Finding the chase and cutting to it

I’m type 1 diabetic: that means my natural state is hyperglycemia or having blood sugar above 7mmol/l when fasting above 11mmol/l two hours after eating.

For days when nothing else is happening, I generally manage to keep to those limits, which gives me a long term measure of glycated hemoglobin of between 5.2% and 6.5%.

But that doesn’t mean that task is easy. My pump is capable of doing “hybrid closed loop” but, in our house, we call it stupid because I generally outperform it in terms of keeping between 3.9mmol/l and 11mmol/l. Hence my glycated hemoglobin levels.

I have some tricks in doing that, but like a non-diabetic individual, it doesn’t give me perfection, just tolerable levels.

Let’s take today, a lovely sunny bank holiday in the UK. When I went to bed, my blood glucose reading (BGR) was 5.7mmol/l – pretty good. By 3:20am it was 10.1mmol/l – third night on a row I’d been woken by a high alert during the night. I started a higher rate of background insulin (twice my normal basal rate), aiming to bring my down to 4mmo/l and it didn’t work, a coughing fit and alarm from my pump demonstrated that I had climbed to 13.8mmol/l by 4:58am when I gave another bolus (5iu which should reduce my glucose levels by 12.5mmol/l) and lengthened the increased basal rate for another 8 hours.

By 7:20am I was 11.2mmol/l (another alarm had been raised) and I gave a further 5iu. I have just over 9iu floating about my system from the boluses, at this point, plus the extra from my basal increases. But this time, things seem to be working, and I start to drop by 7:35am. By 8:15am. I am 6.0mmol/l and I get out of bed. I need breakfast soon, or the hypo is going to be a doozy. I have 85g of carbohydrate (yogurt and granola, orange juice, banana (useful for the potassium), and a wispa chocolate bar) and still drop to 2.9mmol/l by 8:45am, but I hold my nerve and shut off my basal. By 9:00am, my blood sugar is 4.3mmol/l, I still have 5iu of insulin working (plus the extra basal), and I take it easy. A bath sounds real good, but my beloved is enjoying a bath, so I just take it easy downstairs. With my basal back to normal.

Was it an infection, with my body hunting a hypo to fight the fever? I definitely have a blocked nose and sore throat?

Who knows, let’s see how today plays out! Definitely having that bath later, though…

Why not turn on the automated loop at 3am?

Because it won’t bring me down quickly enough, it will bolus, but only when basal rate increases aren’t working. It might have prevented the hypo at 8:45am but I actually wonder if being hypo is actually what my body is seeking – it is how non-diabetics generate a fever.

Because I treated early enough, the hypo was relatively short. But even so, the raised body temperature is useful for fighting infections, and I do wonder if that’s why my previous efforts hadn’t worked. If you body is seeking a hypo and you’re only giving enough insulin to bring you down safely, what is going to be happening?

I don’t do that very often – the first dose is always conservative, unless I am very high – and you can’t do that if you are travelling. But it means I am not generally above 10mmol/l outside of meals very often at all…