Sugar Surfing Lesson #17: Shift happens
As I write in the book “Sugar Surfing™”, blood glucose levels in healthy people are never truly static (at least not for very long). The ebb and flow of blood sugar reflects the natural shifting which occurs in response to the immediate metabolic needs of the human body. Glucose (blood sugar) is a high energy fuel for tissues. Activity, stress, digestion and fasting are some of the forces which affect the minute to minute level of useable energy (e.g., glucose) circulating in our bloodstream.
A continuous glucose monitor (CGM) vividly reflects these shifting glucose levels in real time through the image of a BG level versus time graph, better known as a trend line. Sugar Surfing (dynamic diabetes management) is the art form of ‘steering’ or directing the trend line in order to meet the expectations of the person with diabetes. Sugar Surfing is not based on how one chooses to eat. It is a method of learning how to make choices and decisions regarding one’s diabetes self-care choices. We make thousands of choices each day and some of these choices impact the trendline favorably. Others, less so. Every day’s blood sugar pattern is unique; literally. Imagine collecting a highly accurate blood sugar measurement each minute of the day. In total, this would equal 1440 glucose readings. Now ask yourself: “what are the odds of two different days possessing the identical blood sugar number sequence? Of course, the answer is...astronomical.
Glucose is not our only metabolic fuel, but it is the primary one and the brain mostly depends on it. Changes in personal eating behaviors can be used to increase the use breakdown products of proteins and fats to fuel the body. This forms part of the foundation of the lo-carb approach to diabetes self-management. But no matter how other fuels are manipulated (e.g., ketones), the body still requires glucose. The process of digestion and metabolism of fat and protein also results in some amount of glucose creation, albeit much less than what would result from carbohydrates. Dynamic diabetes management methods are embraced by persons with diabetes (or parents) who use a range of nutritional approaches (lo-carb to higher carb) to manage their diabetes or that of their children with diabetes.
Nutritional choice is essential for all persons with diabetes. It should be individualized for each person. This is now the official stance of the American Diabetes Association (ADA).
As seen below in this person who effectively employs a lo-carb nutritional philosophy combined with the pump-CGM insulin delivery method known as "looping", there is ebb and flow in glucose levels regardless of food choices. If there is a "Holy grail" for blood glucose management, it's spending the most time in a blood sugar "range" than always keeping a straight glycemic trend line. As I say in the book "the only person with a straight line blood sugar is a dead person". Sugar Surfing is learning how to best manage "flux and drift" when concerning or significant BG patterns appear or begin to appear.
Blood sugar levels shift all day in all human beings. It’s only a matter of how much. The same happens in persons with diabetes, only the swings can be much wider if not somehow managed. Shifting blood sugars can result as part of a planned action (e.g., meal, exercise, insulin dose), or it might change unexpectedly, in either direction, for known (or often unknown or unexpected) reasons.
Under ideal circumstances, Sugar Surfers pro-act (plan) as much as they re-act (respond) to unexpected shifts in blood sugar. Using a CGM brings these glycemic detours into sharp focus. The Sugar Surfer aims to unravel the reasons or forces behind the flux and drift in blood sugar trends. Sometimes this can be a straightforward action. Sometimes an immediate explanation for change remains elusive. Shift happens.
The image below shows 24 hours of Sugar Surfing using multi-dose insulin as the method of insulin delivery. A pump is not needed to Sugar Surf. Without question, an insulin pump can be helpful in other ways. This is because Sugar Surfing is about making choices and decisions, not how you eat or how you receive insulin.