March 8, 2004
Daily Care, Insulin Pumps
Question from Philadephia, Pennsylvania, USA:
I have been on the pump for about a year, and my A1c has dropped from 11 to 6.5. However, about five months into my pump therapy, I changed jobs to a more stressful job that requires an one and a half hour commute each way. The basal rates I established before this new job do not seem to be working anymore. There are two time periods each day I can’t get controlled. During my drive into work, my blood sugars jump from 120 mg/dl [6.7 mmol/L] to 250 mg/dl [13.9 mmol/L] within a half hour period, between 6:30 a.m. and 7:00 a.m. However, this does not happen on the weekends when I don’t commute.
My blood sugars also do a similar jump between 12:00 a.m and 1:00 a.m. This happens every day.
I can’t increase my basals before the times my sugars jump because they are perfect up until the jump. A higher basal before the highs will drop me too low. I know the highs are not rebounds because I’ve monitored my blood sugar every half hour to catch any lows. I feel like the basal rates I am setting for these highs are reactive instead of proactive, which defeats the purpose of a basal. Any suggestions? Also, can the stress of driving increase blood sugars? I’ve read something that the release of adrenaline may increase blood sugars. My current basal seems incorrect, but it is the only thing I can do to keep from going into the 300s (mg/dl) [around 17.0 mmol/L].
Time
Basal
Average glucose
12 a.m. – 3 a.m.
1.3
220
3 a.m. – 6 a.m.
0.8
175
6 a.m. – 8 a.m.
1.2
150
8 a.m. – 6 p.m.
0.8
130
6 p.m. – 10 p.m.
0.7
130
10 p.m. – 11 p.m.
1.0
130
Answer:
Your sugars seem high overnight. My general opinion is that these need to be increased so some degree. Many of the recent pump models have the capability of programming two sets of basal rates; one you could use for work days and another for weekends and holidays. It is true that stress can drive up your blood sugars. However, you would have to test whether the stress is the cause of the highs or not. You could do this by riding mass transit or riding with someone else and see if the sugars rise.
JTL
