Wednesday, January 4, 2012

the bermuda triangle for glucose control

I have read a lot about diabetes and glucose control. The one thing that frustrates me about everything that I have read is the lack of specific information about two key factors in blood sugar control.

Experts will all agree that infection and "stress" will impact blood sugar levels and insulin demands. But, how much? It's different for everyone... for me, this becomes a big biological experiment and I spend most of the "off" period of time trying to figure out what the magic formula is for normal control again. It seems like the tighter your control is, the more this factor messes things up in a tangible way.

Stress is cited as a cause of glucose fluctuations in Type 1 diabetics. I have an issue with the word stress. I have a job I love. When I go back to work in the Fall, teaching high school art, I am super energetic and focused on the new school year. I wouldn't call this "stress" as much as adrenaline. However, I do see changes in my blood sugar profiles and I do have to increase my insulin to counter-act the impact of daily adrenaline derived from managing a room full of teens. It's fun, and tiring, and I feel kind of amped up on caffeine for the first 2-3 weeks of school. Even after many years of paying attention to such things, I still don't have a "beginning of the school year" formula for adjusting to the "stress" of teaching. I wish I could just change my basal rate to something known and move on. Anyone have a formula? Oh, that's right this is an individual thing...

Even before I feel sick, my blood sugar levels will tell me I'm sick. I'll see an unpredictable rise in my levels for no apparent reason and the next day or so, BAM! I'm sick. I normally will ride out a cold fine, with no change, but as soon as infection starts to kick in, it's obvious in my glucose control.

Lately, I've been sorting out some sort of sinus or dental issue and it has given me erratic blood sugars for about 9 weeks. It hasn't been possible to just up my basal and do corrections as needed. Some days it's mostly normal and other days it's mostly off. Sometimes I'll watch my CGMS data going along flat as can be and then something will switch and I'll see a rapid, unstoppable rise. And this is without food in the last 5 hours. It's like watching a jet take off. What the heck?
I wish there was a formula for that too...
I've used temporary basals to try to slowly hammer away at them. I crank it up to 200% for an hour or two and watch it till I see it start to descend. Sometimes there's a low at the bottom of the descent, so I'm trying to be more conservative with 130-150% temporary basals. Anyone have an infection or sick formula? Seems pretty personal, right?

I think these kinds of personal, biological variables are the things that make the development of a "closed-loop" system even more tricky. How can a machine, managing insulin with slow reaction times in the body respond to rapid, unpredictable biological changes? Kudos to those trying to accomplish this... I can't seem to figure it out.


  1. Do you keep notes, year to year?

    I used to change my Lantus dose on a daily basis in drastic ways (it needed it, then). I would look at how much I'd bolused during the day and at how active I expected to be the next day. Acttive is a little bit of a misnomer- it's more how much I expected to do things that would keep my blood sugar down. One of my jobs does that way more than my other jobs. I also changed the basal based on my overnights. My formula for changing my total Lantus dose based on overnights alone was to look at the rise or fall overnight, think about how much units correction that would be if I was using Novolog, double that and change the lantus dose by that much. It wouldn't work for me now but it worked then.

    There are some published formulas for changing insulin doses for things like marathons and other sporting events but I really think it's a YDMV thing.

    I thought doing full time teaching was really hard on my blood sugar but in retrospect I think the sleep deprivation was a huge part of that problem.

  2. I don't really have notes year to year. My CGMS graphs will be my best records as time passes. It's one of the reasons that I'm motivated to use it all the time, even though it can be a pain.

    Right now things are looking more normal for me, and I'm looking forward to getting some consistent numbers that might help me wisely tweak my basals.

    I agree sleep deprivation is a huge stressor on the body and the resulting high cortisol levels can make you insulin resistant/ insensitive. I've been doing my best to get the most sleep I can. This is a new thing for me.

  3. It seems like when I was younger, BG control strictly revolved around food, exercise, and insulin. It was just a matter of taking the right amounts at the right times, eating snacks when necessary, etc. Now, it is WAY more complicated. I wonder if through adulthood I've done things to make my hormonal responses more intense. There's the adrenaline rush (and glucagon release) of drinking coffee, cortisol spikes, sometimes out of correct rhythm, but most notably making me insulin resistant in the morning.... Acute stress also releasing cortisol. Exercise didn't use to trigger glucagon release for me, it only utilized glucose... Now it does, making it also a more complicated issue. It seems like food and insulin are the most simplistic factors going on. Nathan, have you looked at any of the information on a leptin reset program, as prescribed by Dr. Jack Kruse? I would be interested to hear about the experiences any type 1's have had with something like that, since it's supposed to help regulate a lot of these hormonal responses.

  4. Maybe "recalibrate" is a better word...

  5. Ariana,
    I haven't seen the stuff by Dr. Kruse. I know about leptin sensitivity stuff from Dr. Rosedale's literature. I am following his recommendations about 70%, with the rest filled in with a Paleo sensibility. They are very similar, but emphasize protein differently.
    I agree that hormones seem to have a much bigger impact as we get older. However, it also seems like the health recommendations that we are paying attention to emphasize dietary-hormonal causes for most health issues.