Last week I attended a lecture about diabetes and the use of motivational interviewing. Interesting as it was, I have remembered one key thing that the lecturer said – that people with type 1 diabetes need to understand maths to GCSE level C, as a minimum, in order to manage their condition well. I knew this of course and I also know that I struggle sometimes, despite my competence at maths; when you are tired and it’s late, working out ratios and residual insulin vs your carbohydrate intake can be a challenge.
Can you work out, for example, how much the total carbohydrate value is for these sandwiches? There was, by the way, no total weight on the pack to help…..
The results from the continuous glucose monitor or CGM
Last time I blogged about my diabetes I told the story of my sensor and how challenging I had found it. I can report that the second time it was a success! My DSN inserted the sensor and I managed to get 12 good days readings. I do think it must be difficult to manage some of the data on your own if you are not inclined to maths and stats. The graphs are complex and not for the faint hearted – I think they are complicated especially when there are multiple-factors that could affect the results. An example of a graph of my results is shown below: (pretty isn’t it :) ). This was the second set of 6 days and are terrible! They are all over the place but the adjustments I have been able to make as a result have made a real difference. The continuous glucose monitor hopefully will have helped me to regain a better level of control. I had accidentally disconnected the pump one night and another I just couldn’t get my blood glucose to go down.
Since I’ve been thinking more about my diabetes I have come to realise that its a lot more complicated than I lead people to believe. As someone once said to me ‘diabetes is a dark art’.
Its not just as straightforward as taking insulin to cover the food you eat, even if that’s what many nurses learn. Well, of course at the very simplest level it is, but there are so many other factors to think about.
Some extra factors to consider….
I found out from my sensor that I am more insulin resistant in the morning than the evening so need a different carbohydrate to insulin ratio between 6 am and 12 pm, so not only do you have to be good at sums you have to be able to tell the time too. And of course there are some foods that just don’t seem to work out; for me pastry and fish and chips just guarantee a hike in blood glucose no matter what I seem to do. Other people complain about pizza or pasta which I seem to manage fine – its so individual and therefore there are few hard and fast rules and its a lot of personal learning.
I also discovered that I was hypoing at night and getting a resultant rise, which meant I was sometimes waking with an unexplained (till now) high blood glucose. I also have some dawn phenomena, a rise in blood glucose caused by the normal production and release of growth hormone which results in a rise in blood glucose in the mornings. Its common but means that the basal (base amount of insulin given continuously via pump) has to be adjusted to different rates over the day. I currently have a pattern that delivers 5 different amounts in the day. Confused yet?
If I am doing something stressful at work then, counter-intuitively (you expect a low blood glucose) I need to take extra insulin. If I am running a workshop all day for example I would increase my basal rate by 25% overall. I’m doing a big presentation this week so I will need to test quite a bit and probably adjust to take account of a probably high otherwise I will feel poorly.
There are so many things to think about. It really is, as I’ve said before, very complicated and no one person with type 1 diabetes is completely like another. I don’t think about it all the time but neither can you have a day off. So, I’ve decided that I am really a white witch who struggles to manage the dark art of diabetes. I quite fancy myself as the white witch from Narnia, slaying the dark monster diabetes.
The white witch from Narnia
Did you get the carb value right? Its 46.6 gm CHO