Sugar Surfing Technique Question

Type 1 & LADA
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For people who swear by Sugar Surfing, and for people who have tried it but may not swear by it: Do you find that lots of mini-corrections (which is what I understand Sugar Surfing to largely be…feel free to correct me) work when using long lasting “fast” insulins like Novolog or Humalog?

Here’s why I ask: As I fine tune my own regimens to get back to my glory days’ ranges of D numbers, I don’t know that mini-corrections would do a whole lot for my control. I’m hoping I’m wrong? But Novolog seems to work 5-5.5 hours in my system as @Michel has indicated it does for them, as well. For Novolog to do much to course correct me, I just wonder with that long of a slow burn if constant nudges really help? In my case, if I’m trending high, I personally need a percentage basal increase to actually solve the problem if it’s not caused by food. If it is caused by food and a poorly timed dose or whatever, a correction dose is obviously warranted but I don’t know that that’s actually “Sugar Surfing”. That’s just a correction dose.

What I am finding might work best for me (especially on sedentary work days) is to pad my breakfast bolus with an extra unit and to pad my lunch dose with an extra unit…but no more than that and to not pad any later boluses in the day. I eat about every three hours…so the extra breakfast unit helps support the strength of my lunch bolus (even with a healthy prebolus time)…and the extra lunch unit helps support my afternoon snack. If I don’t front load those two doses in my day, I end up waiting out some post eating higher-than-awesome numbers (but not terrible spikes), and then the stacking catches up with me and causes an oddly timed dip right after eating dinner, even with cutting down my dinner dose.

Basically, Novolog lasts so long in my system (which I do not think is unusual) that part of my lunch prebolusing might actually be best included in my breakfast dose three hours ahead of time. This distribution seems to suit my habits pretty well…and keeps me from waiting for in-between correction doses to finally take hold. [I’m a very habit-driven person so we don’t need to worry about me missing a meal or a snack when I’ve got extra insulin still active in my system.]

Does this question make sense? Basically, how can a small correction bolus (surfing) really help the big picture when it all takes so long anyway?

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Although, yes, Novolog has a long action rate, the largest portion of that action is “up front”. So even if you’re still getting some of the Novolog acting 4 or 5 hours later, most of the action has already occurred within that first hour or two. So, for us, (we do sugar surf with Liam), giving him boluses do help the BG’s avoid the super high rises that a basal could not eliminate entirely by themselves.

Novolog starts working after 30 minutes and the peak action (greatest effect) will be between 1 to 2 hours, but then it will still be significantly less effective at staving away highs beyond that 2 hour mark.

So, when we eat, we bolus AND we occasionally even add an increased temp basal when necessary in addition to that bolus.

For example, let’s say Liam was 120 with .3 IOB, was on his way down (45 degrees down) and we wanted to give him a snack. If the food were a low GI food, we would give a small percentage bolus up front then extend the remaining amount over an hour to 2 hours depending on what it is. The reason we do the long extension is that we can always suspend and give more up front if necessary, but once the insulin is i the system, that ability is removed.) Then, for low GI foods (like pastas), we also give an extended ADDITIONAL bolus…and believe it or not, we give him 1 unit extra also (extended over 1 or 2 hours). We either do an extended bolus, or an increased basal. We choose an extended bolus over an increased basal because of the requirement to set it an hour earlier than needed.

Anyway, there are a million ways to bolus and apply basal and something different works for everyone, but for us and Liam…we do sugar surf and we bolus him for it due to the fast-acting nature of Novolog. If he has more IOB at the next meal, that’s factored into the bolus with the Omnipod (as long as you have your DIA programmed correctly).

Hope I didn’t confuse things even more. lol

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I see the biggest effect from the tail of Novolog on sedentary days. I saw the same thing on Humalog. Weekends don’t pose as big of a problem for surprise evening stacking lows bc it already got used up from movement…but work days, watch out! Adding one more unit at 11am for lunch means a really interesting drop at 5:30pm…at least a more substantial one than not having that extra unit at 11AM. Part of that is from an afternoon snack bolus…but an extra 11AM unit is impressive even if I shave down the afternoon snack bolus. I know I’m in the weeds here but it’s interesting to me.

I also seem to see a rejuvenation of intensity at the three hour mark for Novolog. I’ve been watching it all month and it behaves differently for me than Humalog did in that regard.

:woman_shrugging::woman_shrugging::woman_shrugging:

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@T1Allison, the tail we see down 5.5 hours or even more is only impactful when we stack or when we inject big boluses. It is common for us to use 12-15U to subdue a peak (we have once had to use 30U, for a boy whose TDD is between 40 and 50). With this amount of insulin, we can run sustained lows all the way down the tail—we use Novolog, btw.

But, as @ClaudnDaye mentions, this tail effect is really negligible in the case of small corrections. We use a lot of small corrections. We would like to live in the lower half of our range (70-120), so whenever things look settled we correct to below 100. Unfortunately, “whenever things look settled” is not half as common as we wish: for a boy in full.puberty each day brings spikes galore :slight_smile: Nonetheless, we use small corrections whenever we can, without concern for tail effects.

There was a time, right before puberty struck, when we had no spikes, and we had become proficient with small corrections. This was, for us, the golden age. We went from 65% time in range without small corrections to between 90 and 95% time in range—just for a few months. After that, we started seeing spikes. The point, though, is that small corrections gave us that ability at a time when things were more settled than they are today.

So, for me, I think small corrections are awesome, when things are settled enough! But, for us and possibly for you too, there are times in the day when BG is chaotic, and you don’t know at all where it will go in the next 30 minutes. In these conditions, small corrections are not very useful.

Our thought, though, is that in these chaotic conditions we just hang by the skin of our teeth and the results are what they are: we just do the best we can. When things are calmer, though, we have a chance to improve BG control and we want to grab that chance. Even a bit here and there counts, for us. I am guessing that small corrections are worth at least 0.5% in A1c or more every month. To us that is definitely worth talking :slight_smile:

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I appreciate that experience and insight, @Michel. I suppose the crux of my situation is discerning the hormone level of the day (which impacts how aggressively or conservatively I’m going to bolus depending on how well matched I think my current basal percentage is) that mini-corrections have not proved terribly useful to me yet. Hopefully I’ll find a way to harness them as time goes on…but it seems my current bread and butter is in my basal rates and prebolus timing. I’ll keep working on it!

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Don’t focus on the size of the corrections as the defining characteristic of surfing. The key idea of surfing is to use the shape of the CGM graph (plus anything else you know) to anticipate where the BG is headed, and treat early and often to steer things back in a good direction. It’s just a way to try to avoid large BG excursions by nipping them in the bud. So after eating you’d expect the BG to rise a while and then start to turn down. If you’re watching for this and instead you see the graph starting to curl upwards even steeper, you might decide to take more insulin. If instead the rise is shallower than expected and starts to turn down “too soon” you might eat more carb. Not because you’re low, but because you think you’ll be heading low in a while if you do nothing. To me that’s what surfing is: watching the graph, anticipating how things are unfolding, and steering it in a good direction.

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I think the philosophy behind sugar surfing is dynamic diabetes management, as opposed to the static principles the mainstream medical community teaches (i.e. fixed carb ratios, testing 2-4 hours later and correcting, static basal rates based on infrequent basal testing, etc.). If you are using a pump, one thing you can try is to take more insulin but lower or shut off your basal for a period of time. For example, if you are spiking and know you need more insulin, but that taking more will drop you low later, you could mitigate this by adjusting your basal so that you have less insulin on board in an hour or two and won’t drop low. It’s all trial and error of course, but the superbolus technique is an effective way to avoid spikes or give faster corrections, where you take the insulin you need + the equivalent of 1-4 hours of basal up front (depending on how fast you need your correction or how quickly what you’re about to eat will spike you) and suspend the basal for as many hours as you took it up front for.

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I do this frequently, and works well. If then start to drop too quickly, I use temp basal reduction, sometimes to zero, so that tail of bolus is basically now covering basal. Inside my body, insulin is insulin, not basal and bolus.

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This is what I try to do, as well. You describe surfing perfectlyl! So even if I see a BG still in range but it is going the opposite direction I expect, persistently, I’ll take action. Good idea to do a finger stick, too.

You make some great suggestions. I’ve lately been using this technique, too, taking the superbolus (with or without food), then reducing the basal for that amount keeps me from going too low later.

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