Okay. 1. I know I haven’t responded to the responses about my little tiny cereal bowl. I’m reading everything and taking it all in. I’ll respond as soon as I get a free minute (because you guys are holding your breath).
But I have a new scenario, and I’d like to hear what you all think (or know) about it.
Here’s a WHOLE bunch of information in case you care about any of it… I decided last minute this morning that I would like to get out for my run before I wouldn’t be able to get any shade. I hit a 50% basal for 1 hour and 15 minutes, which I usually see all the way through before starting, but I was only about 25 minutes in when I went out the door. I did have a coffee not long before + banana, and my BG was a 114. USUALLY the combo of those 2 things (plus complete temp basal) are enough to get me through the bulk of the workout, but today I also had 1.2 units on board. I just didn’t think about it, and off I went.
Almost 2 miles in, I realized I was pretty low so I decided to slow to a walk and have 2 glucose tablets. I was hoping it would be enough with the temp basal. 3 minutes later I tried running again. Almost immediately I realized I was having a pretty bad crash, so I slowed to a walk again and took 2 more tabs. In an interesting decision, I continued to head AWAY from my home. As I got to the three mile mark, I started to become concerned. I was definitely low, and I now had 6 tablets left. 6 tablets, 3 miles, 1.1 unit on board, 50% temp basal, and effects of exercise… I wasn’t sure HOW it was all going to align and realized I may have messed up.
I’m here writing this now, so I obviously made it home, but I will say I made it home with an empty container. My BG was an 81 when I came in the door. At that 3 mile mark, I chose to take 5 glucose tablets at once in the hopes that I could give myself a big enough push that just that one tablet would be enough to get me all the way home. But I wonder if this is sound thinking? It was a big gamble to leave myself just the 4 grams of carbs with all that distance.
So how DO you get the most out of your glucose tablets? Would they have an equal effect being consumed at an even interval DURING a long walk home as they would if consumed all at once?
For exercise, your body will tend to pull more glucose out of your blood during the first few miles then it will later on in the run. Once your body gets warmed up your body will be able to fuel the run with other sources more easily. It will generally go to using more blood sugar initially, because that is the most readily available fuel source.
So for running, in the scenario you described, taking them all at once and right away was a reasonable thing to do.
Another reasonable thing to do would have been to turn your basal off completely at that point!
And this is excellent to know and PROBABLY available in the sports stuff I printed… and haven’t gotten around to reading yet… but will be reading this weekend.
when i am prepping for my swim, i wait till i have no more IOB from eating, then i turn my pump off completely (0% TB) for 2.5 hours before i jump in the pool. so, basically i have no substantial IOB from anything (bolus or basal).
but when i swim, i get out every 1/2 hour and do a finger stick to check if my BG is in a safe range. quite often, i will take 1 tablet (sometimes only a half, sometimes nothing) if needed. i find that by just taking a little sugar boost is very helpful b/c my BG stays even rather than spiking and then having to swim off the high.
however, if my BG has gone down to 30ish, i will gobble those tablets down like there’s no tomorrow. that has only happened to me once during swimming, so i am happy to report this from my home while i sit at my computer in perfect target range.
i also tend to forget about the SUSPEND option on my pump, but every time i have used it, it works perfectly. generally, i set it for 1/2 hour at a time, but that small increment of time seems to pack quite a punch. (and i am not really certain why, either, but i am certain that eric will have an explanation for that question ! LOL )
I hope so, because it doesn’t make sense to me either. I use it if I’m trending low and expect to keep going lower despite treatment (continued activity, say), but if I’m just sitting around and treating a low right now, logic suggests the low would be long over by the time any decrease in basal started to raise the BG.
i have been waiting for him to chime in. usually he is a “first responder.”
when i think about it from what i think is a logical and practible point of view. 1/2 hour of my basal rate is equivalent to .25 units/hour. thats practically nothing !!! how on earth can that amount possibly amount to impacting my BG at all??? it seems crazy.
If your BG was 60, would taking .25 units have an impact on you? Of course it would! So reducing your insulin by .25 when you are low has a similar “opposite” affect.
You can kind of think of it as “removing” .25 units from your body. When you are low, that little amount can be important.
But it won’t have an impact immediately, and if I’m treating a low, I want immediate effects. Humalog doesn’t even start working for 20 minutes with me. If I stop my basal now, insulin doesn’t suddenly vanish. I’ve got a bunch of incremental doses of basal on board that will continue to kick in for the next 20 minutes and beyond … by which time my low will be history, I’ll be back to normal, except I’ll start rising because now I won’t have enough basal.
This is for ordinary garden-variety lows. For extended lows or continued downward trends, lowering or suspending basal makes sense. But what am I missing here?
A corollary to reducing basal while low is taking insulin when treating a low. For years and years this made no sense to me at all, which was problematic because I had a habit of overtreating. And so I’d go from low to high to low to high …
Two nights ago my BG barely budged after dinner, and I was trending low when I went to bed. I figured food would eventually kick in, so didn’t do anything. I went low, took glucose tabs, went lower, took more glucose tabs, continued to go low, and when the Dex said LOW I had a healthy swig of corn syrup, a juice box and a small slice of bread with peanut butter. Then of course double-arrowed up to 270.
Next night, the same thing. Glucose tabs weren’t doing anything, so I ate a Creme Egg (25 g carb) and bolused 3.65U, half my brain screaming “You’re seriously low! Insulin will make it worse!” Went up to 90 and stayed there the rest of the night.
Well no, cutting basal does not have an immediate impact. I would not suggest such a thing. Eating quick-acting carbs will always be the faster way to treat a low.
But in the context of this conversation, Nicky was describing being out for a run and not having much left as far as glucose tabs. So cutting basal in addition to the carbs was suggested.
I think that “no more IOB” is the critical factor. Usually I have almost nothing to nothing at all, but I got rushed out the door and just forgot. That was my concern… I knew all of the things that would push my numbers up and all the things that would push it down… I just didn’t know which was going to win. I NEVER take 5 tablets at once. I was just afraid that those little amounts were going to get washed away from the effects of the exercise and IOB.
That’s 3 now for Team “I forget about the suspend option”. Yes. I’m not just feeling better… I’m feeling like I’m on the cutting edge of exercise diabetes management.
In this case, I was almost 3 miles from home, only 6 tablets left, a low blood sugar, and about a unit on board, AND I had been running for some time. I’m recruiting people for team “I forget to suspend”, but in this particular case, I really do see how much sense a suspend would’ve made. It may have kicked in right as my tabs ran out… I can recruit all I want, but truthfully I’ll have to keep this in mind. It was the second time this WEEK I wasn’t sure if I had brought enough sugar.
Typically though, this is absolutely the truth, and it’s why auto mode was just no good. All of that suspending (or even reduced insulin) at present only to be rising, rising, rising way after the fact.
I know we’re all varying degrees of insulin sensitive, but I often go with temp basal rates of just 10% reduction or addition because that can be all I need. If I add just 5% more, it can lead to problems.
Now I think I’m just butting in on a conversation between you two, BUT I think what you’re missing is the context… This started with the idea that hitting a suspend midway through a workout would be a good option given all of the conditions listed previously. I don’t THINK Eric meant it to be the solution but more a safety net. Maybe. If I did suspend at that point, it would be a relatively negligible amount of insulin, and not anything that would have an immediate effect, but at the tail end of the workout it may have been critical if I had run out of tablets. .6 units is not an impressive amount of insulin, but delivered at a vulnerable time, it can be damaging. This is my attempt at mansplaining, and it’s not as much fun as I thought it might be…
For continued downward trends… that is what the situation entailed.
YES. I just tried explaining what I thought you were saying because I hadn’t read this far down, and I got it right. This is an exciting moment. You did go on to say it much faster, clearer, and in fewer words, but I got it.
