The IOB Predicament... What do you do with a climbing blood sugar prior to starting exercise?

Type 1 & LADA
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My roller coaster has continued into today, but I’m back to feeling less like a helpless lump and a little more driven to just make it stop. So I’m here with a scenario to see how the pros handle such sticky situations because that’s definitely what it FELT like I had this morning…

First of all, I slept through my alarming pump again this morning. 2.5 hours’ worth of my pump warning me of a suspend, but I didn’t catch that. So when I woke up at a 121, I knew I wasn’t there to stay. It was early enough I figured I could just get myself right out the door for exercise and at least try to take advantage of the inevitable high that was coming.

UNFORTuNATELY, I can’t roll out of bed and start exercising, no matter how much I need to, without first having coffee. About 2 cups. I, like many, need insulin for my coffee. I also need insulin for my 2.5 hours of NO insulin, but, as I said, I had my eye on exercise, and I was currently at 0 IOB. 1.5 cups of coffee later (maybe 25 minutes), I was at a 225 or so. I went out the door. My sensor glucose continued to rise for a while, up to over a 300, even at the point in my session where I’m usually plummeting. Finally by the end, I had returned to about a 170, but it wasn’t the end of the high. Even though I never had any glucose tablets, no temp basal, and no carbs, I rose again to a 200 about an hour after finishing. I was watching my calibration factor all morning, I did know I was likely to rise again, and I did make a choice to keep an eye on it rather than treating. My only mistake in that second rise was letting it get that high, and that only happened because I figured a round of food shopping would be enough to drop me. It wasn’t, and I hit 200. It was probably 3 hours after exercise that I was all clear for a carb.

It’s a whole scenario… plenty to pick apart. I KNEW it wasn’t okay to have coffee on top of a suspend like that, but i honestly didn’t know how to handle the IOB. I probably shouldn’t have chosen today to watch that second rise either, given my less than ideal blood sugars as of late, but the opportunity was there to see what happens in this kind of case, and I want to know this. Next time I’ll do a bolus afterwards. That’s all of the justification and preemptive defensive remarks I can think of. If anyone has any ideas, I’d love to hear them.

And about dips… Emotional dips. I get these, and they can hit hard. They make it hard to take good care of myself. After developing diabetes, I learned to keep them short. Er. Shorter. I learned that I couldn’t afford 6 weeks to get myself together. I could afford 1… day, really…and then it would still take me a week. But the point is that I don’t have the luxury of staying blue too long. Diabetes could not care less whether or not I’m feeling demoralized. Anyway, I’m not sure anyone knows what I’m talking about (myself included), but developing diabetes taught me how to get over stuff and move on. This site is teaching me that, too. I wasn’t feeling okay yesterday, and I’m feeling okay today. That’s fast. I’m just talking… and feeling appreciative. :slightly_smiling_face:

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In general I would try to correct the high before I started, but if that was not possible, for the first hour of exercise, I would correct at 40% of the normal correction amount, and then go down by 10% for each additional hour of exercise I am doing.

So for example, during the first 0-60 minutes of exercise, while actually exercising, I would do 40% of a normal correction.

During minutes 60-120, it would be 30% of a normal correction.

During minutes 120-180, it would be 20% of a normal correction.

Anything over 3 hours is 10%, and that it does not drop below that.

Is that what you were wanting to know? Or did I not understand the question correctly?

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Oh, no… I think that’s exactly it. So I was trying to avoid doing any kind of insulin at all out of fear that fresh insulin was going to cause too fast a drop. But I guess that’s not entirely… right. :face_with_raised_eyebrow:

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You had no IOB, right?

If you have IOB, you can factor it as being more than normal IOB, with the same kind of percentages.

Like in the first hour, your insulin is about 2.5 times more powerful. So in the first hour, having 1 unit of IOB is like 2.5 units when not exercising.

( just use the inverse: 1 / 0.4 = 2.5 )

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So this morning I was at a 2.4 unit recommended bolus according to wizard. I had been suspended 2.5 hours and receive 1.25 units per hour. I had close to 2 cups of coffee, and I usually bolus for 7 or 8 grams per cup. So I knew that 2.4 units was actually far less than what I probably needed. How would you bolus… knowing you’re going out for a less-than-Eric run, but a good workout for you anyway, that will take about an hour? (Walk included?)

Sorry… I started writing this earlier and forgot about it. :confused:

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If I were going to run for 1 hour, I would bolus at 40% of normal for corrections and carbs. But on the other hand, I wouldn’t let my pump suspend my insulin on its own choosing, either…

But about the suspension, your pump suspended you for that long, but why?

That brings up my great idea, BTW. It’s funny how I had this idea in my sleep, probably at the same time as your pump was trying to eff your run this morning.

See, that’s The Force at work.

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:rofl: :rofl: I’m sure it was. :grin:

So am I waiting to hear your great idea?? I responded to another post of yours saying I was ready for it… so I’m ready whenever you are… :thinking:

And I didn’t LET my pump suspend itself. I almost THREW it this morning when I realized what it had gotten past me… I have my Suspend feature turned on and set to “suspend on low”. My low is set at 50. Since I woke up yesterday morning at a 26, it seems reasonable. USUALLY I catch it because it alarms to let me know it’s suspended, but I’ve been sleeping through all alarms. So I didn’t catch it. It treated me to the full 2.5 hours, and it ALMOST saw the bottom of the lake this morning…

And now, drumroll please… for your idea please…

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What is your average daily basal amount? Is it possible to get that number from your pump at all?

If not, what was it when you were using a pump that was not trying to kill you? Your average daily basal amount.

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Not my average… it IS my basal rate, and it’s 27.5 units a day.

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Wait… my average rate? Or total daily?

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I’ve confused you… again.

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Zero basal for any extended time is horrible.

I posted something about it on a different discussion a while back, do you remember this?
some basal illustration concept “pics” I made

If you were leave your basal-screwing pump as it is, and just add 5 units of Tresiba to the mix, even when your pump turns off your basal, you would have about 0.20 units per hour of basal all the time.

0.20 units is not a lot to add when your pump is always turning off anyway. You might need to tinker with it a bit, but at least you would never be at zero.

The zero basal for extended periods is totally screwing up everything. Your meals - after having your basal turned off who knows how long - no wonder you are getting crazy numbers.

I would be willing to bet this would be a huge improvement.

It takes a few days to get up to speed, but Tresiba is a very long lasting basal. So you would have a nice steady stream of about 0.20 units per hour, no matter what your pump tries to do.

So when your pump says, “Nicky is at 70, I need to turn off her insulin for a few hours!!”, you still have 0.20 units being snuck in.

It’s like the pump instead saying, “I like Nicky, I will only turn her down to 0.20 units an hour so she doesn’t get screwed up for hours…”

At close to 30 units of basal a day, 5 units over 24 hours is not much.

I bet you this would be a huge improvement. Would you be willing to try something like that?

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I think yes… but, of course, not without it causing all kinds of questions. First of which would be how would I prevent it being too much insulin? Let’s say I add that extra insulin but then don’t have any suspends— I’d topple, no? I guess i’m trying to think of what it would take to make it an even exchange. I also don’t know anything about Tresiba… I think this is the one Sam mentioned taking because it lasted longer??

I wasn’t exaggerating when I said I’ve lived like 14 years with this disease where the most precise I got was “some insulin today” and “probably some insulin tomorrow”. It’s why I have a million questions. To the core, insulin scares me.

You didn’t ask any of that. Yes, I do remember your graph. It was a great help. And the idea of a helper insulin, if I’m even imagining that correctly, sounds good. It’s a great idea, Eric. I will have to look at what it is all about and then flood you with questions and concerns. I imagine this is an in-office conversation with my endo, right? Probably not something she’d write up without seeing me?

JUUUUST out of curiosity, can I ask what kind of insulin you do? I’m not gaslighting… I’m just nosy. :smiley:

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I wouldn’t mention it to your endo. If you did, she’d never script it for you.
:wink:

If your BG drops, your pump cuts it off, no?

So it is the same exact thing, but instead of being at zero, you are at about 0.20 units per hour.

Sure lots of fine points to go through and figure out. This won’t get resolved tonight.

Put out a call out to all the peeps here to see what they think about it. Tag some names with @'s in front of them to get them to read and reply.

Let’s start with Darling Nicky. She always has good advice.

@Nickyghaleb

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I hear she makes stuff up…

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What Eric has described is basically a modification of the un-tethered pump approach. We use the same type of thing for baseball season with my son. i.e. before the season starts we use a basal profile on his pump that provides 50% of the normal basal, and then do the other 50% with Lantus. That way when he disconnects his pump for baseball games, he still has insulin onboard since he needs to disconnect for 3 hours at a time. This sounds suspiciously similar to a suspend that turns off for 2-3 hours before you wake up.

So when you add the basal, just subtract it from your pump bolus, although with such a small change, you might not even need to do that.

Added note: Every diabetic needs to have access to basal insulin even if they have a pump in case of pump failure, so you don’t necessarily need to discuss exactly what you are going to do with the insulin if you don’t want. With that said, our endo loves our approach and supports it 100%

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Okay that doesn’t sound nearly as scary as it did initially. Again, I’ve never heard anything like this…What a great idea. Do you mind my asking how often you all “mess up”? Like maybe forget to subtract something?? So yesterday, once I figured out I had been suspended for 2.5 hours… I would just… nothing?? Because I wouldn’t actually have been at nothing. There are definitely some details to be worked out, but that already sounds like such a relief…

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Glad I asked… I was going to put her on high alert tomorrow with an email. :smiley:

So how DO you get a script?? This is a pretty good idea. I’ll give you that. And Chris is already in here making it sound even better than you did. :smiley: I don’t know who else to ask about this though. Anyone in specific??

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I don’t think you would have to do nothing, but it should make it easier to control, i.e. not start the wild blood sugar gyrations that once started, are very hard to settle down. For my son, if he starts on the see-saw, it takes more than 24 hours to quiet down, so anything that allows the blood sugar not to start going crazy is good for control.

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Oh, I agree. I’m way past 24 hours now, and I’ve been working hard to get it all to settle down. I’m not sure what made this round so bad, but it’s been so bad…