Decisions decisions decisions

So originally today I was planning something long and reflective BUT it’s been a difficult day BM wise and the perfect opportunity to demonstrate the full time commitment needed to manage. I mean let’s think about daily decisions we make. What to wear? What to eat? When to eat? Whether to go out or not? Imagine adding a whole host of other decisions onto that! Today I’m talking about those decisions. 

So first off the images above, not ones you generally want to see. 

To make it really easy I’m going to lay my day out showing diabetes decisions from 9pm last night to 9pm tonight. 

So 2100 my BM was 11.4 and rising slowly (target around 7) questions - was tea insulin right? Should I give CD (correction dose) or increase basal? Wait it out an hour? Is pump still working ok? Early night out the window “wait and watch” time Decision was a 20% increase for 30mins and to wait and watch  

2200 An hour later were at BM 13.1 and steady. Straight line should suggest insulin is working. Wait and see? Just eaten so had 5.2 u worked out exactly (inclusive if recommended CD worked out by pod handset) 

2305 An hour after that there’s only a slight increase(13.9) ...wait or treat, it’s been two hours? 

Increased basal to 30% for an hour

0023 BM now 12.4 so seems to be going down let’s leave it and sleep? 

Pod recommends another CD decide to take half the CD

0330 BM 12.8 It’s held rather than dropped...treat with CD? Or increase temp basal? 

Pod recommends a CD of 3.75 so take that and try to settle again. 

0747 BM 4.2 As a bm that’s a little low for me waking up but at least it’s “in the green” quick sugar hit or wait it out? Take meds for other condition anyway so need to wait half and hour now...

Temp basal decrease by 15% for 30 mins

0813 BM 3.8 and in the red! Should’ve had sugar hot first. Treat with top of luck add bottle? 

Lucozade taken 

0942 BM 8.6 back in the green. Hopefully it’ll stay there comfortably. 

1056 BM 7.1 so decide to eat breakfast. 24g of carbs 

Pod works out 3.15 bolus needed 

Thank goodness it does some of the maths these days!

1157 BM 11.1 and rising slowly...did I wait long enough for prebolus? Set running out? 

Temporary increase to 15% for 30 minutes

1351 - forgot it’s POD change day - nightmare! This means 4 u straight in to stop rise then a temp basal on new pod once in. Pod loaded and old one deactivated. New pod attached to outside of right arm. 

1358 BM 10.5 and steady. Little bit high? Treat? Cause? 

Pod works out no dose needed

1446 BM 9.2 lunch time so pod works out insulin.

4.95u given 

17.21 BM 15.7 no reason it should be! CD? Increased basal? BOTH? Set blocked? Running out? Getting sick? 

40% increase given for 30 mins. 

1747 BM 18.1 and I’m feeling pretty grim...pen injection? Arrow indicates rapid rise...wait it out? 

Increase continued and 3u in.

1800 BM Still rising temporary basal having no impact. 

Remove pod and replace after looking at patterns. Arm bleeds enough to suggest pump partial blockage. Pod deactivated and new one set up on back left hip, Temporary increase and CD given. 

BM shows downward trend arrow. 8u prebolus given for tea.   

1835 BM 15.8 but steady...wait? 

Temporary increase has just finished so decide to wait and watch. 

1912 BM 14.8 steady so waiting it out seems a good idea...? Another small bolus? 

Downward arrow suggests waiting 

1958 BM 9.6 and dropping rapidly! Turn off? Lucozade? Biscuits? Eat the contents of the fridge? 

Small dose of lucozade to reduce dropping time

2011 and it’s 7.2 still dropping rapidly... where will it stop? Why is this happening? 

Finished the lucozade

2100 BM 4.3 and now dropping slowly...lucozade? Turn off? 

Two digestives eaten. 

Going to be another long night 

So why is all, this relevant?  Well partially because it demonstrates the constant need to be thinking about decisions that affect those blood sugars. It’s a 24 hour job. Therefore 21 additional decisions demonstrated in one day. Each one important on its own but also as part of the bigger picture. Some days yes there are fewer but equally some days there are more! 

Can you for a minute imagine not being tired after all this? Exhausted in fact. That’s all before a normal day has even started. So please next time you tel, me I look tired or need a good nights sleep think about this...I probably desperately do but the chances of getting it are slim. And I’ve probably not decided what I’m having for tea tomorrow yet either...