FUDiabetes

24 hours under 100

mdi
corrections
prebolus
nudges

#1

I was able to keep my BG under 100 for 24 straight hours.

I did this as somewhat of an experiment. It was just a proof-of-concept, and an opportunity to practice self-discipline and just bring to the surface the factors that enabled this to happen. I am not suggesting this as a measure of control, this is not my normal practice. But hopefully the things that come to the surface are beneficial.

It wasn’t easy. Sometimes it required ridiculous things, like being in a meeting and having to stop so I could take insulin when I was 88 and rising :slight_smile:. I know there are a lot of lows here. But the Dexcom does linger on the lows, so it wasn’t as bad as it looked. I took care of them all and I never got in any trouble with it.

So while this is not really practical for the real world, there are some behaviors which were useful, and that’s what I wanted to discuss.

Here are some points that came out of this for me. Most are old and well-known practices, but possibly a few new things:

  • Aggressive bolus for meals

  • Aggressive use of insulin for rising BG

  • On the opposite side - very conservative and small sugar corrections for lows or falling BG

  • Trusting that the sugar corrections for lows would work, and most important thing, being PATIENT for them to work.

  • Not looking for a number to correct, but instead correcting on the up or down trend

  • Early bolus for meals

  • Very slow eating! Taking an hour or two for a meal instead of 15 minutes (that’s NOT my normal behavior!)

  • Trusting your basal!

  • Doing some things not based simply on what the numbers look like, but using historical precedent to have an idea of what would happen at certain times of the day.

  • Trusting those :arrow_up: precedents

So what I hope for is that the list of things that came out of this for me on my little experiment are useful for discussion.

I am glad it is over so I can relax when my BG pops up a little bit after a meal.


#2

What I find most amazing is that you managed this with MDI!


#3

THIS! IMHO this is the key to control. Few T1’s could even dream of having the discipline and control that @Eric has, but if trend control was the mindset instead of number control many could. That’s what makes the Dexcom so valuable.


#4

I thought doing it would be a good way of just reflecting on a few key points, and those key points are the ones I listed.

This was a huge pain (that’s why it was only 24 hours). I could never do this consistently. Would not even want to try. But I do think it was good practice and evaluation. And I wanted to bring these things out for the purpose of discussion, things that people do that help them.

Like Doc @docslotnick said, the up or down arrow is so important. If you are moving up, no need to wait until it gets to a number. If you are confident it will keep rising, nail it early.

The thing that came out of this for me which was a little bit new or at least I had not really paid as much attention to, is eating slow!

What else works for everyone?


#5

In honesty though, it was not my first attempt. I failed several times before I got it! I would string together almost a day and fail.

When I would go over, I’d eat some ice cream and celebrate my failure :yum:, and then reset the clock and try again. :joy:


#6

Wow, congrats that is a great achievement. What strikes me as unexpected, is the same thing that struck you i.e. eating a meal over an hour or two. I find this to be interesting and frustrating. Interesting because I have never heard of this as an approach and it is kind of contrary to what I would have thought, and frustrating because it is difficult to achieve this while living a normal life, unless you live in parts of Europe where they won’t get frustrated if you take your time to eat. Do you think the eating over time worked because it gave you more time to micro-adjust, or because there is some intrinsic benefit to it?


#7

I saw it rising while I was on the freeway on the way to work this morning. I wanted to inject when it started going up, despite the fact that there was IOB from my breakfast bolus. I knew it needed brakes applied but it was too dangerous to inject while driving.

As soon as I parked my car I corrected. You see the result of having to wait 15-20 minutes to correct. If I had nailed it when it was first happening the curve would look a lot better :sob:


#8

It just gave the insulin more time to match the food. Since insulin takes so long to be absorbed (the half-life for most rapid insulins is about an hour, with the remainder taking an additional 3-4 hours), eating slow just matches the insulin better.

This is extremely contrary to my normal eating. You know the term “lunch hour”? That term never applies to me. It is usually “lunch 5 minutes”.


#9

But it is great you have a handle on hitting the trends, even if you can’t always get to them on time. That’s the important thing.


#10

Forgot to mention this: I corrected some downward trends with some foods that are not traditionally used for correcting (at least I don’t use them much, I bet @britt_j uses some of them). Things like almonds or cold cuts.

Whereas usually I would hit a downward arrow with something more carb based, like crackers or a small amount of chocolate or cookie, this time I wanted to make sure I did not cause the reverse spike, so I used things more protein based.


#11

Did you eat more than you usually do, to achieve this, or was it more like spreading your food out over the time?


Flat top but not on the bottom :-)
#12

Nice soft landing, just in time to screw it up again with lunch :grin:


#13

Next time could you log the foods you eat so we could do some parallel graphing? Would be so interesting to see how different bodies respond to the same intake.


#14

You’re taking more than 1:1 IC? I thought I took a lot…

I thought I took a lot…


#15

Yes. My insulin resistance had gotten ridiculous in the past four or five years. I’m now 1:1 for breakfast and lunch, 1:1.25 for dinner.

I was concerned about it, and the first time I saw my new end in San Antonio he said not to worry about it, just maintain my good control with enough insulin. I’m starting to have lumps in my abdomen where i inject.


#16

Mine has increased a fair bit over the past year or so but up more like 1:4 in the morning to maybe 1:7 in the evening now… but I’m early into this journey…

I’ve thought about trying metformin in addition to insulin to increase sensitivity but my doc also kind of blew off the idea when they see the total amount of bolus I use in a day is still quite low… like less than 30u on an average day but they seem to not realize that’s that’s with eating very few carbohydrates…

Ever try metformin? Did it help?


#17

Sure, I can do that. But I don’t know when the “next time” will be for something this extreme! :slight_smile: This one was rough!


#18

I was taking metformin for about three years until my doc got me on Jardiance. I like the SGLT2 better than metformin because since I’ve been taking it I’ve never gotten over 275. With the metformin my upper limit was about 310. (Those numbers happen very, very rarely)


#19

No, not more at all. Just slower! And little snacks of nuts and stuff when coming down.


#20

I definitely attempt to treat downward trends and fuel exercise with real food – berries, cherry tomatoes, small bits of chocolate (very dark – 85%+), low carb nuts (mostly pecans, macadamias, walnuts and almonds). I posted a recipe for low carb halva earlier – much more protein than digestible/available carbs.

Depending upon my activity level, I only resort to dextrose (Dex4 bits or Smarties) when <65 or thereabouts.