Endo says that any A1C under 7 is ok

I have 34 basals, although a lot of them are back and forth between .775 and .8 U/hr, to “fake” a .7875 U/ hr. Although I suppose it’s pretty real?

Does your Doc see the data that your stacking? He doesn't freak out? Mine freaks out. Says she can't make head or tails of the data and throws it in the trash. 2 weeks of painstakingly collected data...in the trash! Maybe that's not a hard and fast rule about stacking the bolus. The more I talk to you all, the more confused I get.

34 basals? So, that means your changing basal rates more than once an hour? Am I following you? I've never heard of anything like that. Is that keeping you pretty well situated between 80 and 120?

Yup, the Medtronic will let you program it in seemingly as many 1/2 hour increments as you want. It seeemed tedious but really, I can scroll through them in a couple of minutes to fiddle around with it. I took out the .8s around dinnertime but left them in the AM and things have worked out well. It may be because of switching to the Bayer Meter, which seems to read a shade higher, but it dropped my A1C a couple of clicks. I'd been at 5.2-5.4 but it's been 5.1 or 5.0 for about a year since I made that switch. I guess the next thing might be to switch pumps or try the Dexcom or both but I'm sort of gun shy about making changes...

They download my meter and pump but the last appointment, they were backed up, seemed to be squeezing in a girl "I'm going to New York and am running out of supplies, I need some..." ahead of me or whatever and the guy breezed in to see me "well, looks like everything's great, any questions?" "nope" "ok" "what was my A1C?" [which I thought to be 5.0 as I'd peeked over the nurse's shoulder while she was d/l the pump...] and he goes "uhhhhh, 6.1, that's pretty good..." and I was like Whiskey Tango Foxtrot but the nurse caught it and goes "no, it was 5.0..." and the doc goes "oh, there you go", hence my desire to find a new doc who, for $300 or $400 will at least pay attention to what they are doing...

This conversation made me almost cry. Just the thought of 34 basal changes in one day... I can't even figure out ONE correct basal rate. LOL. I'm gonna, angrily, eat a whole bowl of shredded wheat and think about what you all wrote...

I'm trying to get my head around this: "If I see a 120, even with IOB, a lot of times I redline my basal to 200% to cover it."

If you're at 120, with insulin (but not carbs) on board, doesn't the IOB correct you back to your desired 100 (or lower?) pretty quickly?

Why would you ever correct by redlining basal? If you need a correction, you need it now, not seeping into your bloodstream over a long period of time. Instead of increasing basal rates, why not just do a bolus correction? This is all the more true if your goal is to minimize the time that you are high, which seems to be what's motivating you.

If you're vigorously correcting BG excursions as small as 120, how do you avoid going low?

It seems like you're actually trying to completely normalize your blood sugars. It's a laudable goal, and I imagine it has health benefits (even if counterintuitively the available empirics suggest it might not--I think there are fairly obvious explanations for why those empirics might be wrong). So I'd be curious to hear more about what you're doing here.

I don't *DO* anything, I have my pump programmed with the basal rates. I have a big bump in the AM for DP and then goes back and forth and back and forth. You just program it once and it does the work. I like to share it because I struggled for quite a while with the .775U vs. .8U and would have bumps at various times during the day, "why bump lunch, that should just be the carb/ insulin ratio?", etc. and then figured "hmm, if 8U is too much and .775U isn't enough, maybe I need to do both". I also like to share it because most people and, probably, their doctors, would be like "oh, 0025 U/ hour, who cares?" but it seemed to help smooth things out and seems to have perceptible difference,albeit a small one, in my A1C.

But I'm sort of into "diminishing returns" territory and it took me several years of swearing at my CGM to figure it out. You shouldn't be crying, you should be interested to perceive a shining spark you can touch to your own diabetes! Hee hee....

No, that's with carbs on board too. I don't hit 120 unless there's some carbs involved. Basal "corrections" seem to be sort of nice, you can just turn it up and it runs and when you reach the (Robert J. Macnamara...) "crossover point" when it starts to come down, I turn the temp basal off and everything is hunky dory.

I got a pump in 2008 and had 5.8 A1C for a couple of years and then got a CGM, mostly because I signed up for some 1/2 marathons and didn't want to die or anything, but it got my A1C into the low 5s, like 5.2-4. Then I did the smoother basal and my A1C went down a couple more ticks. Maybe it won't work for everyone. Medtronic (or other pump manufacturers? I have only played
with them a very small amount...Tslim most recently...) probably won't tell you do do that and your doctor probably won't tell you to do that but it strikes me as sort of eerie that, even at a "diminishing returns" level of control (c.5.2-5.4...) I was able to "cook" a "slight return" by faking a basal rate. Maybe the notion should be to recalibrate insulin to make it easier to do that with?

Hi Spock - About four weeks ago I felt I was having too many readings above 200 and was working too hard to bring them down. I bumped up my basal by 15% during the day and 10% overnight and my readings got much flatter. I have had fewer bad lows as well as fewer readings above 200.

Perhaps you can split the difference. Bump your basal up .05 per hour (1.2 units more basal a day) and see if it helps.

You deserve the respect of your medical providers. You have managed your D for over 50 years with great success and it's not like you're unwilling to ask for help. You went to DOIT precisely because you felt you were in a bad place at the time.

I'm willing to correct between meals and I often correct in the middle of the night to help me start the day in a good place. Last night I woke up at 4:30AM at 225. I not only corrected but bumped my basal up by 50%.

Maurie

I see what you mean about turning up the basal rate until you're where you want to be and then turning it off again (of course mindful that our insulin takes about 1.5 hours to peak).

What's a smoother basal?

Relatedly, I love super boluses, though I'm still exploring when they're more and when less appropriate.

Your fake basal approach to getting more fine-grained basals than your pump offers makes a lot of sense to me. I have a t:slim, so I can get pretty fine-grained without that workaround. And frankly, at this point I'm not even using all the adjustability that my pump offers, I started on 0.4/hr (12/day), dropped to 0.375 (9/day), just because it was a round number, and the latter seems like a remarkably good fit. And my basal needs don't vary a ton during the day, so so far I'm just running a single rate.

I'm a pretty unusual diabetic, though, most likely MODY, so I make a consistent buffer of endogenous insulin that helps my control hugely (and acts very predictably). I have no illusions how lucky I am in that regard. My A1cs fluctuate between 5.6 and 6.2, mostly on the lower end of that. Especially with the lucky cards I've been dealt, I should probably make more an effort to do even better than that.

Thanks. I need the support mohe0001.

You just need to understand what your insulin is actually doing. Most carbs are out of your system in two hours, whereas our fast-acting insulin has a tail out to 4.5-6.5 hours. That means that if you dose your insulin to keep a post-prandial BG spike in check, you'll have some extra insulin at the tail end. And if you do multiple boluses, that extra insulin will start to stack. But as long as you're aware of what's in your system, and take action to compensate for it (by consuming a carb correction or reducing your basals to compensate), you should be fine. I actually think basal reductions are a no-brainer--if you've got extra insulin pushing your BGs down in hour two through five, you can just shut off, or reduce, your basal insulin during that time. Of course, at most you can reduce by the full basal rate, which isn't very high, but it's something.

AR and I are on the same page, but I am too old to maintain 34 basal rates per day, but I understand his purpose.

I adjust basals to my basic endocrine system--DP in the morning; raise the basal. Little low overnight; lower it. Drive time iffy; lower it.

A lot of it is understanding your diabetic body. I feel strongly about that. Weather changes destroy me. High altitudes mean high BGs.

I had a friend who always said, "It is what it is." Try to remember that all the time. I can only deal with the day to day, try my best. Nothing more or less.

I'm really happy my endo isn't that scared of my below 6 A1C's. I admit to being an obsessive-compulsive-diabetic (I'm getting my bloodwork done in two days, and I'm mad that I'm going to be at 5.9% again -If I waited a month to see my endo, I could easily go down to below 5.7%.), but I'm thinking that they're happy I'm taking the initiative to prevent complications. I don't know what they would much rather deal with: me being obsessive with my control, or my noncompliant T2 father who only begins to test a few days before the appointment.

I know my NP also tries to aim for a 50-50 split between bolus and basal, but she should know that my basal will most likely be in the 60-70% range. I limit my carbs to about 150g per day, and, if my NP really wanted that 50-50 split, I would need to consume 234g of carbs per day.

Thinking about it now, I'm looking forward to my NP having a heart attack when she sees all the wave boluses I've been doing lately and my reason for them. I've begun taking insulin for some of my protein to account for it converting to pyruvate and then to glucose, and, since I've done so (about two weeks into it), I've reduced my eag from 123 to 105.

That must be tricky, because protein only converts to carb when the body has limited other carbs on which to draw, right? So it's not like you can just dial in an I:P ratio, it depends on what the protein is eaten with.

Have you run the Medtronic marathon? There's one in the twin cities.

Yeah, that was my initial response, to 0025u. Just out of curiosity, how much do you 'bump up' for the DP? I've been considering pumping again, specifically to target down the DP, but not quite sure if I could figure it out. I'm really interested in the multiple basal-thing, but I'm still not confident that I have enough stable behavior, day-to-day, to make it worth it. You guys are helpful in exploring the issue. Here's to the lab rats that have gone before!

Cool. I think Dexcom has a new model coming out soon...maybe wait for that. The Dexcom sensor is totally worth every penny. But, it kinda sucks to have two different devices.

Dont let that Doc boss you around. They work for you!