This month was marked by both some whacky blood glucose (BG) readings and successes including two new personal bests in weightlifting, a 185 lb. clean & jerk and 140 lb. snatch. I also had my first episode of symptomatic hypoglycemia in 2016 which I over treated and ended up with a BG of 260 mg/dl. In addition, I had two high morning readings over 200 mg/dl which are quite unusual that I think were related to my changing exercise pattern i.e. having to take 10 days off from weightlifting due to a lacerated thumb. My BG readings during the 10 day reprieve from weightlifting were excellent which made March not so bad in the glycemic control department considering the whacky BG readings. I did daily aerobic exercise (walking and cycling) while my thumb was healing, but the stopping and starting weightlifting and weightlifting in general definitely is not T1D friendly as far as BG is concerned. But I am OK with that since I enjoy weightlifting very much. I am optimist that eventually I will adapt to it and my BG will too. For example, my BG prior to and after my 2.5 hour weightlifting session including the 140 lb. snatch were 106 and 98 mg/dl, respectively on March 31.
Below are my BG reading along with exercise type and time so you can see how the exercise affects my glycemic control.
The table below shows the summary of current and previous BG results along with insulin dose totals.
My total insulin doses increased due to an increase in basal (Lantus) insulin which I thought might help lower my fasting BG and maybe mitigate the increase in BG while weightlifting. This month I increased my protein intake by a half pound of meat at dinner daily to hopefully add some muscle mass over time which is a good thing as one ages, but also might improve my weightlifting results. This did not result in a significant increase in dinner mealtime insulin (Humalog). The average daily mealtime insulin dose at breakfast was 6.2 IU, dinner dose was 2.8 IU (compared to 2.6 IU in February), and the average non-meal correction dose was 1.9 IU. I think the higher breakfast dose (compared to dinner) is related to the dawn phenomenon combined with a relatively lower dinner dose due to the increased insulin sensitivity related to afternoon exercise.
The table below shows the summary of current and previous BG variability results. Some results were improved, some not, compared with the previous month.
The actual daily insulin doses and totals are shown in the graphs below.
My breath ketones since June 2015 are shown below. I remain in continuous nutritional ketosis.
The graphs below show a new metric I conceived of this month. On the x-axis is the breakfast (AM) and dinner (PM) mealtime insulin dose (Humalog) plotted against the change in BG i.e. Pre meal BG minus Post meal BG on the y-axis in mg/dl. Thus positive values represent a reduction in BG and negative values represent an increase in BG after the meal. Also, note that I removed 3 of 31 AM points and 9 of 31 PM points from the graphs where the Post meal BG was not in the range of 51-120 mg/dl. The rationale for this is to eliminate mealtime doses that were “incorrect” so to speak. This way the graph shows both that larger doses of insulin reduce BG more (obvious), but more importantly even when the resulting Post BG was in an acceptable range, that there is a wide variation in the amount of BG reduction for any given dose of insulin. This is the frustrating part of T1D that we just have to live with.
The graph below is exactly the same but shows the non-meal Humalog correction doses that resulted in a Post BG in the range of 51-120 mg/dl. This graph includes 11 of the 15 Humalog correction doses given in March. Again, the main feature is the wide variation in the response to any given dose of insulin.
Also, note the R squared values (correlation coefficients) in the three graphs above. The closer the R squared value is to 1, the better the fit to the linear regression line. In an ideal world the reduction in BG should be related to the dose of insulin given assuming the meal consumed is constant from day to day. I do place a great emphasis on keeping meals constant from day to day in terms of amount of food and macronutrient composition, so I don’t think that explains the wide variation observed. In the case of Humalog correction doses (last graph), there is no meal to confound the results, yet the response is even more varied.
My next blog post will cover prevention and treatment of insulin resistance, hyperinsulinemia, prediabetes, and type 2 diabetes.
Till then ….