06 December 2010

Multivariable Equations

     As any good scientist knows, if you want to find out what effect any one part of your experiment has on the outcome, you change only one thing at a time. Diabetes is much like an ongoing experiment that I conduct on an on-going basis. Recently it has all gone haywire and after months of not being able to catch up with it, I went a little ape-shit. I decided to change nearly all of it and hope it comes out alright.  Some of the changes came at my own hands and some were dealt to me.
     A month ago everything was stable, relatively consistent diet, workouts getting progressively but slowly longer and higher quality and everything else in life just humming along. And then I got sick. Sickness, I think, is the diabetes enemy. It makes it so you can't workout, which will change insulin needs. It makes it so you sit on a couch and sleep all day, which will change insulin levels. And then your appetite gets all funky and you get hungry at weird times and nauseous at others, which of course changes insulin needs. So after being knocked out for a week I slowly rebounded and began my training again. And then I got hit by another cold and was back on my butt. As soon as that was over I was gearing up for my son's surgery- 3 days in a hospital room with a crying child who just wanted to go home and not be in pain-10 days with not more than 20 minutes of sleep at a time and the other 23 hours of the day constantly tending to his needs and the needs of a four-year-old with two casts up to his groin are abundant and frequent.  So my overall stress level changed in an instant. Which, of course, would make it the perfect time for my doctor to change the dosing of my anti-thyroid meds. More insulin change.
         Now with all this change, one might think I would naturally shy away from more self-inflicted change, but, alas, I am not that smart. I decided to do a complete overhaul on my diet to try to discover what has been going on with my blood sugars and to finally get a leg up in the two-year battle with the pounds my funky thyroid has strapped to my ass. And, of course, there was the addiction to way too many diet sodas a day to mention. I don't know how I got so addicted to a food that isn't actually a food but a product made in a lab somewhere without containing any real food products in it.  I figured I would need to go cold turkey on that stuff for a while until I got a handle on it.
   So Monday morning the changes started. And Monday was rough, Tuesday was worse, Wednesday the headaches were throbbing, Thursday the blood sugar patterns were still undiscoverable, and Friday I decided to cruise through a website that had invited me to blog for them called asweetlife.org. And I stumbled across something that I learned in that hospital Diabetes 101, but had failed to recognize in my wild sugars. I had been fighting frequent, random lows for almost 2 months and then huge swings up to the 300's after. It wouldn't matter how little sugar I gave myself to correct for a low, it always jumped right to 300 after. I read a blog on the 'dead in bed' syndrome , which I have to say is a far too cutesy name for such a horrific, life-shattering event.
        I have always done well with my nighttime blood sugars, which is nice because if you can consistently have good nightly blood sugars you have conquered one-third of your daily routine without having any brownie cravings, or extra time on the bike trainer or a movie marathon on the couch messing you up. It's fixed and it's easy. Well, in the last two months, overnight has been anything but easy. I either wake up low and rush downstairs to get some sugar and then, usually, a few hundred calories to follow up, or I would wake up high. There was no in between.  I was afraid to turn up my basal rate for fear of getting too low and dying in my sleep, but I couldn't turn them down because then my highs would be higher.  My nighttime basals have varied between 0.45 and 0.5 for the last 13 years that I have been on the pump.  It is one of the few basals that hasn't really changed at all over the years. In comparison some of my other basals have changed from 0.8 to 1.6 over time, so the nighttime consistency is nice.
   That is when I was reminded of the Somogyi affect and realized I might not be going about this the right way. The Somogyi affect is this weird thing that I always struggled with when I was on shots because my nighttime insulin needs are so much lower than my daytime needs. I would take a shot, but it would be too much and drive down my sugars. I would be low and asleep and not wake up from it. My body would get pissed off after a while at being so low and pump out a series of hormones to counteract it and let my liver release some stored sugar to counteract the low. I would then wake up high and think I needed more overnight insulin, thus worsening the cycle. The insulin pump fixed the problem back then, but now my inability to listen to my body was forcing the same affect. Even though I figured this out, I was still pretty stubborn about it and didn't want to lower my basals for fear that I might be making myself go even higher.
   But hearing a phrase like 'dead in bed' for the first time shakes off the stubborn attitude real fast and then looking into the research they are doing in what causes it was even more alarming. There are studies out there that say that overnight low blood sugar can alter the way your hearts electrical system works and although more research is needed in this area, the thought of messing with my hearts beating was enough to scare the living daylights out of me. After reading the second study, I promptly took my hand off the mouse, lowered it to my belt and grabbed my pump. Those basals never saw what was coming to them. Low, Lower, Lower than they have ever been. Later, after sitting on the edge of my bed convincing myself not to be afraid, that I would probably wake up tomorrow like I have done for decades already,and very appreciative that I get to sleep next to my husband who would probably notice if I began to convulse with a low blood sugar and be able to rescue me, I laid down to sleep. And God smiled down on me with the first night in three weeks without a low and without a call from my son to itch his casts or take him to the bathroom. I woke up at 6 refreshed and alert and not feeling like crap like I had for weeks before. I tested and was 116. When I laid down to sleep the night before I was 125.
     After this great night of sleep, I realized a few things. When I sleep through my lows, or even if I wake up (typically it's after being low for an hour or more) my body is more resistant to insulin for at least 12 hours after. Which makes the whole day a battle against my body. On top of that, I wake up feeling hung-over and hazy and grumpy and unfocused, which is not a good combination for dealing with a classroom full of fidgety, talkative, well-meaning 6th graders for 7 hours at a clip.  So with my new basals in hand I guess changing up everything all at once wasn't such a crime. Although I think I could have come to the same conclusion if I had only cruised around on the internet a little earlier and not been so afraid to try something new. Now let's see if a happier, more well-balanced body will let go of the extra padding it has developed in some sort of hibernation preparation.

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