Those are important factors to consider, but often overlooked.
I like to also consider “food on board” and “exercise on board”, iob, adjusted basal (with Tandem or looped pump).
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I know that I’m chiming in late, but I was curious to ask about the FOTF phenomenon bc I have had it on and off for years. It comes and goes with seemingly no reason, and I have tried more than several experiements to find a viable solution. Lately, my most recent rule of thumb has been to over basal my 5am pump rate so that I wake up low, bc within 15 minutes of getting out of bed, my BG will rise by around 30 points. So, if I wake up with a BG of 50, by the time I am ready to eat breakfast, my blood sugar is perfectly in my TR.
In the past, I have also tried giving myself a pre-emptive bolus immediately upon waking, even if my BG was 70, just knowing that it would rise very high very quickly.
Any other neat tricks to outsmart this culprit?
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I wanted to understand this a bit more. My experience is that I can’t inventory exercise - it’s good for reducing highs or generally driving my blood sugar down (so sometimes I go low). But when I stop exercising, my recent exercise doesn’t have any lasting aftereffect - so is unlike a bolus of insulin or food.
So @mm2, what do you mean by “exercise on board?”
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For me, it depends on the activity and duration.
I have learned through trial and error (and cgm trend), when I need to eat after exercise, or let my Tandem reduce basal. But if dropping too fast, will have carbs.
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For anyone reading that doesn’t know, FOTF = Feet On The Floor, which is referring to Dawn Phenomenon.
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For me, exercise improves my insulin sensitivity and this effect seems to extend past the end of the exercise period. I would not call it “long lasting,” but I do need to keep it in mind in the following hours.
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I experience the exact same thing. Exercise brings down my BG, even if its just a 30 minute walk, and then even after I have stopped exercising and am sitting at my desk, within the next half hour or so, my BG continues to go lower. Generally, I test (finger stick cause I am not on a dexcom) once I have stopped exercising and then I wait 1/2 hour and retest.
just an example: this morning I had an unbearable panic attack and this kind of “fright or fight” mode raises my BGs every time. My sugars went from a steady 90/95 to a 147 within less than an hour. I did a correction bolus and went out for a 45 minute rather fast paced walk around my neighborhood. when I returned home my BG had come down to 113. I retested half hour after and my BG was 100, then tested again in another half hour and my BG was 93 (i was trying to be safe with all of this testing bc I had all that correction insulin on board)
I had a simple lunch without bolusing and now my BG is a steady 103.
I can say without equivocation that exercise definitely makes me more insulin sensitive.
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By the way, that’s an awesome indication of your post-surgery progress. Good news.
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@shott
Here’s my tip, if I’m over about 150 and taking a meal bolus (I’m MDI) and a correction, I add 1 u. If I’m over 200, I’ll add 2 u. If over 250, then add 3 u. Etc. Your actual amount will surely be different, but you can experiment to find out what works.
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I’ve experienced similar increased insulin sensitivity after exercise. Sometimes overnight and other times for about 12-24hours . Also have observed the reverse…if I have a few days in a row of little exercise my insulin resistance seems to increase pretty quickly.
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Very early this morning my BG went up to 190. I did a rage bolus in my thigh muscle, but my sugars wouldn’t come down. Took another shot of double my usual need, and finally came down to 123.
I have been having terrible panic attacks lately, and I think that “fight or flight” thing has been effecting my BGs (going both high and low) in the mornings before I wake up and once or twice in the afternoons when I feel like I can hardly breathe. dont know what the panic is about specifically, but god knows there is enough going on in the world right now to account for some of it!
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@daisymae I have a pesky, elusive FOTF phenomenon as well – never sure when it’s going to strike, but have just taken to assuming that it will… so long as the DAWN phenomenon hasn’t hit first! (@Chris, they are unique and separate for me – DP will happen at 4-5am and start a slow rise in blood sugar that doesn’t stop until I hit it with a couple of units of insulin; FOTF doesn’t hit until I literally get out of bed - could be 6am, could be 9am, but once that happens, blood sugar tends to rise much faster and also needs a quick hit, otherwise I’ll be in the 200s or higher before long.) So I think, DM, if you have a consistent schedule, your plan to push yourself low with the intent of your natural morning hormones increasing your blood sugar in time for breakfast, is genius! But the panic attacks sound horrible by themselves and then with the attendant rise in blood sugar – ugh! I am so sorry you are dealing with this.
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I’m pretty similar. I think depending on what stage of the sleep cycle the body is in, the insulin needs can be greater. By default, I’ll automatically take 2 units upon waking, followed by another 2 units 10 minutes later and and triple the basal for 30 minutes.Once the number starts dropping, I know that it’s a good time for coffee + breakfast. Sometimes the insulin needs are higher, but in general this works and it’s possible to shut off the increased basal if things don’t go above range.
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I am blown away that anyone could have to take this much insulin without dropping dead. If I take .3 units when my BG is under 150, it can have a huge impact on my sugars.
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I get my care at the local VA hospital. During the last appointment the PA made an indirect reference to “some patients” who used U500 insulin in a pump and went through a Tandem cartridge in about a day. Some folks are more resistant to insulin than others.
To digress, do you folks have any idea how expensive U500 insulin is? It makes U100 seem like a freebie. 
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One my wife’s friends uses most of a U200 vial per day. Extreme insulin resistance is no fun.
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This gives me something to really b grateful for! My TDD is never more than about 15-18 units. I could never afford that much insulin; its bad enough as it is.
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Could always go for some emergency cheesecake 
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Well, since a vial of U100 costs just under $400, the fair price for a vial of U500 would have to be $2000. Anything less would be an absolute steal of a bargain. Aah, healthcare in the USA (shaking head.)
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Freedom isn’t free…just kidding