( © Lynda Covello, 2015. All rights reserved. )
9:50 am: Just returned from the daily morning dog-walk, I am feeling a little wonky, and so I test. The CGM (Continuous Glucose Monitor) says I’m over 4, but the capillary blood from my finger says 3.7. Perhaps not a huge difference from a statistical standpoint, but I feel the difference: at 4.2, I feel a little weak and disconnected from myself, but at 3.7 I’m dizzy and I feel completely empty inside. It’s getting hard to think. I pour myself a big glass of orange juice (about 50 grams of carb), down it fast, and sit down to wait. I know I can’t do anything relevant in this state, so I try to read the paper, but can’t hold the necessary concentration. My brain doesn’t work well at this low a BG (Blood Glucose).
Meanwhile the CGM, having been corrected with the new info, is determined to let me know I’m in trouble and the low BG alarm keeps going off every few minutes. It’s annoying, but that is what it is designed to do, so I ignore it and wait for the juice to kick in and bring my brain back to me. Five minutes go by. Ten. At fifteen, I test again, according to protocol – you have the let the sugar in the juice do its work and bring up your BG to reasonable levels and you have to give it some time to do that. I have learned the hard way that if I just keep inhaling simple carbs, I may feel better sooner, but I will start an upswing that will be hard to correct before it takes me up into the high teens or even higher.
The meter reading is 3.0.
So my BG has continued to fall, in spite of the nearly 50 grams of carb I ingested 15 minutes ago. I pour myself another glass, shorter this time, only about three-quarters of a cup – roughly 25 -30 grams of carb – shoot it down. And wait.
I hear the dog vomiting in the front hall, which he has no business doing in the house after a good hour on the trail, and I feel annoyance and confusion, but I can’t deal with that right now. I file it away for future action.
Fifteen minutes later the CGM says I’m up to 4.0, but my capillary blood test reads 6.6 and I am capable of coherent thought again. I recalibrate the CGM, and decide to have 1/16th of a pumpkin pie to consolidate (carbs, but also some fat to slow down the absorption) so that I can get started with my day’s work, because it’s already 10:30. The label on the box says the pie should be 13 grams of carb, so I consult the on-board computer and it suggests 0.80 of a unit of insulin should cover that, but reminds me that I already have 0.85 units in my body from a previous bolus. That is what is left in my system from the bolus I gave at 7:30 am and I added it because when I awoke this morning my BG was 15.4 – too high, likely from a low I treated before bed last night. That low was the result of a dog-walk as well, one that I had not planned for, but tried to manage with a temporary basal reduction of 30% and a small ginger molasses cookie (10 grams carb, according to the package). My BG was fine when I went to bed at around midnight, then the CGM high alarm went off at 1:30 am, alerting me that I was at 13.1. I woke up and gave the recommended bolus, shut off the high alarm and went back to sleep. When I woke up, the CGM showed that I stayed at 13 all night long, but when I did a meter test, it revealed that I was higher at 15.4. The CGM needs to be recalibrated every 12 hours and it was time to do that, so I did, and gave a corrective bolus to cover the current situation, plus part of the breakfast I planned to eat. I left about 0.30 of a unit out of the bolus to give me the flexibility for my daily morning one-hour walk with my dog. That is usually enough to keep me from going low after the walk, but not today, apparently.
10:48 am: the CGM is now alarming that my BG is rising fast at 9.1. At 10:56 it tells me that I’m at 10.1.
I test and I’m 11.4. I ask the meter if I should bolus for this, and it recommends not, since the corrective would be 0.80 units and I have 1.04 on board already. I wait.
I decide to check out the front entrance and there is clear yellow liquid all over the floor. It’s vomit, not pee, but I gag anyway as I layer some paper towels over it to soak it up. I can’t deal with it yet.
At 11:06 I test again and I’m up to 13.7. I ask for a recommendation and the meter suggests a corrective bolus of 0.30 of a unit to bring my BG back into target (6.5 – 7.5). I give the bolus, knowing that my whole day is going to be like this, chasing my BG with insulin and food and trying to get back to stasis. It won’t really matter what else I do today, I’m going to go high for a while and the really hard part will be not over-reacting to that, but waiting patiently for my BG to come down slowly and stabilize in the desired range. I must resist the temptation to rage-bolus when it continues to rise in spite of the insulin that I have already given it. That would only push it back down too fast and make me go too low again. I must be patient, calm and persistent until I am back where I want to be.
At 11:20 I test at 14.3. Sigh. I give the 0.20 of a unit suggested by the meter to supplement what I’ve already given. I check again at 11:53 am: 14.2.
At 12:48: 14.0. incremental boluses given as recommended. At 1:00 pm I bolus for 30 grams of carbsfor lunch.
I eat my lunch and get to work. I have email to check and problems to solve for clients. I have a jazz cabaret that I’m writing and vocal exercises to do to maintain my chops. I’m also working on connecting some people in the not-for-profit world in the arts community as well as in the healthcare space. I have a 4:30 meeting downtown with a business colleague from Chicago who happens to be in Toronto, and then at 6:00 pm I have a workshop session for a T1D experiential education session we are putting together. I can’t afford a sick day. I have too much to do.
At 3:15 pm I test again and I’m up to 17.2. Shit! Way too high. The meter is recommending another corrective bolus: 2.20 units. I give it and wait for it to kick in.
Much, much later, at my 6:00 pm workshop session, I test again because I’m going to have some pizza. 8.0. Halleleiuiah! Of course, when I get home at 10:00 pm, I’m back up to 15.
My life is a science experiment, and I am the lab rat.