And the mathematical comparison is 0.1 extra units per hour (which works) compared to about 4-5 units of correction boluses given in about a 6 hour timeframe (which won’t budge anything).
I know I’m being very simplistic, but I’m a simple person. I increased basal by 4 units (I’m on Tresiba and MDI) and left my bolus (C:I ratio) alone when I retired and became less active.
Worked like a charm. Flatlined with no hiccups. I think it was just a lucky guess, but what isn’t when it comes to the human body?
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Anyone, male or female, can experiment w this. Take 10% too much basal or 10% too little, and see what all you have to do to work around it. And see how the math turns out on it. And for real fun, have a significant other be in charge of it (5-40% changes for the brave) like a surprise that you have to figure out without looking! 
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Oh no, I am not suggesting you should do it as an extended bolus!
I am simply suggesting that you consider that it is a possible delivery issue.
I wanted to present the idea to you, that if slow delivery of insulin (basal increase) works better than taking larger correction boluses, maybe it is just the delivery and absorption.
Sorry, I wasn’t very clear before.
Does that at all seem like a possibility?
It’s certainly another method of thinking about it. But I’m still missing the piece of “under x cirstances, 0.1 units of insulin per hour (totaling 1 unit of insulin over 10 hours) will accomplish what 50x that in correction doses given periodically cannot budge in the same timeframe.”
Do you take the correction after you are already high, but do the basal increases preemptively, before you are high? If so, that would explain a lot.
And the larger point, in my narrow worldview, is that Sugar Surfing will not work for women at least half of each month, and potentially not very much at all during the transition timeframe of life, which can last 8 years.
Correction boluses are taken once “stuck” somewhere…be it 160 or higher. I don’t let it drift above 220 in high hormone times without attempting to dampen it…but a correction dose won’t work anyway if it is hormone driven in my experience.
Basal changes, which I try to do first if I know that hormone resistance is the most likely culprit, are also implemented once “stuck” at a higher than desired bg. The interesting thing is that implementing the basal change will bring my bg down itself if given enough time. Typically a correction dose is not mandatory.
With hormonally induced resistance, you cannot know that you need more overall insulin until you see your numbers “stuck” somewhere in my experience. This is why I Iet the highs happen to see where they level so I can decide what the treatment plan is, which can save me highs for the next few days if I get it right.
I think I would need to see some examples of time and dosing and stuff to comment.
I kind of need to see some type of comparison to be able to process this thing in my brain. I am not thinking clearly anymore. Friday!
I mean, like as a comparison, just totally random dose numbers:
- you are 150, you take 5 units, nothing happens for 8 hours
- you are 150, you bump your basal up 0.1 units for 8 hours, and you are fine…
Is that kind of a proper example if what you are seeing?
But this is back to the other thread now, because you are talking specifically about things like progesterone and estrogen and other hormones, which have a different effect than just eating.
True. But it still gets at the heart of what does basal really do? It still gets at the heart of what makes an hourly insulin rate behave so much more effective than comparatively huge correction doses? It still gets at the heart of insulin resistance.
I realize men get uncomfortable with progesterone and estrogen and things they don’t experience themselves (maybe you aren’t uncomfortable, but others seem to be - or they don’t believe it makes a difference, or they don’t see applicability to themselves so they aren’t interested) but at the end of the day I’m discussing the science behind what we all do everyday to take care of ourselves. Hormones play a huge (and not well understood) role in that. I wonder if that’s part of why the leading “written by a T1D how to be awesome at blood sugar control” books are written by men. They have a more level playing field and eagerly want to teach their methods that get results. And that’s awesome. But what I’m looking for is the science behind why their tried and true method won’t work in my body half of each month. And I also want to spread awareness that this is a real thing, that women could use some sound science invested in their T1D health care, and that what works for male diabetics may be disastrous counsel for female diabetics.
Like @Nickyghaleb frequently says, you don’t have to respond to that. But I’ve enjoyed picking your brain today, truly.
Yes. Nailed it.
The 5 units would be taken in a few separate doses after the first unit or two didn’t respond, try again. But, yes.
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Let me think through it a bit.
I am not uncomfortable with it, but I don’t have first hand experience with it.
But I do know what hormones can do. I get a 100 point spike when my heart rate goes over 160 for a few miles. Almost exactly 100 points every time. But it’s cortisol, not estrogen. Different hormone, same effect.
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Just to remove the obvious, let me get this out of the way. It takes more insulin to lower a BG from a high, than it does to prevent someone from getting high. We are not talking about basals preventing a high in this example, right? You are definitely talking about basals removing a high?
Can we try a few variations of this? Using the same scenario above, the 5 units that did not work - as you say it does not budge your BG - what if you did it as either:
-
10 separate 1/2 unit injections all over your body (remove absorption issues as a possibility)
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or did a 5 unit extended bolus, over maybe 2 hours (that would be the pod spitting out 0.05 units every 1 minute and 12 seconds)
Just a few different delivery methods to see what difference it makes, that gives us a few more data points to examine.
I mean, we can, but I should probably point out that once enough rage bolusing gets the insulin resistant bg to come down, and assuming I don’t overtreat the low and rebound high from excess treatment carbs, I’m going to drift back up to where I was anyway (I know this from lots of trying the bolus technique during times of resistance) as soon as that bolus correction is gone. I.E. I’ll re-level where I was at the higher bg without either using extra basal, or continual correction boluses.
My question is why the biology and the math works out the way that it does…like why the 0.1 units of extra basal will accomplish more physiologically than so much more in correction boluses.
I’m happy to try things out that might help my health in the long run, but trying different methods of correction bolusing is a no-go for me for hormone induced resistance. I tried it for four years and it earned me a 7.56 A1C…my highest since diagnosis in 2005. Fingers crossed that September’s lab work is significantly better.
We’re talking about fixing and long-term eradication of a hormone induced high. Long-term mean 24 hours or longer.
Okay, I am seeing your thread in a different way now. At first I thought it was problem-solving. But you are thinking about it in terms of the math and making sense out of the numbers, right? Not changing the approach?
A few things come to mind on this.
Timing is extremely important. For example, if I take it long enough before dinner, maybe 4 units is enough. But if I wait until the dinner is on the plate, it could take 8 units to do the same thing.
It’s easier to prevent a high than remove one. If I am 110, maybe I would take 0.15 units. If I wait until I get to 150, that 0.15 won’t do much. 0.15 units now is never the same as 0.15 units later. That’s kind of what you are seeing, right?
A personal story that has a parallel to all of this. When I was in school long ago, I was on a school field trip to a national park in the mountains. Long ago, no cell phones! The park also didn’t have phones. We got snowed in. And my insulin supply was a bit low. Not dangerously low yet, but certainly low enough that I was extremely nervous. I had no idea how long we would be snowed in. And nobody was coming to get us. We were not due back home for a week, so I was basically stuck and screwed.
There was plenty of food, because the park had a stocked food supply store. But food was not the problem. Lack of insulin was!
I started doing some thinking on the best way to stretch my insulin. And it was obvious to me back then - long before there were resources for learning about this - that aggressive basal, and staying as low as possible at all times would help me stretch the insulin out the longest time.
If I went high, that would cost me much more insulin than preventing the high. So I tried to maintain a low the entire time, until the snow melted enough for us to get out.
Endos often say that 60%-40% or 50%-50% basal and bolus ratio is the best. But I can tell you, if you are stuck in the mountains and you want to make it last, you would want to go with 80%-20% or something like that!
Is this somewhat of a parallel to your experience?
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Before I forget to address it, your “trapped in a mountain lodge” experience and your young problem-solving is fantastic.
Here’s the thing about diagnosing the extent of hormone-induced-basal-resistance (my term, bc that seems to be the most accurate descriptor): The only way I have been able to find (thus far) of determining (a) that I need extra basal for sure and (b) how much extra basal to try, is to let it drift up and see where it levels. If I jump on every climbing 140 with a correction bolus (and if it actually worked, which it hasn’t seemed to when I’ve tried that method in this set of circumstances), I’m not going to have any idea if my bg will level at 160 or 190 or 220, AND I’m not going to know if it will get “stuck” there (which would tell me to try 10% extra basal for a “stuck 160” per my past observations or 15% for a “stuck 190”) or keep climbing, which would be a different problem to diagnose (bad site, etc).
The other thing to point out is that it’s not like I’m running perfect 120’s and then all of a sudden something shifts in one climb. BG gets sloppy and tipsy and embarrassing for a few days…all of which can be chalked up to one of a million tiny things that could have caused an off result…and then it eventually gets stuck at a higher number and you’re just there. Hovering. When hormone-induced-basal-resistance occurs, nothing works. Boluses can’t touch it. Eating can make it a bit worse…but it doesn’t move that much in that case, either, in my experience (being a moderate carb’er). But dialing in just the perfect amount of basal can knock sense into it again…not perfectly, but it can get it un-stuck. Until your needs secretly change on you again.
The problem is that just a tiny bit too much basal or a tiny bit not enough basal is the difference between tanking or being stuck at 220 for days on end (I’m seriously talking 0.1 units per hour here). The other problem is that trying to manage it with correction boluses ends up just pumping that much more of an X factor into your system where you are edging closer and closer to a cliff, backwards, wondering if the wind is going to blow you off the edge to tanking eventually. That’s not even being dramatic. That pretty much sums it up for what I (and likely others) are dealing with for at least two weeks at a time.
So, I understand a higher number requires more insulin to bring down than a lower high number on a flexible scale. But a 220 bg during low hormone resistance can get fixed easily in one bolus for me. A 220 bg during higher hormone resistance isn’t the same 220. It’s this stuck, not-enough-basal-but-if-you-get-0.1 unit more per hour-monster that is a whole different ballgame. And I am curious of the mechanism behind it. The “why”. I’ll be less concerned about the “why” if I can come up with an improved patterning system. But until that happens, I’d like to know more so I can learn more about which lever to pull and why it is that way.
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This may look horrendous in the FUD world, but I’m going to be brave, and post it, and say how insanely proud I am of my steadiness and improvement in the last three months (dropped average bg by 30 points, much steadier line). My #1 diabetic challenge, which causes my #1 daily living challenge (I.e. Getting to pay attention to my kids rather than dissecting a tank or a stuck high and when I might get to eat and what that food might be), is managing the invisible but forceful and ever changing insulin resistance via hormones. And I’m in the “easy” phase of female management.
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so we see this trend with Samson a lot – where a bunch of huge corrections do nothing, briefly nudge him down to 150 only to see him float back up to 220 again. Usually when he’s sick or when he’s growing.
What I do on those days is see what his TDD was the day before, divide it in half (just based on my experience that he’s about 50 percent basal/50 percent bolus) and then see how much extra he used above his average. So if he’s normally 7 units per day and 3.5 units basal, today he’s at 12 units so he needs 6 units basal. And I ramp up his basal accordingly and magically the highs don’t happen.
The thing is, at the end of the day when I look at his total insulin, he really has gotten quite a bit more. That extra 0.1 units per hour may not sound like a lot but if it’s over 24 hours it adds up. So the first thing I’d do is when I am using that extra 10 percent basal, is look at your TDD – is it really less than on similar days when you’ve relied only on corrections?
And also, again, I think the issue with the huge corrections is you’re not getting a steady level of insulin into your body unless you’re doing them at regular intervals. And the reason we use temp basals is because it’s easy to not have to think about it while achieving that steady level. If I were to give Samson 0.1 units every 15 minutes it would be almost exactly equivalent to giving him a 0.3 unit/hr temp basal – the Medtronic pump delivers squirts of insulin only at that frequency. So that would be truly parallel. But that’s annoying and even if I planned on doing that I’d probably forget, do one dose late, and pretty soon that steady, consistent level of insulin in the bloodstream will be shot.
In reality what I’m doing is giving him 0.5, waiting an hour, getting frustrated, giving him 0.8, waiting 30 minutes, giving him 0.5, and so on. The steady state level of insulin in his bloodstream at that point is anyone’s guess. (I mean, we could calculate it in theory but it’s tricky math.)
I really do think that at some level, the cells in the liver need to be exposed to a constant concentration of insulin above a certain threshold for a certain amount of time in order to activate chemical pathways to began pulling in blood sugar and storing it as glycogen. When you briefly let that insulin concentration drop below that threshold, your liver starts dumping sugar. Then, once you dump enough sugar, you need a lot more insulin to get the numbers down.
At least, that’s my interpretation. I too see what you do – where a small temp basal will have much more effect on Samson than a ton of corrections piled up, which seem to do nothing until they do too much all at once. And I do think it’s sometimes tied to growth hormones (he gets very “sticky” highs at night almost as soon as his head touches the pillow if we don’t bolus or temp basal him before he falls asleep.) But I also get what you’re saying which is that a daily hormonal pattern (like dawn phenomenon or nightly growth hormones) are fundamentally much more predictable than the hormonal changes associated with a woman’s cycle. The rough frequency at which these things happen is there – but being off by one or two days is a big difference and that’s not unusual at all. And it’s basically impossible with a normal pump to get this cycling to happen on “autopilot” – which is the whole point of a pump. Having 3 or even four basal patterns probably isn’t enough. Having 7 or 8 that automatically kick in is what you need. You need some machine learning.
By the way, your numbers are great! You spend almost no time low! And tons of time in the green zone! Wish we could get Samson that steady…in time I guess!
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