On Saturday night, I downloaded DexCom Studio (the software used to produce logs and analytics) onto my husband’s computer (I’m a Mac, he’s a PC). I realize this is not the Thursday I said I would be doing, but that’s the deal. So I uploaded my DexCom readings thus far and reviewed the results.
And then I broke down in tears.
Okay, that’s a slight exaggeration. I didn’t actually cry. But I thought about it. There were definitely some expletives though.
As you can imagine, based off my recent post about having an A1C at 7.7%, my blood sugars weren’t going to be fantastic. In fact, they weren’t even particularly good, but there was one area that was a particular travesty: after dinner and through the night. Once I wake up, I’m able to correct, and I stay busy enough at work that I don’t have a lot of highs (although there are some). But then as soon as I’m finished with dinner, I crest up to the 300s and basically stay between 200-300 mg/dl for a good — er, not so good — 9 hours. No wonder my A1C is shit!
Amongst my plans for the A1C domination were some pretty lofty goals. And I have managed to accomplish… one of them? Maybe two? If we’re being nice, that is. Let’s review how I’ve been doing over the past three weeks:
1. Wear My Dexcom CGM
Yes! I actually have been doing this! Woot!
2. Eat carbs only when there is a carb count.
Er… no. I mean, I want to. I would love to. But little life things like Erik’s birthday, my mother-in-law being in town, pizza at work and general “Oops I forgot to bring lunch to work!” moments have made this a little trickier. I totally had the opportunity to have a yummy salad for lunch yesterday when I forgot my lunch at home, but instead I bought a burger and sweet potato fries because… yeah, exactly. There really isn’t a “because” other than “Did I mention there were sweet potato fries?”
And I totally paid the consequences later when the slow-digesting fatty burger sank me to a 72 mg/dl before flying me up to 362 mg/dl four hours later. Sneaky bastard.
3. Exercise only in the morning.
Well I’ve been exercising in the morning when I actually get around to exercising. One thing I found out was that my blood sugars actually go up after a morning run. No bueno.
4. Regularly review my blood sugars.
I finally did this on Saturday when I downloaded my DexCom and realized that yes, I really do suck as much as I think I do in the evening and nighttime hours. And I was able to make the necessary modifications to my basal and bolus ratios as well. For the most part it looks good so far, but I need another day or two of trends before I’ll really know if I’m set (for now).
5. Talk to my “pit crew” more often.
When I realized I was going up after running, I was totally confused and wasn’t sure what to do. Rather than just correct for the highs, I wanted to be proactive! So I talked to Gary about it and he said that immediately after running, I should bolus half my usual correction for the spike that I predicted would happen. That would give me the extra boost to keep my blood sugar stable but without going overboard because of the extra sensitivity from running.
6. Overcome “Carb Denial.”
I’m still struggling mightily with this. I think I just have really crappy carb-counting skills or somehow the food I’m eating is an enormous sugar bomb. I kept thinking I was bolusing enough when I was eating out, but I always ended up 300+, sometimes even landing in the 400s. Blech. I wish overcoming carb denial was easier! I swear I’m not trying to underbolus anymore! I just don’t know what the crap is in this crap!
7. Don’t give up.
Well, I’m still here, aren’t I? Another day, another blood sugar…
thebloodsugarwhisperer.wordpress.com 
Allison! If your BGs go up in the morning when you run, that just means a little blop of insulin will help prevent the spike, it’s purely the result of your liver dumping a little bit of glycogen for fuel. When I used to lift weights first thing in the morning, I would take 1 unit of insulin before heading into the gym in order to prevent a spike. Just my two cents tip! ;)
I like you’re 7th goal there. Don’t give up!
I also have trouble with carb denial. I’ve started bolusing for 15 carbohydrates more than what I’ve guessed at a restaurant and then keep an eye on my trending. Sometimes it’s spot on, other times even with the extra 15, I’ve totally under-bolused.
How high is your high alarm set on your Dexcom? Is it on? Because if you are riding high overnight, the alarms should be waking you up. And lack of sleep is enough motivation for me to take a look at my evening dinner bolus and basal amounts.
Haha! You got me! I don’t always keep the high alert on overnight because I don’t like to be woken up, and I know my husband isn’t so keen on it. I leave it on if I go to bed normal and I want to know if I go up, but if I’m going to be high, I turn it off so it doesn’t repeatedly alarm as I drop. Unfortunately, sometimes I don’t drop all the way and sometimes I’ll drop and then go back up. But at least I have the data letting me know and I can make changes using that info. It’s better than nothing, IMO.
For your meals out, have you thought of doing an extended temp basal to help cover up some of the carb denial? I sometimes do a 135% temp for about 2hrs if I’m in a carb denial situation (like thanksgiving). Another thought is to look up carb counts at the same time you check your blood sugar. You’re already occupied with your meter, so why not add your smart phone to the rotation. check, look up nutrition facts on phone, bolus. Back in the old days before smart phones I used to keep the Calorie King book in my meter bag as a reminder that my health depended on accurate information. I have to say Kudos for getting active. That’s my current struggle. I have exercise denial.