Until a man is twenty-five, he still thinks, every so often, that under the right circumstances he could be the baddest motherfucker in the world. If I moved to a martial-arts monastery in China and studied real hard for ten years. If my family was wiped out by Colombian drug dealers and I swore myself to revenge. If I got a fatal disease, had one year to live, and devoted it to wiping out street crime. If I just dropped out and devoted my life to being bad. — Neal Stephenson, Snow Crash
It’s tempting to think that I could become a badass diabetes mofo. (I would say “ninja,” but that title is already taken.) If I could go back into the hospital as an inpatient, start over again, and get the right basal rates while in the hospital. If I had the world’s most dedicated support team. If I had a CGM and all the time in the world to learn from its chirping and charting. If I spent five years and read every journal article and textbook about diabetes self-management.
But I can’t just put my life on hold, drop out, and hope that I could be the baddest PWD around. None of us with diabetes can really expect that. There’s just too much life to be lived to give it all over to avenging the wrongs our pancreases visited upon us. However, I can get better results than I have now, even if I can’t be the zen/kung fu master who parries away every blow from the Big Bad.
I certainly can’t do it all by myself — although I am stubborn enough to feel that with the skills and knowledge I already have I should be able to do a lot. The last week hasn’t been anywhere near perfect, but the little bit of info from the CGM trial has been good and helped me make some much needed changes. I’ve banished the NPH demon and started to get more confidence with larger bolus amounts. Now I feel like I have learned enough to ask dumb questions (i.e., questions I don’t know the answers to). Because it’s diabetes, when I get these questions answered, I’ll have a new set of questions to ask; but that’s progress, and I can live with it.
Here are my questions. If you have any pointers, tips, generalizable experience, or just plain-old speculation or advice, I would be happy to read it.
- How do you know when active insulin (a.k.a., “bolus on board” or “insulin on board”) matters for preventing lows or highs? If I ate three hours ago and have five units of active insulin, will my BG likely go up, go down, or stay the same?
- When should I add an extra bolus for protein or fat?
- What is the correct way to do a combination/dual-wave bolus? I’ve mostly been winging it, but I don’t know if it actually does any good.
- When should I bolus for meals? I’m way past bolusing afterward, but should it be right when I eat? (That seems unlikely.) 5 minutes before? 15? 30? Does “it depend” on the meal?
Any other sage advice for becoming a BAMF would be greatly appreciated and accepted with the greatest of humility and with full knowledge that my diabetes may behave differently than yours. And I promise to share more of what I learn along the way.