Rebound!!
We've all heard about rebounding blood sugars, most commonly in the form of dawn phenomenon. I knew that severe hypoglycemia can lead to rebounding highs, however I'd never thought too much about it in my personal management. This week I had a really obvious experience with this effect.
On Tuesday I did a strenuous Tae-bo workout after work. My blood sugar was 118 mg/dl before my workout, 97 mg/dl half-way through and after a few ounces of OJ, it was 144 mg/dl about an hour post-workout. I had a normal dinner and gave myself 3 units of humalog. At bedtime I was at 82 mg/dl. Since I am on lantus (administered at 10 p.m.), I tend to get low during the night, especially after a workout. So, I had my favorite snack: 1 brown rice cake with a little PB and chocolate chips, plus 6 oz nonfat milk. At 4 a.m. by blood sugar was 50 mg/dl! I had some OJ and went back to sleep. Upon waking at 6:30 a.m. it was 50 mg/dl again!
In contrast, here was my experience Wednesday:
I was in the low range all morning. After lunch, I made a bad decision and had a slice of reduced fat banana coffee cake from Starbucks. I gave myself some insulin for it, but since I'd been low for a day, I gave myself less humalog than I'd usually need. At 6 p.m., as my husband and I were preparing to run, my blood sugar was 227 mg/dl. Darn! I was angry at the high, so I gave myself 2 units of insulin.
We ran 3.5 miles (which was hard, I'm so out of shape right now!) We came back, and for some reason, I wasn't thinking and didn't test my blood. I could feel the low coming on in the shower. I just quickly finished, and started to heat up dinner. I was hoping not to have to have OJ to bring up my blood sugar and just hurry to eat dinner. But I was really sweaty and shaky. So I tested, 42 mg/dl. Now, I am low quite often, but it's typically at night, or after not eating for awhile. I don't have many lows that feel very intense. This one did! I had some OJ, ate dinner (the same dinner as last night) and felt better pretty quickly.
At 10 p.m. my blood sugar rang in at 80 mg/dl. I was just where I was the night before at bedtime. Since I had gotten low during the night after my workout Tuesday, I figured I'd have my same rice cake, PB, chocolate and milk snack, but just have a little extra milk and chocolate! Instead of getting low, my blood sugar was 248 mg/dl this morning!! WHAT?!
Suddenly it occurred to me... that low before dinner was pretty extreme, hmmm. Was this a rebound effect? I gave myself 4 units of humalog and had a bowl of Vanilla Almond Special K cereal (yum!) Typically this recipe would equal a 70 or 60 mg/dl by 9 a.m. Instead, I tested at 9:30 a.m. and was 324 mg/dl. Again... WHAT?!
3 more units of humalog and 2 hours later I'm 110 mg/dl. Finally.
I think this is a really clear example of rebounding blood sugars. Doing the exact same things two days in a row, only one with a low, demonstrated the effect of a rebound. Thinking back, I've often had those totally out of the blue (or so I thought) numbers that didn't make any sense. I'm sure when I flip back through my logs, I'll find that they followed extreme lows.
I think the connection took me awhile to make because I have "lows" fairly often. But, like I said they're typically brought on my lantus or just occur more gradually, thus the rebound response either doesn't occur, or is just less extreme.
Wow, I'm glad to pin-point this. However, it feels like one more thing I have to factor into my management system. I suppose the real lesson is not to let yourself get real low in the first place, huh?!
On Tuesday I did a strenuous Tae-bo workout after work. My blood sugar was 118 mg/dl before my workout, 97 mg/dl half-way through and after a few ounces of OJ, it was 144 mg/dl about an hour post-workout. I had a normal dinner and gave myself 3 units of humalog. At bedtime I was at 82 mg/dl. Since I am on lantus (administered at 10 p.m.), I tend to get low during the night, especially after a workout. So, I had my favorite snack: 1 brown rice cake with a little PB and chocolate chips, plus 6 oz nonfat milk. At 4 a.m. by blood sugar was 50 mg/dl! I had some OJ and went back to sleep. Upon waking at 6:30 a.m. it was 50 mg/dl again!
In contrast, here was my experience Wednesday:
I was in the low range all morning. After lunch, I made a bad decision and had a slice of reduced fat banana coffee cake from Starbucks. I gave myself some insulin for it, but since I'd been low for a day, I gave myself less humalog than I'd usually need. At 6 p.m., as my husband and I were preparing to run, my blood sugar was 227 mg/dl. Darn! I was angry at the high, so I gave myself 2 units of insulin.
We ran 3.5 miles (which was hard, I'm so out of shape right now!) We came back, and for some reason, I wasn't thinking and didn't test my blood. I could feel the low coming on in the shower. I just quickly finished, and started to heat up dinner. I was hoping not to have to have OJ to bring up my blood sugar and just hurry to eat dinner. But I was really sweaty and shaky. So I tested, 42 mg/dl. Now, I am low quite often, but it's typically at night, or after not eating for awhile. I don't have many lows that feel very intense. This one did! I had some OJ, ate dinner (the same dinner as last night) and felt better pretty quickly.
At 10 p.m. my blood sugar rang in at 80 mg/dl. I was just where I was the night before at bedtime. Since I had gotten low during the night after my workout Tuesday, I figured I'd have my same rice cake, PB, chocolate and milk snack, but just have a little extra milk and chocolate! Instead of getting low, my blood sugar was 248 mg/dl this morning!! WHAT?!
Suddenly it occurred to me... that low before dinner was pretty extreme, hmmm. Was this a rebound effect? I gave myself 4 units of humalog and had a bowl of Vanilla Almond Special K cereal (yum!) Typically this recipe would equal a 70 or 60 mg/dl by 9 a.m. Instead, I tested at 9:30 a.m. and was 324 mg/dl. Again... WHAT?!
3 more units of humalog and 2 hours later I'm 110 mg/dl. Finally.
I think this is a really clear example of rebounding blood sugars. Doing the exact same things two days in a row, only one with a low, demonstrated the effect of a rebound. Thinking back, I've often had those totally out of the blue (or so I thought) numbers that didn't make any sense. I'm sure when I flip back through my logs, I'll find that they followed extreme lows.
I think the connection took me awhile to make because I have "lows" fairly often. But, like I said they're typically brought on my lantus or just occur more gradually, thus the rebound response either doesn't occur, or is just less extreme.
Wow, I'm glad to pin-point this. However, it feels like one more thing I have to factor into my management system. I suppose the real lesson is not to let yourself get real low in the first place, huh?!
posted by Kelsey @ 10:42 AM
3 Comments:
At 1:28 PM,
Scott K. Johnson said…
Very nice detective work!
Those rebounds can be very nasty. Your body responds by spurting out a handful of hormones, some of which don't do anything until many hours down the road! When you get blindsided by them it can make control really hard.
And doesn't it just feel awesome to figure something out?!
At 9:46 AM,
Anonymous said…
i did a test. i ate the same thing at the same time and did the same 30 min work out for one week. all day same food/insulin. no two days were the same. unexpected highs mainly. i don't think i get a rebound. i just think i eat too much to cure a low. i don't think you should base having a snack on that you might go low. set your alarm for 2 hrs after bed time then 2 hrs after that to keep a track.
At 9:00 AM,
Kelsey said…
Thank you pumping princess. However, I work out religiously and typically go low in the night even when I've had a bedtime snack. Having a snack at bed to prevent a low was not the problem in this case... not identifying the rebound from the earlier low was the point.
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