Numbers falling down

Halfway through February I went onto a low-carb diet to improve my numbers to a level whereby they could almost be considered to be normalised.

So far it's working well. I look at my blood glucose meter and it gives the following averages:

Last 30 days: 6.1
Last 14 days: 5.8
Last 7 days: 5.6

Averages aren't the best way to show control as I have a tendency to test more when too high or too low so it can distort the results a bit, however it still gives a general idea.

To find my averages under 6.0 since going on the low-carb diet is really encouraging. I'm giving myself a congratulatory pat on the back because to get to this from the woeful results only two months ago is really great.

I feel a lot better than I did in those 'dark ages' when I didn't really know quite where my levels were at throughout each day. My head certainly feels a good deal less stressed.

Here are the full figures

	0	2	4	6	8	10	12	14	16	18	20	22
01		15.6							6.7
02	4.2
03			4.4							7	3.4
04	7.4							7.2				8.6
05					7		7.9		8.6
06	9.6				6.8	9				4.6
07	6.8					2.8
08		7.6					5.4				3
09	6.6										2.8
10	5.8									7.4	4.1	6.2
11					4.8	7.9	4.7	5.2		7		8.5
12					4.7		8.4	4.3		5.5	3.2
13	9.8		4.1	5.3			8.3	5.3	10.8			6.6
14							11.6	6.9	6.6		9.1	8.9
15		6.9			3.4		5.8	3.5	3.7		4.6
16	4.1						7.3			8.9	7	9.1
17	9.4	8.1			3.8		3.7			6.6		4
18	2.7				7.4		8.4	5.7
19	4.7				6.2		4.6			5.8
20	4.6				2.8		6.2				6.1
21	4.6					2.9				8.3		9.1
22		10.2					5.1	5.6		6.1		12.2
23					3.2		7.7	3	6.4
24					3.1		5.1			5.1
25	4.3				3		4.6	2.6		6.1
26	7.5				8.9		5.4			6.4
27	5.9				2.7		6.8			6.6
28								3.7				13.9

Analyse this

This is venturing into geeky territory but it's good stuff for knowing what's happening in me when I eat.

The idea is that when I eat and take my insulin shot the insulin tries to get the energy into the cells (or liver or somewhere) and out of the blood stream at the same rate as the sugar is entering your blood during digestion.

It works something like this

1. I inject insulin
2. I eat more or less straight after
3. The sugar starts to be broken down and begins to be absorbed into the blood
4. The insulin starts to be absorbed into the bloodstream
5. The insulin works to get the sugar from my blood into my cells

In an ideal world the insulin would be acting on the sugar in my blood at the same rate as the sugar is entering my blood, but this is rare.

Typically with meals involving a fair amount of carbohydrate, the sugar will get to your blood at a faster rate than the insulin can get the sugar into your cells.

If the digestion rate is faster than the insulin absorption rate, like this, my blood sugar will start to rise. The further my sugar levels rise, the less ideal the balance.

Of course, different foods have different sugar absorption rates. High GI foods get absorbed quickly, low GI foods are absorbed more slowly. GI means glycaemic index which essenially means how quickly the sugar in different foods are absorbed into the blood.

So how can you measure the balance?
To measure whether your insulin is reacting fast enough to cope with the sugar absorption, you can test yourself after meals. Two hours after meals is thought to be the point at which your blood sugar levels are likely to be at their highest after eating.

So it makes sense to take a sugar reading just before eating and a reading or two 1 to 3 hours after eating.

So how did I do?
Here's my sugar level readings from the last few days

	0	2	4	6	8	10	12	14	16	18	20	22
10	5.8									7.4	4.1	6.2
11					4.8	7.9	4.7	5.2		7		8.5
12					4.7		8.4	4.3		5.5	3.2

Evening meal analysis
On the 10th I had pasta for evening meal with half a glass of orange juice.

7.4 at 18:11 just before eating
4.1 at 20:10
2.4 at 21:16 (I ate sweets to get levels back up to a normal level)
6.2 at 23:37

This shows two things.

I probably took too much insulin for my evening meal (as my levels went significantly below 4.0)
The pasta at this time of day isn't causing my sugar levels to jump up - a very healthy situation

Breakfast analysis
On the 11th I had mini-shredded wheats for breakfast with skimmed milk

4.8 at 09:13 just before eating
7.9 at 10:33
4.7 at 12:45

This shows I'm taking the right insulin for breakfast.
It also shows that my breakfast is being absorbed a bit quicker than my insulin can keep up with.

Why are the levels going up between meals?
My shredded wheats are probably not too dissimilar in GI to the pasta I have at tea time. I would expect the sugar in the shredded wheats to be absorbed about as quickly as the pasta.

However, I think there is another reason that is causing the raised sugar levels. It's a phenomen which I've seen referred to as 'the dawn phenomenon' in Dr Bernstein's 'Diabetes Solution' book. The idea is that in the morning hours, just after one wakes up and for about 2 to 3 hours after, the insulin is less effective at lowering blood sugar levels. The insulin is slightly impaired.

This would offer a good explanation for why my sugar levels are raising a few points up to a couple of hours after eating breakfast.

What can you do?
As far as I can think tonight, there are two main options available

• try to eat less carbohydrate (sugar) by choosing a lower-carb breakfast
• try to eat a lower GI breakfast

I don't really want to change my breakfast as it is already fairly low GI, quick and easy to make, and a cheap option too.

However, I may be able to lower the GI of the breakfast if I switch to using full fat milk instead of skimmed milk.

I am told that having fat with a meal can slow down the absorption of the sugar, so it's worth a go. I'll give it a go next week and see if it helps at all.

Where from here?
I'll spare the lunch analysis but it is along similar lines.

So now I've got an idea of how good these particular meals get absorbed and how well the insulin works against them.

If I were to analyse each relatively regular meal I have I would be in a very good position to control my levels really well. That's the ultimate goal.

As a bonus, the results I've been getting this week have been really good.

A month later, has it worked?

About a month after choosing to post my results on a blog, has it actually worked?

I think so. The results have definitely better and I still feel committed to keep going.

In the past I've 'endeavoured' to record my results and get better permanently but then it's all gone to pot very early on.

When it goes wrong: the usual routine

1. The first week sees a marked improvement
2. The second week I start to get results which don't make sense to me
3. This makes me feel dis-spirited
4. My efforts to keep up the monitoring soon fall apart
5. Within three weeks time I'm back to old habits of not recording and not really caring

It's a pretty sorry tale.

What's different now?
This time I've recognised that things do get out of hand in the second week. I've taken that as given and kept up the work and it's helping.

Now I'm starting to see patterns in the numbers I'm getting. This is good and allows me to see if I'm making regular miscalculations.

Myt highest figure was a 16 which was down to eating a large portion of chips. I should know better for next time.

Now that I've got some basic control, it frees up my mind to concentrate on the details and iron out the creases, like occasional high readings. Previously, there'd be so much to take in I wouldn't even get started.

Regular sleep times
Certainly a big help has been the better sleeping habits I've stuck to this month.

I'm really pleased to see a huge collumn of black in the early hours of the morning. December had readings scattered between 2 and 6 in the morning, in January it became an untouched area.

This is very useful as the more regular your days are, the easier it becomes to manage the diabetes.

Easy on my mind
A useful side effect of my better sleep and diabetes control has been that I feel more awake in the day.

I also think that writing things down in this here blog has made things easier on my mind. It's like taking the problems and offloading them into the internet.

I don't feel I need to spend so much time worrying about things. If I need to think about things I can always revisit them here. It feels like I've freed up space in my mind to think about other things. My brain feels like it can take on more things now than it could just a month previously. It feels like there's less background stress.

blood sugar part III

Here are the results since the last time I updated this

	0	2	4	6	8	10	12	14	16	18	20	22
09		7.7	2.8							5.9		5.2
10							4.9
11	7.8						3.8					8.9
12									5.9
13									3.3
14							5.9				4.5
15					3.8						6.1
16					8.1	5.1					3.5	3.6
17	9.7						4.9

I couldn't have predicted how much better the results would be.

It goes to show what a difference a bit of focus can make.

Knowing that I didn't want to post set of shabby results, I started to do the things I should have been doing for ages:
putting insulin injections in either just before or just after eating - previously I'd sometimes put them in an hour or so after eating, which causes trouble later
thinking about how much carbohydrate is in things - I've had success with this before but it's always been short lived
doing regular blood tests - this used to be a strong point when I was younger but I became more erratic more recently, sometimes going days without a test during times I was perhaps in most need of a test

All I've got to do now is keep doing this and watch I don't slip. Not always the easiest thing to do but I'll see how I get on at the end of the month.

blood sugar

One of the things I really struggle with is keeping my blood sugar levels from going all over the place. I have way too many things about myself I want to fix. My sleep's all over the place as well and I think the sleep and sugar levels are related to an extent. Control one and it should be easier to control the other, however, they seem to be either working against eachother or working together against me (yes, this second statement is ludicrous).

I thought about why I didn't seem to have any control of the blood sugar levels and came to the conclusion that it was because I didn't have anyone to essentially appraise the results. There was only myself and frankly I've been awful at self-appraising my results.

Admittedly, I go to a diabetes clinic every 6 months or so but it's too long a time I find to help me sort myself out. I feel really bad about letting myself slip, about a week either side of the appointment but the rest of the time I'm floundering without giving my sugar levels very much thought at all.

I went to a clinic earlier yesterday and for the first time in well over a decade I showed my doctor an honest set of results. Previously I'd either made the results up because I was too disorganised to write them down each time (and that old blood glucose monitoring meters I had before didn't say when the test had been done - luckily my present one does) or I'd changed the values of the worst results so that I looked like I was doing better.

I don't know why it took well over a decade to realise that lying to myself was a bad idea.

Possible reasons are being too proud to admit I was doing badly and perhaps a certain amount of arrogance in thinking I would be able to rectify problems at the drop of a hat.

So one reason for starting this whole blog thing was an attempt to take some accountability for my well being. By posting the numbers I get, my friends (and anyone else who might care in future) can let me know how I'm doing, offer encouragement and if necessary, help me to deal with problems.

So without further ado here are my (admittedly terrible) figures for December 2008

	0	2	4	6	8	10	12	14	16	18	20	22
01	3.2						3.3
02										12.3
03							6.1			3.1
04
05	8.6					2.4
06		7.2								16.4
07			20.3				4.2			16.9		4.6
08									5.1
09	8.6
10
11		6.3
12					13.3				21.4
13
14												6.4
15
16												14.2
17
18								5
19					18.2	13.8
20									7.1		8.6
21										8.9
22							8.3
23
24										19.3	14.3	13.1
25					10.4		3.8				12.8
26			18.1							3.3
27			9.6						5.4
28												5.1
29				11.7
30	11.5							6.5
31