I had an appointment with my Nutritionist/CDE this morning. I haven’t had an appointment with a CDE for several years – honestly, anything beyond the basics for my own care has taken a backseat to managing the Bear’s diabetes. I have known that I am having too many lows and that my ratios, correction factors & even basals needed more tweaking than I have done since I lost 20 lbs over the past year. Hooray for the weight loss but I felt like the couple of half hearted changes I made to settings were making me see too many high bgs. Though, since I wasn’t logging or downloading it was hard to say.
So, when the new endo said he wanted me to see the CDE/Nutritionist I didn’t argue. I did have some second thoughts over the weekend – what was the point of this appointment? But we spent the whole hour looking at my downloads, talking about what might be going on and making changes. We changed every I:C ratio, 3 basal rate settings, and all my correction factors. We also changed the setting for the action time of the insulin. That’s a lot of changes all at once, but it was pretty clear it was needed. Other changes are needed too: I need to test before treating – whether that is before a meal bolus, or before treating a hypo (when possible). I rely too heavily on the dexcom which results in the omnipod not applying reverse corrections and me not having good data from the meter. I need to not overreact to high bgs, and I need to actually react to low bgs.
She believes that it is very likely that the frequency of lows has depleted my liver’s glycogen response which is why it takes so much longer for my bgs to recover from a low even with appropriate treatment. I need to do my best to prevent lows completely in order to let my body recalibrate. That seems kind of impossible, but rationally I know I can do this. Or at least try to do this.
Today I tested a lot more than usual, treated lows with glucose tablets only, and paid attention. I was low pretty much all day. I would test, eat 4 glucose tablets, come back up to somewhere between 80 & 120, stay there for 20-30 minutes before dropping again. I was pretty careful with carb counts at lunch & dinner but still went low after each. For my most recent low, I only had 2 glucose tablets and then a granola bar (KIND); curious to see if the granola bar lasts a bit longer than the glucose tablets. Tomorrow I’m going to leave the settings the same but will try lowering my basal after a low as well. If I have 2-3 days of these lows, I’ll have to look at changing settings even more.
I’m still concerned (read: anxious) about having more high blood sugars, but I know I have to do something. Over the past few months I have started to feel like I occasionally notice some cognitive impairment. It’s slight, and could easily be regular tiredness, stress, too much multitasking — but it could also be related to too many hypoglycemic episodes.
I like to believe that I have the big picture diabetes stuff under control, and I definitely don’t like to let people know when I’m struggling, but I really haven’t been on top of this one. I’m hoping that I’m on a good path and that getting these lows in hand will lead to fewer rebound highs, more energy, fewer feelings of burnout, and my liver starting to help me out once again when I do have a low.