Ditching the Insulin Pump for Better Blood Sugar Management (Part 2)

Continuing from where the previous article left off, with my wife Nicole, boldly testing out life without her insulin pump. We continued today with letting the pump maintain Nicole’s basal, while we used needles for meal boluses and coverage.

Yesterday’s rollercoaster blood sugars were a bit exhausting for Nicole. Fortunately, thanks to the ketogenic diet she follows (based on Dr. Bernstein’s low-carb diet outlined Diabetes Solution), she never dropped below 2 mmol/L (36 mg/dL) and never went higher than 10 mmol/L (180 mg/dL).

Dawn Effect & Breakfast Bolus (Trial 2)

Nicole started the day at 6am on the high side with 7.2 mmol/L (130 mg/dL). So she took a 1/2 unit of Humalog to bring that down. She also took 1/2 unit of Regular to cover the dawn effect, plus another 3/4 unit to cover her zero-carb kefir breakfast (which she consumed at 7am). Here’s how the blood sugar readings played out:

  • 7:00am – 6.1 mmol/L (109 mg/dL)
  • 9:00am – 7.8 mmol/L (140 mg/dL)
  • 11:30am – 10.1 mmol/L (182 mg/dL)

Obviously 1-1/4 units of Regular wasn’t enough to cover the dawn effect and her breakfast. Yesterday, she had injected 3.5 units and that made for a morning of low blood sugars. Tomorrow, we’ll try 2 units.

When on the pump, using Humalog, she found 1/2 a unit of Humalog covered the dawn effect. Half a unit of Humalog is about 1-1/4 units of Regular. So 1-1/4 units to cover the Dawn Effect and 3/4 unit to cover her breakfast, might be the magic number.

Lunch Bolus (Trial 2)

A half-hour before lunch (11:30am) Nicole went with 3 units of Regular to cover 2 cups of cooked chard, a dill pickle and 4 ounces of turkey. She also took 1-1/2 units of Humalog to cover her high blood sugar. Here’s what happened:

  • 1:00pm – 5.8 mmol/L (104 mg/dL)
  • 3:45pm – 4.3 mmol/L (77 mg/dL)
  • 2:45pm – 3.1 mmol/L (100 mg/dL)

Not bad, but too low. Let’s try 2.5 units of Regular at dinner instead…

Dinner Bolus (Trial 2)

By dinner time Nicole’s blood sugar was right on target — 4.6 mmol/L (83 mg/dL). She had four eggs, sunny-side up and two cups of green beans. We went with the same dose of insulin, 2.5 units of Regular. Dinner was a little late (6:15pm), so she ended up injecting 45 minutes prior to the meal (instead of 30 minutes). We fired the cook.

Here’s what happened next…

  • 5:30pm – 4.6mmol/L (83 mg/dL)
  • 6:30pm –  3.5 mmol/L (63 mg/dL)
  • 8:30pm – 2.7 mmol/L (48 mg/dL)

Obviously that didn’t go so well. But, let’s not blame the meal bolus. Let’s blame the weather.

Really, outside of a gastroparesis episode, 2.5 units of Regular isn’t going to cause a 2.0 mmol/L (36 mg/dL) drop after eating that amount of food.

The weather has become suddenly warm these days. Warmer weather equals less basal. However, Nicole has dialysis treatments Monday, Wednesday and Friday. This always puts up her insulin needs. So, yesterday, her basal worked out well, today, with the aftereffects of dialysis diminishing, she doesn’t need as much basal.

Between the dialysis and the temperature change, we decided to just ignore the post-dinner blood sugar results.

Tomorrow, we’ll continue with 2.5 units of Regular 30-minutes before lunch and dinner. We decided to stick with that for a few days and see how the results average out.

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