Portion sizes and the GI Index. I have a lot to learn!

I’m feeling a little more positive this week. On Tuesday I had a pretty bad day, but a game of Carcassonne with friends helped me to see the brighter side of life again!

My blood sugars have not been hugely better: last week my standard deviation was303, this week it was 299; last week 16% of readings were in range, this week 19% were (click here for this week's analysis in all it's sugary glory!). Towards the beginning of this week I was waking up in the 300’s, which had a hugely negative impact on life in general. Having attempted to figure out my overnight basal doses a few weeks ago, I had lowered my evening Levemir dose from 18 to 14. It turns out this was far too big an adjustment and resulted in the highs. I then put it up to 16 and had a couple of days of more respectable morning readings.

But my overnight readings are still not level. I never seem to return to the normal range before bed, and I have not yet managed to work out why this is. It could be a number of things, all related to my evening meal:

1. going to bed before my insulin has stopped working (meaning there is still some short-acting insulin to impact on my levels)
2. getting my ratio of insulin:carbs wrong for this meal
3. eating too much
4. my food still being in my system before bed.

Where 1. And 4. are concerned… This could be an issue. I tend to try and leave the recommended three hours after eating before I go to bed, but I know that short-acting insulin can work for longer than this. As for my food, my evening meals are often fairly carb heavy. I normally eat fairly low-fat meals with low GI ratings (brown rice/ pasta as a rule, and lots of veg and beans). I don’t yet understand the intricacies of the way insulin works with different kinds of food but I do know 2 things: low GI foods are absorbed slowly and fat slows down absorption too. Maybe my low GI dinners are not being covered correctly by my insulin dose. It may be that I need top up my ratio or even split my dose.

2. and 3. however I don’t know about… I don’t think I eat THAT much at dinner time. Often because I’ve over-corrected a hypo earlier in the evening and don’t have room (something I only did once this week, progress!). But it may well be that my understanding of portion size is completely skewed. I’ve got a lot of detective work to do!

The other achievement for this week was exercise. Only once, mind, but that’s better than nonce… On Thursday I walked 8km back from school and boy did it feel good! It had a massive impact on my blood sugars too: the next day,  I had 2 hypoes, one almost 24 hours later. Just goes to show how positive an impact it would have if it became a more regular part of my life.

On Friday I had my diabetic clinic with Dr. Kim at the Haeundae Paik Hospital. The appointment was good – we talked about the pump and he has given me the go-ahead, on the condition that I spend 7 days in hospital initially. While for some people this might be the definition of hell, for me this is just what I needed to hear. The pump is going to be hard work at first. If I can be in a controlled environment while my daily doses are calculated and tweaked I think it will give me the confidence to do it independently. At home, the thought wouldn’t really have crossed my mind, but here, so far away from the comfort blanket of England and the NHS, I can’t think of anything better. The only thing, which I, in my whirlwind of excitement didn’t consider, is the cost of 7 days as an in-patient. I may need to start saving now…

Finally this week I am gearing up for my appointment with Dr. Scheiner, about which I am still super excited but the nerves are starting to creep in. In preparation for the phone appointment I had to fill in a 13-page self-assessment form. It was thorough and this makes me hopeful.