My control got run over by a reindeer

Frustrated‘Tis the season to be jolly. Only I’m not feeling so festive lately.

Diabetes-wise, I feel like things just aren’t going well. My high-BG corrections aren’t working. My overnight basals aren’t working. My willpower isn’t working.

Maybe my vial of insulin isn’t working (I did throw out a half-full vial, just in case). Maybe the Sure-T’s aren’t working (I can try a Silhouette again, but I really don’t want to!).

Whatever it is, something’s not right. I’ve been hovering in the semi-high (150-190 mg/dl) range a lot more than I used to be, I’ve been spending some nights and afternoons in the 200s, and have a few 300’s sprinkled in there for good measure as well.

I’m not particularly looking forward to my January A1C. If there was ever a time to be befuddled with a “what the hell is wrong” look on my face, this would be it.

I know my extra vials of insulin sat unrefrigerated for a few days after Hurricane Sandy, but they didn’t hit any extreme temperatures. That shouldn’t matter, should it? Are these soaring postprandial spikes or ineffective pre-boluses a sign that I should be trying Apidra or maybe Humalog again? Something’s changing, but I don’t know what.

When it comes to diabetes care, I’m not a big proponent of change for the sake of change. There’s no logical reason why something should work one day and not work the next.

I’m seriously pondering spending the next few weeks in a hypoglycemic state in order to bring my A1C back to an acceptable range. I know it’s not a good idea, and I know I won’t do it, but still… it’s so crazy, it just might work. I was so proud of my last A1C and the improvement I made over the previous one, that I can’t accept the thought of taking two steps back. Not after the “You’re doing great” I got from my doctor last time.

But speaking of my doctor, one of the things he always does is compares my last two-weeks worth of data with my A1C to make sure the numbers coincide. For the most part, they do.  So I figured I could do the same thing in reverse: download some pump data and convert my two-week average to an A1C. (Here, I’m using “Carelink Personal”, not the doctors-only Carelink Pro that I described in an earlier post.)

And this is where I got the surprise of my life — in a good way.

Dec19-TwoWeekStats

Over the last two weeks, this thing tells me that my average fingerstick blood sugar has been 134, and the average CGM sensor blood sugar is 131. Huh? I was expecting numbers in the 160s or 170s.  According to an average-glucose to A1C calculator I found on the internet, that translates to an A1C of 6.2.

I call bullshit. There is no way that my A1C is that good. As a rule, I don’t disclose my A1C on this site, but I will say that the previous A1C – the one I was so proud of – was NOWHERE NEAR a 6.2.

By the way, this little chart also says that about one-third of the time I was running “high”. I’m not sure where these thresholds came from (remember, this isn’t the professional-edition of the pump software), but that’s a little discouraging. I’ve also been testing, on average, 11-12 times a day. Guess that script for 10 strips a day needs to be updated. (Aside: today before lunch, my CGM said I was in the 130s. My fingerstick read 36. I tested again and got a more believable 128. Moral of the story: strips get wasted sometimes).

Two “hypo excursions” in the last two weeks. Glancing at the numbers in the “Low” row, I assume that’s when I dip to 69 mg/dl or below. Those 70s don’t seem to count.  Still, that’s peculiar, I used to have about two (sub-60 mg/dl) a day. (Those should’ve helped lower my A1C, right?)

So does that mean that it’s all in my mind, and that things are going great? Not exactly…

Dec19-TwoWeekInsulin

I’ve always eaten lots of carbs, and I’ve always had more of a 60/40 or 67/34 ratio of bolus-to-basal. Is that bad? I’ve wondered, but never tried changing it. Now it seems I’m creeping into the 70% bolus range.

Many of those boluses are corrections. While Carelink Pro would break-out the numbers for me, the Personal version deos not. However, I’m looking at the number of boluses across the second-to-last row. Numbers like 12…11… and, HOLY CRAP, three 14s!  I bolused fourteen times in one day!? Three times?!  Some of those may have been split for meals (i.e. halfway through, I realize I’m eating more carbs than I originally accounted for), but I’m fairly certain that most of them are corrections. The corrections generally come in threes: half-unit / one-unit / empty-the-reservoir-RAGE-units.

So what does this tell me?

Who the hell knows. I’m still kinda ticked off about the way things have been going lately, but maybe it’s not as bad as I thought. I still don’t believe it, but I guess numbers don’t lie.

Maybe it’s a true (pre-)Christmas miracle.

Posted on December 19, 2012, in Diabetes, Personal. Bookmark the permalink. 13 Comments.

  1. Oh Scott. I have been struggling with this too. There will be a few days where NOTHING works, and then a good day here and there, and a few days again where I am all off. It SUCKS. I keep getting told to go make sure I don’t have a sinus infection (my nose has been runnier than usual) so that may explain it. But who has time for all of that, right?

    Your A1C will be ok. I have to tell myself this too because January I am going to do mine again as well. We are in it together!

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  2. I’m sorry to hear about your frustrations. What a wonderful post that shows how much you really care about your health and how much time and energy you invest to try and figure things out. You’re doing all the right things, keep it up.

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    • I’ll be honest with you Katie, much of that time and energy is due to this blog. If not for the attempt to get some graphs to break up my rambling text, I never would have downloaded the data from my pump (did I mention how awesome Medtronic pump data is?).. I would’ve just bitched and moaned like I used to do, and I never would’ve seen some of the good things. Blogging actually helps me.

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  3. I know you’ve already changed your insulin, but that stuff is finicky. I get real nervous if my new insulin isn’t kept refrigerated for a long period of time. (Even though I had a pharmacist say it could leave it out for up to 10 days.)

    Another thing to take into consideration… stress. It IS that time of year.

    I’m also female, and we have the excuse of hormones… or pregnancy… or whatever… to blame our unexplained lack of control.

    Hang in there.

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    • Oh how I wish there was a test for insulin potency. I also have decided to not stock up on supplies (especially insulin) as much as I used to, because it just goes bad in the end. (Much thanks to K2/Diabetesaliciousness for telling me how to donate some of my surplus pump supplies to kids affected by the storm who can’t easily get what they need. It helps me break my hoarding habit, too!)

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  4. Oh man, you look so freaking miserable in that picture. I think we’ve all been through lots of pockets of time like this, wondering what the heck is going on. I will acknowledge that you went through a lot of work to analyze your data (something I don’t have the patience (or sometimes intelligence) to do.

    I think there is nothing wrong with leaning on your doc a little more during times like these. I think of it like a professional athlete. They have teams of coaches to help them with observations from an outside perspective, and with a bunch of fine-tuning. There’s no reason we can’t see ourselves like a professional athlete in the game of diabetes management, right?

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    • Gee, thanks Scott! (EDITED: Now that I look at it, it’s not too unlike the picture on your last blog post!) I actually debated calling up my doctors’ office, but right now I’ll wait it out ’til my January appointment. He showed me some of the techniques he uses to figure stuff out, so I might as well try out those skills to do it myself, right?? Besides, I don’t need to explain those 14 boluses a day to myself…I know what they’re about and what they mean.

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  5. Thanks so much for this post! When I started reading it I thought, OMG did I write this? I have been struggling with highs that won’t get under 230 for about a week now. Talked to my doc and she adjusted my basal rates and I am still up there. I came down with a cold or flu (even though I had a flu shot) yesterday and now I am wondering if it was body’s way of telling me something was happening that I wasn’t aware of. Hopefully, soon, we all our numbers will go back to “normal”. Maybe stress is effecting us more than we think….

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  6. I’ve been bouncing like a hoppity-hop (are you too young to know what those are?) for about a month. One day my numbers will be like I don’t have diabetes at all. The next day will be like I haven’t taken insulin at all. I can only do what I can do. The same is true of everyone else. Deal with what is in front of you. You’ll work it out. You care too much to NOT figure it out.

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  7. Scott – I hear you, this time of the year is tough! I have been stuggling with 200-300 highs during the night and thinking it may be gastroparesis, so I had a stomach emptying study done yesterday. 4 hrs, not fun. Although I think my Lantus may have gone bad, so through it out and actually slept through the night without any issues last night and it makes a huge difference to start the day! You will figure it out because you always do, right!

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  8. I recently discovered that the “Normal Bolus” feature on my pump does nothing for my bg or it is weaker (doesn’t cover what it formerly did) than a syringe of the same dose. Three Revels – it’s not the pump. My Novolog is fine – it’s the deliveryabsorption that isn’t. The Square Wave works. It’s going in slower than the normal bolus. The Basal is being absorbed. I thought it was scar tissue but the NP says my sites are fine. She says it’s the “rate” of the bolus destroying the tissue/site. Where it is going I don’t know. It is not working. I start with a 100, take 3 units and either nothing happens or it only causes a slight drop in bg. I couldn’t eat knowing what it would do to me. i

    I am using injections (after 17 years on a pump this was not what I had wanted but it works) for meal coverage/corrections and the Square Wave to create a Dual Wave with an injection bolus. My #s went into the normal range after being in the 200s for weeks. I actually am seeing #s in the 80s/90s/100s consistently all day now. Just sharing my experience.

    I can use Silhouettes for 24 hours now without a problem. Before, with the normal bolus through the pump, I’d destroy sites after 12 hours max. Sometimes sites only lasted 4 hours. I can preserve my sites now by using injections for normal boluses, square wave to cover longer needs, and the basals are not perfect every night but there are inexplicable 290s. Just wanted to share this with you because I was blindsided by this and no one knew how to help. I had to figure it out myself.

    I also thought it was the “stress” of Sandy (whicn continues for me) but the syringe insulin works just fine.

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  1. Pingback: Week in Review « Rolling in the D

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