Marching along...

Since the last time I reported numbers I have taken a small step backwards and am averaging slightly higher.
I just ran some reports and it looks like my sensor average for the month was 133 mg/dl. While I remembered things being really great at the end of February, my actual 30 day average for Feb was 132 mg/dl. So, really, with the good and bad all averaged together, things are roughly the same.

My sensor data says that I have been:
 26% above 110 mg/dl
73% between 70-110 mg/dl
1% below 70 mg/dl

My standard deviation (SD) indicates how much swinging I'm doing and it shows 34.9, meaning that my range of deviation is about 35 points around my target. This is okay, but when I get things as tight as I want, I hope to see my standard deviation in the 20s. Some people think this number is more important than the sensor average.

General observations from March...

• I was thinking and blogging that daily consumption Yerba Mate tea was behind my best days. I'm not totally sure that it was the sole player now. I have drunk it every day for the last 3 weeks and still had some high-ish and unpredictable days. I think the main player might have actually been insulin sensitivity caused by regular exercise. The week that I blogged about it was right at the end of a very consistent 2 weeks of daily exercise, strength training and sprinting. I think my muscles were metabolizing more glucose, and causing my levels to hang lower. More recently, with less exercise, I've been seeing a need for more insulin and numbers averaging higher. Lesson learned.
• During Spring Break I have found that my AM dawn phenomenon is always focused around the time I drink my 2 cups of strong coffee, regardless of wake up time. I have learned that if I bolus .5 units for it, I can keep my AM numbers pretty flat. Before I figured that out, I was trying to do it with a basal change, but it was too slow to do the trick. Now, my basal still accounts for DP, but I'm having less lows later from it being too aggressive. 
• One thing that I think is good... I'm seeing a bit faster response to insulin. When I give a correction bolus I am often seeing change happen within 40 minutes. I also find that when I am closer to the target range, things are more responsive.

• Chicken seems to be the protein that gives the biggest glucose spike. I'm still having a hard time timing my insulin to match different types of protein and their effect on my BG. I have started to use the square bolus and dual wave bolus, but can't say that I have have it worked out perfectly yet. 

Caveat: One thing that may have impacted my numbers is that I realized that the box of sensors I was using were expired and I wasn't getting very accurate data from them. I stuck (pun intended) with 2-3 sensors from that box, but found that they would be pretty far off at times. When I switched to a box with a valid expiration date I started getting fairly predictable results again. I had found that both highs and lows were sometimes undetected because of faulty sensors, but, because I didn't trust them, I usually caught them quickly with meter tests. 

More on Symilin

This article and the others from the series taught me enough about Symilin  (in Type 1 diabetics) to know that I want to try it.

I'm finding that my trickiest event with my blood glucose control is dinner. I am finding that I almost always have a rise after dinner, no matter how much insulin I take, and how much lead time I give it. I'm not eating much in the way of carbohydrate, so it seems to be mostly related to glucagon release and glucose released by the liver. If Symilin can help me tame those effects, I think I will benefit a lot from it. Other times of the day I am getting rather predictable results, but my dinner is often creating overnight problems or rises within an hour after dinner. Sometimes some exercise helps, but it seems like slowing down the hormonal side of things might be the best solution.

I'm looking forward to adding it to my regimen, even if it requires a long period of "tweaking things" to get it right.

Labs, coming soon...

I have an appointment with my primary Doctor coming up next month, so I needed to get some blood drawn for my usual metabolic tests. I took advantage of the spring break schedule and went in for my draw on Tuesday AM. I was able to add a thyroid function and testosterone test to the list.

Last time I was at the phlembotomist, I saw some posters about an app that you can get for your smart phone that allows you to receive your labs on your phone. I used it to get my info last time. It's great because, since the data stays in your device you can easily compare results, visit to visit. Well, so far, I haven't gotten anything, but I think my doctor's office usually gets them within 24 hours. My app says it will take 3-4 days for it to be entered into the system. Maybe I'll get some info by the weekend.

Maybe to pass the time, I will pause to predict my A1C. My sensor average says 131 mg/dl for the past 30 days. I guess since my last "at home" A1C test, a month ago, showed 6.1, then it might logically be about the same, or it could be at 6.2 or thereabouts. Based on what I'm seeing on my CGMS, I don't think I'm going to make it into the 5s this time around.

Recently, I've had a harder time getting desired results... I have found that once I have something go wrong, it throws off the precarious balance of insulin sensitivity and then it becomes difficult to achieve that same control for a while. I had gotten to a point last month where I was using only 25 units a day, and now I'm back to 30 units with numbers running higher overall. I think I know why. I have not been doing my 3 times a week strenuous exercise. I have only been using the elliptical for correcting creeping highs. When I was doing fairly heavy exertion regularly I was finding my insulin sensitivity was going up and I had to keep lowering my total daily insulin. I think I'm going to get back on that schedule of strength training or sprinting about every 2-3 days.

Something interesting about A1C measurements

In this article, health guru Kris Kresser says that A1C isn't an absolute test because of the different lifespans of blood cells in different people of different health. It's still always important for diabetics, overall. But, the closer to normal our blood glucose levels are, the more likely we are going to have extended blood cell lives, longer glycation period, and higher A1Cs. So in healthy people he doesn't always expect to see super low A1Cs (like in the 4s).

Kind of a catch 22, eh?

So, I guess there could be different kinds of people getting A1C measurements of 5.3. We might have those with normal glucose and long lived cells (that have collected more glycation over a longer life), and those with almost normal blood glucose numbers, but shorter lived cells. Might be splitting hairs here, but seems like either way it's accepted that it's healthier to keep them lower, as long as the risk of hypos is managed.

Support for a yerba mate theory...

I don't know about how it scientifically works for a Type 1 eating a low-glycemic diet, but from my short experience it has been one of the most noticeable differences from a supplement or tonic. I don't particularly love the flavor, like I do coffee and black tea. However, the energy, focus, and blood sugar stability (insulin sensitivity?) seems really noticeable. I feel like during the last 2 weeks that I have been drinking Yerba Mate I have noticed my overall metabolism has increased.

Over the weekend, I forgot to bring some home, and didn't have it for 2 days. My blood sugar levels crept upwards during the weekend. Upon returning to work, I started it up again, and by Tuesday I was having lower and more stable glucose numbers. Of course, there are other possible factors... like warm weather, weekend food, stuff like that...

Here is an article that seems to go along with my experience.

I'm going to include some of my data that will explain why I'm so intrigued by this phenomena.

The first day I drank Yerba Mate tea. Perhaps one of the best days of glucose control I've had in a while.

Not only did I use less insulin those days, I also ran lower glucose numbers. Notice the creep up on the weekend. 

While Sunday, 3/18, looks to be a low insulin day, I lowered my basal for a 20 mile bike ride, and my BG was higher overall.

This is pretty hopeful stuff...

I like this info.

Seeing all this data in one place is kind of like finding a $20 bill in your jacket pocket. I get lit up by this kind of stuff. Makes me feel like we are making progress, and we have things to look forward to. I will participate as much as I can.

These experts, they speak the truth.

I've been re-reading Think Like a Pancreas. One of the "new" things that I came across was that Gary Scheiner says that hard effort exercise can show it's effect on your glucose levels much later, sometimes 12 or more hours later.

Yesterday I took some students indoor rock climbing, and I worked pretty hard. During the event my levels were a bit higher than usual... adrenaline, surges of glycogen, etc. Sore forearms and everything. Lots of fun and challenges.

Well, overnight my blood sugars were fine, but this AM I have been running low all day and have had to eat some candy twice to keep myself in the comfortable zone. My glucose has been under 90 all morning and dipping below 70 at times. No bolus at lunch. He described his experience with this almost exactly the way it has gone for me today. If I hadn't read that recently, I would have thought it was witchcraft.

I also had some Yerba Mate tea this morning? Hmmm. Maybe something to that theory too.