Rosh Hashanah Dinner – The Aftermath

As I’ve mentioned in other posts, my BGL tends to go high during exercise, and then I often have to deal with several lows some 4-6 hours later and beyond.

Today (actually it’s 3:00am the next day) I was out at a venue, cooking for Rosh Hashanah (Jewish New Year).. and eating. What’s that Jewish credo? We fought, we won, we ate. But on Rosh Hashanah, we pass commiserating over 1 & 2 in our history, and go straight to eating.

Managing diabetes can be a minefield at the best of times.

Today, I had activity on top of yesterday’s activity (cooking and prepping), and (between serving & clearing) eating an evening meal of several courses that promised to be a carb-fest of the worst kind! I blogged yesterday about how much restraint I might show. All that went to hell in a hand-basket!

Despite all that, I seem to have managed ok-ish, but could have done a whole lot better.

I got to the warehouse around 3pm and we started work in earnest around 4pm. I couldn’t have anticipated that timing as I left home and thought to increase my basal. Glad I didn’t because we sat around for more than an hour shooting the breeze before we headed for the kitchen. I would have headed low before we started.

I had some highs during the afternoon and evening (under 9mmol/L (160mg/dl), though), but fought the urge to treat them fully. Every time I BGL-tested, I got freaked out by the higher numbers, but I knew if I treated more than I did (1 small correction at 5pm), I’d get into trouble later.

At 7:15pm I bolused for food at 1/3 of pump-suggested dose for the big fat carb-lie I told it (brave, eh?).

On a combo over 2 hours, I’d told the pump only about 1/3 the carbs I really had!!! Tell it 1/3 and bolus 1/3 – interesting formula? And then had square of banana cake and pretended I didn’t have diabetes at all!

I had apple dipped in honey, at least 4 half-slices of semi-sweet bread (Challah), sweet fish (Gefilte Fish), a stew that was loaded with rice and potatoes, salad with a dressing I made (that had tons of honey-mustard in it)… and some other salads. All that, along with tasting from 4pm, and boy did I taste a lot of dishes,.. adjusting seasoning and tasting again. Yummmm!

Seriously, I can’t tell you all the stuff I ate that was loaded with carbs! While I didn’t have huge portions, it all added up, and kept on adding up.

Only the coleslaw (S&W Mayo) and beetroot salad (lemon/oil) were without added sugar or honey. It was like one big hypo-food fest! I think I told the pump 30grams of carbs and I’m sure I had at least 100+grams and more!

On the other hand, I had been standing and walking around the kitchen so long, I was in pain, which usually raises my BGL (I have lupus arthritis in all the wong places for being on my feet). A few hastily-bought (today) supermarket painkillers at various times really helped. After that I could hardly feel my aching feet, legs and back.

Right now, I can barely move! All pain meds have definitely worn off!!

Last thing I ate was around 8:30pm – 6 hours ago.

Highest BGL was a 9.9 mmol/L (178mg/dl) at 8:41pm, just after we’d finished eating, and while that number is high, I kept fighting the urge to treat.

I’ve been on a 40% reduced basal for about 4.5 hours, and at midnight started to head down… 9 (162) then 8 (144) and I’m now 7 mmol/L (126mg/dl).

Talk about exhausted! I fell asleep (sitting on the sofa) around 9:30 when we got home and woke around midnight. My BGL could have gone higher during that time, but I’ll never know. I doubt it though. Without treatment before or during those 2.5 hours I slept, it would probably have stayed high for when I woke.

The last insulin I bolused was that combo at 7:15pm with 4.30 units. Before that was 0.7u around 5pm.

I’ve dropped 2mmol/L (32mg/dl) in just over 2 hours since midnight with 40% less basal started at 9:15pm and no bolus.

It’s only 3am now (yes, this night owl should be sleeping) and I assume I’ll come down further by 4am. Who knows where I’d be if I fully treated every time I tested? Probably in the hospital by now!

How could I have avoided those early highs and not had hypos later? Maybe I should have corrected more early on, or increased the basal for 4pm, but I also didn’t know how much I had to do and when I could rest.

Not so easy.

Difficult to know what to do when you don’t know what you’re going to be doing 1-2 hours later, when the insulin has its peak effect!

Early in the evening, every time I thought to do an increased basal, or a correction, I simply couldn’t estimate at what time my body would start doing its usual post-activity BGL drop, or indeed when that activity would end – and that was on top of yesterday’s activity and hypo some 6 hours after.

So, I just didn’t do much correction all day or evening, and the one time I did, it was at half the pump-suggested dose.

Most of the time, I totally ignored the pump-suggested corrections when I entered my BGLs.

You’d think I’d run a marathon the way I’m carrying on, when in reality what I did was a little like working in a slow-paced restauant kitchen for one 5 hour shift! Nothing like my usual chained-to-the-desk work though.

I know I’m steady at 7 mmol/L (126mg/dl) now, a little higher than usual for this time of night, but I suspect a small, long-acting carb might still be necessary. Will assess in an hour, if I can stay awake.

I don’t want to reduce the -40% basal any further at this point, but I’d set it to 9 hours and I have 4.5 hours to go. Will see how I am before sleep, and readjust then, at least to beyond when I’ll wake up, just to be safe. I’ll deal with whatever in the morning.

And I get to repeat all this for lunch tomorrow? Maybe not! No idea how I’ll drag myself out there again by 10am!

I definitely have a much better picture of what happens with increased activity over several hours, over two days… FOR ME – and I can’t emphasise this enough. Someone else’s blood glucose reaction to the same experience, might be vastly different. So many people go low during increased activity or exercise.

Having only been on an insulin pump since June 1st, relatively speaking, I’m still pretty much a novice. Maybe it gets easier as time goes by and experience grows.

The management of diabetes during (for me) unusual and rare prolonged activity is certainly a minefield. I learned lessons tonight and for me, that was as important as not getting enormous and immediately dangerous spikes during the process, or having equally worrying hypos afterwards. The middle-ground, erring on the side of caution, is surely better than possible extremes.