Stress, Weather and Basal Rates
For about 3 weeks, I’ve been so unexpectedly busy that on this fine but very hot Sunday morning, I finally get the opportunity to take stock of how my diabetes has been during that time.
I do know how much and how easily my BGLs go up with stress – any kind of stress… the kind of stress that you wouldn’t ordinarily call stress. Day to day living is a stress of sorts. Having to be somewhere on time is stress. Trying to get a job done on time, even when you have plenty of time, is stress. Being in a crowded room with the din of everyone talking, is stress. Unless you’re in a meditative state 24/7, it’s all stress of sorts. While I may be more sensitive than some, daily living does have an effect on everyone. Managing diabetes is sometimes more an art form than a science.
Put stress together with the really hot weather we have here (in Australia) over late spring and summer, and it’s time for me to take a good look at my basal rates. Weather definitely has an effect on insulin needs too.
I know my current basal rates are not serving me the best way they could at the moment.
Who’d have thought in just 3 weeks, what was once a nearly-perfect basal program, is now quite off at some times of the day?
The problem is that being as busy as I’ve been, I’ve hardly had time to notice. Yes, I’ve noticed the numbers being off, but I’ve also had a much more varied diet (read: mostly more carbs than usual) and I’m very aware of my BGLs going up some 4-6 hours after a meal that is only a tad more than would be considered ‘light’, let alone a heavier meal – that one is a disaster! Mostly after dinner, the struggle with BGLs going up consistently, so long after dinner, is something I’m not yet sure how to handle.
Despite using extended boluses over several hours, I’m thinking I have to extend any bolus I do quite a bit longer. It doesn’t matter what time I eat, it still happens around the same time later. If I skip dinner (rare), it doesn’t happen, or if I have a very light meal, it also doesn’t happen. It’s called gastroparesis – delayed stomach emptying. Many people who’ve had diabetes for a long time have it. And it’s a bitch to handle, whether you’re on a pump or on MDI.
Sometime in the next few days I have to formulate a plan to test all the basals I have right now.
Remember that on injections (MDI), you do possibly 2 injections a day and it’s pot luck whether the relatively flat-line of Levemir or Lantus can come close to what the human body really needs. This is one of the reasons a pump is so great. You can adjust your basals any way you want and have as many as you need.
If you’ve never seen basal rates for a pump, this is what mine looks like at the moment. The time indicates what time that rate starts, and it continues until the next time listed. The number next to the time is the units-per-hour of insulin. I have 6 different basal rates at the moment. After I reassess it could go to 4 or 8 or whatever I need with the rates I need for that time of day. I used to go very low around 4-6am so the reduced basal rate at that hour is great! Also remember that you’re adjusting the rate for a peak around 1-2 hours later.
Basal Rates
12:00a 1.100
01:30a 0.925
02:30a 0.750
09:00a 1.075
03:00p 0.900
07:30p 1.125
I’m fast coming to the conclusion that unless you’re a total creature of habit – go to sleep the same time, wake up the same time, eat the same things at the same time, do exactly the same thing every day, on time – then the daily, and sometimes inexplicable fluctuations in blood glucose needs quite a bit more managing. Even creatures of habit have fluctuations, but certainly not as much as if the criteria changes drastically from day-to-day. I’m definitely not a creature of habit and I wouldn’t change that for anything. You live with some things, you change others to manage diabetes. Some things are not negotiable!
