Fresh, new diabetes supplies…how nice.
I saw this question today and I’d like to give it moment because it is an excellent and common question. The reason this happens is related to our bodies having a natural rhythm in which they release glucose into the system and at the same time, our bodies metabolize these sugars at different rates throughout the day.
Typically, someone on insulin therapy will need higher basal doses in the mornings. This happen for two reasons. One, in the early morning hours, our body starts to kick out glucose that we will need for things like waking up, moving around, conscious thought. Yes, thinking on purpose requires more fuel than daydreaming. The second reason is that our bodies generally metabolize those sugars at a slower rate in the morning. Put the two together and your 107 mg/dL at bedtime can easily turn into 253 mg/dL at 8:00 am. Sucks, huh?
And, sometimes, you drop low in the night without knowing it and your body naturally “rebounds” to save itself. See photo at right. —>
So, what do you do about it?
Well, you can adjust your pump settings to a higher temp basal rate during those early morning hours.
You can change the time of day that you inject your basal insulin if you use multiple daily injection therapy (MDI).
I find that exercising in the evening hours helps to keep my numbers stable over night but this is not for everyone. It could very easily lead to a dangerous night-time low. Go back to photo at right.
Before you do any of these things, you MUST talk to your endo or diabetes educator. True, once you have goals, settings, and techniques set up, you can (and will have to) make adjustments on your own. If you are having trouble with unstable BGL readings, you aren’t there yet. Diabetes management is very serious and trying to go it alone can be deadly. No shame in admitting you need help. After all, we weren’t born with this disease and we certainly weren’t born knowing what to do with it. So, no worries, no shame. Work with your diabetes management team and stay alive. Survive and thrive!
Today we’re covering some basic terms. Many of these terms, terms which EVERY diabetic should know, were never explained to me. And with 90% of all Diabetics being Type 2, and most diabetes education classes be designed for Type 1, there’s a good chance that if you have diabetes, these haven’t been explained to you either. Let’s get started:
Bolus: A bolus is the dose of insulin give just prior to a meal (usually 15-20 minutes) to cover the carb count within the meal.
Basal: Basal refers to the “background” insulin. Basal insulin is a long-acting insulin that covers the insulin necessary to cover the glucose that your body naturally produces and uses throughout the day.
A1C: A test that measures average blood glucose levels for the previous three months.
Insulin/Bolus on Board (IOB, BOB): IOB or BOB refers to how much active insulin is in your system after a bolus. How long fast-acting insulin lasts in each person’s body varies and you must work with your endo and diabetes educator to determine IOB as well as correction factors and insulin to carb ratios.
Correction Factor: The amount of fast-acting insulin that covers a set decrease in BGL. For example, 1 unit of fast-acting insulin will bring my BGL down 50 points. Again, cover this with your doctor.
Insulin to Carb Ratio (I:C): This is the how many grams of carbs by covered by 1 unit of insulin.
Blood Glucose Value (BGL): The amount of glucose in a set amount of blood. It is measured in mg/dL.
Diabetic Ketoacidosis (DKA): An accumulation of ketones in the blood. Meters are available to check for ketones. This is a no-joke condition. If it is not treated, it can be fatal.
Hypoglycemia: Low blood sugar under 70 mg/dL.
Hyperglycemia: High blood sugar. Goals are different for everyone but as a rule, BGL levels should remain between 70 mg/dL and 130 mg/dL. Don’t be discouraged if your numbers run higher than this because they will. Set range limits with your endo and correct as needed.
Insulin Resistance: An inability to utilize available insulin in the body.
Lancet: A needle designed to fit into lancing device.
Lancing device: A spring loaded mechanism which contains a replaceable lancet that allows an easy draw of blood for use with a glucometer.
mg/dL: milligrams over deciliter, the measurement used to read the amount of glucose in a sample of blood.
I remember the days following my diagnosis. I sat on my living room floor, pouring over articles and books and websites and pamphlets trying to figure out what in the world I could eat that would be safe. It was so frustrating to be hungry with a fridge and pantry full of food but feel like EVERYTHING was off limits. I found advice like “celery and peanut butter is a safe and healthy snack”. Okay? How much peanut butter? How many celery stalks, damn it?!
The answer to that question is:
two stalks celery (2 grams of carbs)
1 serving of peanut butter (2 leveled tablespoons – which is usually 6-8 grams of carbs)
Ta-da! A hydrating, protein-containing, tasty snack with 8-10 grams of carbs. So, go get that if you’re starving to death (no pun intended).
The first thing to remember is that you can eat. There is plenty you can eat. Personally, I am unable to consume wheat, dairy, pre-made frozen foods, anything fried, alcohol, food colorings, or red meat without catastrophic gastronomic consequences. And I don’t feel like I am missing out. Well…okay, an eclair would be nice once in a while but am I really missing out with that one?
So here are a few things I wish someone would have told me up front that I had to figure out on my own when it comes to diet & diabetes:
-15 grams of carbs is considered one serving of carbs
-It is recommended that each meal be between 45 and 60 grams of carbs
-Consistent carb counts meal to meal (always having about the same amount of carbs at meals) makes it easier to maintain stable blood sugar
-As a Type 1/LADA/1.5, regular exercise and insulin therapy is a sure-fire way to manage your diabetes
-As a Type 2, exercise is your best medicine. And I mean exercise, man. Regular, consistent cardio will do more good for you than I can possibly express in a blog post. If you’re BGL is high, start runnin’!
-Always know your insulin-on-board (how much active bolus insulin is in your system) and sharpen your math skills!
Some helpful websites and info:
Think Like A Pancreas by Gary Scheiner
Common Food Carb Count – as a new diabetic you’ll have to do some experimenting. I have to use a total carb count vs. a net carb carb whereas other are able to use a net carb count
Did You Say Net Carbs?
Okay, okay. I know you’re head probably feels like it’s about to explode and you may just want to curl up into the fetal position and die right now but you can do this. Millions of people are living with diabetes every day. Millions of people carrying on and taking this disease with them. Educate yourself! Empower yourself! And remember that diabetes never takes a day off, so you can’t either. Stay on it. Do your best. And if you need help – ask!
Make a difference in the lives of others with diabetes!
Do you or someone you love have diabetes? How has it affected your life? Have you run into diabetes related complications? Has it put weight on and damaged your career, your relationships, your quality of life? Do you want to share your story?
Hello everyone. I am writing an ebook on diabetes and I would love to include stories, real stories, your stories. This is strictly a volunteer opportunity. You will be quoted with your story (or you can choose a pen name or choose to remain anonymous).
If you would like to take part in this ebook meant to be a starting place for those with diabetes, a place where they can begin to learn that being diabetic does not mean that they cannot LIVE, please send the following by October 31, 2013 to firstname.lastname@example.org:
-Name (use the name you want to be quoted as or type “anon” to remain anonymous
-City and State of residence (optional)
–Diabetes Type (1, 2, LADA, etc)
-Age at time of diagnosis
-Your diabetes story (no more than 1,000 words please)
-Include EVERYTHING in the body of your email – attachments will not be opened
I hope that you will take this opportunity to share your story and let others know that we are not alone. There are a lot of us out there and we don’t have to be smothered by the weight of a lonely diabetic life. Let’s get the word out. WE ARE ALL IN THIS TOGETHER!
I found this terrifically hilarious blog entry by Kerri Sparling and just had to share.
“‘They’re glucose tabs! I have diabetes, and I’m having a low blood sugar reaction,’ I blurted out to the woman standing a few feet away, staring at me as she stood with her car door and her mouth opened (…) ‘Not eating dog poop.'”
Read the rest here.
It’s a great time to be a college student with diabetes.
OK, maybe it’s never a great time to have diabetes at all, but if you’re a PWD (person with diabetes) off to college at this time of year, you’ll likely have access to an amazing resource unlike anything offered ever before in the history of this disease…
Read more here.
By Ginger Vieira
“I don’t have any children—especially any children living with type 1 diabetes. I live with Type 1 diabetes and celiac disease myself, since I was 13 (today, I’m merely 28 but the anxiety of eventually turning “30” into an “old woman” increases daily). In the many years I’ve been chatting with, writing for, presenting to, and working with all kinds of people with all kinds of diabetes, I have developed a personal theory that I’m only more certain of after recently spending another weekend surrounded by families raising children with diabetes: raising a child with diabetes seems significantly more stressful than living with it myself.”
Read the rest of the article here.
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