Wednesday, August 23, 2006

The Math

Math has never been my friend. It's been the bane of my existence and the savior of my life - all at the same time - since I was in grade school. Math and I - we have a love/hate relationship, for sure.

Lately though, I am perpetually frustrated that, in spite of me and math being totally in-sync when it comes to my diabetes care, I am still landing up with bloodsugars that don't make sense. I wish the rules around diabetes care - around dosing, bloodsugars, and all of the phenomenon that come along with the disease - were more finite, more consistent. You know - if I do X then Y happens...

Some examples.

I'm starting with a bloodsugar of 120. If I eat a corn muffin and the package says it has 45 grams of carbohydrate, I'll give 3 units of insulin. If I eat a large sized wheat roll and the package says it has 45 grams of carbohydrate, I'll also give 3 units of insulin for that. I'll give a slight correction to bring my bloodsugar down to my goal bloodsugar of 105 - that's another .3 in both cases. Why - oh why - when I eat one does my bloodsugar skyrocket to 255 and when I eat the other, I slide in at 108?? I know - the fat content, the sugar content, the fiber all factor in... But does anyone have a formula that will help me to get it right every time or even every other time? If you set rules, I can follow them - I don't like to - but I can.

Another example... If I test at 80 and I feel symptoms of a low, should I always treat? In the past, I've found that treating a bloodsugar that high results in a bloodsugar too high for my comfort (say, in the low to mid 200s) - and I've found that sometimes not treating results in a flummoxed and angry Nicole with a 41 on her hands. How do I tell the difference between a normal bloodsugar that's on its way to a low and a normal bloodsugar that's going to stay exactly where it is - or even worse, that's going to rise astronomically? And how does the Somogyi effect factor into this? When does Somogyi kick-in? At 80 is my body already trying to bail me out or do I have get really low to have it happen? Can someone, somewhere please come up with some rules around this stuff? Because there is nothing worse than a 55 that turns into a 300 within 3 hours or an 80 that turns into a 40 in 30 minutes...

I just want this to make more sense - I want it to be more rules-driven and less trying to hit a pencil mark dead-on using a faulty weapon. Some days, I think I'm not equipped to deal with the chaos and nonsense that is this disease. I need some order.


Val said...

The numbers always bug me too, and I am a real math geek. I just keep trying to remind myself that I may know a and b (my BG and the food carb count) and maybe even c and d (the fat content and whether I'm headed up or down).

The only problem is, there are a heck of a lot more variables in there. I may know a-d, but I have no way of measuring or even knowing what e-z are, and they're all part of the equation.

Pretty darn frustrating most of the time.

Scott K. Johnson said...

You nailed it again with this one.

This is exactly what makes managing diabetes so damn difficult.

Like Val said, there are just so many more variables than can be dealt with - and that's assuming we could quantify those things and put them into numbers.

We can do our best, and make the fine tuned adjustments as we collect more numbers (post-prandials, etc), but asking more of ourselves is pretty unreasonable.

We could eat EXACTLY the same things every day at EXACTLY the same times, and still only get it right half the time.

Great image by the way - I got a kick out of it!

art-sweet said...

Great post.

I feel like I've spent half of my life trying to explain to people that diabetes is not a reliable equation. The x's and y's don't stay the same, so x+y on tuesday = z but x+y on wednesday = a + a few tufts of hair pulled out in frustration...

Rachel said...

excellent post. My husband grows so frustrated (since he DOES have a master's in computer science) with the uncertainty of it all. The lack of routine. Yeah. (And of course, it is difficult watching from the sidelines.)

Minnesota Nice said...

I can't tell you how many times I've not treated an "impending" low, expecting that I'll be rising in just a bit, only to be in la-la land minutes later.
My dr. always refers to "pattern control" and I feel like screaming to him "YES BUT THERE IS NO PATTERN".
I have eaten the exact same breakfast for nearly 4 years, and sometimes have huge variation 2 hours and 4 hours later.
If we could "crack the code" I think we all would jump at the chance..
Until then, guessing is about the best effort.

Lyrehca said...

Hear, Hear.

Personally, I just end up not eating the corn muffins so often, but have you tried to say, double the amount of insulin you'd need for a corn muffin, or remember how much correction insulin you took for the muffin, then take that for the initial bolus?

Sandra Miller said...

Oh Nicole-

I am so in the moment of this post.

Joseph just went to bed 30 minutes ago-- we had a very late dinner two hours prior (last gasp of summer, what can I say?), and his bg is 150.

He has over a unit left on board (which is a ton for this kid), BUT he had couscous with his dinner, which always tends to send him high overnight (no matter what we bolus at dinner time-- even with a combo).

Oh, and his pre-meal sugar was 201. (My fault-- took the kids to the bakery for a cookie at around 5:30 and it was still working its magic on his bg... ).

Soooo, I didn't give him a snack, but I'll be checking him SOON to make sure he doesn't tank.

Aand likely giving him a snack.

But then again, maybe not.

I guess this is my long-winded way of saying-- nope, I don't think there's a hard and fast rule to any of this.

Nicole P said...

Thanks, all - it IS good to know that at least I'm not alone in the giant mystery that is math and diabetes.

Another perfect example. Last night, for the third time this week, I had a turkey sandwich with lettuce and a glass of milk for dinner. I gave the exact same bolus - my sugar started off pretty much the same.... This what it looked like:

Tuesday BS=129 - Turkey sandwich, milk, bolus of 3.4. 2 hours after 121, 4 hours after 113.

Wednesday BS=116 - Turkey sandwich, milk, bolus of 3.4. 2 hours after 137, 4 hours after 129.

Thursday BS=119 - Turkey sandwich, milk, bolus of 3.4. 2 hours after 208, 4 hours after 235.

Same activity level - we're moving, so there was a lot of activity in our house all of these nights.


Re: the photo. I googled on "math" and found this picture - only it said something else where it says diabetes - and then I photoshopped the diabetes into it.

julia said...

See? Your post is exactly why I want to punch people when they say "Oh, is she regulated yet?" Regulated? She's not a fucking carbeurator. So, that'd be a no.

Gah. People.

And what Sandra said. There's no rhyme, no reason. It's like throwing darts at a moving target.

J said...

I hear you Nikki I for the life of me can not figure out a bagel that has 62 carbs will send me to 300 and a cranberry orange muffin with the same 62 carbs leaves me at 180 ugh I stoped tring to figure it out and just don't eat the bagels anymore .. it pisses me off but it was not worth the hassel for me to figure out why and how much so I just deleted it .

Johnboy said...

I think we almost have to memorize those little differences for specific foods...but how hard to do.

I have also come to the the (perhaps hasty) conclusion that the food item that causes more spike than should be indicated based on carb content alone, is probably unhealthy in some way...and not fit for anything other than an occassional indulgence.

Still, it's perplexing and it sucks quite frankly.

MileMasterSarah said...

Sometimes, I just think of the correction as an extension of my bolus, I just try to catch it a little earlier. You know Im playing bolus extension game when Im checking 1, 2, and 3 hour pr blood sugars.....and correcting every single time....Thank god stacking doesn't bowl me over....not usually anyhow

I get frustrated with symlin because at 1 and 2 hour pr if Im slightly elevated, I know in the next two hours Im gonna be a whole lot more elevated......and the bolus wizard on my pump just doesn't take the symlin into consideration. At those times I typically triple correction bolusses....isn't that wild?

Hannah said...

Hey Nicole...I've de-lurked and started d-blogging myself. Love reading your stuff.

I am notoriously horrendous at math (except for geometry for some reason), but I am a month away from marrying an engineer who wants to analyze all my BS numbers and insulin ratios until he can fine-tune it to some kind of equation that will work. All the time. I hope he realizes it won't be that simple.

But hey, it'll probably help.