Today’s Numbers 8/14/12

This was one of my best days ever.  While not perfect it was very close with only a 42 mgdl variance.  Everything was just a tick low and it ended with a mild hypo both subjective (symptoms) and objective (blood glucose < than 60) .  Here’s how it went down

4:49 a.m. 65mg/dl / 21 nph +1asp. — 5:00 a.m. 15 grams carb — 7:31 92 mg/dl — 8:24 90 mg/dl 12:02 p.m. 92 mg/dl / 1/2 asp. — 3:37 p.m. 100 mg/dl 1/2 hour walking — 4:50 p.m. 79 mg/dl 10nph + 1/2 asp. 15 grams carb. — 10:55 58 mg/dl 8 grams carb.

At this point I feel a mea culpa is in order.  I had resisted switching from Regular insulin to Aspart despite the recommendations of a number of Dr.’s over the past year and continue to resist ongoing attempts to change from NPH to Lantus.  This is for several reasons which I will go to in further detail in other posts.  The most salient reason being that the other times I switched from NPH as a basal to something different without question or without really understanding the basal / bolus concept, it didn’t really work that well or more recently when I switched from NPH as a basal to 70/30 N/R as a basal it was an unmitigated fucking disaster.  (Why the fuck would anyone prescribe 70/30 NPH/R, particularly without imparting a crystal clear understanding of the relationship between carbohydrate intake and blood glucose levels?  That’s like like chaining someone in a roller coaster, setting it in motion then walking away.  Whatever happened to do no harm?)

Furthermore I should note that every single Dr. I have worked with at the Phoenix VA tried their best dissuade me from continuing with 70/30 and thereby getting me off that roller coaster.  However, since their alternative was Lantus and Novolog and I didn’t know how they worked, or what the side effects were, or really anything about either product the assertion that Novolog magically appeared and the poof was gone and that Lantus has no peak just sounded like a bullshit sales pitch to me.

I wasn’t going to fall for a sales pitch again and I knew in the back of my mind by the time I spoke with my new PC Physician that I could just break up the morning dose of 70/30 and reconfigure it into a more reasonable ratio by mixing NPH with R myself.  Therefore, I blew her off just like I’ve blown off every other Doc. that’s tried to persuade me to change.  So Dr. Patel, if you ever read this, don’t take anything I say or do personally because from now on I’ve pledged to myself to come to my own conclusions based on the facts and not based on bald assertions however genuinely expert those bald assertions may be.

Just to be fair to myself this did work to an extent ultimately resulting in an A1C value of 6.2%.  Much less deadly than the 9.2% A1C I registered in December using 70/30 and resulting in a configuration quite similar to the one I am using now, essentially a 97/3 ratio of NPH to Novolog.

So I decided after my last encounter with endocrinology wherein I discovered my new and improved A1C that I would try stupid Novolog.  It couldn’t hurt because I could just pitch the shit it in the trash can if Novolog didn’t work as well as Regular and since I was using so little short or rapid acting insulin the cost differential was no longer a significant factor.  As an added bonus what the VA pharmacy calls a three month supply is close to a three year supply.  I can continue to manage my diabetes free from state coersion.  (Novolog and Lantus require a prescription Regular Insulin and NPH do not).

So here’s the actual Mea Culpa directed specifically to Dr. Jon Cartsonis M.D. Maricopa County Department of Health, Dr. Lisa Kilgore-Christensen PA-C Phoenix VA Regional, Dr. Susan Rogers PA-C Phoenix VA Regional Endocrinology Section, Dr. S Mitchell Harman M.D. PhD Chief, Endicronology Section Phoenix VA Regional, and last but not least Dr. Harshana Patel M.D. VA Regional Thunderbird Clinic:

Remember all that bullshit you guys were telling me?  Ya, know bullshit like “it works more like a normal body’s response would” and “it has a shorter onset, faster peak, shorter duration.”  You guys probably remember and if you don’t well, I’m sure you spout that bullshit all the time to lots of people.  But, it turns out that all that bullshit wasn’t really bullshit.

If the “bullshit” were true one would expect a less dramatic spike. Normally 15 grams of carbohydrate could cause a spike in my blood sugar of 45 to 75 mgdl but closer to 75mgdl in the morning without a bolus dose.

If the “bullshit” were true one would expect a leveling off in blood sugar levels after the spike as the NPH  begins to peak and the Novolog begins to crash then a steady but slow increase in blood glucose levels in the afternoon as the noontime bolus ends and the morning basal dose begins to wind down.  Which if you look at the numbers is exactly what happened today.

4:49 a.m. 65mg/dl / 21 nph +1asp. — 5:00 a.m. 15 grams carb — 7:31 92 mg/dl — 8:24 90 mg/dl 12:02 p.m. 92 mg/dl / 1/2 asp. — 3:37 p.m. 100 mg/dl 1/2 hour walking — 4:50 p.m. 79 mg/dl 10nph + 1/2 asp. 15 grams carb. — 10:55 58 mg/dl 8 grams carb.

So I have to say, my mistake or in Latin, mea culpa.


About roguediabetic

I am a Type 1 diabetic diagnosed in August of 93 while serving in the United States Marine Corps. After over eighteen years of poor blood sugar control and early complications including a left big toe amputation I finally figured out how to control my blood sugar. What I finally learned about blood sugar control ultimately had little to do with what I was told.
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