Wednesday, August 22, 2012

Running High Out of Fear

"Reminded me of the curves of diabetes management"
Why we do it and tips to hopefully prevent doing it. Diabetes definitely has its curves, and lows are by far the worst of them.

I have noticed a trend in my own diabetes management and those I see weekly in the clinic I work at.
That is, folks on insulin tend to run their blood sugars higher before bed to avoid being jolted out of bed in the middle of the night and will do anything to prevent that from ever happening again. Including eating a snack with too many carbs so they run high all night, cut back on insulin so they don't worry, but wake up with higher fasting blood glucose readings, which as we all know drives up our A1C percentage.

I have to disclose that I too still do this on occasion but not nearly as often. The newer insulin that lack a significant peak and the insulin pumps with continuous glucose sensing capabilities are proven scientifically to be safer in preventing nocturnal lows. But sometimes, lets say if I have a really intense endurance workout after 7 p.m., I will purposely run high, knowingly doing damage to my tiny vessels for the sake of a sane night's sleep. It is really quite frightening, kind of like the sign I seen on my recent camping trip.

Now, I notice we (my spouse and I) letting our wee one run a little high and being very reluctant in giving correction shots after 7 p.m. for fear that she will drop too low, not wake up, and suffer seizures or, the worst case scenario, death; see my earlier post about my Smallest Type 1 Kid not feeling her lows. Scary stuff; improved though. I mean, during waking hours, she sometimes comes and says "I feel low," which I am so happy about. It sounds strange to be happy when your kid feels a low, but it was really stressful for the longest time when she didn't. 

Okay, back to the theme of this post.  I still tend to let her glucose level ride higher then target, not crazy high but a little high, and I know this effects her A1C and long-term health. For now the risks of her not waking up from a nighttime low far outweigh the benefit of keeping her alive and a little high.  But what about us adults, specifically those who don't use a pump and CGS (Continuous Glucose Sensor)? What's my excuse? I wake up, so why run high?

Well, I think it helps to to know your normal physiological profiles, like; responses to stress, food, and exercise as these are key to preventing the sudden overnight lows and the associated fear.

How?  Well test like crazy, I mean before bed, every two hours. Borrow and or buy a continuous glucose monitor(CGM), or get an insulin pump that has one incorporated into the device. My experience with CGM's are good for finding out your profiles what your requirements are in a 24 hr period of time.  My trusted way is just trial and error, and using a meter to test yourself using the mindset that you are the scientist and also the Lab Rat  Yes you will have to set the alarm and test, yes you will figure out weird responses to things like high intensity training and rebound highs that later result in extreme lows, but that's my point.

With a lot of testing and record keeping, learn about how diabetes, food, activity, medication, and stress effect you body and more importantly your glucose levels. The more we figure that out the more trust we have in the shots we take and then hopefully we have more happy nights and less fearful ones.



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