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Nothing Gold Can Stay.

April 9, 2010

It’s a common misconception, I feel, that diabetes is supposed to stay the same.

When someone I know is newly diagnosed or recently changed from multiple daily injections to an insulin pump, many times they express frustration with their blood sugars and the dosage of insulin they’re taking (it’s either clearly too much or too little). I always tell them, “Don’t worry, you’ll figure it out.”

“And then two weeks later, you’ll do it all over again.”

For the most part, diabetes doesn’t change that rapidly. Or maybe it does. I have a tricky time with making adjustments to my basal rates and bolus ratios. I am usually not even aware that there is something consistently wrong with what I’m doing. Even if I do think something might be amiss, I usually point to that one day out of twenty where my blood sugars were perfect and say See! I’m doing just fine.

I do know some people who have stayed remarkably consistent in their basal rates and bolus ratios for many years. I don’t happen to be one of those people, although I am lazy and wish to be. Right now is one of those times. Since March 15, when I went on Metformin, I can count on one hand the number of times my blood sugar has gone over 300 mg/dl. I can count on two hands the number of times I’ve been over 200 mg/dl.

Until yesterday – when my blood sugar was in the 300 mg/dls three times for an unknown reason. I didn’t eat anything out of the ordinary. I’m not getting sick. I’m not PMSing. I’m not doing anything differently, and yet, my blood sugars have taken a 180 degree turn.

Could it be that my insulin is going bad? Possibly. But I did change my insulin and my set, and the next reading was normal. But then it went back up.

Could it be that I haven’t gone to the gym in ages and that’s affecting my insulin? Possibly – but I didn’t go to the gym last week either and that’s when I had my four-in-a-row low blood sugar spree.

Could it be that the sun is in Aries and the moon is in Sagittarius? Well, I’m not expert in astrology but sometimes I wonder!

The hardest part about consistent high blood sugars is not knowing what’s causing them. I sit with my meter in my lap, telling me that my fasting blood sugar is 300 mg/dl and I don’t know why. How can I fix something if I don’t know what the problem is being caused by?

When that happens, sometimes I just pretend there isn’t a problem until a cause is more clearly known. But this also means that I’ll suffer through days – even weeks – of completely random and hopeless high blood sugars. Not a practice I want to encourage, however, seeing as how I’m trying very hard to lower my A1C.

What do you do when you have a series of high blood sugars, but don’t know what’s causing them?

Diabetes is a maze!

  1. April 9, 2010 8:57 AM

    Try, try and try again….
    We live a trial and error life, in a way.
    The constant in Diabetes is change. Frustrating, for sure.
    For me, after breakfast, no matter amount of basal or bolus I go high. No matter what I eat either, or amount of carbs total, I go high.

    No. Idea.

    So I make adjustments, see what works, what doesn’t. Trial and error. Try and try again.

    It’s no fun.
    Almost 25 years and things are still changing.

  2. April 9, 2010 9:11 AM

    What do I do? I rage bolus until I crash….although it can be days before that happens. I woke up 250 this morning. 😦 Yesterday morning, and pretty much every other morning: between 85-130. It’s so freaking frustrating. 😦
    If I don’t rage bolus, I usually up my basal to a 24 hr temp basal or 120%. That helps, but doesn’t always fix the problem.
    And I totally think it’s the moon and the tides and the storms in some country around the world.

  3. Autumn permalink
    April 9, 2010 10:54 AM

    Well now that I’m almost 7 months pregnant, I have a more vigilent approach. Since I’m writing down every freaking bite of something that I put in my mouth and the corresponding dose of insulin, I’ll go back and look at what I last ate and see if there is a possibility that I under-estimated the carbs in what I ate. The CGM is nice too because I can download the data and see if I tend to be running higher/lower at a certian time of day. Then I’ll do a small correction dose or basal rate change and see how the next 2 days go. (Oh, and I totally rage bolus too, but I’m working on stopping the habit.) But then there are days when eatting a salad for dinner and precisely dosing to cover the dressing still causes a 100 point rise in my BS and I think to myself, “I should’ve just had the brownie. At least that would make sense.” Good luck!

    • April 9, 2010 10:57 AM

      I should’ve just had the brownie. OMG – I have thought the exact same thing! I actually told my boyfriend that I’m more apt to eat junk food when my blood sugar is high because I’m like, “Well, I’m already screwed!” Terrible way of thinking. And yeah, I really need to just take a closer look and not be such a fraidy cat of making changes, even if I have to change them back in a few days.


      • Autumn permalink
        April 14, 2010 3:38 PM

        Glad to know I’m not the only one who thinks about brownies when I have a freak high. The other thing that my endo told me a couple of years ago that helps me give myself some slack is that “Approximately 30% of blood sugar readings can’t be explained.” Meaning that even if everything else was the same day in and day out, my blood sugar could be 30% higher or lower than it was the day before. JUST BECAUSE IT WANTS TO BE.

        BTW-It’s hard to work “Hey, I’m pregnant.” into a response to a blog post. I guess I should’ve tried harder ;-P

  4. April 9, 2010 10:59 AM

    If bolusing from the pump is not bringing you down — STOP. Do not eat, only drink water (and lots of it), take the pump out of the question and take a shot of insulin to bring you down.

    After bringing my BG down it is far easier to rationalize what is wrong (usually a bad set, my bad math, or bad delivery from the pump). When your BG is back to normal, it is far easier to think logically and rationally.

    Take things out of the eqution (food, pump, etc) and the problem will arise with greater ease.

    • April 9, 2010 11:02 AM

      Cary – When I’m high two or three times in a row, I definitely do this. That’s not the problem here. My problem is that I’m bouncing between the 300s and normal blood sugars and I’m not sure what’s going on! I don’t know what’s causing me to bounce so high. I’m good, then high, then good, then high… so frustrating because I don’t know what’s wrong. Just a few days ago, I didn’t have any of these highs!

  5. Wendy permalink
    April 9, 2010 5:26 PM

    I recognize that corn field. LOL.

  6. April 9, 2010 6:51 PM

    Take more insulin…

    I am not trying to be a smart-a$$ but suggesting this from personal experience… I have encountered this situation many times myself (okay, who hasn’t?) and have learned that I can be really resistant to increasing my insulin. Of course I am always asking, “Why?!” But also I need to remember to fix the problem. If there is nothing obvious that requires fixing (like bad infusion site) then usually the answer for me is to take more insulin, either increased basals or boluses or both. I really, really hate lows, so this is hard for me to do. But I get the sense, that once I get things down, things become a little easier to manage. This is the lesson I try to tell myself, anyway.

    Frustrating though! I hope it smooths out for you.


  7. April 9, 2010 9:25 PM

    Allison, I LIVE in that cornfield! LOL Actually I’m being literal. But I totaly understand where you are coming from. Changes happen so swiftly! Sometimes they recede and othertimes, they stick around.

    Being on the CGMS has helped. I have a tendency to forget boluses. I get an alarm when my sugars hit 180 [usually], 150[now that i’m pregnant], and I can usually look back and figure out why. Bad calculation, missed bolus, etc. I try to wait two or three days to fix something…thinking that’s the magic staying number. It doesn’t always work. I often end up going back to an old number because the fix wasn’t quite right. FRUSTRATING!!!

    FOund your blog through the Dosie Awards. I’m enjoying myself as I peruse your posts. 🙂

  8. April 10, 2010 12:25 AM

    Hi! I just found your blog, and I’m having fun poking around your site and reading your posts 🙂

    Like Cara, I try rage bolusing…its probably not the best way to go about things, but sometimes I can’t help myself, especially if I’m about to explode from frustration. I normally forget to check for bubbles in the tubing…sometimes I find them after a couple of hours. As a last resort, I pull the infusion set. I know I should probably do it sooner, but I hate wasting them! Especially if I just put one in. 😦

    I have been having this problem the last couple of days…finally pulled the set and it was clogged with blood. Then, the next day before a meal I was 102 and two hours after 330! I don’t know what happened. I’m used to seeing 200’s after a meal (and even though I know that’s not good, it could be worse.) I had carb counted, bolused 15 mins before eating and am not PMSing, sick or anything else. It was so frustrating. I guess that’s just part of it.

    I hope things settle down (if even for a day). I usually fax my BG to the dr. once a week and most times she will suggest some sort of change. Every once in awhile I will get a call back saying to leave things the same, and I get excited- then my blood sugars start bouncing around again! ARGH!

  9. April 12, 2010 3:11 PM

    Nothing gold can stay… I had Ponyboy on my mind just the other day myself. The Outsiders. Great flick. Great reference to the porch sunset scene. And, great cornfield!

    • April 12, 2010 3:25 PM

      And I hope by “Ponyboy” you mean “Robert Frost.” 😉

  10. April 12, 2010 5:22 PM

    Hi, I’ve just found your site too 🙂

    I tend to rage bolus as an absolute last resort. But sometimes, all that perfect schmerfect carb counting/sliding scale/correct bolus guff just doesn’t seem to work. I have been known to be so worried by perpetual highs that won’t budge that there has been the odd tear – I hope I don’t sound pathetic, I just HATE not understanding why. If it’s because I’ve pigged out on the world’ s biggest High GI carb feast or am wearing a teflon cannula for more than a day, then at least I understand… but it’s the total randoms that knock me for a six.

  11. April 13, 2010 3:58 PM

    Oh! I thought of the same reference. Great movie.

  12. April 25, 2010 8:47 PM

    Ha! Awesome cornfield! Totally feels like what we’re walking/running through sometimes. I have a lot of periods like that too, and it feels like it takes SUCH a long time to work through the process of elimination. So frustrating.

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