sugar, and the other "raisers" that, um, raise blood sugar.
I feel pretty comfortable with my basal rates on the mornings of my basketball days. I also feel pretty comfortable with a routine that usually works pretty good for me. My troubles are usually self-inflicted. Due to bad eating decisions. Today? An english muffin with butter & peanut butter for breakfast, and some type of protein/nutrition shake before basketball. Most of the time, this works great. Same exact thing as last time (minus the 1/2 sugar cookie last time. Shhhhhh...). Let's take a look at today.
Sigh. Started the day off at 75 mg/dl. Almost low. I did not treat this. My blood sugar rose up to 110 mg/dl by the time I got to work. 8:45 am, I had breakfast. My english muffin with butter & peanut butter. I bolused for 30g. 10:15 am, blood sugar is 129 mg/dl. Not bad - about an hour and fifteen minutes from hitting the court. 11:00 am, 119 mg/dl. Lower than I would like being only a half hour out from playing. I have my sport shake in the car. 27g.
I get to the gym, get changed, start to warm up. Blood sugar? 161 mg/dl. Perfect. Right where I like to be. A bit of insulin on board from breakfast, but I've got my temporary basal reduction and that sport shake balancing it all out.
Amazingly I didn't check my blood sugar again until 1:30 pm. For one, there were exactly 21 people in the court. Two games going at all times. Breaks in between just to get the next players switched out and then the games started again. I felt good. I felt confident. I was not worried about my blood sugar going low - which is the usual danger I have to watch for.
1:30 pm, games done, people are packing up and heading to the locker room. I sit down next to my bag and check my blood sugar again. 270 mg/dl. Huh? What the hell? What just happened?
What was so different today from other days? Ketones? I really thought so at first, but tested negative once I could finally test for them. Besides, it's unusual for them to cause such a high and rapid spike all by themselves. Infusion site trouble? No - I came down just fine afterwards. I just don't know what happened.
I DO know that I wish I would have tested more often! I'm sure that my stamina & performance was affected by the high blood sugar. If I could have caught this earlier I may not have spiked so high, and may have enjoyed the latter part of basketball even more. Lesson? Test more often! I usually do - four or five times during ball most days. I found myself concerned about making 9 other guys wait around while I "tended to myself" for 10 seconds or so. Silly, I know. Especially because many of them know I am diabetic and have to do that. Lows demand attention - but target and highs do not usually present "symptoms" for me.
I chalk this up to being another "what just happened " day, a "WTF" experience. I am determined to take a few seconds to check on myself better, and try to head this one off in the future. We cannot always explain what happens, and it's even harder when you don't have much data to "explain" it to you. Take what you can from it and move on. It's the only way to go.
* Excel logbooks courtesy of Kevin at parenthetic (diabetic)