Without coffee, I grow horns.
Two cups is enough to make me sane. After that I switch to water w/ lemon juice for the remainder of the day.
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Kayaking is one of our biggest intense exercises. We try to minimize the IOB. I don’t really know what it does but my mental picture is the IOB becomes supercharged once we are on the water.
Sometimes we can not easily control the IOB due to our relatively poor planning skills. Well - my poor planning skills. lol. But when we are ready to launch if the IOB is larger than I would like, we balance that with extra carbs right in the beginning.
Everything is workable. I do think it is easier to start with the simplest approach. Get something working. Know it is working as simple as possible. Doesn’t mean that is the end game. Once something is working then start complicating the situation by adding in the additional options one at a time making sure the overall activity is still “working”. Could find that adding particular complications are just not worth the overall effort required to keep a balance. But adding (or starting) with multiple complications often IMHO makes it almost impossible to balance everything out.
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The things you guys are saying makes perfect sense. Now whether or not I can be reasoned with is another matter. 
I’m listening, considering, and trying to make mental adjustments… three of my least favorite activities.
Exercise is probably not going to happen today since I got up feeling bad. So I’ll put up some more graphs for your review… (or for your entertainment). I added another unit to my Levemir this morning (13 units) and did 9 last night. I needed probably 2-3 sugar tabs over night.
Last night was another big jump at around 7ish, and this time I tried adding one unit of novolog around 6:30… I was afraid of doing too much, but obviously a unit didn’t cut it.
And here is this morning’s coffee. I went in low, had 3 sips before any insulin, saw that rise, and waited until my cup was ice cold before finishing. I’m going to find a way to harness it… it’s going to take some experimenting and lying to Eric…
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So was your evening dose too much this time?
The spike you saw at 7…tell me about the hours before.
Was there any food or coffee involved? Anything other than lack of basal? Or are you certain that it is the Levi wearing off?
When was your morning dose of Levi yesterday? 12?
Try sticking with 2 shots, but a bit more in the morning to see if that early evening spike can be avoided with 2 shots. If not, then we can move to 3 shots.
From this pick, it doesn’t look like your morning dose is too much yet. Adding a little in the morning will lengthen the duration a bit. Once you get up to the highest dose of Levi you can take in the morning without dropping, that will be the longest duration you can get. This morning was 13, right?
If it still wears off when you get the right amount in the morning, we have a fork in the road - either 3 shots of Levi or Tresiba and Levi.
Put a lot of ideas out on this post. Does all of that make sense?
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Yes, and this all very important, but I’m talking coffee with Millz (coffee master) right now so I’ll be a minute…
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I put chocolate milk in my coffee just now to recover from a post-grocery store low! 
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Grocery store lows are the best!
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After all of my house sale prep this weekend (crazy activity levels all day long), I definitely started thinking in terms of my body’s “efficiency rating” for each meal or snack bolus.
I have such a stark contrast in bolusing for breakfast and lunch on work days (long commute/office work) vs bolusing for dinner on work days (very active at home). And I have to bolus differently for dinner on work days when my husband is out of town vs when my husband is in town…there is that big of a difference in my step count and activity level solo parenting vs tandem parenting. It is insulin-proof of how much my husband shares responsibilities with me at home when he is not traveling.
And then comparing work day boluses to weekend boluses is a whole 'nother story.
Does everyone else experience this? I mean, I only needed 4 units of insulin for three pieces of pan pizza this weekend…which normally would require 12-14 units. So that was a surprise. But just comparing variation throughout my routine weeks is startling.
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I forgot I was going to answer this. I need to look at the questions again and will think them through before responding. I’ll put this up first though just so you can see the pattern…
Three nights. Three spikes at the same time. All just before the end of the Levemir. My BG in the one image where I lost my sensor value was a 300.
That would be my guess. I bumped it back up to 9 on the third night in response to the spike and then the difficulty in getting it to come back down. But I don’t think that was the right thing to do. I think my My spike was from the Levemir fading and that increasing the next dose is like doing Tylenol after the headache is gone. And then going to low all night from it. 
Now it’s all a blur, but I can tell you I have been exercising around that time (between 6 and 7:30 maybe?) and that because it’s all spontaneous, I’m having some difficulty finding the balance in how many carbs to have. That’s been pretty consistent since the beginning. So then there are 2 factors that are consistent… end of Levemir and exercise time (and added carbs). However, I really have been TRYING to get the carbs right, and I still see the same thing. I’ve done shoddy exercise prep for many, many years and do know how to give myself some carb fuel without battling a 300 POST-exercise, so I should be able to do better there. Unless it has to do with the Levemir…
It was 12 yesterday, and I did 13 this morning. [quote=“Eric, post:124, topic:4871”]
Put a lot of ideas out on this post. Does all of that make sense?
[/quote]
Yes, it does, and thank you. I’m sick today and am kind of floating a bit. I’d like to exercise this evening but really probably can’t.
If you are sick, a lot of this stuff gets thrown out the window. Coming up with the right basal numbers when you are sick and then applying them when you are not sick is just not the same…
Anyway, for now, let’s just assume your rise in the evening is from Levi leaving.
- You can see if an increase in your morning dose extends it.
- You can take your morning dose later (but that kind of screws your morning if you wait too long…)
- You can take your evening shot earlier (that also possibly screws your morning a bit…)
- You can go to 3 shots of Levi
- You can go to both Levi and Tresiba
With your current morning dose, you are very close to that 12 hour window! Just a bit under 12 hours right now probably.
| Levemir dosage (units / kilogram) | Average duration |
|---|---|
| 0.1 units/kg | 5.7 hours |
| 0.2 units/kg | 12.1 hours |
| 0.4 units/kg | 19.9 hours |
| 0.8 units/kg | 22.7 hours |
| 1.6 units/kg | 23.2 hours |
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So are you telling me something or asking me something?
Just giving you the big picture so you can start looking at the next steps in fine-tuning and see which direction makes the most sense, and see why it makes sense. Giving you options to see what you think will work and what won’t work.
If you want someone to just tell you dosing numbers that they come up with from a book, without involving you in the decision or discussing the rationale with you, or analyzing the different options…go see an endocrinologist. 
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No, no, no… this is not what i was looking for… I just wasn’t sure if you were looking for an answer, agreement, approval… confirmation… so many possibilities. I want to understand.
And am still trying to. So I was at .2 units/kg to start? And now I’ve moved up? We never discussed these exact numbers.
Funny. It actually amazes me for how many years I’ve done routine appointments and routine tests and check ups and just swallowed whatever I was given. Do endos care that they have patients who do not understand their disease at all?? Do they prefer it? They certainly wouldn’t be the first kind of doctor who likes being the authority and likes their patients quiet and compliant.
I know I thank you all a lot, but when it came to diabetes, I had no idea there was all of this.
Sick as a dog. Doing a lot of insulin. How much of what I determine here is going to relevant at all??
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I can’t speak for all endo’s, but we have had seen three diabetes doctors in approx. 2 years due to some insurance changes and so I can say this:
One would have preferred an uneducated patient
Two really like working with us, and mentioned that we are a nice “abnormal” from their usual patients.
I would say that an educated guess in your situation is that most endo’s are used to uneducated patients, but that doesn’t say anything about what they prefer.
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Having a perfect non-sick basal figured out helps you greatly for when you are sick.
But, having a perfect sick-day basal figured out does not do much to help you for when you are not sick…
So just get through it and then when you are not sick anymore we can get back to work on figuring it all out.
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My endo seems to just be impressed with my increased knowledge and even MORE impressed with my increased interest. She laughs sometimes and says, “You never even used to carry a meter”. 
That’s true. You are probably right. I don’t think she wanted me in the dark, but she also had no way of getting me to where you guys are getting me. She probably just deals with patients at face value.
I’ve lived in doctors’ offices for the last 12 years. Maybe longer? I’ve had some crazy experiences, and it has left me very cynical. I don’t trust most doctors. It really says something how easily I handed it all over when it came to my diabetes.
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My experience with most endos is they preferred patients that saw the Dr as decision maker, and good patients followed their rules. For too many years, I was one of those great followers, even though my A1C didn’t always make THEM happy. But I followed all their “rules”. They probably should have recommended a pump for me long before I knew they existed.
Meeting other T1Ds in person and online led to my independence. Now I consult with my Dr, and we give and take during conversations, and I think he benefits as much as I do. My previous endo was THE BEST, but retired a few years ago.
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Just possibly I might be able to relate. In a broader sense.
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Yep, I’ve been very vague. I go back and forth depending on what I feel like and if I’m experiencing too many site issues. I like the pump mainly for being more discreet, i.e. the ability to bolus around other people easily without anyone noticing what I’m doing. It’s harder to do this with pens. I used to think my control was better too until I discovered the power of R & the ability to adjust Levemir dosing & timing to suit the situation. Now I think my control is better on MDI and with less hassle. I had a lot of misconceptions about MDI because the focus is always on pumping techniques, which I think is a disservice to people who can’t access a pump for various reasons or don’t have success with one. I really think people on MDI are set up to fail because they are not taught how to use R or how to bolus for protein really, and not taught that there are basal options such as Levemir which can be taken at different doses for day and night as well as at different doses every 12 hours to suit changing basal needs.
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