Re-setting my hypothesis
I’ve was diagnosed with Type 1 diabetes over ten years ago. Throughout that time, I have been reading papers, articles, magazines about diabetes. As I have previously mentioned, I was worried that although that meant I knew about diabetes in general, my knowledge about diabetes for me was not growing. So I wrote to my consultant to ask for the loan of a continual glucose monitor (CGM). His immediate reaction was positive: he offered me the chance to trial a new “not quite” continuous monitoring device once they received them. Unfortunately, they never did and the offer went nowhere even though I chased him. In the end, I decided it wasn’t going to happen
Fast forward six months to when I had my latest annual review and I saw yet another consultant who turned out to me far more helpful than all the others. As well as suggesting I learnt more about a pump, she suggested I borrowed a CGM.
My initial idea was to borrow the CGM for a month, to watch my blood sugar readings change as I had different experiences like running, climbing, late nights, drinking alcohol, eating different foods (such as pizza), run a high profile meeting at work, … Unfortunately, my local diabetes team (which covers a number of large towns and, at least one city), only have two CGMs available. This meant I could only borrow it for six days (the life of one sensor). And the meter, being one of the cheaper models (to keep the cost to the NHS down), had no user interface: the results were downloaded after the six days using dedicated software that I did not have. Nevertheless, I was excited to get some more information about diabetes and me.
One Tuesday evening, I had my CGM attached and was given instructions. This was, basically, to keep a food and activity diary which included at least four accurately timed readings each day and the amount of insulin I took. The CGM was attached to my abdomen with a very, very, very, thin wire embedded into my stomach and it was checked that it was collecting data. I could not feel the wire and the CGM was about the size of a 10-pence piece so, overall, it was not too intrusive. (Although next time, I will position it a bit lower than the waistband of my trousers!)
For the next six days, I made no changes to my planned activities. I had early mornings (including a 6am train journey to Sheffield), meetings with customers (one where I was running vey late due to the wonderful London Underground), I went climbing, I went for a run, I walked back from the hospital fast because I needed to make my next appointment, I had a couple of glasses of wine, I snacked during the morning, I had a carby dinner in the pub, I slobbed in front of the television, … all part of a normal six days for me (except the climbing wasn’t as intense as usual because it was the same day as my trip to Sheffield).
Then I gave the CGM back and waited.
Three weeks later, the results were explained to me. Despite my varied days, the overall results were pretty similar each day. However, I still learnt about my body, diabetes and insulin.
Not only did I learn, I updated my hypothesis from the start of the year: in January, I had a busy week in America on business and watched my morning blood sugars rise. I assumed this was due to my body needing more basal insulin. It was a reasonable assumption based on the data I had: a high blood sugar reading, when I went to sleep at midnight and another high one when I woke at 7am. Like any scientific research, a theory is as good as the data you have.
When I had the CGM, I had more data; I had my blood sugar readings at five-minute intervals throughout the day, including when I was asleep. This showed that my blood sugar levels could not be drawn as a straight line from the midnight reading to the morning reading; instead, there was a huge wiggle. My levels dropped to hypo-level between 4am and 5am. Then, as I did not wake to correct it, my body over reacted leading to near-hyper level by the time I woke. Instead of taking more basal insulin, I need to take less.
Yes, I was wrong at the start of the year. But I am not going to beat myself up about it. Given the data I had, I made a reasonable hypothesis. But, the CGM proved my other hypothesis: the more data I have, the better I can manage my diabetes.
It was suggested, I may want to repeat the exercise in six months’ time. I will definitely be taking up this offer (and would highly recommend it to anyone else in the diabetes community). I hope to see more stable night time blood sugar levels. On the other hand, I want to push myself more to see how the levels react to an evening of intensive climbing and, perhaps, focus on late nights next time rather than early mornings. I just need to arrange work appropriately. Whilst remembering my moto that diabetes does not stop me doing anything, including my job!