Proud to be erratic
Well-Known Member
- Relationship to Diabetes
- Type 3c
- Pronouns
- He/Him
Alas, @jtg1964, you've now come across the diabetes roller coaster. I spent most of my first 12 months on that: no CGM, NICE Guidance and CCG direction then; well-intentioned but in hindsight very poor support from both my GP and (really amazingly) from my DSN who supported my GP in trying to ration my testing strips to only 4x daily. [There are some things you just can't make up - no pancreas = reduce testing?!].
Anyway the roller coaster needs you to take extra care to not over-react and treat the initial hypo "modestly". When I'm hypo I want to eat everything in sight; I'm panicking a bit (well maybe more than a bit!) and no doubt my brain is telling me to eat more. Also, I suspect my adrenaline kicks in and sending messages to my liver to open the glucose store, adding more glucose that I can't even account for. Hence the hyper.
The rule of 15 is a great bit of discipline: hypo, treat with 15 gms fast glucose (JB heroes), wait 15 mins, fp test, if still very low treat with more JBs, wait 15 mins, repeat, etc. In practice, from trial and learning, I find 12 gms rather than 15 is all I need and I try to wait 20 mins before the 2nd test to give that fast glucose a true chance of doing its stuff. Also, I know now (and after just a few hypos knew then) that the hypo is horrible but hasn't killed me in the past and won't now. My natural adrenaline response is probably adding glucose AND the chances are that cortisol from just stress is adding even more glucose! So staying calm and disciplined is a necessary counter to the hypo scenario; hard to do, I know.
Once I'm feeling the recovery then I frequently treat with another 12gms, but not fast acting JBs. Just something with medium or low GI such as a cookie (even a plain biscuit). This allows further trickling of carbs into me, to reinforce those first fast carbs and counter the potential next low. I should add this is hard to reconcile why it works for me - with my unusual circumstance of being totally panc'yless. For you, @jtg1964, you still have a panc'y, albeit underperforming. So currently your panc'y may well be making some home grown insulin, over and above what you are injecting and as you go higher your panc'y may be resupplying insulin - possibly hence the roller coaster effect.
One medical curiosity, that is partly a digression, but partly relevant to yourself. Our brain has no direct means of communicating with our liver; it's how we've evolved apparently, unlike many other mammals. So when our brain realises our BG is going up it tells our pancreas to release glucagon, which sends a message to the liver to open the store and release glycogen (ie glucose). When going high our brain tells the panc'y to send extra insulin into our blood. And we have another hormone/enzyme called somostatin in the pancreas, which acts as a regulator between glucagon and insulin. I have no pancreas so need to do my own regulating. Your panc'y is impaired by the destruction of beta cells, but not necessarily by the destruction of all the other hormone and enzyme generating functions. For example you will still be making your own digestive enzymes; I need a PERT such as Creon. So I know that my glucose and insulin responses must be provided by my actions. You have the uncertainty of not being sure what your pancreas is definitely doing in response to signals from your brain to your pancreas. Your trial and learning process, @jtg1964, is from a different start point to myself - when managing BG.
I appreciate this response today, Jill, is from your last reply in late April and you may have already got past this "learning point". May has been a full on month and while I blinked it's now June!
Anyway the roller coaster needs you to take extra care to not over-react and treat the initial hypo "modestly". When I'm hypo I want to eat everything in sight; I'm panicking a bit (well maybe more than a bit!) and no doubt my brain is telling me to eat more. Also, I suspect my adrenaline kicks in and sending messages to my liver to open the glucose store, adding more glucose that I can't even account for. Hence the hyper.
The rule of 15 is a great bit of discipline: hypo, treat with 15 gms fast glucose (JB heroes), wait 15 mins, fp test, if still very low treat with more JBs, wait 15 mins, repeat, etc. In practice, from trial and learning, I find 12 gms rather than 15 is all I need and I try to wait 20 mins before the 2nd test to give that fast glucose a true chance of doing its stuff. Also, I know now (and after just a few hypos knew then) that the hypo is horrible but hasn't killed me in the past and won't now. My natural adrenaline response is probably adding glucose AND the chances are that cortisol from just stress is adding even more glucose! So staying calm and disciplined is a necessary counter to the hypo scenario; hard to do, I know.
Once I'm feeling the recovery then I frequently treat with another 12gms, but not fast acting JBs. Just something with medium or low GI such as a cookie (even a plain biscuit). This allows further trickling of carbs into me, to reinforce those first fast carbs and counter the potential next low. I should add this is hard to reconcile why it works for me - with my unusual circumstance of being totally panc'yless. For you, @jtg1964, you still have a panc'y, albeit underperforming. So currently your panc'y may well be making some home grown insulin, over and above what you are injecting and as you go higher your panc'y may be resupplying insulin - possibly hence the roller coaster effect.
One medical curiosity, that is partly a digression, but partly relevant to yourself. Our brain has no direct means of communicating with our liver; it's how we've evolved apparently, unlike many other mammals. So when our brain realises our BG is going up it tells our pancreas to release glucagon, which sends a message to the liver to open the store and release glycogen (ie glucose). When going high our brain tells the panc'y to send extra insulin into our blood. And we have another hormone/enzyme called somostatin in the pancreas, which acts as a regulator between glucagon and insulin. I have no pancreas so need to do my own regulating. Your panc'y is impaired by the destruction of beta cells, but not necessarily by the destruction of all the other hormone and enzyme generating functions. For example you will still be making your own digestive enzymes; I need a PERT such as Creon. So I know that my glucose and insulin responses must be provided by my actions. You have the uncertainty of not being sure what your pancreas is definitely doing in response to signals from your brain to your pancreas. Your trial and learning process, @jtg1964, is from a different start point to myself - when managing BG.
I appreciate this response today, Jill, is from your last reply in late April and you may have already got past this "learning point". May has been a full on month and while I blinked it's now June!