Everyone of us here is unusual in our own unique way. No good and no bad, just different.
4 Likes
I think insulin duration is different for each of us. Hwr, it seems the developers of Loop recommend 6 hours for Humalog/Novolog. It is graduated based on the insulin DIA curve provided by the manufacturer, but still 6 hours is a long time, even if it is next to nothing by hour 5! I myself will correct even at 90 if I’m on an upward trend.
2 Likes
wow.
How many of you are NOT using a CGM?
I don’t mind finger sticks.
Do you check every 15 minutes, or 30 minutes for up or downtrend?
Balancing the food digestion and insulin peaking is the challenge.
3 Likes
No CGM here. I like to check premeal and 2 hrs post meal, if too high, I’ll correct. In my case, the bolus lasts around 3 hours, for the most part, so I’m comfortable correcting at that point. A lot of it is by feel for me, I’m pretty sensitive to lows. If I’m slipping low, I take small corrections in the form of smarties or similar to get back on track.
2 Likes
I agree! CGM really, really helps with this, and using CGM with Loop (or other automated insulin delivery system) is icing on the cake, so to speak. This is because Loop can start correcting right away based on your Loop settings (ISF, I:C, Basal, max Basal, TiR).
For example, last night I had dinner at 6:40 PM. I took 1.7U (Fiasp) at 6:20 PM with a DIA of 5 hours, for the 30 estimated dinner carbs. Loop noticed I was still going up and at 7 PM and it increased with a temp basal - see the blue bars in the bottom graph. However, I was still concerned I was trending high too much, so I gave 1U bolus at 8:35 PM with BG of 113, and again 1U at 8:55 PM with BG of 121. I didn’t know it then, but I was already on a downward trend. BG 121 was my max. So I changed the 30g estimated carbs to 25g, so Loop would not continue to high temp basals. You can can see in the bottom graph, Loop was already reducing my temp basals, eventually suspending basal all together where you see the flat blue line at 0. This lasted 9:10 - 10:30 PM when Loop resumed my basal at nearly my normal basal of 0.5U and I remained virtually flat all night. Until I had coffee this morning, that is, which promptly initiated a spike! I forgot to take a bolus for it, and spiked up to 112. Without Loop and the temp basals it initiated, I probably would be at 200 though!
Last night was not ideal, since it looks like I really did not need the extra 2Us! But with Loops help, I came out okay with no low nor high. That doesn’t always happen of course!!!
So, I know you are not on CGM, nor Loop, but maybe you could duplicate this process somewhat on MDI. That is what I did when I was on MDI but it was a ton more work and not as successful.
3 Likes
I think I would feel similarly if weight management were not an issue for me. As someone with very real limits on the degree of exercise I can do and as a woman in my late 30s, it definitely is though, so part of my aversion to potential overdoing of insulin and lows (and I suspect true for others) is that eating to feed insulin causes weight gain. If I were skinny and/or muscular enough to get away with that though, I’d think like you!
2 Likes
Yes, and I think one thing that has not been emphasized enough is the shelf-stable glucagon. Not the inhaled one (Baqsimi), but the injected on - Gvoke.
This would be a great way to treat a low without food and without weight gain.
And putting it into a smaller dose and taking it with an insulin syringe instead of the bigger syringe they give you would allow great flexibility
2 Likes
Yeah I should look into that—I think I might be need to be on a pump to take advantage of it though (which for a range of reasons I’m otherwise not planning to do anytime soon), because my suspicion would be, similar to what we discussed on another thread, that using glucagon and thus depleting glycogen would temporarily reduce glucose output and thus basal need, driving more lows if using a static basal approach like with MDI, unless you eat to compensate, but that defeats the purpose of using glucagon to avoid eating to treat lows.
I wonder if someone could use micro-dosing glucagon to essentially keep the liver in steady state of depletion, thus reducing liver output and associated dawn phenomenon and glucose stress reactivity, similar to what keto does, but without the extreme diet. And if that would be bad for a person besides the fact that then you would not be able to utilize glucagon for emergencies.
1 Like
That is an interesting idea. It makes sense - as far as if it would work. The body does not like to completely deplete its reserves, so as your liver glycogen amount becomes less, the output from it will also decrease.
But the downside - as you stated - is that your emergency store would not be as readily available. 
1 Like
I’ve never actually used glucagon in my 28 years of being a diabetic, nor have I ever had a hypo incident where I was incapacitated to the point where I couldn’t just eat something (I think due to be exceptionally sensitive to hypos), so for me personally, I think the lack of availability of glucagon for an emergency might not faze me much. My biggest concern would be if I were really sick/vomiting and needed to treat a low, but somehow I’ve gotten through those moments so far too, and if it were prolonged, I’d want IV fluids and glucose anyway. I’m more concerned about the longer term metabolic impact etc, as well as the feasibility of doing it well (you’d really almost need a basal/long-acting form of glucagon, or to pump it). But it’s an interesting idea…
1 Like
I’m in this same boat, and it’s partly why I resist the idea of eating whatever you want. Being told in my mid-20s that I could eat whatever I want, without any guidelines, fuelled significant weight gain, and that’s very hard to undo.
I love the idea of mini-dosing glucagon for lows and will jump on this as soon as it becomes available here.
2 Likes