Do I need basal? No basal in early diagnosis of T1D, but dealing with pretty big and frequent spikes

Type 1 & LADA New T1/LADA
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Well hello! Nice to meet you!
I am not really sure how everything around here works yet, since I am very very new to this forum, but I didn’t seem to find any thread to answer my question. If there is one, please direct me there and I am very sorry for wasting your time. Otherwise, please bear with me, 'couse it’s gonna be a long one.

I am 23 years old and a recently diagnosed T1 diabetic (about two months in at this moment). Since my c-peptide revealed that my pancreas still produces some insulin, with 0,8 ng/mL, my doctor only prescribed bolus insulin for me, Humalog to be exact. He told me that I should eat at least 120g of carbs a day, since aparently I wasn’t eating enough (because I was suspecting diabetes and waiting for all of the blood tests to arrive). This was so I can feel full and not be hungry all day long, as I used to be. Also, he told me to only test my blood sugar before eating, and not after. I am now thinking that is because he did not want me to see the really high values post-meal and freak out as much, at least not in the beggining.
So, therefore, in the beggining (meaning 2 to 3 weeks in) I would just eat pretty normal stuff, about 40g of carbs and just avoiding sugar for the most part. I would measure everything and bolus accordingly. Things seem to work pretty ok, since I only took my blood sugar before the meals, meaning that even if I went high after a meal, I wouldn’t really know, because when the time came for another meal of the day, my blood sugar has already lowered to the initial value.
In the third week I was sent to a nutrition specialist to create ‘‘kind of’’ a meal plan (meaning that she gave me some options to try out and see what the results are). I started trying out the meals, seeing which one does what to my glucose levels and found things that work better and things that don’t work that well. I guess that’s normal.
Problem is, a couple weeks in the diagnosys I start digging the internet up for information, as one would, and see how everyone talks about testing your blood sugar 2 hours after the meal as well, and so I start to do so myself. And now, don’t get me wrong, I knew the blood sugars were going to be higher after, of course, but did not have a grasp of how high they were going to be. Now I also have the Freestyle Libre and I am able to see EVERYTHING, which is pretty scarry, not gonna lie…
Now, the thing is, no matter how I pre-bolus, and I always pre-bolus, I seem to get huge spikes afterwards. And even with the foods I tought worked pretty good, I am seeing quite a high spike about an hour or two after the meal. I have tried bolusing anywhere between 5 to 25ish minutes before meal, and nothing really seems to do it for me. Probably I should mention that I keep away from fast carbs 90% of the time and it doesn’t really seem to make a difference. I am also afraid to correct afterwards, since in the end, after about 4 hours, the blood sugar does come down slowly and so I fear that if I was to correct, I would end up really low before the next meal.
Now, I am wondering, is it that I may be needing basal, or it’s just that I haven’t quite grasped how Humalog works for me? In any case, I am pretty exhausted of trying and trying and not geting very good results, since I see so many flatliners around here, and the internet in general, and I am nowhere near that. At this point I get anxiety everytime I eat and I have decreased my carb intake again, hoping that it’s gonna help somehow… I should also mention that during night I run pretty low, but then in the morning I usually am around 140.

All in all, to sum it up (because I did write a lot, sorry about that), I am wondering if basal insulin would help me control the spikes better or if it has nothing to do with it? And if it’s the latter, how can I have a better understanding of how my boluses work so I can avoid going so high after a meal?

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Hi Flavia, welcome to the forum!

I am sorry to read about your diagnosis. It is really stressful at the beginning! So, the first thing to do, imho, is not to stress out too much. To start with, it is hard to figure out how everything works.

Your Humalog is, as you know, fast insulin. But it does not mean that it works really fast. For instance, my son’s bolus insulin takes 45 minutes before it “turns the corner”, ie starts activating strongly. His nurse practitioner is T1D also, and hers takes 1 hour and 45 minutes to activate. So my son pre-boluses 45 minutes ahead of time.

So, for you, if you look at your BG curve, you may be able to see how long it takes for your insulin to “turn the corner”: some time after you inject, you will see a sudden trend going down. Ideally, this is when you would eat, although there are many reasons why it may not always be the case. When you prebolus at the right time, your BG won’t rise too much after your meal (although this also depends on the meal).

One other possibility is that your insulin to carb ratio (ICR) may be a bit too low: if your BG is still quite high 2-3 hours after the meal, then it is possible that you are not dosing enough per carb. For us, for instance, we dose, most meals, 1U for 13 carbs. But if we see a high BG after the meal, then we might need to inject 1U per 12, or 1U per 11, and see how things work.

Your basal, normally, is not made to help you deal with meals, although it could indirectly help, because it would allow some of your beta cells still working to respond to a meal if they are not already cranking out to deal with your continuous needs for insulin. You should not, in general, use basal to deal with meal carbs.

When I read what you write about your coming slowly in range after 4 hours, I figure what may happen is that, after a long time, your beta cells are able to bring you down in range. This might mean that you need to dose a little more per carb? The fact that you peak quickly probably means that you are not pre-boluses early enough? For sure you want to be very careful in increasing dosage: if you do, do it VERY progressively and with great caution. Being a bit high is no danger in the short term, but being too low definitely is one.

One suggestion: two books we have found very useful to learn with are “Think like a pancreas” and “Sugar surfing.”

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Welcome, Flavia! I was diagnosed at 25, and had to figure out quite a bit of this on my own, so I understand a bit where you’re coming from. I’m so glad you’ve taken charge, so to speak, and are trying to get on top of your post meal numbers. I didn’t even check my blood sugar for the first 8 months post diagnosis because no one explained adequately what was going on - I hadn’t a clue. I actually just started basal insulin last week after 18 months off of it (had to be on it during pregnancy due to insulin resistance). I’d been doing only bolus (Novolog and Afrezza) prior to that.

I agree with @Michel that you might want to try to extend your pre-bolus time, if possible. I take Novolog (which I know can behave differently than Humalog for some people), and I also have to pre-bolus 45 mins. Because I only had a meter when I was first diagnosed, I started with the recommended 15 min pre-bolus and inched that back in 5 minute increments until I was seeing what I wanted after meals. You’re ahead there in having the Libre - watching for that downward trend to know how long you need to wait before your insulin is active is easier with the constant monitoring.

After addressing your pre-bolus timing, if you’re still going higher than desired at the 2 hr mark I would consider an insulin to carb ratio change. You still have some insulin production going on, so eventually your beta cells can catch up, which is probably why you’re seeing that drop after 4 hours. I saw that, too. I understand the worry about going low, but just take it slow on upping the dosage.

One thought I had while reading your post - you say you’re around 140 when waking, but lower during the night. Have you confirmed the lower numbers during the night? Is the 140 on your Libre or a meter? I ask because I use the Libre now myself, and mine tends to read lower than my actual blood sugar most of the time. I’d be curious to know how low you are at night. The standard fasting recommendation is to wake under 125. This varies for a lot of people, too, in what they’re comfortable shooting for once they’re on basal insulin. I personally aim a little lower, closer to 100, because I’m insulin resistant in the mornings, so if I wake much higher than that, breakfast won’t be pretty.

ETA: I second the book recommendations! Think like a pancreas was so helpful for me in the early months.

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I agree with what others have said about pre-bolusing. When I was bolusing for food (not to confuse you, but I’ve gone to a keto diet and rarely need to bolus for food or corrections now) … that said, when I was bolusing for food, I learned from the DOC (Diabetes Online Community) about pre-bolusing and what a difference it made! Wow. The doctor (endo) and his staff (cde and rd didn’t like the idea of pre-bolusing, but I explained there was always a roll or a soda that could help bring me up if my supper didn’t come as timely as I had planned for). I had to tweak the timing for many foods and found many foods required 45 minutes or longer to be able to stay relatively steady afterward. It didn’t happen over night. I think it took me a dedicated six months … where I recorded my food, the insulin (Novolog) dose, and my blood sugars, pre-meal, and thirty minutes, an hour, two hours, three hours, sometimes four hours post-meal until I knew how my body was reacting to various foods. And, no sooner did I figure it out, something came along and said, ut un … none of that … and what used to work, no longer did. LOL. It’s a constant change, but staying on top of it will help you understand how to change with it. I wear a Dexcom Continuous Glucose Monitor (CGM) and it helped a lot too, but in those days, I was still testing ten plus times a day, even with my Dexcom G4.

I loved Think Like a Pancreas by Gary Schnier; his website, Integrated Diabetes is great! https://integrateddiabetes.com/

And the very first book I read, made me realize I could do this … The Diabetes Solution by Dr. Richard Bernstein; his website, Diabetes Solution, is wonderful! http://www.diabetes-book.com/

I’m looking forward to reading Sugar Surfing, I’ve heard only good about it!

I wish you the best of luck as you move through this maze of all things called diabetes! Come back often to let know of your success or setback. Someone here surely has had or heard of another and can possible help with setbacks. As to your successes … they definitely help the rest of us because we may not have thought through your angle (or approach) to something, which could mean all the world around here!

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Hi, Flavia! With more experience I think you will find great comfort in being able to see what is happening with your BG. This comes as you learn how to guide your blood sugar to a good level based on what you see in the Libre graph. Then it’s not scary because if you see anything you don’t like, you can simply fix it with insulin or glucose. No problem, so no fear.

“If your blood sugar is too high, you need more insulin.” This simple statement is what my diabetes educator said. The statement is of course too simple, but it can help cut through the confusion. Suppose that when you eat, you pre-bolus so far in advance that you almost go low during the early part of the meal. If your BG still ends up too high at 1 or 2 hours, you needed more insulin. I would make a small change to your insulin:carb ratio so you get a little more insulin. Then use the Libre to see if that helps or was too much, and keep making (quite small) adjustments each time until it is working better. If you get to the point that the spike at 1 or 2 hours is well-controlled but you are going low in 3 or 4 hours, then you can try taking a little less insulin but pre-bolusing even earlier.

I think it is important to always have glucose tablets with me, 100% of the time, because they are the fastest acting carb I can eat to stay safe if I see that my BG is too low, or it is dropping fast and soon will become too low. The rule of thumb for beginners is take 3 glucose tablets and check again in 15 minutes. With experience you will learn to look at the Libre to see what your BG is and how fast it is dropping so that you can decide the number of glucose tablets. And if the BG is not too low and not dropping too fast, maybe you will eat something tasty like chocolate or a cookie rather than glucose.

Good luck as you learn how to do it; there are lots of experienced people on this site who can give ideas and suggestions to help.

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First of all, thank you so so very much to everyone who took the time to respond, and not only that, but also respond so quickly! I feel like I came to the right place. I appreciate you all!
Second, thank you for the readings recomandations, I will surely look into them very soon. Hopefully they are available where I live. Oh, and also, thank you @Michel for clarifying the basal issue.

Now, just to be sure I understand correclty how to find out when exactly the insulin starts to kick in, or “turns the corner”, as @Michel said, I took out the last 3 days graphs from the Libre:
*here I should mention that the lunch spike is less pronounced because that is when I usually power walk to school for about 20 minutes, and I am almost running because that’s just how my schedule works…

Values
Values989×989 181 KB

So, as I see it, Humalog kicks in a bit over an hour after injection, right? Am I understanding this right?
I am so unsure if I get it right because my doctor first told me that 15 minutes should be enough, and then the nutritionist said that even 15 minutes is too long to wait, and so I should only wait about 5 minutes after the bolus. And there’s a big difference between 5 and 55 minutes, you know… But now I see so many of you that bolus such a long time before the meal and, of course, you are the ones with the ‘hands on’ experience, so I do trust that. So, if I do get it right, I am certainly going to try this out. Today I am trying a 30 minute wait, because one hour seems like a very big change all of a sudden and I like to take things slowly. I am hoping to see some kind of a difference. I will report back on that.

On the other hand, how in the world do you manage to bolus that much ahead? It seems like such a hard thing to do! Most of the time I don’t even know where I am going to be in an hour, not even mentinon what I am going to eat. I am in my last year of masters so my schedule is pretty hectic right now. I have school, work and projects on the side. I struggle just having regular meal times. I will absolutely try, but I don’t know if this is something I can introduce to every meal since even with the 15 minutes wait time I am always on the run. Maybe when I graduate and have a more stable schedule things will get easier.

@Pianoplayer7008 The 140 is on both the Libre and the meter. However, during the night usually I do not use the meter. As you can see in the picture, the lows are not threathening, it’s just that compared to the BG after I wake up, they seem low. Also I have read about what are called “compresion lows” during night, which is when you sleep on the sensor which causes it to record lower values for some reason and I think that is what may be happening. I actually did finger prick the night where you can see I went low for a long time and the meter said I was at about 70 something, so Libre was defenitely showing lower results.
Other than that, my Libre is pretty on spot, usualy between 1-5 mg difference to the normal glucometer, but the difference can go up to 10 mg if the BGs are changing quickly.
BUT, and there is a big but, this is my second sensor I am wearing. With the first one, things were very different. The first one always read waaay lower than the normal meter and was absolutely nonreliable whatsoever. After about a week of trying to make it work, I took it off and put a new one, which works very very well. I even tried calibrating the old one with the Glimp app, but didn’t work at all. The readings were all over the place. So maybe it’s just a faulty sensor for you too.

@Tapestry I find it so weird that doctors do not reccomend pre-bolusing, as I went through something similar with my doctors as well, altough I haven’t got the chance to tell them that I am experimenting with this approach just yet.

@bkh Thanks for the tip, unfortunately I can’t seem to find those glucose tablets I keep seeing on the internet, here where I live. Maybe I haven’t looked in the right place. Anyway, for now I found out that really sugary “chewable” candy, such as Maoam (I don’t know if you have it in the US) or gummy bears work pretty well for me. And they are also convenient as I can take a smaller dose if I need to. I can have one, two or however many depending on the situation. But I guess that’s how glucose tablets work as well :).

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I think you are kinda right: I am trying to read the diagram as well as possible, and I don’t have a big screen :slight_smile:

I am saying only kinda right because, if you take a bunch of carbs, the upwards movement of your BG will stop the insulin from making you go down for a while, so the insulin will look like it turns the corner later than it really does. In reality, your insulin turns on earlier than that, but you can’t see it because your BG is going up so fast because of the carbs you just ate.

When we look at my son’s CGM, he waits until he see his BG start dipping after he takes insulin (he needs to identify the right dip: if it dips randomly 10 minutes later it is not the right dip) to eat. If he waited too long after that, he would end up going low, then his carbs woiuld bring him back up after a while.

Yes, you are doing it exactly the right way. Go slow! Eventually, you will come to the time when you can see the dip before you eat, then you eat right away.

That is the probably biggest hassle of being a PWD (person with diabetes). You have to plan more :frowning: For instance, my son has a snack at school at 11:05, so he injects in class at 10:20. When you go to the restaurant, it can be a real hassle because things are much more uncertain.

But there is a new inhalable insulin available, called Afrezza, that allows you to pre-bolus a lot less early: many people use it right when they eat. Many people here use it. We don’t because it is not yet available for kids. You may eventually decide that it is the right thing for you.

Many of us don’t use glucose tablets. For instance, we use mostly Skittles candy: one piece is about one carb, and it is much cheaper. What you need to find is something that will take you up FAST. All sugars are not equal. For instance, fructose is quite slow. Sucrose, the regular table sugar, is also rather slow. One of the faster sugars is the one made from corn sugar, what you have in corn syrup, which many hard candies are made of. Using a fast sugar is best if you can.

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It is a hassle, but I try to just do the best I can depending on the situation. Also, as @Michel says, Afrezza is a good choice for those times you can’t pre-bolus far ahead. I use it regularly and I actually dose it 10-20 minutes after I eat, because it’s so fast.

There are a couple of strategies that have been helpful for more uncertain eating times or foods. One is the “eating soon” strategy - I’ll do a correction dose just to get me to the low end (so, say I’m at 130, I’d dose a unit to drop me to 70-80 - amount you dose varies, of course, based on the person). That way I can start eating without prebolusing as much, but the climb won’t go as high before the rest of the insulin I dose starts working because I’m starting off lower than I would have otherwise.
Another strategy I’ve used - which only works if you know pretty exactly when you’re going to eat but not exactly what you’ll eat - is I’ll dose a unit or two (based on my current BG) about 30 minutes before I’m going to eat, and when I sit down to eat, I dose for the remaining amount of carbs that aren’t already covered.

Obviously with both of these, you have to be very careful.

As to the Libre - if you’ve confirmed with your meter you can go as low as 70 at night, I definitely wouldn’t recommend basal yet. I stayed in the 70-90s during the night for a good long while. Also, I’m not sure how Abbott is over there, but here in the US I’ve had success calling them about sensors that either have been very inaccurate or have ripped off after only a day or two, and they’ve been very good about replacing them for free. Maybe give them a call the next time you have an off sensor.

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The meaning of “turns the corner” is if you take the insulin and don’t eat yet and just watch the Libre graph, as soon as the graph turns down, that is the point to start eating, because it means the insulin is actively working in your body to lower the BG. If you start eating while the graph is stable or rising the graph will turn down later than that for the reasons Michel explained. In the 3 graphs you showed, it looks like you started eating before the graph turned down. Which is ok, it just means you’ll get a higher spike, that’s all. No big problem.

The medical staff are worried that if you don’t eat soon enough you could go dangerously low. They don’t want to be responsible for that, and think it is safer for you to have a big spike during the meal instead of risking the possibility of going low. But many of us have learned how to use the CGM or Libre to see a low before it happens, and prevent any real problem by taking a fast sugar. We are safe because we pay attention and treat it before it becomes a big problem.

I’m sorry to hear that glucose tablets might be hard to get where you are. Glucose is the same thing as dextrose, if you find that somewhere. We have things like what we see here Amazon.com : glucose tab that we can order over the internet or even get in the local pharmacy.

Anyway, the thing about sugar is that pure glucose/dextrose is fastest. Complex sugars like sucrose (normal table sugar) must first be digested a little to split the molecule into the glucose half and the fructose half. The body can use the glucose right away, and it can then convert the fructose into another glucose but the chemical reaction takes a little while. The addition of fat or protein can slow the absorption of the glucose even more. I looked up Maoam because I don’t know it. The first three ingredients are sugar (that would be sucrose), glucose, and palm fat. The sugar will need some digestion. The glucose is immediately available. The palm fat will slow the digestion/absorption of both. We have something called jelly beans that don’t have the fat so they are somewhat faster. Haribo gummi bears (gold bears) are Glucose Syrup (From Wheat or Corn), Sugar, Gelatin, Dextrose (From Wheat or Corn), Citric Acid, Corn Starch,Artificial and Natural Flavors, Palm Kernel Oil, Carnauba Wax… so it looks like they should be a little faster than Maoam, but you can run the experiment if you like. Take 12g of table sugar and watch your Libre graph to see how long it takes to spike your BG. (Then take insulin to fix the spike.) Try it again with a candy like your Maoam. Try it with chocolate. You can learn what is a fast sugar or fast carb just by trying it. Many people avoid glucose tablets in favor of something a little slower but much more tasty. I can’t fault that. We even have a guy who said “never waste a good low” when he recommended that we eat something we really like but normally don’t permit ourselves to have.

That’s the practical reality. Welcome to our world. If you can’t pre-bolus far enough ahead, you will get a bigger spike. That’s all. If you wish, you could reduce this spike by taking some extra insulin in your meal bolus. But then you will need to be attentive and take some fast carbs later, after the spike has passed and you are heading for a low. Some of us go to great effort to take a pre-bolus far in advance just to avoid a spike or extra insulin. For myself, I generally take the bolus 10 or 15 minutes before eating, but I watch the graph early in the meal, and often I find myself taking additional insulin when I see a spike starting to form, and then later I’m taking extra carbs to make up for the extra insulin. There’s no single right way to do it. Just find a way that works ok for you. By the way, if you want lots of instruction in this “watching the graph” business, consider the book Sugar Surfing by Dr. Stephen Ponder. It’s available in a Kindle version for a lower price than the physical book.

Generally so. The 40s on Monday around 3:30am would worry your medical staff. Generally we all live with episodes like that, but it’s worth taking efforts to avoid it as much as possible.

I found that over time I learned to recognize when to trust the sensor and when I should not. It sounds like you already have adapted to this. I think you are a fast learner.

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One thing I’ll throw out there regarding the “turning the corner” stuff is that for me, I can only do this if my blood sugar is increasing, or holding steady at at least 100-120+. This is very likely a YDMV (your diabetes may vary!) thing, because many others do it very successfully. But if I’m already in range, waiting until I see the drop on my CGM will send me quite low before the carbs kick in!

When I was starting out with all this, I began experimenting with breakfast, and I increased the pre-bolus time by about 5 minutes every day or two until I found the sweet spot, which for me/for that particular meal/at that time of day, is 30 minutes. I won’t see the drop on the CGM until after I’ve started eating though! However, if I’d waited for it, I’d be in the 50s or 40’s and feeling crummy in no time flat.

Again, it’s totally an individual thing… it’s an awesome technique and it’s absolutely what I do as well if I’m higher or climbing at mealtime. Just thought I’d chime in with my experience when starting out in range… it might be worth taking it slow and working up the pre-bolus slowly until you see how your body reacts!

And welcome! You are in good hands here! I’ve only been diagnosed a tad longer than you, and these folks here have been invaluable in the learning process!! :blush:

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I think I am starting to understand things maybe a little better. I have tried the 30 minute wait a few times now, but I don’t want to jump to conclusions just yet. I will try to extend it to 40 minutes maybe over the next days and see what happens.

I am really interested in that and I keep seeing people talking about it. I am not sure if it is avaliable here, though. I am very curious about it since it seems almost too good to be true. I mean, fast acting and no injection?! That sounds great. Are there really no disadvantages?
I am all ears to hear what anybody has to say about Afrezza, if you don’t mind sharing!

Thanks for the clarification, @Michel I had no ideea, I was told that straight up table sugar is the best. But Skittles sounds way better anyway :smiley:

@Pianoplayer7008 How long before the meal do you dose that one unit?

This seems like a good strategy and I am going to try it for sure, but first I want to finish my first “experiment” in finding out when is the best time for me to pre-bolus. Then I will work off of that.

I know… I have seen everywhere on the internet that they have great customer support are returns policies. Unfortunately, the Libre is actually not available yet in Romania, where I live. I got mine with the help of a friend who lives in Germany and they send the sensors my way every month or when they come visit (or when I go visit). It would be quite a complicated situation to replace a sensor because of that. I am cheating the system just a little bit on this one :sweat_smile:.This is also why I worry that Afrezza might not be available as well.

But isn’t it also dangerous in the long run to have 3 big spikes a day every day of your life? I seem to have a spike no matter how much or little I eat. I know that the danger of a low is immediate, but the freqvent spikes must be dangerous too, right? Or maybe I am stressing out too much. I don’t want to drive myself crazy by obssesing too much neither :smile:
Also @bkh, thanks for the ‘‘sugary’’ explanations. I am very scared to experiment on myself like that just now. I don’t know why, I know I can always fix it with some insulin. In a way, it also has to do with the fact that I am on a pen, so I would have to inject so manny times… Anyway, I have to get over these fears and try things out so I can better myself. Also, I have to admit I kind of relate with the “never waste a good low” theory :grin:. I would not aply it if it was a really low low though.

I think I would be having weight issues if I were to do this everyday, even though it seems like a good strategy as well.

I actually checked with the meter than night as well and it said 70 something. So it must’ve been a case of a compression low. I was probably sleeping on the sensor for an extended period of time.

At least for now I think I have. Thank you :blush:

@kpanda01 This is exactly what I am doing right now! And I totally understand what you are saying. It is very tricky when I am a tad lower before the meal as well. Now, I’m just curious, what do you do in those cases?

Thank you so much! I can already see that. This place is great and everyone is so nice and caring! This forum is the first time I feel like someone understands exactly what I’m going through and more than that, are able to share their expertise. The doctors I’ve seen I feel are a bit disconnected, because they moslty work with type 2s and that requires a very different approach.

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You have to do yearly lung tests to make sure your lung function isn’t decreasing, but so far (I haven’t researched this; just going based off what I’ve heard), there hasn’t been any issue associated with Afrezza use, though it is still relatively new, so I guess theoretically there could be a problem discovered down the road. Also, if you do have any lung issues, you can’t use it. Otherwise, it’s a pretty amazing thing. I love the freedom of not pre-bolusing and not closely carb counting. It makes my hectic life just a bit easier.

For the “eating soon” strategy, I usually shoot for dosing 45 mins-an hour before I plan to eat, since my pre-bolus time is 45 minutes - that allows it to drop, but doesn’t go too far and risk me going low before I start eating.

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Welcome! I’m so impressed with your questions this early after diagnosis!!

Just a heads up, my prebolus timing is affected pretty significantly by how active I am that day. I don’t know if this is unique to me or if lots of other people experience this. But if I’m sitting at work all day, I have to prebolus much earlier than if I’m at home doing physical chores all day. Someone may have already said that above, but I just want you to have a heads up that your body might not need as much prebolus time on a day with lots of physical activity.

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@Flavia looking at your overnight curves, it would seem that your physicians recommendation to not start basal is a reasonable one. Your overnight fasting numbers look great.

You meal spikes aren’t really that bad to be honest. Much better than ones we see routinely. With your hectic fast-paced and irregular lifestyle that wouldn’t be a horrible outcome really. You might be able to flatten those curves a bit with more pre-bolus, especially with your lunches. But it honestly looks like you are doing a great job.

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@Eric, please note for the FUD world map, that @Flavia is in Romania!

@Flavia, your English is flawless! Are you a native English speaker?

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@Pianoplayer7008 I did some research and apparently Afrezza is only available in the US for now. I guess I’ll be waiting patiently. Until then, the “eating soon” strategy seems like the way to go :grin:.

@T1Allison Thanks for the heads up! Up until now I did find out that doing chores really helps soften a meal spike, if my brebolus time was on the shorter side. So what you are saying makes perfect sense to me :blush:

@Chris Thank you so much! You have no ideea how good it feels to hear that, since i’ve been trying so hard :grin:. Since I posted those graphs I’ve been experimenting a lot with different pre-bolusing times to see what works best, so I’m hoping things will only get better.

@Michel Thank you! No, I am not. English is my second language, but to be fair, I’ve been studying it since I was about 7 and never really stopped :grinning:. Next semester, which is my last semester of grad school, is actually going to be the first time I’m not taking any english classes or classes that are teached in english since the first year of elementary school.
But I also do freelance work in content and copywriting in english (and romanian, of course, but that’s irrelevant to the subject :sweat_smile:). And also, spending a lot of time online helps too :grinning:.

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