This story is classic Eric! Amazing that you were able to figure that out… and as a schoolboy, no less.
We also have noticed that we need a lot less insulin if we just keep Samson on a higher basal than he needs. it’s not a great long-term strategy because you’re feeding the insulin all day long, but using a higher temp basal he can basically eat all he wants without us carb counting or paying too much attention. And yes, he uses a lot less insulin when he’s hovering between 80 and 100 then when he’s between 170 and 190.
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Last night…not a perfectly sterile example bc pod change at 8:30pm, 14g snack at 9:15pm, but anyway…
I’m approaching peak progesterone spike in a few days so it’s a guessing game of the sporadic ramp up until then.
I used +10% until late afternoon and then up’d it to 15% bc my bg stuck at 175 when it really should have been lower w my activity level and w how well 10% worked the first half of the day.
Anyway, correction dose of 1.2 units at 11pm, up’d temp to +20%. At 4:30AM I saw the continuing downward trend and backed off to +15%. The decline stopped and hovered back up to 120. So today, a +15% might be able to hold me at 120
depending on a lot of things.
@TiaG, I love your methodology! That’s great! I do see a significant TDD difference when using basal vs bolus for hormone highs. I’m typically (non high hormone days) around 30-32 units per day. “Stuck” hormone high days treated via correction boluses (unsuccessfully - so I’ll still be high all day) will put me at around 40 units, and that’s w not even getting to eat half of what I would typically eat for a day bc I’m waiting out highs that never break…so I’m taking meal boluses in there, too, but end up only eating half of what was planned bc of bg terribleness…so that insulin could be counted as correction bolus, too, I suppose. Treating a “stuck” hormone day with basal at most adds 3.5 total units, but usually only 1-2 extra units.
@TiaG, I really like what you are saying overall and I will keep thinking on it. My tiny basals can move hormone mountains that aggressive correction boluses cannot touch. Plus the right basal rate allows me to eat which is nice. 
This is great. Yes, that is basically what I was saying in another post way up above. Without insulin, your body decides the liver needs to “feed” instead of “store”.
When insulin is present, your body believes it is in a fed state, and therefore stores instead of releasing. It’s several posts above, here is the technical description.
@Eric and @TiaG (and anyone else who wants to weigh in), do you feel this is also explaining the “drift” and “hover” as I call it during my times of hormone-induced insulin resistance? Bc per leading authors (T1D’s Scheiner and Ponder), if you are level, you ONLY need a correction dose. They say if you are level, no more basal is required. That is patently false in my body during insulin resistance two weeks (or more) each month. Correction doses will not touch what tiny basal adjustments manage easily (talking 2 total units of extra basal per day vs 10-12 units of correction doses that same day…which is really undershooting bc that is my personal limit of how much correction to try over the course of the day, and even it didn’t bring me down and keep me down).
So do you think the explanation above still explains insulin-resistance hover and drift? I.E. Certain inadequate basal rates will hold you level, but at 200. You won’t keep climbing (i.e. the liver stops “feeding” the body?).
Yes, I think the explanation is plausible for your situation. At least a partial possibility for what you experience.
BTW, don’t get too caught up in what authors and people like Scheiner and Ponder say. Because they are not writing a book for Allison, they are speaking and writing to thousands. So they are making generalizations. And absolutes are very difficult in the D world!
Amen to that. But I also had this disagreement, politely, on the phone with one of them and it fell on very kind but very unreceptive ears.
This is a difference between male endocrine systems and female endocrine systems. I think it is a wild disservice to women to not have this understood on a large scale.
It took me seven years to really feel proficient on shots and managing Lantus for hormone changes and using my Humalog to fill in the gaps during transition times in hormones in between Lantus shots. This is due to the lack of information for women on this topic.
I am now five years into pumping, without birth control steadying my hormonal shifts which I was on during MDI, which means my basal changes are more frequent and of greater magnitude than when I was on birth control. This is also a phenomenon that has not been studied. And it’s a damn shame.
I feel like, knock on wood, I’ve gained much greater personal proficiency for my basal fluctuations on the pump in a shorter period of time than when I was on shots. But if this was generally understood, or even acknowledged widely to be A Thing, because it is A Thing, women would have MUCH improved health outcomes with this disease. I’ve lost so much time that I could have been well controlled if this topic was invested in in the diabetes care community.
Thank you for discussing this. I’m open to more theories and possibilities and questions and experiments, but I think we’ve scratched as much of the surface as we’re going to right now. I will continue honing my “what works” methods and sharing those (and questioning those) on my other threads for anyone interested.
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So one some level I do think with insulin resistance your body has a tendency to get stuck at a higher level, not sure why.
But also, I think the “level” thing is a result of you not just leaving your blood sugar at that level with no corrections, etc… For instance, if you were to hover up to 190 – do you then just leave it there for 12 hours and do nothing? My guess is probably not. There is some level at which you would plateau with no intervention but i doubt it would be in the 190s to 220s.
@TiaG, nope. It does hover at 160. Or 190. Or 220. Or whatever level the hormones push it to due to resistance. And it stays there. It is the most bizarre thing to watch if you’ve read all of the diabetes books out there about what to expect and how to treat things. This phenomenon ain’t in there. And it should be.
I used to take correction dose, upon correction dose, upon correction dose. And walk. And drink water. And wait to eat and miss meals. And stand on my head. And do everything to make it move.
Now I do big picture diagnosis, careful tracking, and basal changes. Plus maybe one or two correction doses. And then it moves beautifully like I have four gladiators pushing my car out of a mudhole.
The place at which it levels is crucial information for how to fix it. It determines what percentage of basal I try to get it unstuck and to re-level it lower. Also, if it were to keep climbing, it’s not a hormone resistance issue, in my experience. It’s a site issue which is rare for me these days, knock on wood. The leveling is the biggest gift of this phenomenon bc it helps for quicker problem-solving. It’s not pretty, but it is helpful.
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This is the best Day 20 bg run I’ve had in a long, long time. This timeframe is notoriously difficult to pinpoint proper dosing for because of the hormonal ramp up to peak progesterone (which doesn’t give physical clues like ovulation does). +15% basal for the win today!
On a related note, my sites seem to tolerate meal doses better when I’m utilizing basal to handle hormone-induced insulin resistance (probably bc I’m not pumping repeated correction doses through them). I enjoy not having to take meal injections for now (which I had been doing to prevent site leaks and failures). And I got to eat as planned today which was awesome.
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Adding this here because I think it displays what I’m discussing pretty clearly:
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My Dexcom graph in the post above does fly in the face of prevailing basal guidance.
All of the prevailing T1D guidance says that the correct basal rate keeps you level. If you take more, you’ll supposedly trend downward and keep going. If you take less, you’ll supposedly trend upward and keep going. It’s this idea of a specific, finite basal rate (that you must decipher) that probably keeps all diabetics from changing their rates as often as they might need to. Furthermore, additional basal insulin (during hormone induced insulin resistance for me) LEVELS me at a lower LEVEL. It does trend downward at first after I dial up more basal, but then it finds a new leveling point.
I think this detail might help a lot of people, particularly women. Is this unique to me? Maybe. I imagine this applies to a lot of people experiencing insulin resistance due to a variety of causes, though.
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Basal and bolus interaction…when I’m accidentally running too much basal, my bolus kicks in and can tank me fast. But the extra basal doesn’t seem to do anything on its own too impressive. Conversely, when I’m not running enough basal, I’m not climbing or anything…but my bolus can’t do anything without more and more and more being taken. This is the gray area that I spend all of my time managing bc prebolus rules for one day can lead to drastically different results the very next day.
Input is welcome.
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So is it fair to say that taking too little basal is worse than taking too much basal?
If I know I am managing a situation of too much basal, it can work out okay sometimes. But it can turn ugly on me faster than too little basal…as far as acute ugliness…which I’m pretty adverse to. But these margins in straight units of insulin astound me.
Insulin resistance due to hormones (most likely) is at it again: near ovulation (day 14).
Top graph is last night’s overnight timeframe. Bottom graph is the last 24 hours (yesterday and overnight). I had to use +20% to get through breakfast yesterday, but got through the rest of the day with +0% and pretty decent balancing with peaks and dips care of boluses the rest of the day. I would have liked the average BG to be lower, but in dealing with hormone induced insulin resistance this is a pretty good balancing act. No tanking lows. No stuck highs. BG movement throughout the day is what I’m going for. I was able to eat 2100 calories which was no small feat.
Snack bolus at 7:15PM of 4 units. Ate a snack at 8PM. Mini correction of 0.5 units at 9:15PM. Going into bedtime, I used +15% basal because I had noticed increased resistance through the evening. I haven’t gone above +10% temp basal overnight in a long time because it almost always results in a persistent low.Then here are the overnight actions:
Using +15% basal overnight
11:20PM: 1.35 correction
3:20AM: 1.8 correction
6:40AM: 1.5 correction
6:40AM: Turned up temp basal from +15% to +20%
7:10AM: Turned up temp basal from +20% to +25% when I woke up for the day
Clearly I didn’t have enough basal overnight. The correction boluses would eventually chip away at the high bg, then the insufficient basal would win and I would drift back up to 200+. This is the information that is always changing on me. This is why it is hard for me to eat enough each day because I’m trying to pin down what the basal needs are while eating enough but not tanking and not spiking above 220 if at all possible. I am pleased with how well I kept the full day in balance without getting into a rebounding rollercoaster situation, which is super easy to do in this set of circumstances.
I went ahead and pulled the pod 8 hours early even though the cannula looked fine in the viewing window. Blood all the way up the cannula. So chicken and the egg problem for me…did the site wear out from the number of correction boluses the last two days from hormones? Or did the blood prone site just intensify the problem?
Don’t know. Hoping for better luck on the new pod today. My percentages for extra basal are close enough to what I would expect to see that I think both hormones and blood in the cannula contributed to what I was seeing last night. Always managing the gray area.
And after this post I saw a six inch long run of blood coming down my arm. Awesome.
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@Eric, I used +10% basal today and have ridden the wave. It’s been enough to drive me slowly down but not so much to get in my head and stress me out about surprise tankings. It has helped me eat like a bit of a jackass today. Not a total jackass, but enough of a jackass to make me happy and help my calorie count for the day while being pretty active. Thanks!
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Awesome!
I know it’s not the commonly held practice, but basal really supports the meals a lot. Just a little bit goes a long way.
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How frequently do you employ this tactic? Under what scenarios? Just curious.
I struggle w finding the balance of just enough extra without throwing myself into overtreating and bouncing.
It would actually be easier to say when I don’t do it. Because I always do it except under a few circumstances like these:
- Away from home - lack of access to my own refrigerator and pantry totally screws up the tactic.
- Any travel situation, driving or flying.
- Working in an office, which I don’t usually need to do.
- Something like a dentist appointment where I can’t stop and eat.
- Any time I am needing full concentration and can’t take a break for eating or can’t afford the mental lapse a low might bring,
- Any time when I am trying to cut weight and the extra eating will screw me up.
Other than that, I will do it.
It is generally not any kind of crashing low, or anything that needs a lot. Just a handful of peanuts, or a few potato chips or bite of cookie, or something small like that.
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