Altogether Unrevealing

Fast day number 2: altogether unrevealing. At least, for now...

After my early-morning correction dose (from a 'Hi' reading) I managed to get a more reasonable 14.6 mmol/L before breakfast. I took my usual correction dose for the reading, 4 units (1 unit for every 2 numbers above 6, my target), and 1 unit less than my normal breakfast injection (usual is 4 units for 35g of cereal). These were guess numbers, of course. I was still fairly concerned about insulin sensitivity, despite having very little basal insulin by this time, hence not going the full hog with the breakfast dose. It seemed to be a good guess, though, because by 10:30am I was 7.9. By 11:30am, though, I felt as though I might be heading for a hypo. I checked my blood sugar, which was 5.1, and ate a cereal bar (85 cals). By 2:30pm, with no further food, my level was 7.8, a reasonable level, though revealing of how little insulin I had in my body. That was the end of the 'reasonable' sugar levels, though - by 5:30pm it was obvious that I needed more basal insulin, as I was an unexpected 16.3. Unfortunately I can't remember whether I had a tiny snack at this point or not, but I did have a correction dose of 5 units. I also took my usual lantus dose of 28 shortly after this (i.e. slightly earlier than usual) in the hope of holding out until the end of my fast without needing any more correction doses!

The one thing I am not struggling with at all is the actual fasting. I don't know whether this is due to my annoyance with often having to eat (a common thing amongst diabetics, so I am told), or from the delight in the focus it seems to give me. The hunger pangs are fairly few and far between, and are very short - easily overcome by having a nice hot drink and occupying oneself with some small task or other. My next step is to move from having tea with milk to having either green tea of some kind, or red bush (which I can happily drink black). I think this might make a difference to how easy I find it, but I am going to try that on my next fast day. If I don't count the calories in the tea, I've found myself easily under the suggested 500 calories, and with them, only around 560. I reduced my breakfast size to a small bowl of cereal about 9 months ago now (I used to have a HUGE bowlful every morning!), so that is now about 200 cals - easily incorporated into a fast day - and then I don't really eat anything else for the whole day, until I break fast between 8-9pm. I wonder if this matters?

At the end of my fast today (8pm) I was 10.4, and had a medium-sized meal of bread, cheese, oatcakes and grapes, with approximately half of the novorapid I would normally take (still not sure what was going on with insulin sensitivity and now back on my normal lantus dose I didn't want to take any chances!). Two hours later I was 11.8, and as I was offered a chocolate at the time, took the opportunity for another minor correction dose with it in the hope that I could get through the night without any extreme highs or lows.

All the struggle with my basal insulin today led me to wonder whether, in the future, I should ask my consultant about trying detemir (marketed as levemir) again which, I believe, lasts between 12-16 hours in the body. I used it while I was pregnant with twins, for two reasons: I needed so much basal insulin from about 6 months on that I had to do it in two lots, and as a plus it had been tested to have no detrimental effects on babies in-utero. (Insulin requirements can more than double during pregnancy so you can imagine the effect having twins has on the body!) I don't remember many differences between it and lantus, but the advantage would be that I would be doing an injection morning and night - lantus is a 24hr insulin - and could therefore reduce my basal insulin purely for the fast day, and nor have to worry about the night before. I could also take less for the night following the fast, if it turns out to be a necessary change, without having to worry about having less come the following day. This would be much easier with a pump...

Anyway, it is now 11:30pm and my level is 10.9. Let's hope it stays fairly sensible throughout the night, and bring on tomorrow!