# To Nibble or Cram? How do you get the most out of your glucose tablets? **URL:** \ **Category:** Type 1 & LADA\ **Created:** [June 16, 2018, 5:58pm UTC](https://forum.fudiabetes.org/t/to-nibble-or-cram-how-do-you-get-the-most-out-of-your-glucose-tablets/4238 "2018-06-16T17:58:50Z")\ **Posts on this page:** 17\ **Page:** 2
**Author:** ![Nickyghaleb](https://avatars.discourse-cdn.com/v4/letter/n/5f8ce5/32.png) [@Nickyghaleb](https://forum.fudiabetes.org/u/Nickyghaleb)\ **Post date:** [June 17, 2018, 10:24pm UTC](https://forum.fudiabetes.org/t/to-nibble-or-cram-how-do-you-get-the-most-out-of-your-glucose-tablets/4238/21 "2018-06-17T22:24:09Z")
> [@Beacher](#): > > corollary I can’t quote your whole thing, I don’t know why, but I’d like to… Yes to the first paragraph, oh yeah to the second, and so true to the third… You’ve summed up my 15 year journey of learning how to treat properly in three paragraphs. I learned during my second pregnancy, desperate to keep my numbers down, how to do a bolus with every treatment of a low. Everything about it felt wrong and dangerous, but it worked really well. This wasn’t just for overtreatments but for any treatment at all. A straight 15 grams of carbs taken for a blood sugar of a 50? I’d give myself half the regular bolus while I was eating. Sometimes all of it. But those ones that you described where you’ve got all that insulin on board, and there just seems to be a relentless push downward? Those are tough. I start with a reasonable treatment, then, truly not knowing what my situation is, I go until I know I’m safe. Completely off subject, but I’ve always wondered how much of that huge rebound spike is because of the carbs and how much is Symogyi… suhmohggi………. smoggy effect? ---
**Author:** ![Beacher](https://avatars.discourse-cdn.com/v4/letter/b/a6a055/32.png) [@Beacher](https://forum.fudiabetes.org/u/Beacher)\ **Post date:** [June 18, 2018, 1:30pm UTC](https://forum.fudiabetes.org/t/to-nibble-or-cram-how-do-you-get-the-most-out-of-your-glucose-tablets/4238/22 "2018-06-18T13:30:54Z")
> [@Eric](#): > > Well no, cutting basal does not have an immediate impact. I am glad to have that confirmed. I know it didn’t apply in Nicky’s situation, but it wasn’t clear whether @daisymae was making a blanket statement about handling lows or focusing on an exercise context when she said > [@daisymae](#): > > 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 And the same tactic came up in another thread > [@What do you binge on to correct low lows?](https://forum.fudiabetes.org/t/what-do-you-binge-on-to-correct-low-lows/4146/11): > > If you are a pumper, Step 1, suspend your pump basal. then treat your hypo. After regaining control, take pump off suspend. Suspend mode will alarm to remind you. so I was beginning to wonder if I’d missed a class somewhere along the way. ---
**Author:** ![docslotnick](https://yyz2.discourse-cdn.com/flex030/user_avatar/forum.fudiabetes.org/docslotnick/32/75_2.png) [@docslotnick](https://forum.fudiabetes.org/u/docslotnick)\ **Post date:** [June 18, 2018, 3:16pm UTC](https://forum.fudiabetes.org/t/to-nibble-or-cram-how-do-you-get-the-most-out-of-your-glucose-tablets/4238/23 "2018-06-18T15:16:04Z")
From an MDI perspective, would I take a few units of insulin every hour if my Bg was crashing? That would be crazy. So with a pump, why would I not suspend basal if my Bg was low? It sounds like a no brainer, but then again I have never used a pump. ---
**Author:** ![Nickyghaleb](https://avatars.discourse-cdn.com/v4/letter/n/5f8ce5/32.png) [@Nickyghaleb](https://forum.fudiabetes.org/u/Nickyghaleb)\ **Post date:** [June 18, 2018, 3:56pm UTC](https://forum.fudiabetes.org/t/to-nibble-or-cram-how-do-you-get-the-most-out-of-your-glucose-tablets/4238/24 "2018-06-18T15:56:45Z")
> [@Beacher](#): > > If you are a pumper, Step 1, suspend your pump basal. then treat your hypo. After regaining control, take pump off suspend. Suspend mode will alarm to remind you. Now I’m confused… are you talking about lows in general?? I rarely use a suspend in case of a low. I prefer a positive action rather than a negative… for some reason a carb treatment feels like a positive action whereas a suspension of insulin feels negative… that there will be a deficit. My suspend is not helpful for lows because it take way too long to take effect. The only tome I’ll let my pump suspend itself is when I’m so low I’m having difficulty getting a handle on it, and I’ll let it suspend I’m CASE it’s gotten out of my control. I turn the bugger back on within 12 minutes every time. I hate me some suspend. 😁 ---
**Author:** ![Nickyghaleb](https://avatars.discourse-cdn.com/v4/letter/n/5f8ce5/32.png) [@Nickyghaleb](https://forum.fudiabetes.org/u/Nickyghaleb)\ **Post date:** [June 18, 2018, 4:01pm UTC](https://forum.fudiabetes.org/t/to-nibble-or-cram-how-do-you-get-the-most-out-of-your-glucose-tablets/4238/25 "2018-06-18T16:01:53Z")
Because your pump iS your underlying basal. So I think the difference is you’re talking about a scenario where you have your basal already in the background and you are not ADDING insulin where we’re talking about the SUSPENSION of insulin. No, I wouldn’t add insulin either, but if I suspend my basal now, it’s not likely to have any effect for at least 30 minutes, and depending on what I’ve done, it can continue to affect me for an undetermined amount of time in the future. Maybe? ---
**Author:** ![Eric](https://yyz2.discourse-cdn.com/flex030/user_avatar/forum.fudiabetes.org/eric/32/9209_2.png) [@Eric](https://forum.fudiabetes.org/u/Eric)\ **Post date:** [June 18, 2018, 4:14pm UTC](https://forum.fudiabetes.org/t/to-nibble-or-cram-how-do-you-get-the-most-out-of-your-glucose-tablets/4238/26 "2018-06-18T16:14:09Z")
Suspending for a short time is fine, but when you get crazy and do it too long, you get ugly results. ---
**Author:** ![docslotnick](https://yyz2.discourse-cdn.com/flex030/user_avatar/forum.fudiabetes.org/docslotnick/32/75_2.png) [@docslotnick](https://forum.fudiabetes.org/u/docslotnick)\ **Post date:** [June 18, 2018, 4:28pm UTC](https://forum.fudiabetes.org/t/to-nibble-or-cram-how-do-you-get-the-most-out-of-your-glucose-tablets/4238/27 "2018-06-18T16:28:28Z")
If you turn off your insulin for 10-12 minutes it’s almost the same thing as not giving yourself a shot. I know that in MDI there is background basal that can’t be stopped, but any additional insulin, either pumped or injected, is adding fuel to the immediate fire. Again, leave the basal on only if you know you’re going to overeat. Otherwise I think you might want to suspend it for a very short time. ---
**Author:** ![Nickyghaleb](https://avatars.discourse-cdn.com/v4/letter/n/5f8ce5/32.png) [@Nickyghaleb](https://forum.fudiabetes.org/u/Nickyghaleb)\ **Post date:** [June 18, 2018, 4:32pm UTC](https://forum.fudiabetes.org/t/to-nibble-or-cram-how-do-you-get-the-most-out-of-your-glucose-tablets/4238/28 "2018-06-18T16:32:51Z")
And 10-12 minutes is about my limit. The 670G is a sneaky suspender of insulin… it will try to slip one by me. When I look down and see I’ve been suspended for anything longer than that (sometimes like an hour), I want to hurt my pump. It’s still on my hip though and not at the bottom of the lake though… for now. ---
**Author:** ![Beacher](https://avatars.discourse-cdn.com/v4/letter/b/a6a055/32.png) [@Beacher](https://forum.fudiabetes.org/u/Beacher)\ **Post date:** [June 18, 2018, 6:02pm UTC](https://forum.fudiabetes.org/t/to-nibble-or-cram-how-do-you-get-the-most-out-of-your-glucose-tablets/4238/29 "2018-06-18T18:02:22Z")
> [@Nickyghaleb](#): > > Now I’m confused… are you talking about lows in general?? Though it looks like it in your post, those words aren’t mine. I was quoting someone else, and I was skeptical of the approach. I **do not** suspend for an ordinary low. I **may** suspend (or eat extra) if I’m going low and I expect to be expending energy for a while. Any time I temporarily increase or decrease my basal, I’m thinking about what the desired outcome is after about an hour. ---
**Author:** ![bkh](https://avatars.discourse-cdn.com/v4/letter/b/da6949/32.png) [@bkh](https://forum.fudiabetes.org/u/bkh)\ **Post date:** [June 18, 2018, 6:19pm UTC](https://forum.fudiabetes.org/t/to-nibble-or-cram-how-do-you-get-the-most-out-of-your-glucose-tablets/4238/30 "2018-06-18T18:19:22Z")
> [@docslotnick](#): > > From an MDI perspective, would I take a few units of insulin every hour if my Bg was crashing? From the MDI perspective, you are always taking your basal insulin every hour, even when your BG is crashing. Your basal (Lantus, Tresiba, Levemir,…) isn’t a big problem to overcome, you just take advantage of the low with tasty carbs. Typically a pumper will do the same. Suspending the basal on a pump won’t help much with a crash (although it might make the difference between life and death if you pass out,) but it is used in the automatic “low-suspend” or “predicted low suspend” techniques by some pumps in an attempt to blunt a slow or moderately falling BG. It takes quite a while to have any effect, and then it usually results in a moderate high BG a couple hours later. On Medtronic’s Loop Blog, which has nothing to do with “looping” AP systems, they had an article on the threshold suspend feature of the 530G. They show an example graph of the insulin automatically suspended at 1am. The BG continues to fall for another 45 minutes or so, and doesn’t get back to the BG level at which the suspension occurred until 1 hour and 45 minutes after suspending. That’s just too slow by comparison with eating some carbs. > **[How To: Use the Threshold Suspend Feature | The LOOP Blog](https://www.medtronicdiabetes.com/loop-blog/how-to-use-the-threshold-suspend-feature/)** > > Threshold Suspend is a Continuous Glucose Monitor (CGM) enabled feature that is designed to automatically stop insulin delivery when your sensor value reaches or falls below a pre-set threshold. ---
**Author:** ![Nickyghaleb](https://avatars.discourse-cdn.com/v4/letter/n/5f8ce5/32.png) [@Nickyghaleb](https://forum.fudiabetes.org/u/Nickyghaleb)\ **Post date:** [June 19, 2018, 2:07pm UTC](https://forum.fudiabetes.org/t/to-nibble-or-cram-how-do-you-get-the-most-out-of-your-glucose-tablets/4238/31 "2018-06-19T14:07:07Z")
> [@bkh](#): > > On Medtronic’s Loop Blog, which has nothing to do with “looping” AP systems, they had an article on the threshold suspend feature of the 530G. They show an example graph of the insulin automatically suspended at 1am. The BG continues to fall for another 45 minutes or so, and doesn’t get back to the BG level at which the suspension occurred until 1 hour and 45 minutes after suspending. That’s just too slow by comparison with eating some carbs. Just read it… Yes, I do like they’re gentle slope that returns perfectly to an 80. It’s inviting, that slope. In reality, for me, it’s like a 90 degree angle. > [@bkh](#): > > in an attempt to blunt a slow or moderately falling BG. It takes quite a while to have any effect, and then it usually results in a moderate high BG a couple hours later. That about sums it up. The only time I like the suspend is over night. And that’s only if I’ve woken up enough times to keep it in check. You know, one of the things I saw in auto was also just a reduction of insulin. So maybe from midnight to 5, I’d get a total of about 58% of my actual basal rate (random example). Here’s my question… does the amount of time you’ve been at a reduced rate have any effect on how long your blood sugar can be affected EVEN if you’ve done a bolus to cover for the missed amount? You guys might not know the answer, and it might not be a clear question to start with. I’m just thinking about the mornings I would get up following one of these nights, and it would take MANY hours, as many as 6? 7? To straighten out my blood sugar. Is that real? ---
**Author:** ![Nickyghaleb](https://avatars.discourse-cdn.com/v4/letter/n/5f8ce5/32.png) [@Nickyghaleb](https://forum.fudiabetes.org/u/Nickyghaleb)\ **Post date:** [June 20, 2018, 3:05pm UTC](https://forum.fudiabetes.org/t/to-nibble-or-cram-how-do-you-get-the-most-out-of-your-glucose-tablets/4238/32 "2018-06-20T15:05:57Z")
> [@Eric](#): > > 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. Been thinking about this… for me, it’s actually counter-intuitive. I would think this process would progress as the session grew longer. However, I most commonly need a treatment about 15-20 minutes in. Do you think that’s why? Or am I looking for a connection where there is none? Here’s my question. If you were to apply that idea that your body will tend to pull more glucose from your blood within the “first couple of miles”, does that translate to all forms of exercise? Or are you only talking about running? Is there any kind of defined period during which this can be expected? And, Siri, how soon might one expect this to “reset”? ---
**Author:** ![Eric](https://yyz2.discourse-cdn.com/flex030/user_avatar/forum.fudiabetes.org/eric/32/9209_2.png) [@Eric](https://forum.fudiabetes.org/u/Eric)\ **Post date:** [June 20, 2018, 3:28pm UTC](https://forum.fudiabetes.org/t/to-nibble-or-cram-how-do-you-get-the-most-out-of-your-glucose-tablets/4238/33 "2018-06-20T15:28:08Z")
> [@Nickyghaleb](#): > > However, I most commonly need a treatment about 15-20 minutes in. Do you think that’s why? Or am I looking for a connection where there is none? If you are needing sugar within the first 15-20 minutes, that is probably exactly what you are seeing. Glucose is the body’s preferred fuel source. It is the most easily accessible. Once you have warmed up, you can use other sources more easily, like muscle glycogen or lipolysis. > [@Nickyghaleb](#): > > Here’s my question. If you were to apply that idea that your body will tend to pull more glucose from your blood within the “first couple of miles”, does that translate to all forms of exercise? Or are you only talking about running? It’s the same for any activity. The push to go from a resting state to an active state will cause the body to use the easiest fuel source that it can. What do you mean by “reset”? ---
**Author:** ![Nickyghaleb](https://avatars.discourse-cdn.com/v4/letter/n/5f8ce5/32.png) [@Nickyghaleb](https://forum.fudiabetes.org/u/Nickyghaleb)\ **Post date:** [June 21, 2018, 12:46am UTC](https://forum.fudiabetes.org/t/to-nibble-or-cram-how-do-you-get-the-most-out-of-your-glucose-tablets/4238/34 "2018-06-21T00:46:50Z")
Reset… like how fast would the whole thing reset? 🙂 So if the warm up period is when it happens, what would happen if you stopped then? Would coming back in an hour enable the whole thing to work the same way?? Don’t ask me why. I’m just wondering… ---
**Author:** ![Eric](https://yyz2.discourse-cdn.com/flex030/user_avatar/forum.fudiabetes.org/eric/32/9209_2.png) [@Eric](https://forum.fudiabetes.org/u/Eric)\ **Post date:** [June 21, 2018, 2:28am UTC](https://forum.fudiabetes.org/t/to-nibble-or-cram-how-do-you-get-the-most-out-of-your-glucose-tablets/4238/35 "2018-06-21T02:28:28Z")
> [@Nickyghaleb](#): > > Reset… like how fast would the whole thing reset? 🙂 So if the warm up period is when it happens, what would happen if you stopped then? Would coming back in an hour enable the whole thing to work the same way?? It depends on the intensity and length of the work and the conditioning of the person. For someone who is highly-conditioned, the "reset’ would happen faster. Just like how the heart rate of a well-conditioned athlete returns to normal quicker than someone who is not as well-conditioned, a person in very good shape would return to that rest level faster. And the longer the work, generally the longer it takes to return to a rest level. Like you can recover from running up one flight of stairs faster than you recover from running up 5 flights. ---
**Author:** ![Nickyghaleb](https://avatars.discourse-cdn.com/v4/letter/n/5f8ce5/32.png) [@Nickyghaleb](https://forum.fudiabetes.org/u/Nickyghaleb)\ **Post date:** [June 21, 2018, 2:33am UTC](https://forum.fudiabetes.org/t/to-nibble-or-cram-how-do-you-get-the-most-out-of-your-glucose-tablets/4238/36 "2018-06-21T02:33:45Z")
That makes sense. If I’m done with my pity party tomorrow, I might formulate… something. Maybe a plan. That doesn’t involve self-pity… or chips. ---
**Author:** ![Nickyghaleb](https://avatars.discourse-cdn.com/v4/letter/n/5f8ce5/32.png) [@Nickyghaleb](https://forum.fudiabetes.org/u/Nickyghaleb)\ **Post date:** [June 21, 2018, 2:34am UTC](https://forum.fudiabetes.org/t/to-nibble-or-cram-how-do-you-get-the-most-out-of-your-glucose-tablets/4238/37 "2018-06-21T02:34:52Z")
Thank you… for the thorough answer. I appreciate your answers. [Previous page](https://forum.fudiabetes.org/t/to-nibble-or-cram-how-do-you-get-the-most-out-of-your-glucose-tablets/4238.md?page=1)