More Set Change Stuff – Or Is It…?

QuicksetI’m still fighting my set changes. This is something that has been a thorn in my side for a long time, and it’s been hard for me to pound out all the variables and get some steady consistent testing figured out.

This is another good example of that.

I woke up around 1:50am last night (this morning?) and did a test. Didn’t feel anything weird, but was up to use the bathroom and thought I should just do a test to see where I was at. I was 191. I took a correction bolus of 2.6 units figuring I’d wake up with a nice, close to target blood sugar.

But when I woke up I was 211! I can’t think of any real good reason for me to be high. Where would I be if I hadn’t taken that correction bolus last night?!

It was a scheduled set change day. I’m trying a combination of suggestions from kind commenter’s here. I’ve left the old site in (to avoid any leakage), and took a bit more extra insulin on the new set than I should have needed. In fact I took a whopping 4.3 extra units right when I did the set change.

Then I had breakfast, which was the following:

– 1 slice whole wheat toast with a bit of butter and jelly (17g & 13g)
– 8oz skim milk (13g)
– 1 serving sugar free nestle quick chocolate powder (7g)

As Wil & Kevin have suggested previously, this is still pretty high GI (glycemic index) stuff, which probably has a lot to do with it – so that’s another area that I need to nail down a bit and do some testing.

About 1 hour after all this, my blood sugar was at 399. Off the frickin’ charts! Damn. Now I’m down to 287, so it is coming down (so again, I’m confident I’m not having set problems). But boy am I sleepy!

Looking at this, I’m thinking that there may have been something other than just a set change throwing a monkey wrench into the mix today. Especially since I woke up higher this morning than I thought I would – even after a correction. Maybe I had some air bubbles or something (I was near the end of my cartridge) – but I’ve never had problems with that before (or maybe I just never paid close enough attention?).

I kind of feel like I’ve been half assing the testing of strategies around set changes. As I’ve talked about before, it seems that I have trouble keeping track and paying attention to things every third day when I change the set.

Yes, I’ve tried a few different ideas – but have I really eliminated the variables around those? Did I eat the exact same breakfast those days? Maybe it was something as small as not having the same bread that morning as I did the previous set change? I just don’t feel confident that I’m setting up a stable test environment. I think there are still a lot more variables than there should be.

I do think that I need to do something different for my breakfast – but just didn’t plan for it very good this morning. The breakfast I had is a pretty habitual breakfast, and seems to be something I fall back on when I don’t have anything better planned.

There was also a suggestion from Jay to take my breakfast bolus on my old set prior to changing, followed by an extra unit bolus on the new set after changing.

I think that I started taking my bolus after changing sets based on another suggestion from a diabetes educator I spoke to a while back. I think her philosophy was to give the new site a nice big breakfast bolus to give it a little “kick start” on the absorption.

Again, it really seems like a YMMV thing (Your Mileage May Vary), and I’ll have to try it both ways and see what works best for me. It seems like there are many different approaches on similar problems, and a lot like the exercise adjustments, it’s trial and error until you find something that works well for you.

I also have to pay attention to whether I’ve played basketball the night before, because I feel when I play in the evenings that it does have an effect on my mornings much different than when I play in the afternoons.

With all this going on, I’m thinking about keeping a set change journal, where I can detail the different things I try, and the surrounding circumstances.

I would like to stress what I perceive to be a very difficult thing – to pay particular attention every third day. My brain just doesn’t work like that. If it was every day, or even every other day, I think it would be easier. This whole every third day thing throws me for a loop! So, I’m hoping keeping the set change journal will help ease that pain. I’ve been trying to keep good track in my logbook, but I find the “Comments:” section too small – I’ve got more to say then space to say it!

So, the game plan is this:

– verify my basal rates.
– verify that this same breakfast doesn’t spike me so high on non-set change days.
– start a set change journal.
– list the ideas or possible solutions – things to try.
– eliminate variables as best as possible (this is key).
– look at lower carb & lower GI breakfasts.
– diligently record things tried, variables in the mix, and results.
– trial and error my way through until I find something that works for me.

For right now, I’m going to sit here and close my eyes for a precious few seconds. Maybe I’ll be lucky enough to avoid any interruptions for a bit…

***edit*** – 7 hours after my set change I was back down to 86. So again, I know it’s not a problem with the set. It took a solid 5 hours before I got down under 200, and the rest of the day is sailing along just fine.

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Scott K. Johnson

Patient voice, speaker, writer, advocate, and Senior Community Manager at Blue Circle Health. Living life with diabetes and telling my story. All opinions expressed are my own and do not necessarily represent my employer’s position. Read more…

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