Sunday, 25 February 2018

Try, try again

Welcome back where this time round in the "Andy quits being a lazy slob and starts to get active" I will be looking ot how things went the second time round with lessons I applied from last time.

So let's do a quick recap on what I learned last time, first off the good:
  • Delaying my morning basal shot until after the run and then doing a stepped reduction in basal based on time seemed to work well.
  • Sugars were nice and stable during the run
Well that was great and to be honest I was thrilled at the time that I didn't hypo but then it all went wrong after that, so here is the bad:
  • Correcting at lunch to bring my sugars down caused a bunch of hypos.
  • My dinner time ratio was clearly a bad idea as that too caused hypos
  • Night time basal was way out caused me to hypo all night, so not a lot of sleep there.
Well nuts, so I got it more wrong than I got it right. Well that's one view though I will choose to see it a different way and basically see the second list as lessons or wonderings.

What needs to change?

Before I started in the morning I had a really good look through the previous weeks data to try and work out what I would do, I will try to run you through it so you can see my thinking though I should put the caveat on the front of this that you should NOT treat this as a guide as your diabetes may vary.
As I said, it kind of went wrong from lunch time so lets look at that.
BG before lunch was 12 and I was eating 24g of carbs. So I went with my normal 1:1 ratio to give me 2.5UI and then I did a "gentle correction" of 2.5UI aiming to bring me down to around 7mmol/l (1UI drops my bloods 2mmol/l approx)

As you can see that dropped me to 5.7 an hour or so later which seems amazing, for me this is too good since it takes more than 2.5 hours for me to return after a meal. Then at around 17:30 I had an early dinner as was hypo. So clearly my lunch ratio was off or maybe I should NOT have corrected.. okay thats 1 point.

So dinner was fairly carb heavy at 100g, normally evening ratio is 2UI:1CP but due to hypo and the guess that I was still dropping (No Libre or CGM so I have a scalal value not a vector... it's a pain!)

A couple hours later I am hypo AGAIN!
Then we see a pattern where I keep throwing carbs on top but pretty much remain hypo the whole time.
I should mention that I do not really follow the standard guidelines of 15g carbs and then more. I calculate what I need to eat and it usually serves me well... usually.

What makes this a little complicated to work out is that I did not return to a "good" number before bed so it is difficult to tell the difference between where the bolus ended and the basal becomes the dominant factor in all of this.

Bolus first

Since this is all one big experiment I will simplify things and make some assumptions to test.
BG between dinner and 21:30 (when I take basal) remains about the same so lets say that I had 120gC and that 17UI kept me stable. That means my ratio was about 1.4UI:1CP for that... so we will take that forward for next time.

Basal baby

To show you the whole story I need to add an extra view of last times overnight BG's and they are not
pretty... I'm fairly sure that my specialist will have a fit tomorrow at my annual review but I'm still here so clearly not totally unsafe!

Between 21:30 and 8am I was up to deal with hypos a few times. Total additional carbs before breakfast was 25g. Going with on the assumption of 1:10 I will say that I needed at least 3 units less than I took. So I took 16 which means 13UI basal. To complicate matters my night time basal is changing anyway (reducing) so that makes it trickier.

Looking back at my logs from last year it seems to be a year on year trend that as the days get lighter my night time basal drops off, recent night time hypos or low morning seem to back this up so I will go with 12UI next time I think.

And again

I've gone on an aweful lot looking at last time however since I cannot see the future I have to look at the past and try to build a predicitive model from previous data (look at me sounding all sciencey) so this is what I intend to try this time around:
  • Back off morning basal and inject after the run since it worked last time
  • Make a judgement call about lunch of either reducing ratio (currently 1UI : 1CP so not sure) or do not correct.
  • Reduce dinner time bolus ratio from 2UI:1 to 1.5UI:1.
  • Reduce evening basal to 12UI
That is a hell of a lot of changes which is going to make it hard to understand what is doing what. Yes that's true however given the number and duration of hypos last time I decided that for safety sake being quite aggressive in backing off my insulin intake is probably the best thing.

How did it all work out then?

To be honest, better that I expected. I had thought that I would spend a lot more time hyper and have

to correct at some point.
Morning started off a little high so I did a small correction since I didn't want to start too high as I figured that would make me feel rubbish.

Levels during the run remained pretty stable again with the small correction I put on (3.5 Units, aiming for about 7mmol) meant I was on target when I finished by 9:48 with 7.8.

Something which did surprise me (even though I didn't notice it last week and it was there) was the rise an hour and a bit afterwards... that's the 17.1 here.
Lunch time came around and I was 12.3, again I was really missing the vector value since I had no idea how fast my sugars were dropping.
Lunch was something yummy (and spicy) from Nandos as we had to go run some errands. I decided that I would dose normally and just ignore the correction since I guessed it was dropping on its own.

Well that sort of worked. By dinner time I have been running high but still in single figures though I think the reduced basal is running low either that or I need more basal and less at lunch... not sure which to go on that one, will have to mull it over some more.

So dinner time and I go with the reduced ratio and add a correction to bring me towards 5 before evening basal.
So basal time and I am running at 4.5 (again... no clue which way it's going) so go with basal of 12UI (last week was 18UI) an almost straight away I hypo to 3.8.
Working on the assumption that this was left over bolus I did a small correction of 5g which should kick me to around 5mmol/l by morning.

It's no morning and I woke up after a nights sleep uninterrupted by hypos and my test came back at 5.7mmol, I will take that as a morning reading any day you care to name thank you.

Where do I stand now?

Well I improved my parkrun time by 7 minutes which sounds amazing, well I guess sit is since I only expected to gain 2-3 but I have now gone from bloody slow to just merely slow now however that's the bonus and I still have more to do.

The key thing I have achieved is that I can now say that with the changes this week I can now do this exercise safely, only 1 hypo this time compared to 6 last time around. I haven't got this dialled in fully by any measure but I am defininitely further forward than I was before and I now have more datapoints to work from.

What next?

I think for now I want to do a few more weeks following this exactly pattern to build up more data. The big reason for making a load of changes compared to last week is that it just was not safe to leave things that way. Now that I am safer I can let things settle a little so I have more information to inform decisions for the further adjustments.

I have ordered up a Libre sensor to give me a little more data even though I know my skin will react but I just need the data. So let's build a bigger dataset to work from and move from there.

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