It sometimes amazes me why my sugar levels can run so erratically, despite the fact that I follow a similar routine each workday, with a diet that does not vary to any great degree. It's not as though I eat Mexican one day then Thai the next, then opt to try Ethiopian. I enjoy all of those cuisines but my diet typically involves whole-grain bread with peanut butter in the morning, occasionally with a bowl of whol-grain cereal such as Kashi with soy, rice or almond milk, and an apple or some sort of fruit.
Lunch typically includes a salad or vegetarian sandwhich. Working in Washington County this week, I've been frequenting Jersey Mikes and relishing the vegetarian sandwich on whole-wheat bun. It does raise my sugar about 20 points higher than I would like, so I usually test and take a shot once back at the office.
Supper is a little more catch-as-catch-can. But it typically includes a salad of some sort, often including broccoli, along with a relatively humble helping of fish, chicken, and on rarer occasion, beef. My big supper sin is heated white bread with butter. If Suellen makes it, I can't not eat it. And it does raise the sugar level.
I usually don't snack between meals or before bedtime.
So yesterday the question arose, "What gives?"
Yesterday my sugar levels ballooned various times over 200. I took three different shots, but by the end of the afternoon, when I had exhausted my insulin pen, my sugar still was topping 200. With no insulin left, I headed home late (about 7 p.m.), where I tested again to find my sugar at 160. I retrieved a new insulin pen and quickly took a shot -- enough, so I figured, to get me down below 100 so that my Chinese supper including steamed rice and broccoli would not send my blood sugar through the roof once again.
Well, by about 8:30, as I was attempting to write at my computer, I couldn' focus and what appeared in front of me didn't make sense. I figured my sugar now was low. I tested, and it had dipped to 50 mg/dL. So I drank grape juice and ate some candy. I tested before I went to bed and my sugar was in the 100 range.
But in the middle of the night, when I awoke and tested, it again was over 200. I took a huge shot and when I tested a few hours later (my poor kidney function requires me to empty my bladder about every three hours) I still was at 130 mg/dL. Two more units of insulin. When I awakened I was in the normal range.
So what gives?
Most days are variable for me in terms of blood-sugar readings. Some days are low-sugar days and some are high. Occasionally there are extremes, as I experienced yesterday.
But thinking it through, here is my assessment of what went wrong:
Obviously I was having a high sugar day. But my insulin pen of Novolog might have exceeded the 30-day limit. Insulin pens are not supposed to be refrigerated after they are opened and used. So I keep mine in my bag with my test kit. I'm thinking that insulin pen grew stale and failed to work as readily as usually.
So a person like me, who doesn't use a standard dose of Novolog each day and instead uses it as needed, might want to designate the date it is opened. When the one-month deadline approaches, it would be a good idea to note how well the insulin is working. (One unit drops my readings by 30 mg/dL.) If there is a deterioration of impact, such as I experienced yesterday, toss the insulin away and get a new pen.
This morning, my insulin is fine once again. Right now it is 99.
I have my grape juice ready in case it dips lower. I just ate an apple and a Kashi whole-grain cookie, which is my idea of a big dessert. It looks as though today will be more routine than yesterday. My usual goal is nothing over 150 and nothing much under 80.
We'll see what the day brings.