Those Negative Inner Voices

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Last week (in "Fifty-One On, One Off [Kinda]"), I mentioned that, while I was on vacation, I’d been having some trouble keeping my blood glucose numbers down within the target range I’d become accustomed to. I figured that when I was back home and once again settled into a routine, I’d find it somewhat simple to ease out of these higher ranges. I was mistaken.

Over the past 10 days or so, I’ve been dismayed to find my blood glucose hovering around 200 mg/dl two to three hours after many of my meals. This is a significant bump for me to see on my meter. I was used to seeing readings of 155 or so, which would then dip back down and hold, for the most part, in the 110 to 120 range. Am I counting carbs correctly? Yes—at least I’m pretty sure I’m making the same carbohydrate estimations I had been prior to the bg spike. Have I altered my insulin-to-carbohydrate ratio for the boluses I give myself through my insulin pump? Yes. Did I add a bit more to my basal rates? Check. Changed the site? Ditto. Tried a new vial of Humalog (insulin lispro)? Again and again, yes yes yes.

The results I often get with insulin-to-carbohydrate-ratio and basal-rate tweaking do yield slightly lower numbers; except, as those of you who self-adjust your insulin may well have experienced, it’s sometimes difficult to pinpoint whether or not that one thing you did helped to lower your blood glucose, or if it was something else that snuck in and sent the numbers down. I’ll ask myself What did I do? when I see good results, and often the mitigating circumstances work their way in. Any activity, stress, change in routine…these could have contributed to lowering my blood glucose this time around. And then I have to think about What I didn’t do, because that’s often just as significant.

The adjustments that I make to my basal and bolus rates are often so slight—and infrequent—that I find it a mostly calculated guessing game as to which variable I need to pay attention to. If I decrease the number of carbohydrates per unit of insulin, and then the next meal bolus I perform doesn’t show any improvement in blood glucose control, should I assume I didn’t adjust the ratio enough? Maybe my pancreas still produces some insulin for me (drawn-out honeymoon phase, perchance)? Or maybe my rather regimented winter exercise routine helped keep my control in check more than I realized, but after my extended bout with the flu and an ear infection in March—and then a week away on vacation—the lack of exercise has caught up to me and is now biting me in the blood glucose.

It’s like this with my diabetes. It shall continue to be like this. It’s the nature of struggling with good self-management.

There’s one thing, though, that I hope I’m not alone in feeling (and please feel free to post a comment on whether you’re familiar with this; or, tell me if my thinking is completely off-base). See, quite often when my blood glucose goes low—a mild case of hypoglycemia, for example—I’ll correct with 15 grams of carbohydrate, wait, check again, and repeat if necessary. But then, when I get back to an acceptable blood glucose level, I typically have these moments of guilt. I feel that because the insulin is something I’m putting into my body, and because I control how much goes in, that I therefore am responsible for any episodes of hypoglycemia.

Does this low blood glucose guilt ring a bell with anyone? I know that my endocrine system is complicated. And, rationally, I see that there’s no real blame to place for a low blood glucose (it’s bound to happen at times, and it’s part of living with Type 1 diabetes). I’ve spoken to my wife about this, and she says I’m being silly because there’s no reason I should feel this way. But still, there’s that moment when the voices in my head take the antagonist’s role. They tell me that I should have been more careful, that the 30 minutes or so I need to get back to a normal blood glucose level—if I go low while I’m at work, for example—is pretty weak. Really, I probably subconsciously self-induced a low in order to take a break from my job.

Yeah, right.

Those voices suck, but they’re there in varying degrees depending on how I’m feeling on any given day. Anyone have any familiarity with this?

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