How long does it take you to change something?
I recently finished an article for Diabetes Forecast about using CGM data, and one thing that I learned was that patterns can be identified when they happen more days than not over at least two set changes (so that you’re not making changes based on bad absorption or insulin gone awry).
The other day I was dealing with a 300 mg/dl blood sugar with two up arrows and I was at my wits end. I had been dealing with crazier than usual blood sugars and I couldn’t identify the problem. The only time my blood sugar came anywhere close to normal was when I gave a huge injection via syringe, and that just ended up with me crashing to 55 mg/dl at 5 am. Not exactly a pattern I wanted to maintain.
Were all these highs because I wasn’t exercising quite as often? Maybe. Was it the Thin Mint Girl Scout cookies I was eating? Could be. Was it my menstrual cycle? Probably not, I wasn’t due for another two weeks. My pod rotation is pretty good, and I had problems over two pods, so I thought perhaps it was time to change my basal rate or bolus ratio.
After a pho lunch at a Vietnamese restaurant (which was the cause of this particular spike), I almost headed across the street to a coffeehouse with the best chai tea, thinking I should at least hold out until the evening before making any decisions about tossing the pod I was wearing. But I just couldn’t shake the feeling that there was something more to it than just needing some tweaking.
When I got home, I decided to use a fresh bottle of insulin. Within a few hours, my blood sugar was back down to normal.
So all of this made me think about thresholds. How long do you stay miserable before you do something different? On our CGMs, our thresholds warn us that we need to do something. They are super helpful when it comes to making in the moment decisions about whether to drink some juice or shoot up some insulin. But what about other kinds of thresholds? Like, the threshold for how many times you can go over your threshold before doing something to identify and remedy the problem. Whether that’s sticking with the same bolus ratios or basal rates despite knowing that it just isn’t quite cutting it, or maybe it’s a insulin set that’s past due, or an insulin bottle that just needs to be thrown out. Sometimes I find myself suffering with consequences without actually addressing what’s causing them. Why do I wait so long to do something? Why did I wait almost 3 days before deciding to change the bottle? I came precipitously close to living another few hours with dangerously high blood sugars. Why was my threshold so high when it came to making the changes I need?
I often see this when it comes to changing my basal rates. I will give correction bolus after correction bolus like insulin is water and sleep ain’t no thang, when really just a small tweak in the basal is all I need to flat line over night and I can wake up (more or less) completely refreshed. I can’t figure out why my tolerance for nausea, unquenchable thirst and blaring alarms is so high.
What’s your threshold? How long do you wait before you do something?