Thursday, January 13, 2011

62 Before A Meal - What's A Girl To Do?

You and me both, Magic 8-Ball!

The last few days I’ve been waking up low. Not super low, but low nonetheless.

Yesterday my pre breakfast blood sugar was 62, and this morning I woke up with a 65 blood sugar.

Sidebar: I’m slowly working my way off an extended temporary basal rate due to my ongoing sinus issues, so before you say: "Kelly, just cut back on your early morning basal rate,” it’s not so easy. When I cut back from my original Temporary Basal Rate of 1.4 units on Sunday afternoon to 1.3 units. I woke up on Monday morning with a 240 blood sugar. I decided to stick it out until Tuesday in case it was a fluke, but Tuesday’s Breakfast blood sugar was 222. So I increased my temporary basal rate to 1.35 units, and it seemed to be working quite nicely.

Until I woke up yesterday morning and felt low the minute I opened my eyes. Magic 8-Ball in the form of my meter confirmed my suspicion, and flashed the number 62.

No breakfast bolus for me! I had my coffee, 1 slice of Ezekiel toast w/peanut butter & ¼ of a small banana, & a ½ a glass of vanilla soy milk and went I with my morning.

And I felt great. Until I took my blood sugar at 10:30 a.m. and was rocking a blood sugar of 290 - And I was pissed! And not just at the number, but with my self! I knew better! I knew I should have been monitoring more closely, but I had a heavy workload and for one stupid reason or another, the morning slipped away from me and I neglected to test.

I gave myself a correction bolus, and I have to say, for the rest of the day my numbers were perfect. Until this morning, when I woke up with a blood sugar of 65.

Once again, no breakfast bolus for me! I had my coffee, a pear, a ½ a glass of vanilla soymilk and some cheddar cheese. And now, with my meter & test strips next to my laptop, I’ll be monitoring my numbers every hour until lunch.

The whole, low right before a meal & mixed in with a temporary bolus thing does not make Kelly a happy camper!

Oh, Magic 8-Ball, if only you worked in real life! Thank God I have the D-O-C!

How the heck do you guys handle a right before a meal low blood sugar combined with a Temporary Bolus Rate balancing act?


Unknown said...

BUMMER...especially on the 290. I appreciate you sharing this though. Sometimes I feel like I am missing something with Joe's care...He can be a bit all over the place due to his not routine activity level etc...and, not to mention, he is seven.

Anyway, if he was 65 to 100...I would usually let him eat and then program the pump to give his bolus extended over a half hour. If he was 65-80, I would not start the bolus until he was about 10 minutes or so into his meal (does that make sense?). This has worked well for us for now, but who knows ... "d" is always changing the rules and then not following them. LOL

Jacquie said...

I usually eat, and then hold off on the bolus until I feel normal.

Then, I bolus for whatever I'd eaten.

Interesting question, though. I don't know if there's an official recommended procedure for this situation. I just kind of figured it out on my own, I guess.

Kim said...

This scenario happens to me often too, and for me, here's what works: I don't treat the low, wait an hour (dawn phenomenon takes care of that 65 right quick!), then eat breakfast and bolus normally. It's hard to not treat that low when I wake up, but if my will power lets me, it all turns out pretty well.

Hope you find something that works for you!

Allison Blass said...

I always separate out the low from what I'm eating. For instance, this morning, I woke up at 66 mg/dl. I had a juice box, and then oatmeal, and when I was back to normal, I bolused for the oatmeal. Now I'm 182 mg/dl, but I still have 2.8 units of insulin on board, so I know I could still be coming down from that.

I rarely treat a low with a meal, even if it's exactly the carbs I need. It's too complicated, and I'd usually end up over treating. Occasionally, if I'm low and I'm just about to eat a decent meal, then I'll bolus for half of what I ate, so I use some of the food to bring me up. But I find anything other than juice is too unpredictable to work with when it comes to when and how much it will bring me up.

Sarah said...

I've been dealing with this one a lot lately, too. At pre-brekkie, and pre-lunch and pre-dinner, too. Oh, and pre-regularly-scheduled snacks. Totally annoying. And I've done exactly what you did, too.

I've been v. frustrated with treating a low pre-meal and then eating/bolusing and going WAY high, or treating the low and then waiting/starving for 1+ hours after to check again and then eat. Good grief! I don't have time for that.

But the last time this happened (yesterday), I tried not treating the #bgnow 57, eating what I was going to eat, and checking about 45 minutes later. I was about 120, and just bolused for the carbs I ate. An hour later, I was in the 110's, and my day went on pretty well.

Of course, who knows if that strategy will work today--or again--or for you--but I offer it anyway as something to consider. I was thrilled that at least once, something kind of worked. >;)

Penny said...

I'm not sure I am doing this right, but it works, so who cares if I'm doing it right, the girl ends up with great numbers. Maybe I just cannot express what I do, but it looks like this:
G wakes up low-ish - anything from 70 down to 60. (She's never woken up lower than 60 though - and now I am knocking on wood!)
I see what she wants for breakfast, then I subtract what I would use to bring her up from the low, from her carb count. So say she wants 50 grams of carb for breakfast. I would only bolus her for 35. Somehow my rule of 15 works for G.
Now, don't any me anything scientific or WHY it works, I just know it does.
I'm not sure if this even helps, but it sounds like you are always on top of things Kel - I learn so much from you!

Fiona said...

In my case it depends on the severity of the low. If it's a "close" low in the 60s, I just bolus like normal. If it's something < 60, I use Penny's method of subtracting a portion of the carbs from the total to get me back up.

Lora said...

I usually let Justin start eating first and then bolus him. If he is really low... I will also back aff the bolus a little.

Auntly H said...

My CDE recommended that I treat the low (15g of quick carbs), eat the meal, then bolus for the meal (do not include the anti-low carbs). Waiting til after eating to bolus allows the treatment to work, but keeps the BG from soaring. Seems to work pretty well, or as well as anything D-related these days.

LaLa said...

So interesting to read all of the comments on this one. Hmmm . . .

I'm a little worried about what people will think about what we do now but it works for Nate.

If Nate is low before a meal >60 I would bolus normally and feed him his regularly scheduled meal but maybe add some fast acting carbs (still covered). If <60 I would treat with fast acting, make sure he comes up and then bolus for the meal and the fast acting carbs.

The OmniPod has a Reverse Correction Feature that automatically adjusts the bolus for the low.

Nate is super carb sensitive so if I give him 15g of uncovered carbs he would be HIGH.

Good luck, Friend!

Sara said...

I'll echo what everyone else (darn it for late blog reading!) seems to be saying. If I am moderately low before a meal, I will start eating and then bolus for the meal once I start to feel better. Well, at least I'll bolus as long as I don't forget and notice a hour or so later when my numbers are through the roof like I did this morning :(

Alexis Nicole said...

This is a great post I was just discussing this! For J it depends if low 70s I let him eat minus a few grams and delay bolus till mid meal. If 60s or lower we usually give him juice wait till he comes up to atleast 80 and let him eat bolusing again mid meal.

We tried something new other day he was soo hungry and at 64 he ate an apple for low and then was 110 so he could finish waffles and bolus. He liked it cause it was food!

I could be wrong but works for us :)

Unknown said...

I give a juice first thing...because I'll have to fiddle around getting breakfast figured out and she needs to start getting ready for school.

Then I bolus her for everything, including the juice..."add bg" (Animas lingo) to the calculation, and it subtracts the carbs we shouldn't need to cover.

Works like a charm for us :)

Karen said...

I basically do what Penny does. I input my blood sugar and my meal carb count into my pump and let the pump do the fancy math and correct for the low by giving me a smaller bolus because of that low blood sugar. I also bolus right before eating, instead of 20 minutes before like I usually do. That way, I'm coming back up before my insulin starts kicking in.