So here is something that I have done countless times and have from yet to learn my lesson:
One example: I woke up at 5am this morning and did my finger stick, perfectly in range with a BG of 70. I calculated my breakfast carbs, and then bolused from my pump. It wasn’t until my pump reminder went off 2.5 hours later, to find that I had spiked to 145. What the heck? So I looked at my “bolus history” and immediately realized that I had only bolused for one of the things that I had eaten for breakfast rather than bolusing for the entire meal. (hey, it was 5am, and I was a little off my game ) So I reacted immediately by doing a bolus correction for the amount I would normally bolus if that were my BG and I wanted to bring it back down into my TR. But then, about 5 minutes later, I looked at my CGM, and saw that my BG was rapidly rising (direction arrow straight up …what the heck???). So, I did another finger stick to confirm, and realized that yes indeed, my BG was rising. SO, out of sheer “panic,” I reacted rather than thinking things through, and I bolused more insulin to ward off an even worse potential spike. And I bolused heavy handed. Enough insulin to really bring down a high BG.
Shortly afterwards, my CGM read that my BG was steady and no longer climbing. Now I had all of this IOB, and knew that at some point I was going to crash. OMG. I did it again. Why do I keep making such silly and foolish choices? This is my self-inflicted “Yo-Yo Effect.” ( If I had taken the time to consider that my CGM was just being wonky, I wouldn’t have reacted with such frenzied vigor.) But so be it. I did what I did, and I would wait things out and repair the damage done. There would always be time for orange juice .
So what silly things have you done, reacting rather than taking some time to think things through (or not) ??? PLEASE share them here, so I don’t feel alone in this!!! My EGO can’t take the idea that I am the only one to be so bonkers !
I frequently end up doing exactly what you do, @daisymae, and you, too, @Eric (at least this week for you!). I end up on a yo-yo. This most often happens on a new Dexcom sensor for the first two days when readings can be very off, or even on the SIXTH day, as in today, when a reading is STILL off. Dexcom shows 78, finger stick shows 45! Just a good thing I didn’t believe Dexcom! Then as usual, I eat part of an apple, start to spike, and bolus correction is too much, now back at 57. But at least I’m going up!
My most common mishap is prebolusing and then distracted on various things, not starting meal prep when I should. Then overeating everything in sight, leading to more insulin and corrections.
I don’t think I really have “panic” highs. Certainly, in the range you spiked to,t hat’s a range I hit daily, so I’d just correct and move on, nowhere near panic range for me. For me, panic range isn’t until I get really high like 18+ mmol/L, and when I’m that high, I’m doing all sorts of things like site changes, checking ketones, troubleshooting causes, taking injections, and so am pretty attentive to how much insulin I’ve taken and monitoring for the next few hours.
I have done rage boluses, but usually it’s in response to being high for hours on end (usually due to hormones). That just happened last night. After spending all day correcting constantly and bumping up my basal rates and changing out sites and staying at 8-10 mmol/L for most of the day and seeing that I was rising even more in the evening, I just rage bloused 10 units after dinner before going to bed. I woke up this morning to find I’d stayed pretty flat at around 7 mmol/L all night, so it seems I needed the 10 units. Today I’m running a +120% temporary basal rate all day and blousing more aggressively for what I’m eating, so it’s been better.
Oh i give myself by what most measures are way more than enough to cover meals… insulins just don’t match well with my digestive rates… I’ll often dose for a meal and end up at 200 2 hours later then low not terribly long after that. I think I digest quickly and respond to insulin slowly… other times it seems like I respond to insulin quickly and digest the food slowly— some benefit can be had by bolus timing… but still I’d consider your example of frustration to be a good example in a good day for me when I did everything perfectly
This is pretty much my experience. The food just hits before the insulin does. Pre-blousing does help, and using Fiasp helps a lot, but it’s never perfect. I read somewhere that it’s typical for people with Type 1 diabetes to digest food too quickly due to the lack of amylin, I think.
I find meals that are high in protein don’t digest slower, per se, but a “second wave” of the protein hits hours after the carbohydrates do, after which the insulin has worn off. I try to remember to set an extended bolus for this, but sometimes that isn’t perfect, either. I wish the pump had a feature where I could deliver a bolus when eating but delay the delivery by a few hours.
That’s one of the things I like about LOOP. I can have a BG of 70, tell loop that 10 minutes from now I’m eating 100g carb that will take 5 hours to digest. They’ll recommend some amount of bolus, but I can enter 0 for the bolus. Then loop knows the carbs are coming, and expects to see a rise start on the CGM, and starts to give more insulin as it sees the carbs actually reflected in the BG.
My experience is like Sam’s. If I take a larger dose I’d go low. If I pre-bolus farther ahead I’ll get distracted and go low before I get around to eating. So I just tolerate a spike that comes back down reasonably quickly.
Sam, any change that you have Gastroparesis? Symptoms sound similar. I take medication for this, as I have it as well as other GI issues. But the insulin timing sounds like a good plan. Maybe don’t bolus till after eating??? Or maybe the other way around? Like a longer pre-bolus???
Just an idea. (I am far from being a professional!)
I’m sorry for your frustrations. I should really try and be more grateful.
Just an idea: do you ever keep a food journal? I know that for myself, that I have different reactions with certain foods. (if I eat a higher fat meal, my digestion is slow, so I need to do a dual bolus. If my meal is high in protein, I will need more insulin. If I eat fast carbs or just extra carbs at a meal, I digest very quickly…and so on and so on.)
Yeah I’ve kept food journals, and I don’t think I have any sort of gastroparesis… I think it is just what it is… the fact that I eat a lot of crappy foods that I don’t really know how many carbs are in doesn’t really help…it doesn’t particularly frustrate me… i used to be able to keep super flat lines, now not so much but overall my time in range and A1Cs are still fine
Mine too. Prebolusing and then taking too long over cocktails and snack, dinner gets delayed. Or because there’s more carb up front, I’ll prebolus with Fiasp instead of Humalog, and if I’m not super careful with timing then that’ll drive me down fast to where I’ll be eating glucose tabs with my dinner.
I so wish I could use LOOP. If I had any hope of being able to wear the OmniPod for more than 24 hours, I’d be using LOOP already. My goal is that my next pump have some sort of closed-loop capabilities, whether commercial or do-it-yourself… I think closed-loop would really help me and the fatigue I experience with the constant decision-making and shifts in insulin requirements.
I was using the Spike app for a while, with my phone showing me a graph predicting my BG a few hours in the future. That predicted high BG caused me to over correct based on ominously high predictions produced by the app, followed by stubborn lows. After riding that yo yo too many times I decided to give up on Spike. It turned out the predicted BG from that app was not accurate for me, probably something was off in the settings. It seems like my insulin sensitivity varies a lot, especially in the evening, depending on how active I’ve been each day. There was no way for the Spike app to account for that with its predictions.
I go with my gut feel now in those after meal rises when deciding how much and If/when to correct. It does not always work out but it helps avoid panicky over corrections.
) So I reacted immediately by doing a bolus correction for the amount I would normally bolus if that were my BG and I wanted to bring it back down into my TR. But then, about 5 minutes later, I looked at my CGM, and saw that my BG was rapidly rising (direction arrow straight up …what the heck???). So, I did another finger stick to confirm, and realized that yes indeed, my BG was rising. SO, out of sheer “panic,” I reacted rather than thinking things through, and I bolused more insulin to ward off an even worse potential spike. And I bolused heavy handed. Enough insulin to really bring down a high BG.
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Just a good thing I didn’t believe Dexcom! Then as usual, I eat part of an apple, start to spike, and bolus correction is too much, now back at 57. But at least I’m going up!
