Healthy Actions Breed Healthy Habits

The more I fast, the more I get used to it and discover what works for me, which makes perfect sense. 

Diabetes, on the other hand, doesn't make perfect sense. 

I'd been having my usual basal insulin on fast days, now that my body is more used to it. I might go a little low by mid-afternoon if I've been more active than usual, but generally have few problems. Today, though, I'm hypo at 10:45am... Not feeling at all hungry and, being slightly under the weather, not really wanting to eat anyway, it was very annoying having to have food. I chose to have a cup of tea with sugar, and half a cereal bar (at 42 cals). I keep in mind the calories I've consumed to treat hypos, and might have a few cals less for tea, but generally don't count them into my fasting allowance because it just makes things far too hard as a diabetic.

Generally speaking, though, I've been enjoying fasting. It opens your eyes to the extra snacking and picking you may do, too. As a mum, I'm always having to go into the kitchen for things, which means that it's frightfully easy to pick - a piece of chocolate here, some blueberries there, even a sliver of butter... fasting reminds me that today I can't do this (and shouldn't too frequently on other days either), and means that even on non-fasting days I'm much more aware of this. 

Fasting also enables me to make positive changes, so for example I will more often evaluate whether I really am hungry - and if not, I don't eat (at least, try not to). I'm also finding it much easier to choose fruit or other healthy snacks for when I am hungry. The more healthy food I eat, the more healthy food I want to eat, which is great. Cakes and other sweet treats are far less appealing nowadays. I still have a weakness for chocolate, though!

Another tip for anyone trying fasting is that, while drinking a lot is essential, I would discourage, for example, drinking loads of coffee to fill you up. If you're hungry, wait for it to pass. Yes, have some water. Yes enjoy hot drinks throughout the day. But I was drinking far too much, and my stomach wasn't getting used to being empty because I was constantly putting liquid into it. It's good to drink, but don't go over the top like I did! Your stomach will get used to being emptier, and this will help you with your portion control on non-fasting days too.

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!

The Post-Fasting Effects

Again, without really thinking (diabetic habits are now fairly ingrained, I suppose!) I had a normal bolus with breakfast plus a correction dose for the 15. However, this was obviously the wrong thing to do because only 90 minutes or so after breakfast my sugar was low, and I had to snack. By noon it had only raised to 4.8 and I had more snacks while making lunch for the kids. By the time I got round to my lunch I was still only 4.3! The increased insulin sensitivity I was vaguely aware of existing was definitely serious stuff with immediate effect. I was feeling so wobbly that I actually skipped my lunch injection altogether. By 3pm I was 8.6 but still felt bad, so left it another hour, by which time I was 12.2 and felt safe having some correction insulin (with a snack). 

The rest of the day my sugar levels were great, around 7. Unfortunately I had another take-away to contend with (i.e., having to seriously guess my carb intake). By 11:30pm I was 7.1 (fine). At 2am I was 11.5 (acceptable-ish) but did not correct at all just to see what would happen by morning.

What happened today was a 22.2!

Here's one of the joys (read: pains) of diabetes. It can seem fine (maybe a little out of sync, but even if it isn't) it can hit you with a crazy sugar level. I don't know if that is what happened, or if it was because of some low-lying carbs or something... anyhoo, I decided not to worry about that too much!

Today my sugar levels have, again, been lower than normal, with lower insulin-requirements. Tea this evening was the first 'ordinary' meal I'd had since fasting (apart from breakfast cereal) and therefore knew exactly how many carbs I'd eaten. I had my usual dose, counting 1 unit to 10g of carbs, but despite my fast day being two days ago, it was still too much! I came down from 8.2 at tea to 5.9 an hour and a half later (unheard of for me in the evening), so had a snack (a ryvita, raisins and a mini chocolate roll). By half 9 I was feeling even lower, so had yet more food...

At some point I know that this will be really great, but it's going to take time, isn't it?