High BG Excursions

Type 1 & LADA
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Just wondering, with the variety of T1D experience, treatment approaches, technologies etc. represented here…how often do we each have high BG excursions. We all have our BG range goals, but we also have an overriding goal of minimizing excursions into high and low BG land.

So the question is: How many times per week does your BG exceed 200 mg/dl? If you aren’t comfortable answering that’s fine. For me, this is more a curiosity and a reality check. (I picked 200 because it’s easy to spot on the Dexcom Clarity overlay plots).

My answer: average of 3 per week over the past 90 days. For me, almost every high excursion is caused by either (a) bolus timing errors or (b) inattention to the CGM during a moderate rise and neglecting to do a correction bolus soon enough.

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Probably about 1x/ week for me on average…

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Carb counting errors for new foods or restaurant meals also contribute to my BG excursions, over 200 maybe a couple of times a week. I hate when it happens and have to remember to stay calm and just “solve the problem”. I find that exercise or Afrezza brings a high BG down faster than more Humalog.

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Just counted. So far this month I’ve had eight >200 excursions. All pretty short, less than 30 minutes.

The usual cause: over correcting. Tasty, but I need to control that better. That being said my relative SD stays at or below 30%.

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I’m not sure about times per week as I don’t think Diasend can break down data that way, but over the past 90 days I’ve spent 7% of my time above 11.1 mmol/L (200 mg/dl). So that seems to equate to spending about half a day per week above 11.1 mmol/L, or about an hour and 45 minutes per day, on average. (But of course they aren’t all spread out evenly like that, so it’s more lke I might spend two days running high one week and not go over 11.1 mmol/L the next.)

For diabetes management I use a pump and CGM, eat very low carb, frequent fingerstick testing, sugar surfing, and frequent review/adjustment of pump settings.

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Every time Liam eats, he goes above 200. :slight_smile: So that’s about 25 - 40 times per week. For us, going high isn’t the big deal…STAYING above 200 is a bigger deal. For toddlers, we can’t avoid the spikes w/o causing lows by over-bolusing. So, we have to find that fine line where they go up QUICKLY, then come back down with minimal time stayed above the upper range (for us 160), and not coming crashing down into hypo territory.

Right now, we’re at 20.8% “HIGH” readings (> 160) for the previous 90 days.

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Are you figuring SD as a percent? I don’t… well unless your mean bg is exactly 100 then I suppose it’s essentially the same as a percentage

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Yes, xDrip+ figures both SD and Relative SD (%SD). Studies show that Relative SD is the more precise data, and that it should be kept below 36%.
http://care.diabetesjournals.org/content/40/7/832

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I don’t get worked up with what I call a “spike” where the BG shoots up (well past 200) and then shoots down. It is more about when the BG gets stuck up in the 200+ for a period of time where I try to focus corrections as well as attempt to determine the cause. Sometimes it simply is a mystery.
According to Dexcom Clarity AGP, we have ~ 18.5% > 200 and ~ 6% > 250 in the past 3 months.

If I look back further in Clarity AGP (using the custom date range instead of the standard 7/14/30/90 day selections) at the 3 months preceding the current 3 months (make sense?), we were ~ 28% > 200 and ~ 13% > 250.

So whereas for some people they might look at our current stats in horror (lol), for us, I feel we are actually making really good progress. The difference between the current 3 months and the previous 3 months is IMHO due to a number of great ideas and suggestions picked up from others on these forums. Certainly everything does not work for everybody and our level of control is clearly far different from others level of control but for me the bottom line is we have learned new techniques and were able to put them into practice with some pretty clear results.

And we are not done. This is still a work in progress. However I am careful not to try and get ahead of where we are. This is a marathon - not a sprint.

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I have problems with such a precise recommendation based on one smallish study (376 subjects in France; the majority were Type 2, 122 were Type 1.)

Here’s the relevant quote from the abstract of the paper docslotnick referenced.

A %CV of 36% appears to be a suitable threshold to distinguish between stable and unstable glycemia in diabetes because beyond this limit, the frequency of hypoglycemia is significantly increased, especially in insulin-treated subjects.

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Is an “excursion” just stepping outside for a moment, or going for a long walk?

I don’t worry about the number of times I step outside my upper limit after a meal and then step back into the target zone again. But those intractable highs, where I hover around 11 or 13 (200 to 240) and Will Not Come Down without risking over-correcting, I have those maybe once a week. Most of them I can attribute to site or pod problems, but sometimes they are just mysteries of the universe.

In the past 90 days, I have been above 200 17% of the time and above 250 3% of the time.

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For me an excursion is a catch all for a brief or long lasting roller coaster up and down above 200. If I catch it at around BG150 or lower, the excursions are usually brief. Brief meaning less than about an hour which is achievable by correcting on the way up. There’s guesswork involved.

If I don’t catch it on the way up I’ve been getting more aggressive with the correction bolusses to get down from that high range. I agree 100% with other replies who pointed out that a workout or a brisk walk works well especially if combined with insulin. Seems like the only times I get stuck above 200 for longer than an hour is if I’m driving, socializing, etc and can’t micro manage those correction bolusses soon enough.

With all that said…I was averaging 2% above 200 for 90 days but the past week or so these “excursions” started hitting more often so I figured I’d get a reality check.

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When I look at my dexcom reports - since I started bernstein on sept 1 I’ve been over 200 a total of 1hr when it went up the first time I had the sudden increase in humalog as i was eating too much protein. Ive been over 140 my personal target 13% since Sept 1
Before that looking back into August / July when I was trying to control with CGM and lowish carbs but still eating bread etc - it was >200 15% of the time

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My Xdrip+ stats say I’m over 200 2% of the time (mean/median 133ish & SD of 31.4 mg/dl). When it’s due to food I usually just peek over 200 briefly before I go back down or pop up high overnight, but it seems like half of the time I go high is from exercise rather than food. This is incredibly frustrating because part of the reason I exercise is to help control my blood glucose (which works on the whole), but roughly half of the time I vigorously exercise (1 hour of kickboxing- punching and kicking a heavy bag) I shoot up over 50 points. Spikes of over 100 during a workout are not uncommon, but sometimes I don’t really go up at all. I think my worst was being 80 and level before a workout and 273 after it. This never happens from running or other exercise, just kickboxing. My blood sugar never noticeably drops during exercise of any kind though. I thought this was odd, but my PCP was unfazed by it. He just said that adrenaline spikes during vigorous exercise can do that.

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Hi bwschulz.
It’s normal for that to happen. Intense exercise causes the release of hormones that increase the release of glucose by the liver. Your body releases stress hormones (epinephrine (adrenaline), norepinephrine, cortisol) your heart rate goes up, oxygen flowing to the tissues increases, and liver glycogen stores are released for fuel. You’ve heard of the body’s “fight or flight” response. That’s what it is

Do you do more than vigorous for that hour, or is it only vigorous? There are ways to fix it.

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No idea what would technically qualify as “vigorous” or “more than
vigorous”, but it’s likely the heart rate spikes that do it. The middle 30
minutes is very much like brief maximal intensity sprints with lower
intensity activities mixed in. I’m resigned that it’s normal (for me at
least), but the inconsistency is annoying. I’d take a bolus of insulin
before each class if it was consistent, but it’s not. Any other ways you
know to fix it that don’t involve more insulin?

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The non-diabetic responds to intense exercise by releasing the same hormones, and the liver releases glycogen to fuel the activity. If the non-D is being chased by a bear, his body gives him what he needs - instant fuel and a way for the fuel to be pushed into the cells so it can be used (insulin).

Your body is doing everything exactly the same! Except no insulin.

One workaround would be to put the intense stuff at the end of the exercise time, which means your spike is only at the end. But since it’s a class, that won’t work for you.

Since it is a class and you can’t control when the intense parts are, you need to take insulin for it. But if you don’t spike, you need to have carbs available to cover the insulin.

Take a look at Gatorade Prime (get it on Amazon). That’s a very fast carb treatment that is easy to take. Very fast. So you’d take the insulin, and if you don’t spike, the Prime will cover it.

It takes guts to do it the first few times. You can be at 90 but you take insulin and start exercising very hard. Endos won’t tell you to do that. It doesn’t sound like it makes sense. But it does. It just takes a bit of practice to find the amount and timing.

Really, other than insulin, there isn’t a good practical solution. I mean, you could deplete your liver glycogen stores with a glucagon shot earlier that day, take insulin to bring down the high BG, and then don’t eat anything before your class. But that is not practical and would suck. Insulin is the best bet for this. It just takes practice.

Do you want to go over practical applications of it? Are you on a pump? How do you dose? There are things that make it more practical, like if you can have a pump or pen you can dose right before you start the intense stuff (or a few minutes before). There are easy ways to carry pumps or pens for exercise, easy ways to have carbs available, all of those things.

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Gatorade Prime I assume is the chews? Or are the gels better? Faster than usual glucose tabs? I’ll give them a shot.
I already kind of take extra insulin for the Sunday classes because my schedule is more consistent- my blood glucose is usually headed down and I tend to start right around when it gets to 80ish and keep it around there. It’s the afternoon or evening classes that are more variable regarding my schedule and carb intake and those seem to be the spikiest. I’ll just have to get some of those Gatorade Prime things and take a dose of insulin before class and figure out what dose and timing works for me (I use a pen, but I’d be better off taking a shot at home when I leave to get the timing right). Thanks for the suggestions!

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Liquid. 4 ounces. 25 carbs.

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@bwschulz
If you are looking for something to proactively maintain BG, we find these bars to work really good. Dose and eat at the same time. Specifically no pre-bolus. Works great for us. This flavor is Gluten Free which we need - not sure about the other flavors.
(BTW - We ignore whatever crap it says about sugar-free. And dose for what the Total Carbs say on the label and ignore the fiber and the alcohol sugars and the fat and the protein or whatever else they say. Works for us.)

However this does NOT work very good for a low. At all. lol.

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