Finding the chase and cutting to it

Readers of my blog know that I am a professional in the IT industry but some of the tools and techniques that we use in that industry are things I have been doing as a type 1 diabetic since I was 8.

One of the key things is reviewing a new situation and working out what worked and what did not so that the next time I encounter that situation,  I can get my insulin as close to normal as possible.

Tell me all about it

I talk about how stress impacts my blood sugar and therefore my insulin requirements because my body cannot do that itself.  Longer term stress is not sustainable in my body – so even if my mind is still stress, the normal flight and fright response fails after a period.  Over the past few months, I have been in a very stessful situation that peaked since Christmas.  Because I had other distractions, the impact on my blood sugar had been very small apart from a few notable days , after Christmas. those distractions disappeared and all I have been left to focus on is my current predicament.

It’s caused me to lose weight and my late evening blood sugars have been very high (typical of stress – I had a similar pattern for my GCSEs, A levels and finals.  Not so much for my apprenticeship because that was only in 9 week blocks so there wasn’t time for a sustained stress event).

I modified my basals to cope and basically waited for the climax – in my case a couple of two hour meetings: the last one yesterday.  Because of the measurements I had from the last one and my distress while discussing certain things (in itself a stress event), I used the measurements and planned to get my blood sugar as low as possible: with stress, the release of the stress hormones is not guaranteed, especially over such a prolonged period, but that was the model I had in mind.

The day itself was very different – I had a dramatic drop in blood sugar levels the day before and actually entered the day on a reduced basal rate.

Given the image below, you can see where I was when I woke at 06:10.

Doesn’t look so bad

it really doesn’t, does, it?  Given I had some time on my hands before the meeting at 2pm, I could actually focus on what was happening.

OKAYYYY

By that, I mean I could look at my capillary blood results and compare them.  I’ve known for some time that capillary blood and interstitial are not exact matches, the leaching of sugar from the blood to surrounding tissues and interstitial fluid takes my body between 10 and 17 minutes.  I’ve known it’s not great at measuring highs – it’s out and becomes increasingly out the higher I am.  If my blood sugar is above 6.5mmol/l, that’s a pretty linear scale in the normal course of things but of course, this is an exceptional event.

Let’s do that comparison now, in the graph, the capillary blood testing are the purple blobs:

Time	Interstitial glucose reading	Capillary blood glucose
12:39	13.7
12:52	13.2	20.3
13:09	10.4	17.2
13:17	9.1	14.5
14:06	6.1
14:36	4.3
14:43	4.7	9.8
14:57	6.4	13.9
15:29	7.9	16.5
17:08	4.2
17:19	3.6	2.2
17:36	2.7	3.6
17:04	Not scanned	4.1
18:31	5.7	6.8
19:00	4.5
20:05	4.9
20:14	5.7	10.7
20:33	7.1
22:01	9.4
00:35	4.4

There’s no correlation – that’s not a percentage out, the interstitial sensor did not pick any of this up!

It doesn’t look like it, does it?  Unless we look at the lower readings which follow the delayed rule.  The Libre missed the 20.3 completely and the pattern shadowed the high blood sugar but did not reach the same limits.

Abbott report that the sensor is not good at picking up rapidly changing levels precisely and maybe in the case of a severe flight and fight response, that is why the misalignment.  May be the stress hormones themselves stop glucose leaching out or block the sensor like paracetamol/acetaminophen does for older sensors but it explains why I feel so rotten at the moment if my Libre readings are above 7mmol/l!

Learnings?

I haven’t mentioned my learnings.  On finding I was 20+ mmol/l, although I’d already given 4iu by my pump, I gave a bolus of 10iu via injection.  Hence the monitoring: when I got to 9mmol/l, I had a mars bar and taking the Libre at its word on the drop, had a 21g CHO via glucose gel.  I firmly believe the gel was a mistake – I felt low, the graph suggested I was dropping but actually I was still kicking out at least cortisol.

I should have waited until 15:30 when the meeting was called closed and had it then to cover the drop from the cortisol.  I only had the 15iu bolus between 13:01 in my system which would have been completely out by 17:01 to bring down my glucose so the drop between 16:58 and 17:10 was purely the stress hormones being stopped.

I call this the cliff face drop and I only get it with prolonged stress!

My biggest concern is the cause of the stress.  I always say I don’t sweat the little things, people being rude is meaningless and up to a point, some of the stupid things people say about my type 1 are down the ignorance and I often try to educate those people about the situation us type 1s are in.

But I normally can talk about these things as funny anecdotes.  I’m so stressed at the moment, the frustrated is coming out as anger and my normal coping mechanisms are not working.

I’m thinking some short therapy is the next logical step?

Or is this a quantum thing, does opening the box, change the state of Schrödinger’s cat?

That’s a difficult question to answer.  I really don’t know.