On Friday, I had a follow-up appointment with my endocrinologist to assess how the insulin treatment has been working out for me. My insulin regimen right now is Lantus as my long acting insulin (in the AM) and Novolog as my fast acting insulin for meals. So far, my numbers have been ok and I feel I can eat a normal meal now. However, there are a few wonky trends I have been noticing that I asked about.
One of the weird trends I have noticed is being in great range 2 hours after a meal, but having blood glucose continue rising within the next couple of hours (well after my fast acting insulin is long gone). I have noticed this sometimes happens in the morning and other times at night. One night I was in great range 2 hours after dinner (low 100mg/dL) and then when I checked before bedtime I was all the way up to 153mg/dL (although I didn’t eat anything after dinner nor did I experience a “low”). This problem seems to get worse if I eat carbs that are higher GI throughout the day. I have a few theories as to what this could be. Of course, I am not a doctor or anything so these are just my theories about what could be going on. They may be somewhat right or completely wrong, lol:
- The fast acting insulin may not be enough to cover the initial rise in blood glucose that happens with some faster acting carbs, and while my numbers may be in range 2 hours after my meal, my liver may “think” I am low whenever I drop below where I have been averaging during my meals throughout the day and keeps dumping out more glucose after my meal.
- Another possibility is that maybe I drop too low when I take my insulin when I eat carbs that aren’t super fast acting enough. Therefore, when I check with my meter I am in good range 2 hours after dinner and higher afterwards due to a rebound from a slight “low”. I have checked with my meter at times 1 hour after a meal and sometimes I can be quite low so maybe the insulin works too fast for the slow acting carbs I eat. However, other times I’m in a range where there’s enough glucose in my system as the insulin is working so there’s no way I could have gone slightly low and had a rebound.
- Maybe my basal insulin (Lantus) isn’t covering all the glucose generated by gluconeogenesis once my body starts processing the proteins I have eaten and converting these to glucose.
My endo thought my numbers were very good, and I had no reason to worry. I am not 100% convinced though. I may be fine during fasting and before/after meals, but I’m not convinced that I am always fine during the in-between hours (and maybe overnight). Although my blood glucose sometimes rises 2 hours after a meal, I am still in good range before my next meal and before bed, which is why he probably told me not to worry and we didn’t make adjustments to my dosages for now (So far that 153mg/dL seems to have been an anomaly). I guess I’ll just have to keep testing to see if this is a consistent trend and not just something that happens once in a while. Plus I’ll have to continue researching and learning as much as I can about insulin as it’s all pretty new to me. Right now, I feel like a duck out of water.
In addition to reviewing my numbers, we also talked about insulin pumps to see if I had an interest in getting one in the future. I think an insulin pump along with a Dexcom continuous glucose monitor would be extremely useful as that would help me figure out these trends and see what is happening when I take my insulin and during the in-between hours. This would probably give me a bit more peace of mind and may enable me to have the tighter control I would like to have (of course, I know every form of treatment has its downsides). Right now, I feel like I am guessing from the data points I get from my meter trying to figure out what’s going on and it causes me a lot of anxiety. Having more data would be extremely helpful.
Now for some good news. I think I am finally starting to put some weight back on. My scale is starting to show an upward trend instead of continuing downward (at one point the scale used to read 99-100 pounds, not a healthy weight for someone that’s almost 30). I assume a lot of the weight that is coming back now is my water weight that I lost while being in ketosis, but I do feel that I am starting to gain some actual body weight now and don’t look as sickly/frail. I’m assuming the weight gain will start showing up in my mid-section initially and eventually (with the continued strength training to develop more muscle) it will distribute more evenly throughout my body. So far, I seem to be gaining weight all around though and not just in my mid-section, which is great.