Hey @Proudtobeerratic, you're not lecturing me.
That's a relief.
As it happens, I didn't skip a meal because of worries about insulin, but because I was running around doing errands and I just forgot to eat.
Great, sorry I presumed otherwise.
What I AM doing in response, though, is a lot more exercise because I've read that it can help. I walk a lot anyway, but for the past couple of days have put in earphones and gone walking for an hour while listening to a podcast. That's helped calm me and stopped me thinking about this horrible diagnosis.
Exercise and destressing are probably the next 2 most important components of D management after getting insulin and carbs to match relatively smoothly.
We all (diabetic or non-diabetic) have a degree of insulin resistance. The idea of our bodies being resistant to insulin can seem strange, since for most of the population one's metabolism just creates enough insulin to deal with accumulating glucose; and conversely when glucose is low and people feel down because of that the body releases additional glucose. As a digression, our brain recognises the low glucose thresholds and is unable to talk directly to our liver, which has the main insulin store; so the brain sends a message to our pancreas telling the panc'y to tell the liver to open the glucose store. The panc'y sends the hormone Glucagon, which tells the liver to release glycogen, a type of glucose. When there is too much glucose the panc'y releases more insulin and uses its hormone somostatin to regulate the balance between insulin and glucose. I have no panc'y so this has to be done artificially; your panc'y capabilities are under review.
Returning to insulin resistance: various things change this - it can be different at different times of day (often higher at breakfast time than in the evening, but not for everyone); different in different temperatures (warmth reduces - I find I need to slightly increase my basal with longer periods of cold weather) and different at different BG levels. Insulin resistance is the reverse of insulin sensitivity; where resistance is the dominant factor there is a natural tendency to talk about dealing with insulin resistance and where resistance is relatively slight we can tend to talk about our altering insulin sensitivity. Moderate, aerobic, exercise and general activity alters our insulin resistance; walking, (shopping is deceptively good at catching us out), jobs around the house as well as going to work - these all cause our bodies to have lower insulin resistance and in essence existing "insulin on board" can go a lot further. During busy periods I can reduce my bolus doses by 50%; trouble is this science too often feels like guesswork; and exercise effects can linger over the next day or two - but I find it nigh on impossible to know if that is going to apply today!
Anaerobic exercise, strenuous exercise, will usually increase BG before the BG will eventually more noticeably go down and probably lower for longer. One beauty of having CGM is that these BG changes from eating, insulin taking and exercise/activity are readily revealed to us, allowing us to use the alerts as just that (alerts). Until recently the vast majority of insulin dependent folks only had finger pricking available to provide momentary snapshots with no upward or downward trends. So a very different management opportunity is coming into existence and its been noticeable over the last couple of years how people are increasingly aware of the changed, greatly improved, techniques (thanks to recent great strides forward in availability of CGM from the NHS). Conversely I have a cousin of some 50 yrs T1 who simply has no interest in adopting the current tech and I wonder if he'll ever adopt CGM.
The great thing is this terrible thirst has gone away, and I'm not peeing all the time. And - TMI warning - the thrush treatment has finally worked and I'm not tormented by itchiness.
TMI aside, understood; taken ages to get daily stability with various bodily matters. Life is sooooo much better when respite arrives.
Also, I think I'm the luckiest patient alive, because my consultant strikes me as the kind of person who would otherwise be a social media addict. Instead of doomscrolling Twitter, he's doomscrolling his patients' blood status.
My slightly cynical thought is its pretty easy money for a private Consultant; trained staff (usually thanks to NHS training investment) providing 24 hr cover (with the safety of fees paid by an insurance arrangement). That said I'm delighted for you that you have this arrangement and the consequent reassurance.
I'm sorry to hear about your insulin insomnia and I hope today turns out to be much better than expected. And I was very interested in all your advice.
I awoke with my BG at almost 11, very high for me - but not seriously high. More relevant was that I eventually started to sleep just after 2am with a BG finally nudging above 4 and then it steadily climbed. My brain was telling me I'd had more than enough carbs for recovery, yet my body was denying that and its at those moments when BG management is very confusing and contradictory. My wife was asleep, but even if she'd been awake the responsibility for my decision making was mine, not something that can be shared and the self doubt that creeps in is (at the very least) unhelpful. Its a matter of keeping your nerve and trusting your all too scant knowledge sometimes. A normal breakfast and a considered correction dose has now brought me to low 7s, but I'm busy and very active today, so content to keep a modest buffer; the alternative is to commit more time to constant monitoring and stay lower, but I want to be less restrained just now. My choice.
