DBW follow up thoughts and Q&A

I was driving to work/the gym this morning and reflecting on Diabetes Blog Week. 142 of us participated! I didn't read all the posts, but I read lots of them and I added a few blogs to my Google Reader. And I discovered that most of us would have some mixed up feelings about a cure we can barely let ourselves imagine (nice to know it isn't just me). My DOC grew last week and that was pretty cool. But, I gotta say the week took it outta me. That was a whole lot of opening myself up and letting you look around inside. Thank you for being such kind guests. Anyway, I was thinking I might give myself a few days off before writing my summary and answering the few bigD questions I received. Then, The Current played this song:



It sounded like living with the bigD to me. I think it's going to be my new theme song. "...whether you're high or low, baby, you gotta tip on the tightrope...."

And I'm thinking when you find a theme song, you gotta step up. So, with no further ado, the Q&A:

Lumpyhead's Mom asks: What does bolus mean? I read it as "bollocks" and it makes me giggle every time.

Bolus is the jolt (sorry, dose) of insulin I ask Gromit (my pump) to give me to correct a high blood sugar or to take care of the carbs I'm about to eat.
According to wikipedia, the common phrases "Bollocks to this!" or "That's a load of old bollocks " generally indicate contempt for a certain task, subject or opinion. To be honest, I don't think they're unrelated.
Though you didn't ask... Basal, on the other hand, is the continuous drip of insulin Gromit is programmed to give me in the background, just generally keeping me alive while life swirls on around me, causing me to need insulin. The amount of insulin/hour varies throughout the day, but being of the Animas variety, Gromit gives me a droplet every three minutes.

S asks: What is considered a "good" number for BG? Does it vary by person? By time of day? By other things?

First of all, thanks for using quotes on 'good.' You've already picked up on the fact that judging numbers as good or bad can be an emotional trigger for PWDs. So, let's see if we can pick our way through this one.... Humans without diabetes have BGs in the range of 80 - 110, typically. A high-carb meal might raise it to ~140, briefly. (These numbers are from some very quick research I did online, not gospel truth, but I think fairly accurate. T3 has stayed in the 90-95 range when we've tested him, even after a pasta dinner.) My target range is 70-140. That means that I'll treat anything below 70 with some fast acting carbs and over 140 with a bit of insulin (a correction bolus). Now, that's my target range, based on trial and error, discussions with my endocrinologist and my A1c (a blood test that indicates average BG over ~6 weeks) goals. Humans without bigD have an A1c under 6.0. My latest was 7.0 - not bad, but I want it lower for a lot of reasons.
Other PWDs have other target ranges. Some have a different (higher) post-prandial (2 hours after eating) goal. Some may find that they need to run a little higher to avoid crashing into scary lows. It's all a balancing game and each of us needs to find our own fulcrum.
I also consider what activity I am about to do/have just done. Sometimes I leave a particular BG alone because I think it is on it's way up or down to where I want it. Shaun the CGM should help me understand what direction the BG is going, but we're still getting to know each other and he's not 100% reliable yet.
And, yes, it can (and does) vary by time of day. I set a goal BG in Gromit of 110 for the daytime and 120 for night. That way, when he calculates my correction bolus, he is trying to bring me to a slightly higher number at night so I don't crash while sleeping. Which brings us to...

S also asks: how do you know you're having a low in the middle of the night?

Sometimes, I wake up fretting and eventually I realize I should test. It's a signal, but a weak one. I suspect sometimes, I go low, but I don't know it. If someone else were there, they might notice me feeling clammy or shaky and try to wake me and make me test and drink some juice. My liver does seem to have retained its ability to kick out glucose when I'm low. This usually results in wicked rebound highs (roller coaster anyone?). So, if I wake up in the morning really high, it's possible that I was really low in the middle of the night. I try to do some middle of the night tests once in a while to make sure I'm not regularly crashing because one of those crashes could be the one I don't wake from. (Sorry, but that is one of bigD's really scary short-term risks.) I also occasionally do an overnight basal test, waking every 2 hours to see how the BG is doing. Last time I did that, it was rock solid in the 90's all night long. If only that were my normal.... Shaun (CGM) is my latest weapon against scary middle of the night lows. He alarms if he thinks I'm below 70 and below 55. Sadly, his accuracy this week has been crap so I don't trust him yet. But, having him is better than not.


Damn, those answers were longer than I expected. You get me started...

There are already plans afoot for another DBW next year. I'll be playing along. In the meantime, feel free to post more questions in the comments. I will do another Q&A post when I get a few Q's built up.

One more little pitch... I'm leading the Pancremaniacs in the Twin Cities' Tour de Cure again this year. I'd love it if you would join the team. Or sponsor one of us. Or just send us some good thoughts for a sunny weather on June 5. Thanks!