Ask Dana: Leveling the Roller Coaster
by IDS Director of Technology and Applied Research, Dana Roseman
QUESTION
Dear Dana,
I feel like I eat the same foods and take my insulin at the same time every day but my blood sugars are never the same. I can be perfectly in range one day and the next day I'm on a roller coaster for no apparent reason. I've been living with T1D for 15 years, but I still get so confused. What am I doing wrong or is diabetes just like this?
Rachel Meyers
Austin, Texas
ANSWER
Dear Rachel,
You are not alone in your T1D frustration. This is one of the most common things I hear from people living with T1D, regardless of how many years they have been diagnosed.
As a reminder, or maybe as new information, some variability in your blood sugars is completely normal.
Even people without diabetes experience glucose variability throughout the day. Someone without diabetes will have a change in blood sugars from a meal, anywhere from 30–50 mg/dl or higher.
People without diabetes are rarely wearing a continuous glucose monitor (CGM) so they don't see this meal impact. Living with T1D makes these rises more variable and more extreme but some variability can be expected even with the same meal and dose.
Along with this expected variability, blood glucose levels are impacted by so many environmental and biological factors. When trying to decrease the variability of blood sugars, even when focusing on the variables you can control, there are plenty of factors that are outside of your control.
For example, a single night of poor sleep can increase your insulin resistance the following day. Even low-level stress can trigger hormones that tell your liver to release stored glucose. And, of course, hormonal shifts in both growing children and teens and many women can change insulin needs dramatically. Many other factors, including infection or illness, can strongly impact your blood sugars outside of mealtimes.
With so many factors impacting your BGs, it is easy to get frustrated. The first step is to focus on things that are within your control that can make a meaningful difference. To start, management of your insulin and its delivery is key. Whether this is rotating your injection sites or managing pump sites for the most predictable insulin absorption can help tremendously.
You might also consider taking advantage of new technology available to people living with T1D to help manage blood glucose predictability. But it cannot be overstated that pre-bolusing or adjusting insulin timing for meals can often be the largest change with the biggest payoff for many people.
Think about the type of meals that you are eating and how sharply your blood glucose will rise. If it's a fast-acting carbohydrate, then it is helpful to take your insulin sometimes far in advance of eating that food. If it's a high-fat food, then it is helpful to take insulin when you eat, as there will be a delayed rise in your blood sugars.
While everyone's diabetes management is unique, there are things you can control. It is often helpful to begin tracking habits to detect patterns and create strategies for common meals and common activities. After identifying patterns, it is helpful to know when variability is higher than usual and perhaps there is something else going on with your diabetes management. An unusual spike can be normal. A week of consistently higher or lower numbers is a shift worth investigating. These changes can often highlight a dosage that needs adjustment or a shift in your insulin sensitivity that is worth further thought.
Perfection is not the goal, or even biologically attainable. Yet, it certainly would be nice to feel more confident and comfortable with your diabetes management.
If you want help identifying your personal patterns and working on your personal variability, our team at IDS specializes in exactly that, and we can help.
