Testing for insulin to cover coffee...a fail? Well, not quite.

"Ever wonder why your blood sugar rises after drinking a cup of coffee – even when using

artificial sweetener? It’s probably due to the caffeine. Intravenous administration of caffeine

was found to reduce insulin sensitivity (the degree to which insulin lowers blood sugar) by 15%.

Caffeine produced an increase in epinephrine (adrenaline), free fatty acids and blood pressure.

The solution: either take extra insulin with your coffee, or switch to decaf!"- Gary Scheiner

I purchased Gary Scheiner's "Think Like A Pancreas" on Friday and had a very hard time putting it down because, even with 12 years as a diagnosed Diabetic and having read almost every related book I can get my hands on, I was so very impressed. I finished the book last night and spent several hours basking in the afterglow of new knowledge.

Since the spike I get from coffee has been a thorn in my side since day one of my diabetic life, I decided to try his suggested test to find out just how much insulin I need for coffee. Mind you, I use no sweetener but do add two tablespoons of half and half or heavy cream to an eight ounce cup. Plain brewed coffee and espresso have no carbs but Gary's above-quoted explanation makes sense and damn it, decaf just isn't the same. (As a side note, I don't get spikes from other caffeine-containing drinks unless I consume a huge quantity) I refuse to give up my java so I bolus for it. That's been pretty much a shot in the dark for me as sometimes my guesses are good and other times they aren't so good. I figured following Mr. Scheiner's advice would help me come up with a better plan.

What he suggests is to test the coffee without other food and bolus just for the carbs in the coffee. I use no sweetener so that means bolusing for just the half and half. Two tablespoons of the lovely stuff contain two grams of carbs and since I prepared 16 ounces of java, I added four tablespoons of half and half. That means a bolus for four grams of carbs. However, my blood sugar was 66 before starting the test and since anything under 70 is considered low, my bolus calculator gave me "0.00" for insulin needed. Got that? Uh huh, I thought you did, you smart cookie.

So, at 3:40 PM today, before the first drink of iced coffee with half and half, my blood sugar was 66. I started to drink the stuff, figuring it would take me about 30 minutes to scarf it all down. After drinking about half of it the nausea started. Yep, nausea! No way could I get all 16 ounces of it down in 30 minutes. I thought I'd check the blood sugar at one hour just to see where it was and the result surprised me. 73! Just 73? For those not familiar with Diabetes, a rise of seven points is just about negligible, especially when the usual result is much higher than that. What happened to the spike I normally get from even one eight ounce cup of coffee? Hmm, I'm not sure but it was nowhere to be found and after an hour the coffee was pretty watered down by the ice.

I kept sipping on it, fighting nausea, determined to finish the three hour test. Yes, three hours of my life spent trying to get an accurate picture of how much insulin I need just for coffee. That's how important coffee is to me but it's also how important controlling my blood sugar is to me. If I'm not willing to give up a food or drink that causes my blood sugar to rise dangerously high, then I must bolus correctly for it. There are no ifs, ands, or buts on this.

At the two hour mark, I'd managed to drink about 12 ounces. That's it. My blood sugar was 75 and the nausea was still present though not so bothersome. I gave serious consideration to canceling the test but since I drink coffee at different times of day and my coffee-free blood sugar readings vary, it's vital that I have the information a finished test will provide. So I persevered. Gagging, I sipped a little here and a little there, fighting the nausea that came and went, anxiously watching the clock for the three hour mark, and more anxiously watching the barely changing level of coffee in the glass.

Finally, at the two and a half hour mark, major waves of that sick feeling in the stomach demanded I throw in the towel. My blood sugar was 67 and I thought I'd never drink another cup of coffee. I don't think I'm getting sick and perhaps all this is related to drinking coffee on an empty stomach. Normally that doesn't bother me but who knows? I needed to eat something and since I desperately wanted to tough it out until that three hour mark had passed, I threw what was left of the coffee in the sink and went outside to sit on the patio.

The three hour mark came and I checked my blood sugar, holding my breath. 63! I put the number into my PDA and it said I needed to eat. Not a surprise. The only thing that sounded good was yogurt so I entered the 15 grams of carbs for it into the calculator and bolused the 3.2 units of insulin it said I needed. Yep, I still needed a smidgeon over 3 units of insulin to cover that fairly small number of carbs even though I was on the verge of a big fat hypo. Blast it all!

I suppose some people would say this test was a failure but I don't agree. I did learn something and that is that starting at 3:40 PM on a Sunday afternoon with a blood sugar reading of 66, I can consume 12 ounces of iced coffee with about two tablespoons of half and half without a spike. At least on this day. ;)

Truthfully, the last three hours have confirmed what most diabetics know and some experts acknowledge. Diabetes is a very individual, complicated, and ever changing disease. What works today might not work tomorrow. In fact, it might not work later today. And what works on Sunday afternoons might not work on Monday mornings. Yes, I'm going to try it again tomorrow morning and adhere to my normal routine of waking at 5 and drinking 16 ounces of hot coffee with four tablespoons of half and half before heading to work. If I can stomach it.

We'll see what happens.