Mastering Diabetes at the DRI: Day 3
On Day 3, I got to the DRI and went for my vitals.
After I got to the classroom, we were quickly put into our divided groups. We evaluated the transparencies from the night and day before to see if the changes the CDE’s and endos made worked for us. Well, that one little change of my basal rate completely turned my numbers into a good looking range of numbers over night. I could not believe it. I went from ranging in the 180s-200s to 120s. Totally unbelievable! If you don’t believe me, check this out:
If you look at Friday @ 4 pm that's when they changed my basal rate to 1.0 for 24 hours. At 7 pm, my number was already at 108 and I had Cheesecake Factory for dinner, too! It may have been because I corrected my high at 4 pm when I was at 240, but if you look at all of Friday night into Saturday, you can see how more stable my blood sugars became at a 1.0 basal rate.
After looking at all of the transparencies, I was in complete amazement of how everyone’s blood sugars were so different than when we first got there two days prior.
Granted we were doing it all day long and had people to answer any question we had for 8 hours straight for 5 days, but that's besides the point!
We finished going over the transparencies and then returned to our main group of 9 members. We had a session on altering the rate of insulin absorption; the fastest insulins are Novolog, Humalog and Apidra, which enter the blood stream quickly, and are used in insulin pumps. For people that use injections, they use fast acting insulins plus an intermediate by combining regular insulin with NPH. There is also Lantus, which lasts for 24 hours with no peak. For people that use Lantus insulin and have the dawn phenomenon, you can use NPH to control your higher blood sugars in the mornings. Something I never knew until this class. We were told that when using rapid acting and longer acting insulins together it is important that you inject immediately since the additives of longer acting insulins could slow the absorptions of rapid acting insulins. The amount of insulin you inject can alter the peak time and duration of insulin action. So, lets say you inject 5 units of regular insulin with your NPH of 20 units. In this case, you will have an earlier peak and still have NPH on board. Depending on where you inject your insulin, you can also affect insulin absorption. The fastest and most consistent place to inject is in your stomach, then arms, thighs and butt. Insulin injected into areas that have more blood supply (deeper areas of the body) have better absorption. So, for instance, if you use regular insulin and want it to be absorbed as fast as Humalog or Novolog, inject it into your muscle in the forearm or in the calf.
**A trick we were taught while we were in the program was if you have an extreme high blood sugar from pump failure or you forget insulin or any other thing you can think of, get a syringe and fill it with fast acting insulin and inject into the meaty part of your forearm. Rub your arm really fast with the knuckles of your other hand until it feels warm. This will bring your blood sugars down quickly. Also, applying heat to an injection site works as well.
I know this method works because one of the girls in my class found out when she went to the bathroom that her pump wasn’t connected to her body, and when she checked her blood sugar it was in the high 400’s. So, Jane, our CDE, took a syringe and injected Humalog into her forearm and massaged her arm quickly to cause some friction. Her blood sugar came down pretty quickly. By utilizing this tip, you can avoid a trip to the emergency room! We all know that stinks big time!
Going to the gym can also alter insulin absorption. If you are going to the gym, try not to inject into areas that absorb quickly to prevent hypoglycemia, which brought us into a discussion about exercising with diabetes. They told us how exercising is important for people with diabetes because it lowers blood sugars, helps with weight loss management, gives you improved insulin effect, lowers the risk of heart disease and can improve circulation (as well as improving cholesterol, blood pressure and stress!).
Before you start an exercise program, you should always consult a physician.
Another thing you should consider before exercising are to check your blood sugar and make sure you are in a range that you and your health professional decide is best for you.
• Check your blood sugar to make sure you are in your exercise range. Over 120 mg is recommended.
• Check for ketones if your blood sugar is over 240. If it is, don’t exercise.
• Do not inject into muscles.
• If you eat right before, take less insulin to prevent hypoglycemia.
• If you exercise before you eat, eat complex carbs to keep up your energy level. If you are working out at a higher intensity, you need to keep fast acting carbs with you.
• If you use an insulin pump, consider using your temporary basal features.
• Have fluids on hand to avoid dehydration.
• Wear a medical alert bracelet.
• Avoid exercising in extreme temperatures.
• Make sure you warm up 10 minutes before.
• Carry fast-acting carbs
• Check your blood sugar while exercising to make sure you aren’t dropping too fast.
• Drink water.
• Stop exercising if you have pain, feel light headed, or short of breath. You may be experiencing symptoms of hypoglycemia or another health condition.
• Check your blood sugar.
• Cool down.
We were told that an exercise physiologist was coming in on Day 5, so I will go into more detail about what I do for exercise and what the physiologist said in that post.
After the exercise session, it was time for lunch and our "last supper".
I say last supper because we had to fast for 24 hours from Saturday into Sunday. I, along with everyone in my class, were really concerned about it. None of us had done a 24 hour fast before, and, quite frankly, it was a scary thought. The reason for the fast was to test our basal rates to make sure they were correct, and the only way to do it accurately was a 24 fast. OY!
For lunch, we all went to lunch at Au Bon Pain. I had a chicken sandwich on a baquette with chips. We were able to eat anything we wanted. One of the girls in our class brought her calorie king book which had Au Bon Pain in the fast food section so we could count the exact carbs we ate and bolus accordingly. But, of course what I had planned on eating was not in there. I decided to look it up on my phone because maybe the book we had was outdated, but it wasn’t on the website either. I searched for something else that was similar and used that carb count instead. After lunch, we went back to class to get our guidelines for the fast. We were given sheets to fill out with a log of the last meal.
This is how mine looked:
Target blood sugar in my pump: 100-110
Correction scale: 1:40
2 hour post prandial: 160
Carb ratio: 1:9
At 1 pm, I ate 76 carbs. My blood sugar was 76, so I took 8.1 units of insulin in my pump. If you refer back to the chart above (after 1 pm on Saturday), the carb count was obviously off. When we got back to class, we were given our fasting guidelines.
All I could think about was that I was already hungry (and I just ate lunch!).
Here's a summarization of the fast guideline sheet:
When you think of fasting or 24 hr hours without eating, you may be thinking:
• I can’t fast, I have diabetes.
• I have to eat, or I will go low.
• Go without food? NO way!
• Are you nuts?
The 24 hour test offers you the best way to test your basal rate, and that it is not necessary to eat in order to prevent hypoglycemia. If your basal rate is correct, your blood sugars should remain stable throughout the entire 24 hour period of the test.
In the MYD program, there was no specific target range. If your blood sugar is at 100, for example, they recommend that your blood sugar stay within 30 points up or down within that range. If you are on shots, you would only take your all day insulin, such as Lantus. Pump users were to rely on their basal settings. During the 24 hours, we had to check our blood sugars at least every 2-4 hours and watch for signs of hypo/hypergylcemia.
Reason to suspend the fast 2 episodes of hypoglycemia (blood sugars below 70mg) or 2 episodes of hyperglycemia (blood sugars above 250mg). The bottom of the sheet said: "Remember, hunger is not a reason to stop your 24 hour fast!"
This made me laugh.
If we had to suspend the fast, it meant that our basals were off, and needed to be adjusted. We would evaluate our fasting numbers the next day. This will bring us to blog post number 4: Day 4, The FAST!