Changes

One of the harder things for me about living with diabetes is that my body is not consistent. I don't have the same insulin needs regularly. I don't digest my meals in the same speed or to the same extent twice, even if it's the same damn meal. My hormonal response, and therefore my blood sugar response, to various stressors vary a lot. So first of all, I have to look for patterns in numbers that are not usually very pattern like. And I have to be willing to make adjustments over and over and over and over again. And accept that my hard earned data will be worth less and less as time goes by.

So I find some patterns. I pick the carb ratio that looks like it would have worked best for the previous days. I pick the Lantus dose that looks like it would have worked best if I combine yesterday's insulin sensitivity and tomorrow's activity. I check and see what happened when I tried what, months back.

Things change on a day to day little scale. I have a really hard time answering questions about how much insulin I take. Some days in the past four years I've taken as little as three units of Lantus. On others I've taken as much as forty. Doses that actually were working for me varied from about four units to forty units. That's a huge spread.

And that does a wonderful job of masking the fact that things change for me in diabetes management both on a seasonal scale- I need more insulin in the winter- and simply as time goes by.

Some of the changes are fairly easy to notice. At least once per month I make a note of how much insulin I've been using. My Novolog use has varied from month to month, and it varied more initially, but not all that dramatically. Most months I've use 20-30 units of Novolog per day. The Lantus use has varied a lot more. Two things have clearly made a sharp difference. One was the testosterone dose- my Lantus needs but not much of the Novolog needs changed sharply with changes in testosterone dose- and the other was switching from AM Lantus to PM Lantus, which cut my Lantus needs by about a third (without raising my Novolog needs noticebly).
My current insulin use is lower than it was when I was diagnosed, which I attribute to having been diagnosed as a non-honeymooning teenager.

Some of the changes are harder to notice. One thing I've been wondering about lately is that exercise no longer seems to affect my blood sugar. It certainly doesn't make the dramatic difference in my overnight Lantus needs that it used to, but it also seems that most of the time it doesn't affect my blood sugar at the time. It used to be that taking a brisk walk or running would dramatically lower my blood sugar. Now it seems that it might maybe affect it a little bit. Sometimes. I tested this yesterday- I left at 5 PM with a blood sugar that was pretty stable at 226 on the Dexcom, with no Novolog or food taken in the previous three hours, and walked two and a half miles in snow in thirty five minutes. My blood sugar at that point per Dexcom was 209, which is a drop of 17 mg/dl. Not really impressive. My blood sugar another half hour later of sitting, per Dexcom, was 197. My blood sugar continued to drop during my meeting and was down to 165 two hours later when I decided to walk another two and a half miles, at the end of which walk I was up to 178. So that didn't really answer my question of whether exercise has been affecting my blood sugar, and I intend to be paying more attention to it soon.