Racing Cars and Freight Trucks in my body

Dear Bloggers,

My ups and downs have been a little more up and down of late (read for most of this year, it's still nearly Christmas, right?). Not exactly disastrous, but I've not really managed to ever get things into any kind of groove for more than a week at a time. A bit wearying to say the least. Yes my brain exists best by complete chaos.

Part of me knows the best way to improve things is to go back to basics and do some fasting basal tests and tweak my basal profiles based on actual information rather than the (un)educated guesswork I've been relying on for a while. Another part of me is having enormous difficulty summoning up any enthusiasm, since I know that the holidays are coming and I'm likely to stop going to the gym for a couple of months which will have a knock-on effect in itself.

So I'm spending my time grumbling and hurrumphing instead (my family are so lucky!). The old nagger is coming to town and no it is not Santa, it's Santabetes


On the plus side it does give me a chance to jot down this analogy that I've been meaning to for some time. It's something that usually strikes me when my blood glucose levels are a bit errant, and Victoza and food are just not playing nicely.

When it comes to trying to balance the effects of food and Victoza on blood glucose levels (well and everything else.. but specifically food and Victoza), one thing that makes it very tricky is the difference in the speed of action of carbohydrate and Victoza. It's not enough to accurately match the dose of Victoza to the amount of carbohydrate you are eating - you have to try to ensure that the two act more or less together to reduce blood glucose wobbliness (technical term).
Almost all carbohydrate is very much in the Formule1 car class. Fans of glycaemic index tables (GI) might agonise over whether something is high GI, medium GI or low GI, but in my experience the differences equate to something being 'almost instantaneous', 'really very fast indeed' or only 'very fast'. Not a great deal of protection against the ravages of a post-meal spike, either physiologically, or that emotional kick in the guts of seeing your levels rise from a decent pre-meal number well into double figures an hour or so later. From the very first mouthful those big outboards start roaring and the carbs go zipping and zooming about, gleefully spraying glucose in their wake.

Victoza, on the other hand - even the fancy schmancy 'rapid acting' analogues can seem painfully slow to get going. More like one of those behemothic freight trucks or road trains. With a great groaning and clanking, the thrum of the plunger on an insulin pen or pump delivers the dose and then... Nothing. Watch and wait. Is it an illusion? Is it actually moving yet? Nope. Still can't see anything happening.

Vooooom! Swish! The carbs go tearing past again. Running rings around the slumbering giant.

This is particularly the case for me when I am waiting for a correction dose to kick in. I've had to stop myself from checking post-correction blood glucose levels before an hour has elapsed. Any less than that and the chances are my blood glucose levels will be almost unchanged. An hour!

Of course... one of the things about a freight truck is that once it is moving, there's not a lot you can do about it. All those stories about them needing however many miles to slow down or turn a corner. And so it can feel with rapid insulins. 

Nothing... nothing... nothing... Ah good, movement! Good... All good, back into range. Right that's enough now thanks... STOP!

But on and on, the dose lumbers forward - an unstoppable force. All-ahead full. The truck has now run straight over those race cars crushing them to matchwood and we could very well be steering directly toward Hypocity.

Corrections can be a tricky course to navigate. My doctor tries to help by offering a suggestion of 'Active insulin' - how much dose is still working away, but there are many variables to factor into that equation. Sadly I find my doctor's attempts to be the vaguest of indications at best, and often wildly inappropriate to the particular circumstances of the moment.

Patience is the skill I have to master. I am always trying to remind myself that while the spike in my blood glucose levels may have happened in only 45 minutes or so, the insulin correction will only have stopped after something like 4 or 5 hours. If I get impatient and overcorrect in the meantime I am likely to cause myself another problem (and more wobbles) by overdoing it.

The Old Sailor,


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