FUDiabetes

Grande Pumpkin Spiced Latte + a Glazed Donut: Thanks Basal-IQ

tandem

#1

So let me first say, I don’t typically have 100 carbs of pure sugar for breakfast. I got my blood drawn this morning, and I decided to treat myself afterwards to break the fast, since the clinic just happened to be next to both a Starbucks and the best donut shop in town. I am a huge PSL fan but I don’t have them often because I find sugary drinks pretty tough to manage. Today I kinda decided to do breakfast on hard mode!

Surprisingly, it didn’t go too badly for me. More “coloring inside the lines” rather than a proper “flatline” but I’ll take it. Kind of hard to see what’s going on with the bolus/food situation but basically I bolused for the latte while it was being made, started drinking it less than 5 minutes later. Left the latte in my car while I acquired the donut, then bolused for the donut when I got back to my car with it. I waited about 20 minutes between bolusing for the donut and actually eating it, but drank the latte the whole time. Highest I hit was 149 and lowest was 70.

I think I waited a little bit too long to actually eat the donut, as noted by the near-low I had, but thankfully Basal-IQ caught the drop. Actually, Basal-IQ was doing a lot of work here, and this day probably would have been a rollercoaster if not for it.

I haven’t talked much about my experiences with Basal-IQ yet, but so far I am loving it. Knowing that my pump is looking out for lows I feel like I can be more aggressive in preventing highs, and more unlimited :grin:


#2

Your lines are awesome! That’s great!

I know @Thomas is also a big fan of Basal-IQ.


#3

That is awesome. I’m so hoping I get my hands on this in the next year or so.


#4

If looking closely at the screen shot a couple items of interest for people who are not familiar (but may have a passing interest at least?).

In case not obvious, the large vertical red bars are the Basal-IQ going active and suspending (entirely) the insulin delivery. Any place without the red bars is normal insulin delivery.

  • The Basal-IQ activates at different points and does not activate (ie - suspend the insulin delivery) at a fixed BG but rather at any BG if the algorithm predicts (based on simple linear regression using 3 out of the last 4 cgm data points) the BG will be at (or below) 80 BG within 30 minutes. So some of the red bars shown on the screen shot may look to be a bit high of a BG when the Basal-IQ went active (and suspended). But that is by design.

  • The Basal-IQ turns back off (ie - enables all regular insulin delivery) as soon as the FIRST cgm data point comes back which is higher than the previous. This is why you sometimes get very narrow red bars as one data point came in with a slight cgm increase. Also when the BG is still low, the Basal-IQ will turn back off and enable the insulin delivery even thought the BG may still be low. This also is by design.

The way this works is different than other algorithms in other pumps may operate.

Only a couple people on the forum have this, so I try not to bore people with it. I find it very interesting and extremely helpful.


#5

I love your flatlining pic. What a lovely feeling!


#6

May I ask, how many units of insulin you bolused for this marvelous treat? My mind boggles at the sugary goodness!!


#7

It was 5 units for the latte and 5 units for the donut, 10 units in total!

My daytime carb ratio is 1:10 and experience has shown me most glazed donuts are around 50 carbs, and the Starbucks nutritional info lists a PSL at I think 48 but I just went for the full 50 haha


#8

Another change we do in regards to Basal-IQ.
(Can’t recall if it was already mentioned.)

For a low which we want to treat (Basal-IQ is not perfect and some lows still require carbs - hopefully that was obvious) we use half the carb count we would have previously used.

In such a situation, the Basal-IQ may not have been able to prevent the low but the Basal insulin was still cut off for a period so there is less insulin on board (even if Basal is not reported in IOB - it clearly is still in one’s system) such that there are fewer carbs required to work against both the current low BG and the insulin in the body working to bring the BG lower still.


#9

Yes I’ve learned this along the way! Sometimes carbs are still needed but I need much less carbs to treat it if so.

Although I may be guilty of hanging out low for a little while extra just to see how effective Basal-IQ will be in bringing it up. It seems that except for alcohol-induced lows and pretty bad food bolus miscalculations, it typically doesn’t need much assistance from me.


#10

If you don’t mind my asking, what is your “recipe” for handing drinking and the associated low. Next month my son gets the pleasure of his alcohol and drugs class with the endo.


#12

Not sure I said single


#13

I am not sure if you are being foolish, but our endo and my wife and I think information doesn’t equate to license to perform said activity. I would just hate that he made a choice to start a behavior and didn’t have all of the info available and then something bad happened. Not sure I could live with myself. With that said, we aren’t putting the beer can in his hand quite yet.


#15

My celiac friends drink plenty of gluten free beer and cider. Of course none of them are diabetics.

Just do me a favor, the next time you pour yourself a vodka, show your daughter how much one shot looks like in different glasses. My kids could not believe how small one shot looks in a juice glass. They would have undoubtedly made a poor decision the first time they crossed the spirit line without that little lesson.


#16

EH likes drinking (and at 39 is entitled to do so - any children reading this, wait until you’re old to start drinking).

He has good BG luck with wine, alcohol no mixers (scotch for instance) or really, really dry cider. Although finding really, really dry cider is not easy - the general ciders everywhere (Angry Orchard, for instance) are really sugary and difficult to manage.

And - as a person with no children (put away your pitchforks, friends, I know I am speaking out of turn) but who was a teen and remembers it - I would say information earlier would’ve probably been for the best and not encouraged or scared me off of what I was up to. Although you all know your teens best. :slight_smile: But if you’d asked my parents they would’ve been sure I wasn’t drinking.

That is the best advice I’ve ever read in regards to drinking and kids. Wow.

EH’s younger brother toted his best friend to the ER their first year of school because the dude drank a red cup of vodka. He’s fine now. :wink: But it sucked at the time. He was raised in a faith that didn’t drink. He’d never seen alcohol.


#17

Let me just preface this answer with the fact that I may not be the best person to model after because I have never recieved formal education on how to handle diabetes and alcohol, and my knowledge and strategies only come from my own experiences. I also sometimes prioritize having a good time for a night over having excellent control for a night. I have never had a serious incident involving alcohol and diabetes in all of my college shannanigans though, if that adds to my credibility here :smile:

First off, I will agree that red wine is very easy because it has minimal impact on BG for the most part. I can’t speak for beer because I can’t stand the taste, I never drink it. I used to drink ciders but I stopped because the ratio of “amount of drunkness achieved by drinking this” to “how hard it is to manage BG with this” was not up to my desires haha.

I am a huge fan of getting sugary, girly drinks at the bar… it complicates things, but I love them so what can you do (think Lemon Drops, Cosmos, and Magaritas). Typically when I go out with friends my first 2ish drinks are of the sugary variety, and I give insulin for roughly 75%-80% of the carb content I believe that those drinks have. This tends to land me in the 150s to 180s depending on where I was before, and running a bit higher when drunk just makes me feel more comfortable. I will give small correction doses if I start to run higher than I want, but I will be conservative and keep my intoxication in mind… I typically use the Bolus Wizard function for this and reduce the suggested dose by a little. I can’t keep a good track of IOB when drinking so I trust Bolus Wizard to handle that for me.

Past the first couple of drinks, I switch to diet coke + (insert hard liquor here) because I don’t trust myself to estimate the carb content on drinks anymore.

Now, I still get drops in the middle of the night sometimes, depending on where my bg was at the end of the night. I usually still get woken up by dexcom alarms so I just reach over and grab a few skittles off my nightstand.

What I should do, and am planning to start testing soon, is create a different basal profile for nights where I’m drinking and reduce my basals a good amount between like 12am and 6am (I typically start seeing the drop between 2 and 4). I had previously thought the only good way to do this would be a temp basal, and a temp basal seemed too hard for drunk me to figure out. But I think a whole different basal profile that could be started before I start drinking would be the ideal solution. And because of the way pump profiles are set up in the t:slim, I could also adjust the ISF and carb ratios to make my more conservative adjustments more fully handled by the Bolus Wizard.

And just a general comment, learning your limits when it comes to alcohol is really the most dangerous time with alcohol, in any young person’s life not just a T1s. I probably made this problem worse for myself because I had a sense of rebelliousness about it when I was younger… my dad had told me many times that drinking was bad for diabetics and I should never do it. I saw him hand beers to my brother at age 18 at family events, but when I was offered wine (at a similar family event) at age 19 he said I couldn’t have it because I was diabetic… I ended up deciding that drinking was bad for everyone and I would do it if I wanted to, screw the diabetes. And that is exactly the wrong attitude to have! So I applaud you all for your desire to teach your kids about drinking safely and having an open dialogue about alcohol :grin:


#18

Yes. It does.
Personal experience counts for a lot.

Very nice write-up.
:slight_smile:


#19

Thanks for your very thorough write up. You may not have had a class, but your personal experience, especially being closer to my boys age than mine, goes a long way towards establishing the street cred that my son listens to more closely than his old-fogy dad.


#20

If only our kids had any idea…


#22

Just wondering if you are also snacking while you’re drinking. Carbs in bar snacks like sweet-salty peanuts and bits-and-bites mixes can add up fast, which combined with not bolusing for 100% of the carbs in the drink would help you stay high (BG-wise).

I grew up the opposite, in an extended English family that saw nothing wrong with the children having a sherry glass of wine with Sunday roast, or some sips of dad’s stout, at home or at the pub. And by “children” I mean 8, 9, 10. This is SCANDALIZING in North America, but it’s a common approach in parts of Europe, and what happens is you grow up appreciating alcohol, in moderate amounts, as part of a meal, rather than as a means to get smashed out of your skull. Consequently I never saw any appeal in the drink-till-you-puke approach. (Not to say I’ve never overdone it … there was that poker party in a hayloft …)


#23

I don’t typically but I think none of the bars I go to really have any out. I do order fries on occasion and those get bolused for haha.

I did think about saying something about this previously, the kids I knew throughout college who were often the safest about drinking reported being able to have glasses of wine with dinner with their parents on occasion when they were growing up. Making something not so taboo and “scandalous” makes it a little less enticing to go absolutely wild with it at your first opportunity haha.