For the past several weeks, I've implemented a system of working smarter, rather than harder, to maintain my blood sugars. After numerous instances of highs or lows brought on by improper insulin boluses, I figured the area that needed the most focus was boluses and interpreting my blood sugar results. I concluded that many of my erratic blood sugars could have been avoided if I'd taken a few moments to consider some basic variables that effect blood sugar before delivering a bolus. I jotted down a few reminders on a small Post-it note and kept in it my meter case. Then, whenever I tested my blood and determined a meal or correction bolus amount, I'd quickly run through the list and think about the current circumstances before acting. I've seen a significant improvement in my control; specifically I'm experiencing far fewer avoidable highs and lows.
These small reminders make a big difference because they encourage me to weigh various factors that impact my blood sugar, so that I deliver the most accurate bolus possible. Pausing for a moment to think about what's going on in the near future helps me to avoid sudden highs or lows that would likely occur if I'd bolused without considering those future variables. Each individual variable includes several factors, thus I will address each of the following variables separately in a series of posts over the next couple weeks. The topics will include:
1. Blood glucose trend? Does my current blood sugar represent an upwards or downwards trend based on what I've eaten or insulin delivered recently? Did I just eat something that spiked my blood sugar, but won't keep it up for long?
2. What is the nutritional composition of this meal? Does the food I'm about to eat contain a high amount of fat, protein, or fiber? Conversely, is the food high in simple carbohydrates?
3. What will be my activity level in the near future? Am I going to exercise soon? Am I planning to be sitting around and inactive?
4. What time of day is it? Is my blood sugar high from dawn phenomenon? Am I approaching a period of the day when I often go low?
5. When am I planning to have my next meal? Will a particular correction bolus have me going too low before it's convenient for me to eat again?
These questions highlight variables that tend to be the culprits whenever I have an unexpected high or low blood sugar. There are undoubtedly several other factors that impact our blood sugar throughout the day. Unfortunately, some of these frustrating variables are beyond on control, such as when a meal is suddenly delayed, your insulin pump malfunctions, or you're served food with hidden carbohydrates. However, I think by focusing on what we can control, namely, our food choices, insulin boluses, and timing of it all, we can cut down on the instances of uncontrolled blood sugar.