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.