It started with a mobile Symlin bolus (a symlin dose delivered via pump while driving) on the way home from work.
I was hungry for dinner and I wanted to eat soon after getting home. My wife has been graciously helping me with dinner (one of my trouble spots) and was cooking a portioned serving (a.k.a. “box”) of pasta roni fettuccine alfredo for me. Yes, far from gourmet, but the carb count is clearly labeled. That counts for a lot in my book.
Similar to traditional insulin dosing, Symlin is best delivered a bit before the meal. I’ve been aiming for 15-20 minutes pre-meal when I can. Since my I had about 10-15 minutes left in my commute, I figured the timing would be perfect.
But as I got home and made my way to the dining room table I was feeling the tell-tale symptoms of a low blood sugar. 56 mg/dl. Damn. I must have had some phantom insulin on board from a late lunch bolus. Symlin and insulin on board do not mix well (nod to Bernard for this info).
I had to treat the low with something much faster than fettuccine alfredo, so I had a couple rolls of smarties and reeling from low starvation I nabbed a couple small squares of luke warm pizza that the kids had.
I sat down and started eating my pasta. Not more than three or four bites into it and I was hit with the post-low exhaustion that sometimes happens. I was wrecked. That low really took it out of me. I was very much not interested in finishing my plate. I think this was a combination of feeling run over by the low and the Symlin doing its thing with my appetite.
I was suddenly quite frustrated and emotional. I didn’t have any simple way to figure out how many carbs I had eaten between the partial pasta dish and the pizza. I think the pizza was nominal – less than half of a typical thin crust slice. The main goal of eating some crappy boxed pasta dish was to have a (fairly) accurate carb count, and now I didn’t even have that anymore. I had to guess, and I got it wrong.
I woke up the next morning with a 200 mg/dl blood sugar, and felt a bit upset that I had probably been sitting at 200 mg/dl all night long. Highs overnight are a sure way to ratchet up that A1C.
As I reflected about the night before it struck me that I had nothing but good intentions with that Symlin bolus. But rather than help things, it set off a slight chain reaction that worked its way to a 200 mg/dl blood sugar for a solid eight hours overnight. I just wanted good blood sugars.
That thought ran a bit and I thought about how each and every one of us has good intentions in regards to our diabetes management efforts. I don’t know a single one of us that willingly runs out of control. We all try very hard, but maybe run into challenging scenarios that we haven’t figured out yet. Sometimes it seems hard to muster up the energy necessary to figure out those challenges. Sometimes despite our good intentions we can’t seem to get that A1C where we want it, or successfully manage an intense work out without a low blood sugar, or whatever.
Our good intentions do count for something, and our resolve to keep working towards the good is critically important.