So, i’m still trying to get my basal/ic/blah blah blah in order. i recently dialed everything up a few notches, and now i’m running on the lowish side… not too low, i probably hit 60 at min, but i’m not going over 120 (which is my upper limit) now… should i just leave everything like it is? I’m not going too low, and i’m not going over my upper limit, so i’m thinking just leave it like it is. I’m also able to drink a cup of milk without a bolus now… so i’m thinking i have it pretty much in my happy zone
you will run into short-term problems if you’re low, and long-term problems if you run very high.
in my opinion, you’re running a bit too low. For me, 1-2 lows per week is about the max i’m comfortable with. (I prefer to run high than to run low. That being said, i keep it all pretty controlled, have a 6.0 A1c.)
Now for a quick story:
I know someone, let’s call her a friend, who also has Type 1 diabetes. She is deathly afraid of having a high blood sugar (she always over-boluses at meals, freaks out if she has a blood sugar of 160 - acts the same way i would react if i had a BG of 300). She recently had a low BG-related seizure while standing at the top of a set of steps trying to get into her house, and broke her leg in the fall.
I’ve also heard stories of people who had toe/foot/leg amputations later in life as a complication of uncontrolled diabetes (read: high BGs).
You had a high A1c the last time and I understand and encourage your effords. But I think 120 mg/dl is a bit too low for the upper limit. I aim at 120 because I am very sensitive to insulin and my upper margin is 130 mg/dl for normal values. For post meal I accept a rise to 160-170 mg/dl at the one hour mark. For me this will lead to an A1c below 6.
In general I am a friend of a strict basal setting. This will create a controlled drag down that needs to be stabilized by some carbs. For me this works much better than too many corrections which have a tail and will influence the following values. A strict regime also means that physical activity always needs to be fueled by additional carbs. It is important to find the right balance here. 60 is not that low but it would be nicer to just reach 70 for example. This can reached by raising the upper limit a little bit. We should not get used to lows because this could really harm our interests:endagering us and others, withdrawal of drivers license and so forth. Congratulations on your success so far.
I’m T1 and following Bernstein (low carb, low insulin, exercise etc) so I sit between 4 (72) and 5.5 (100) almost all the time. I’d start to feel dodgy at 60, but everyone is different. Perhaps its ok for you, but I think you’re pushing it if you are getting that low.
If you are following a high carb/high insulin regime you are definitely taking risks because an accidental extra 1/2 unit will put you in serious trouble.
In his book, Bernstein outlines a test to see what your Basel should be. Basically take your morning basel, but dont eat (and dont bolus). Skip lunch and dinner too (and their boluses). If you go low, your basel is too high. If high, your basel is too low.
Actually both excessive high’s and low’s effects you long-term & short-term. Both can equally damage organs, and inhibit the body’s ability to heal itself… You must examine and weigh in both A1C and routine testing. It is not good to be at 60 mg/dl and your out and about. Your body is constantly using glucose & insulin; you can easily put yourself in a dangerous situation and not even realize it. you must give yourself a cushion for lows…
60 is too low and lows affect your brain cells.
I’d rather run “a little high” instead of chasing my tail treating lows, but it is what I’m comfortable with in my life.
I prefer to have my niece on the higher side from 3am to 7am (one of us will go to bed by 3am usually) and do not want lows when she is sleeping and we are not checking. Prefer to have her on the higher or in-range side when at school. If home and we are up, since we check frequently, prefer to have her basals normal to lowish. Easy to bring up a 60 or so with a few carbs; takes such a long time if high to come down. So it depends on where she is and what she is doing. For a non-D, 65 is an entirely normal blood sugar so I don’t think of a 60 as being a bad low, more of an acceptable low. Don’t like any numbers under 60. P.S. If talking postprandials, different story. Our recommendation, based on her DIA is 200 at the one hour mark, 160 at the two hour mark then normal by four hours. With Apidra this has been doable; with Novolog, not.
I don’t see 60 as terribly low & agree your basal setting needs a little adjusting. Not going over 120 is awesome. Drinking a glass of milk without a bolus–tad high basal.
Diabetics are forced to choose a side in this debate. I think it’s pretty much impossible to always run perfectly, so diabetics tend to prefer to be high or low when they make a mistake. The vast majority of diabetics choose to run high, though some prefer to run low. I prefer low. People who run high will have maybe 1 low a week but probably a couple of highs a day. People who run low will have maybe 1 high a week but probably a couple of lows a day. (Just in my observation.)
But, really, I think it’s a matter of what works for you. Both sides have their downsides, but it’s just part of being diabetic. Your sugars are not going to be perfect all the time. You can try your hardest to be perfect, but you’re not going to be.
Holger, you explain this so well!
That tail from too-frequent corrections of which you speak is difficult to calculate and certainly does affect the hours (and boluses and food choices) after.
It seems to me that when pumpers have lots of ping-ponging blood sugars, often too much correction and not enough basal-rate testing and refining is one prime culprit. Refined basal rates help eliminate variables and make it easier to figure out what may be causing lows or highs.
It’s very easy to overtreat lows, especially with the unfortunate and continuing myth that “lows must be treated with a snack.” Which can lead to highs. Which can lead to corrections and more lows and thus a vicious cycle. Lows most often should be treated with a measured amount of pure dextrose and rechecked–unless there’s insulin on board or physical activity is continuing or planned, when a snack may very well be called for. Easier said than done, of course–yes, I’ve raided the pantry, too, when my brain is screaming feed me, feed me during a low
Thanks for all the input guys!
I honestly kinda like running lowish instead of high… i’m very sensitive to highs, and i’ve i’m over about 180 i start feeling bad/getting a head ache… one hour post meal i’m usually in the 140-160 range, and then two hours post i’m usually in 120-140, then after three hours i’m between 100 and 130. My uppper limit set by my doc is 120, so i’ve found that to keep my BG below that all the time causes a few lows… during the night i try to aim for 140 (just while i’m asleep… basal rates drop to account for this too) so i’m not running low when i’m asleep. I usually wake up around 120 or so, and then my BG stays there throughout the day.
60 is just the worst case… usually the lowest i get between meals is 80 or so… i did go ahead and drop my evening basal rate though, cause i’m going through milk like a mad man (what i use to correct slight lows), so i’ll see how that goes tonight…
Honestly, i’d rather run slightly low than slightly high, and when i’m slightly low i can just suspend my pump for a bit and my BG come up without any side effect, and i test 10 times a day, so there’s not too much of a chance of surprises… i don’t like being quite so low as 60 though, so i will try and adjust my basal rates for that.
Thanks for all the help guys
80 between meals is perfect!
Easier for me to correct lows than highs.
Same here. I can correct a low with a glass of milk, or most of the time just suspending my pump for a bit… takes me hours to get over a high (like 220) for some reason though
Everything about diabetes is a pain in the butt & doesn’t follow any predictable course!
It depends on the diabetic. I start to feel light hypo symptoms when I am @ 60. Especially when I am outside walking, doing my thang…
I am very aware of hypos and quite insulin resistant so I can aim for lower BG than might be otherwise prudent.
I’m pretty aware of them too, and i’m on a 1:8 IC ratio, and a correction factor of 40 during the day. During the night it’s 1:10 and 50, so i’d say i’m somewhat insulin resistant…
1 to 2 carbs is insulin resistant.
Oh, wow… that’s pretty bad haha
My Dr. says that i’m slightly more resistant to Novolog than most people, and that my insulin action is about an hour short of most people’s… but he’s never said 'You’re insulin resistant"