I changed my Dexcom CGM sensor site yesterday and the post-change line shows some of turbulence I usually see in the first day of a new sensor. My after dinner dessert also made its presence known.
I ate my usual breakfast earlier then normal, at 9:37 a.m.. I inhaled 4 units of Afrezza at mealtime and one hour after eating. The extent of post meal lows were due to the new sensor.
I met a friend for dinner out at 6:00 p.m. and didn't keep good records. I do remember taking 4 units of Afrezza as I started eating a chicken and vegetables main course. I decided to treat myself to a piece of banana cream pie for dessert, something I've sworn off for many years. I dosed 8 units of Afrezza for the pie alone - 58 carbs!
I went for a brisk 40-minute walk after dinner to work off some of the extravagant calories consumed at dinner. While I enjoyed a break from my usual eating style, I can see that adding all those extra carbs start to degrade the stability of my usual blood glucose line. It's kind of nice knowing I can eat a decadent treat but likely will not choose that option often.
I am pleased to report this recent BG flatline. The green stripe ranges from 65-120 mg/dl. The syringe symbols depict 4 unit doses of Afrezza. I am amazed by the results I have been getting. It's like I've been given a glimpse of what it feels like to be non-diabetic.
How would you characterize the difference in your carb behavior? Overall average daily increase, what percent? Larger carb doses in individual meals/snacks?
Besides helping control, how has it changed the other side -- freedom, enjoying life?
Congrats Terry, that’s a great visual demonstration that it truly pays off to educate yourself and study your own blood glucose responses to this new form of insulin. Thanks for taking the time to share!
Dave, I haven't changed my carb intake much yet. My original intent was to add in some carbs like sweet potatoes, carrots, and legumes. I wanted to give enough time to this introduction phase so I could reliably dose Afrezza with optimal results. I'm not in a big hurry to add carbs but will do it.
I have eaten two pieces of pie in the last two weeks with very good BG results. While I enjoyed eating this long-forbidden treat, I wasn't that satisfied. I didn't feel physically stuffed but I had an over-satiated sensation. These slices of pie were about 600 calories, almost as big as a complete meal.
I don't miss or long for a return to my bread/rice/potatoes/noodles former way of eating. I have become used to my way of eating and I truly don't miss those carbs.
I am enjoying life. I love being able to correct a 120 BG and bring it down to 80 in about an hour. My CGM woke me up at 11:30 p.m. last night with a 124 blood glucose. I inhaled 4 units of Afrezza and my CGM showed a return to under 100 in 80 minutes and I flatlined around 80 unitl I got up this morning.
Maybe my sense of fun has been permanently altered but I do take pleasure in tightly controlling my BGs. I feel better, have more energy, and feel emotionally stable and happy.
Afrezza has simplified my meal dosing a lot and I am enjoying that, too. Habit has shouldered most of the burden of taking care of my diabetes so I, perhaps, don't feel some of the weight of the diabetes chores that others might.
I've been watching the Diabetes Online Summit for this last week. I am convinced that more than ever, a high carb high fat diet is one of the root causes of many of the chronic diseases that our modern society suffers, especially diabetes.
Can't speak for all Type 1s but the factor we were given by Gary Scheiner when she was 8 years old was that one gram of carbohydrate raises blood sugar five points. Ten grams would raise her 150 points and still does. I'm sure one gram will raise some people a 8 points some 3 or 4 points. But when eating free carbs for correcting low blood sugar we need to know the amount so we don't overcorrect. These results with Afrezza truly amazing and in line with what others are commenting on social media... that, alhough it makes no sense to the way we have been dosing with insulin, Afrezza is different. And that a 4 unit cartridge is basically what you would use when you would have used one unit via injection, either to bring down a high blood sugar or for food. Where you would use one unit, instead you would use a four unit cartridge. So dosing for 10 grams or dosing for 32 grams, we would use one four unit cartridge. Still watching for 100 pound woman to begin posting; these are all men. And if our DD did end up using Afrezza eventually, I would caution her to use standard dosing for quite some time. So if she needed two units for correction, either correct then eat 15 grams of carbs in a half hour to account for the other two units in the cartridge or correct via injection. I still have a hard time wrapping my head around that one and it will take a lot more documentation before I would risk using a four unit cartridge in the place of a one unit dose.
Jan - You may be interested to read today's Diabetes Mine Amy Tenderich's account of starting Afrezza a few weeks ago. I don't know her weight but she's a slender type I, I'm guessing around 120 pounds. (I hate to ever guess or even talk about a woman's weight!)
Afrezza does take some trial and error testing but I don't think it's nearly as dangerous as the current rapid acting analog insulins that we now use. The absence of a sustained tail is the most prominent feature. It gets in and gets out of town quickly! After 60 or 90 minutes you're out of the hypo danger zone. Amazing.
Looks great terry. I’ve had a couple numbers higher than I like, but like others it’s been largely from my trying to precisely carb match doses (hard lesson to unlearn) effectively not taking enough afrezza. No pump vacation in future plans for you?
Sam - I've been on insulin pumps continuously for the last 28 years. I'm like the hardened longtime convict that doesn't jump at the chance of getting out of prison!
The biggest dissuasion about swapping my pump for Lantus or Levemir is that I don't think I could duplicate the basal control I get with the pump. I have a prominent dawn phenomena profile.
I'm now making many effective micro-corrections to guide my blood sugar. AR likes to call these corrections, "nudges." Temp basal rates, like cutting off basal for 30 minutes to avert a slightly trending low, can only be done with a pump.
You're right, though. I should seriously consider trying MDI again and see what I learn. I may find a very workable regimen. I'd have to address, however, some kind of tech to help me remember if I took my insulin dose or not. Oh, the pleasures of aging!
When you said "(I discard 3/4 of the bread)" you also said the meal consists of
"This meal contains 12 grams of carbs"....so that is referring to the amount of carb left after the other 3/4 or 36 g of carbs was discarded?
Another interesting experiment would be to see the results with eating the whole meal including the full carbs=not throwing anything out. Not saying do it all the time, but as a contrasting single experiment so people can see how the carbs are affected.
I avoid carbs so please excuse my ignorance about totals. If you had the total sandwich it would have been 48 carbs?
If memory serves me, the entire sandwich is listed as having 42 grams of carbs. So 10.5 grams of carbs would be exact. Since portions at restarants are not exact and somtimes the 1/4 I eat is from the thicker of the two slices, I’ve been using 12 grams fir my arithmetic.
I could do the full sandwich experiment. That would mean I would need to dose 8 units of Afrezza and add perhaps 1 unit of pump carb insulin. I’m not motivated to do that since I don’t wish to eat that many carbs.
I’m also concerned about keeping my total daily dose of insulin on the low side. Hyperinsulemia has been cited in the medical literature as a possible contributor of cardio-vascular disease.
Since adopting my low carb high fat way of eating, I have not only greatly increased my BG control but also more than cut in half my total daily dose of insulin.
I’ve been watching the Diabetes Online Summit videos for this past week. More than one of the interviews cautioned T1Ds to eliminate gluten in the diet due to allergic inflammation and possibly contributing to the diabetes autoimmunity via a leaky gut. I’m not sure I want to continue eating any gluten.
Thanks, I just read it and it was illuminating. Amy, also, wishes they had two unit cartridges for corrections. She does not use the 4 unit cartridge for corrections unless she's at home and has been 150 for more than two hours. And she has cgms, not sure if she always wears Dex though. The two males who reported had a correction factor of approximately 1 to 50 and the 4 unit dose brought them down 50 points. Afrezzuser took a four unit cartridge with a BS of 110 and he dropped to 46, leveling in the low 50s, I believe. He was dosing on a normal blood sugar but 4 unit cartridge dropped him 50 points still. Therefore, by that logic a four unit cartridge would drop DD 100 points. Still not comfortable with that and Amy isn't either. But great for meals and snacks. Really do hope they come out with a 2 unit cartridge. And you are right, Amy is tiny and I'm delighted to see she is using Afrezza and posting about it.
My experience correcting with Afrezza is that it produced wide-ranging results. I've had it drop me as little as 20 points and as much as 45-50. I've found that the bigger drops happen in the afternoon when my basal rate is at its minimum.
I corrected a 124 BG last night while I was sleeping. It dropped to 80 and flatlined for several hours until I woke up. I've always hesitated to correct night-time highs with rapid acting analog insulin due to obvious hypo risks while sleeping. The lack of a sustained tail is a big plus with Afrezza.
I am a woman (about 140 lbs). A 4U Afrezza drops me 100 points if I don't have any food on board. So I don't correct with it unless I'm at 180 or higher (unless I know I'm still digesting food.) I would LOVE to have 2U cartridges!
Yeah, I can see where a 2 unit cartridge would be a big help for you. One thing I would do with my pump (I see you don't use one.) in your case is to take the 4 unit Afrezza correction and then set a 1-2 hour temp basal to minus 100%, or off, to counteract the over-correction.
Yes IV insulin is administered by drip, but what you didn't mention is in conjunction with the IV insulin drip, is an IV dextrose drip. Which the nurses titrate simultaneously. But what they do is, if a patient gets 1 unit an hour and they require an insulin IV drip during surgery, they give the patient 2 units of insulin an hour via one IV drip. At the same time, they give the patient enough dextrose through the IV drip...I don't remember if it is two separate IVs or one. It's 50/50, fifty percent insulin, fifty percent dextrose. So there is always dextrose running at the same time as the insulin and they can adjust either the dextrose or insulin immediately. IV insulin is immediate. No room for error. With the dextrose drip up and running they can correct immedately as well.
