Friday, September 30, 2011

Bad days make the good days look really good...

On Tuesday I woke 10 up with normal blood sugar levels. Throughout the first few hours of the day, however, my levels climbed to 200 despite the fact that I didn't eat breakfast. I bolused a few times and didn't see any change. I wondered if my site needed to be changed, even though it was rather new.
We had dinner plans with extended family, so instead of sitting at home trying to sort it out, I just went along with the plan, and went to dinner with hopes that things would level out. By 6pm I had been over 200 for 10 hours. I felt a lot worse than I usually do on a short excursion into hyperglycemia. I was tired, had a headache, and feeling pretty blah. Not hungry, pretty sick. During dinner I ate a bit of protein, salad, and some wine and my blood sugar made it to 325. I checked my pump tubing and discovered that the quick release was loose and clicked it back together. I bolused again, just in case I hadn't been getting insulin all day for that reason. I could tell I was in DKA and it was lousy. I drank a lot of water. When I got home I changed my infusion site, and my reservoir (which was close to it's end). Within an hour I started to see it come down. I think when I went to bed it was 260 and dropping. In the AM it was 125 and I felt normal. Off to work I went, but it left me with a clear sense that I hated being out of range, and that I will immediately change infusion sites if something is mysteriously off.

As I have tightened my control my expectations have gotten a lot higher for the way I feel. I'd say a lot of days when I was younger, that was a normal day... to run 200-300 all day. Yep, I felt bad, but it was a normal bad feeling that I was used to. I'm really happy that my new normal day is one where I look at my sensor graph and it's flat somewhere between 100-150.

Wednesday, September 28, 2011

Dawn Phenomenon and Intermittent Fasting

I always have tricky blood sugars in the AM and I usually think of it as the time when my numbers are off, and insulin doesn't work well.

The Dawn Phenomenon is created by your liver doing some cleanup work over night and releasing glucagon in the wee hours of the morning before you wake up. When you wake the glucagon makes you more insulin resistant and you have a harder time with bolusing for food as well as correcting AM highs.

A surprising solution to my DP effect has been to skip breakfast. I never thought I could be a breakfast skipper, even though for years my breakfast has been only eggs. Even having protein in my system seems to be complicated by DP.

I became interested in the possible benefits of intermittent fasting this summer and started to go from dinner (7pm) to lunch (1pm) as a short fast. I had read that it might help me to reset my metabolism and help me to lose some weight. In the end, I found that increased energy levels and better blood sugar control have been the real payoff.

First of all, it was hard for me to imagine that I'd feel comfortable going that long without eating anything. I was pretty sure that I'd feel fuzzy in the head and not be able to function. Well, for a day or two I did feel strange (jittery and wired, not tired) and then my body switched over and was able to do the extended overnight fast. I even exercised in the morning and it didn't make me uncomfortably ravenous.

I was doing these experiments on myself in the summer, but I wondered if it would work when I went back to work teaching high school art, thinking on my feet all morning. It still works for me. I am still functioning in a mostly fasted state for my whole work day, and having good energy and attention. Mid-morning I have tea, some nuts, and a piece of chocolate. Those are my only calories before I have lunch at 1:30 or 2:00pm. 

I think part of the reason this is working for me is because I'm eating a ketogenic diet, getting most of my energy from fat. My body is burning my body fat and it is used to burning fat for energy as well. My brain responds well to this, and I've found that I am more attentive, decisive, and mentally nimble since I've been eating this way. Our brains need fat to function.

My body also likes having glucose in a normal range, and once I got my basal insulin nailed down with my pump, I have cruised through my fasting period keeping my sugars at 90-120 the whole day. When I break my fast I take a square bolus that is spread over an hour and works slowly with the fat, protein and carbs that I eat for lunch. Right now my basal is doing most of the work because I don't have much of a spike from meals. My diabetes educator doesn't really know what to do with my numbers because they usually insist that your basal:bolus ratio should be 50:50 or something like that. I'm at about 80:20. My total insulin for the day is averaging 38 units of Novolog.

Needless to say, I'm planning to keep things this way. I feel great and am very slowly losing some of the extra weight that I have gained over the past couple years of higher insulin doses.

Tuesday, September 27, 2011

Some background details...

I am starting this blog about my diabetic experience because I think it's important to share information with other diabetics. I blog on other topics, but don't feel comfortable getting into deep medical details on general purpose blogs. It is not an interest that everyone shares.

A few things about me: I've been diabetic since I was 12 and am now 38. My dad and sister are also Type 1 diabetics. I have six siblings, so genetically, it only passed on to two of the seven children in my family. All three of us Type 1s in my family continue to maintain good overall health, despite the disease. We enjoy comparing notes on our control when we get together.

I am an art teacher. I have been teaching high school art for 16 years. I have three children, all of whom we will be watching for Type 1 diabetes as they grow older. So far, none of them have shown any signs of immune system malfunctions. 

I have moderately good control. I have followed some form of low-carb lifestyle since 2003, and it has been my best tool for good control, depending on how disciplined I am. I am currently achieving success by focusing on fat as one of my main energy sources. I began following a low carb eating regimen from information that I got from Dr. Bernstein's book Diabetes Solution. I don't necessarily agree with every single thing that he prescribes (he doesn't like insulin pumps), but for the most part, he's a genius.

I use a Minimed Revel insulin pump with a glucose sensor. I don't like using external devices much, but tolerate them because my control is so much better with them. This year, I have become much more disciplined (again), and having a glucose monitor has made it much easier to keep track of my progress.

My A1C levels have been coming down. In years past I have gotten as low as 6.2, but in recent years it has been in the 7-8 range. It is usually directly proportional to how often I test and how much fast acting carbs I allow into my diet. My most recent A1C test have been 7.9 (in July '11) and 7.3 (in Sept. '11).

That's it for now. I'm looking forward to writing about my experiences.