One of the biggest frustrations for physicians and patients is when patient’s sugars are all over the place. I mean, really all over the place. There is no rational explanation for it. Patients are very upset and can’t figure it out.
They have tried everything. They have changed their basal insulin, changed their carb ratios, eat less, eat more, exercise differently. No pattern is seen from one day to the next, even if they do and eat the same thing. It’s a nightmare.
Well, here’s how we approach it as endocrinologists. We get rid of all the lows first. We go through all the lows and figure out why you had them and change everything to avoid lows. Too much basal, too much during meals, not enough food, whatever it may be. That is on our radar first. Why?
Well, think about it, let’s assume you have sugars that are high, normal, and low from day to day without any patterns. You don’t know where to begin to make changes. Now, imagine if you only had normal sugars and high sugars without lows. Pause to really imagine that. What would be the next step? Get rid of the highs which are much easier to get rid of.
One of the many causes of highs is a rebound from low sugars. You know, when you get a low in the 40s or even 60s and you freak out and eat the fridge and have the pantry for “little snack”. Well, what happens, you sky rocket and get a highs. Then you freak out from the highs and then what do you do? Well, you don’t want to end up in the ICU, so you give the entire bottle of insulin or unload your pen in your belly. I exaggerate…. just a little….
So, think about why you get lows! Get rid of those causes and then life becomes much easier.
The most interesting question is, “well, won’t the highs be too high?” Or, “that’s stupid, now I’ll just be high all the time and maybe i won’t get any lows?”
First of all, this is only for a short period of time until we can figure out the pattern for the highs and then life’s better. This takes two visits over two weeks. Sometimes a little longer if you don’t use a continuous glucose monitor, like Dexcom.