Winging It like a Penguin

Last Thursday, I saw my endocrinologist. We all agreed that my 7.8% A1c should be lower. Not in the sense of “Hey, you know you should lower your A1c,” rather “Your BG readings and CGM data look great; I don’t know why your A1c isn’t lower . . . yet.” There was general agreement that if I keep going the way that I have been for the last couple months, my A1c should show actual improvement the next time we meet in late July. I want to be optimistic, but it’s been so long since I’ve seen the low 7s or — g-d help me if I dare to dream — the 6s, that I think I’ll just keep my feelings low-key. After all, my heart got a little broken last week, when I saw a more-or-less unchanged A1c result in my labs.

They — my endo and her newish physician’s assistant — thought it was great that I ran a half-marathon and that I’m doing a triathlon in five weeks. And they thought my lipid profile was probably as good as it could possibly get. (My HDL and LDL were almost identical at 66 and 67.) They also made sure that my education order form got sent to Joslin so that I could see an exercise physiologist there this coming Friday.

I’ve been trying to see an exercise physiologist at Joslin for a while, because I need a little help. As I told my endo and PA, “I love all of the exercise and training for events, but I feel like I’m winging it on the insulin and nutrition front.” Where I am now has come mostly through trial and error. Sometimes, like during the half marathon it isn’t quite right, and other days (like today) everything works out really well.*

I don’t like winging it. I don’t expect rainbows and unicorns every time, but it would be nice to understand a little bit more of what’s going on and what I can do to maximize my chances of success, how I can make sure most of workouts are quality ones, and what post-exercise things I might do to prevent lows.

That’s why I want to get some professional help. So far, I’ve mostly been trying to repeat what works — and fortunately most of what I’m doing these days seems to work, even if it feels sketchy — and to learn as much as I can from the days that don’t go quite right.

Last Friday, the day after my endo appointment, is a good example. On Wednesdays and Fridays, I wake up at 5:00 to go to my local high school pool and swim laps. It’s early, and I usually feel tired, but I know that it’s what I’ve got to do, so I go. This particular Friday, though, I didn’t get the chance to swim the laps because I had hypoglycemia before I started. Since I had eaten like I normally do before going swimming, I decided to see what happens has to my blood sugar from the food when I don’t actually swim. How long does it really take those carbs to hit my bloodstream? When should I eat them so that they actually help me when I’m working out?

Here’s the data:

2:01 - 83 mg/dL - Uh oh, better eat a tiny bit
5:03 - 88
5:15 - Energy gel (22g) and 2 glucose tablets (8g)
5:30 - Shovel snow for 10 minutes (grr . . .winter in April)
5:50 - 59 - Treat with 3 glucose tables (12g)
  No swimming :'^(
6:22 - 157 - Going up! Better correct w/ 0.5u
7:27 - 302 - Oy! Better correct some more, plus I'm hungry.
  1.9u (correction) + 6.6u (for the food)
7:51 - 289 - Well, a man's gotta eat despite the BGs, so I did.
10:15 -143

What do I take away from this? Not sure exactly, but here are some thoughts.

  • The amount I corrected was almost exactly what I would have bolused for the 22g of the energy gel. Yay?!
  • Use a lower basal overnight after days that I do crazy awesome half-mile repeat running workouts.**
  • Leave all of the shoveling for Lisa. Have a snack before shoveling.
  • Try moving my energy gel consumption about 15 minutes earlier to about 45 minutes before exercise.
  • Consider lowering my AM basals on days when I swim.

We’ll see what happens when I go swimming tomorrow morning to make up for last Friday.

* — I had never thought I would ever say, “I just did an easy 11 mile run,” but that’s what happened today. Yeah!

** — I haven’t run 800m repeats since high school; I don’t think I’ve run a timed half-mile since there either. But running them was on my training plan, so I did four sets, and I was pleased to see the results: 3:13, 3:15, 3:15, 3:25. Boo-yah!

This entry was posted in Data-betes, Diabetes, Reluctant Triathlete, Running, Swimming. Bookmark the permalink.

3 Responses to Winging It like a Penguin

  1. Simon says:

    An easy 11 mile run is…..well it’s awesome. I’m sure the lower A1C will come. Without a CGM I feel like I’m always winging it to some extent but I dont really see the benefit in the information overload. That being said I am curious to note the time taken for consumed carbs to take effect. I have issues of going low when I bolus with or before meals.
    Anyway enough of my life story, keep up the great work Jeff, I think I’m happy riding on the coat tails of your success

  2. Filipe says:

    Hi, i would like to know if you use a specific software to manage your diabetes. if so i would like to know wich one. is there any tool to calculate those bolus and correction based on carbs? THX

  3. Jeff Mather says:

    There’s a dearth of really good diabetes logging and management tools that don’t require tons of time or that I’ve been able to stick with. (That’s why I’m writing my own that works with my pump data so that I can automatically log most things and take that data with me wherever I go. But that’s nowhere near ready yet.) I have found that Medtronic’s CareLink does a good job of aggregating all of the data in one place, but I kinda feel like I have information overload when I use many of its graphing features.

    So what I mostly do is use the bolus wizard in my pump to see what I should bolus and then watch the CGM traces and BG finger sticks to see how those rates/ratios are working. It’s not ideal, but after enough experiences doing more-or-less the same thing, I’ve gotten a pretty good idea what works and when I need to make changes. I wish it were easier, and I wish there were better “decision support” software that actually mines the data for us and provided computerized “expert” advice.

    The hardest part of all — at least right now — is keeping track of what happens when I “wing it.” That is where I mostly just write things down (as in this post) so that I can remember it for next time. I find that telling myself what I’m going to do next time right after I have something happen is easier than trying to remember what I was going to do when that next time rolls around. Make the next decision while the situation is fresh.

    If you find any great pieces of diabetes management software, let me know.

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