Possibly one of the most inexplicably stupid things I have ever done diabetes-wise
Last night we had a smallish portion of spaghetti as our evening meal. This I realise for many would be a complete no-no, but pasta has typically not been the nightmare for me that it is for many. After little experimentation and tweaking I have managed to work out a reasonably successful strategy so it no longer fills me with dread – we eat it maybe once a month.
My approach (depending on recent results) usually involves a 2.5 hour dual/combo bolus at 60:40 for the calculated dose plus an extra 1u. Previously I’d also needed an extra unit up front too, but had dropped that about 9 months ago following some post-meal dips.
More recently my previously solid post-meal performance has been *slightly* marred by a smallish rise something like 4-5 hours after eating (when the majority of the bolus was waning) so yesterday I decided to rejig my approach a little since I have a Libre sensor in at the moment and can watch what’s happening. So last night I went for the calculated dose+1u as 40:60 over 3.5 hours and added the extra unit up front and watched and waited.
Annoyingly I was starting from 8.3, but spaghetti often takes a while to get going for me so I wasn’t unduly worried. Stayed pretty steady for the first hour then rose gradually by about 1.5mmol/L towards hour 2. Stupidly during this time I decided to confuse matters by bolusing and nibbling on some snacks that were circulating. By about 3hrs after eating I was 5.2 with vertical down arrows (and DW still chugging away) so I gulped some precautionary Lucozade. Headed off the hypo fine, but then my BG rose and flattened at 8.5-9.5 for an hour and a half (presumably spaghetti kicking in at this point). Then inexplicably at 4.5hrs post-prandial (10.30pm) I had another unexpected BG ‘kick’, up to something like 11.5 so, getting a little frustrated, I whacked in another unit despite considerable IOB (insulin on board). Sat and waited until midnight while the Libre trace was pretty flat in the 10s-11s – no sign of the 1u or IOB making any impact. Just after midnight I topped-up my IOB to make it the scary-sounding 2u I had intended to go to bed on to counteract the remaining spaghetti fallout.
Just to recap: Spaghetti is usually pretty predictable and not a huge problem. Added complication of snacking/bolusing/dose stacking/dipping/overtreating *and* trying a new system all at the same time.
But we’ve STILL not got to the stupid thing…
The stupid thing
One of the great things about the Libre for me is the ability to see what’s going on overnight. And also that if I happen to wake, even for a moment, I can scan and check levels in a way that I simply *do not* do if it requires me to fingerstick test.
I checked at 4am and had been pretty much flatlining around 9.5 since 1am. No insulin left on board. I consulted Artoo who suggested just over a unit as a correction, but I wanted to err on the side of caution so I went for a manual bolus of 0.9u (about two thirds of the recommendation).
I woke three hours later a little groggy and scanned for the Libre to read ‘LO’. Artoo showed nearly 2 units of insulin on board.
Checked downstairs via BG meter which confirmed BG was 2.2mmol/L. Bewildered and glugging Lucozade I tried to make sense of the situation…
Checking my bolus history I read that at 4am I had bolused not a cautious 0.9u, but 6.0u. Six units. SIX! My BGs had, not surprisingly, dropped off a cliff around 5.30am.
I simply cannot understand how I managed to do that. Even though one figure is very like an upside-down version of the other, I can’t believe I could have made that error as all the buttons etc would be on the wrong side of my robot counterpart if I was holding the pump upside down.
But however it was that I managed to construct that error, there seems no denying that I did it.
And it’s not one I’m wanting to repeat any time soon!