@daisymae I just went through a period when my bolus amounts decreased dramatically. One of the problems I found was that my basal dosing was too high (I’m on MDI). There are other things at play, like a 25-30% reduction in carbs per day, but the main cause was the basal dose.
I don’t know if any of these are true for you, just mentioning some possibilities.
So when you wake up in the morning and eat breakfast, you have no IOB before breakfast. You have only been on basal all night. But after you eat breakfast, since you took insulin for breakfast, and that insulin lasts you about 4-ish hours, you have IOB after breakfast. That IOB may be the reason you don’t need to bolus for a snack later on.
Make sense? Not saying it’s correct, but does the thought make sense?
i see my endo this week, so i will bring it up with him. he a complete A-hole sometimes, always thinking that its his way or the highway, so i dont know if he’ll be willing to work with my suggestions. i see my CDE next month; she’s awsome. i know she’ss be more up to date and informed and experiemental. so if i cant work it out w/ my endo, she’s my go-to gal.
Actually does not make sense to me. If that were true than would that not also mean that if the snack is NOT eaten that a low would be experienced due to not enough carbs which basically would mean the breakfast bolus was too much insulin?
“Time of Day” in my mind is a pretty big factor.
Also @daisymae - if you do not like your Endo why not switch to a different provider?
The insulin absorption does not always match up exactly with the food metabolism. You can have insulin still needed after your breakfast food has started digesting, or too much insulin still hanging around after you finished digesting. So a lot of it depends on the timing. Eating a snack right after versus waiting a few hours.
And also, different times of the day might need different IC ratios and also different basal levels. So there are a lot of things possibly at work here.
Again, not saying this is the case with you, just putting out possibilities.
i’ve been with him for 30 years. i’m use to him. i have had other endos but didnt care for them either. sometimes i think i should have a younger endo, b/c they would be totally up-to-date with all the latest; but then i wonder if they have the experience i want that only comes with age/long-term practice. wtf. also, i really like the cde so much, and they work together. i wouldnt want to give her up for anything.
i’ve discussed this w/ eric before. his suggestion was to just deal with my endo with regards to getting my perscriptions filled and then see the cde whenever i feel the need/desire to. makes sense to me.
I know a lot of people who need more insulin to cover food in the morning, including myself—doesn’t seem uncommon. Also, it could be that while your basal gives you some wiggle room during the day, in the morning, it doesn’t, perhaps because of increased liver output (i.e. dawn phenomenon), even if your DP isn’t strong enough to make you rise if you do nothing. I doubt you’ll find a definitive answer though—seems like the end result is just that if you have a midmorning snack, to take insulin for it, and if it’s later in the day, not to, and that’s fine.
Many people with diabetes (such as my son) are more insulin resistant in the morning. For these people, a small snack that may not need a bolus in the afternoon (for my son, that would be, possibly a 4 carb snack) would need some insulin in the morning.
this is whats weird though about it: i have no insulin resistance when i bolus to eat. i pretty much remain flatline, sometimes even going lower after my bfast meal. so it doesnt make sense to me that i would be resistant later on in the morning. i mean, wouldnt i still have IOB?
@daisymae I have the sneaking suspicion that a lot of insulin resistance in T1’s is more of a problem with varying basal needs throughout the day. Do you have varying basal rates programmed for different times of day?
yes i do. i have 6 different basal rates programed into my pump currently. i used to just have 2, but my needs seem to change over time. in one direction or another. i try to keep on top of it as best as i can. i keep very detailed notes so that i can see patterns. i dont wear a sensor cgm. (couldnt stand it; used the dexcom for about a year before i called it quits)
The way I eat, I have a meal and then 30 minutes, 60 minutes, 2 hours later, a snack if needed. I take a bit more insulin than I need for the food so that I will trend down, and then cover it with a bit of food.
It’s easier than chasing the high. A little chocolate makes a nice fix.