Do you think diabetics get altitude sickness easier? I've always wanted to ski Taos, NM, but I have always failed. Never considered that it could be, in part, a consequence of diabetes. I'm sure its the smoking, more than anything, but I will be watching my numbers more closely, next time, after hearing you say that.
10.5 to 8.0 is like a 25% change in basal. A 25% change is a pretty big change. I think if anything you just needed a fine tuning... somewhere between 5% and 10%.
I will make changes bigger than 10% when some base rule has shifted (e.g. I'm sick with an infection or something) but otherwise more than 10% is a pretty big deal, not a fine tuning.
50/50 is a nice starting point but should not be used to disrupt an already working regime!
If your basal is too low, then the corrections are not boluses, they are making up for the too low basal!!!
By smoother, I mean that over a longer period of time, my BG doesn't go up or down, but stays flat, with no other inputs. Most of the time, I have tons of inputs, I like snacks and things like that so there's always something going on but I don't worry about stacking because if I have IOB, it's because I have FOB (food on board...) that the insulin is "chasing" so, if I have more food, I will have a bit more of both. When I started the back and forth basals, I'd see the CGM trend down during the .8U sections and up during the .775U sections, like waves. I wish I was more organized about documenting things, taking notes, etc. but I've always blown that off.
Amazing that your body is predictable enough, and your CGM is accurate enough, to watch drops during 0.8 sections and rises during 0.775 sections! Then again, I suppose those differences aren't so subtle, in the same order of magnitude, 0.4 was significantly too much for me and 0.375 seems to be a sweet spot for now.
Re IOB vs. FOB, isn't the main issue that FOB lasts about two hours and IOB lasts 4.5-6.5 hours? I've always thought of that as the primary stacking concern.
I'm trying to learn what I can from your super-intense management approach, because you've clearly put a lot of thought, based on a lot of experience, into this.
Yea, high altitude has a negative effect on BG readings. My son lives near Estes Park and whenever I visit my grands my BG skyrockets. Going to Cheyenne in the summer, which has a higher elevation....
As I freak with high BGs, I just try to cope.
I go from .375 to .675..and maintain the higher level til mid afternoon.
.025, that extra order of magnitude makes it sound crazier than it is.
spock, mine said that too, not to correct between meals or before bed. who the heck wants to spend the night with high BG's (which I can't sleep if I'm high). Do they not understand that unless we correct there's nothing that will do it, our bodies won't bring it down (nor will it raise low blood sugars) unless we manually do it...hello, it's called type 1 diabetes. my endo also said, as we're adjusting my basal (again) not to correct anything unless over 300. what do these doctors think this feels like. we were trying again to go from 2 doses levemir to one AM dose of levemir, I woke up at 2am and my CGM arrows were pointing straight up going up past 278, i'm like...ah, OK...am I going DKA clearly I don't have near enough basal on board. I would never intentionally let my blood sugars go up to 300. I also don't have a 50/50 split. However, an A1C of 5.1 is too low, IMO, and something I would never attempt and I think any endo i've seen since diagnosis would probably fire me as well. don't you have hypo unawareness, too? Aim for 6%?
OMG, mine has done the same thing too, whom I fired, brought in tons of data for him, that's all we have and one of the reasons why we wear the CGM for the data and trends, and he just got all flustered when I too was desperate for help, just started throwing F Bombs at me, saying he couldn't sort through all this stuff. HUH?
me too, again. i'm not sure I can find a significant pattern to restart pump, it's so frustrating and I never ever wake up to a good number, ever now. i read some of the stuff AR does and I think, I don't even know what half that stuff means now would I ever want to try 34 basal rates. ugh. all this just confuses me more.
It’s just going back and forth between two basal rates, 1/2 hour of each! A bump up to like 1.1u/ he in the wee hours of the AM to cover DP and a flat bit around dinnertime. Piece of cake!
I agree, what is the obsession with the 50/50 split? I follow a lower-carb diet so my boluses are not very big, so I'm usually 60-70% basal, which seems to concern them. My endo recently had me bump down my basal 0.1 throughout the day, which as you say turned out to be too much. But I was going low quite often, so I am splitting the difference and bumping it back up 0.05/hour. I'm planning to do a basal check this week to see how it's going. Correction boluses are just that, for correction. Different from a meal bolus, but ultimately you want to make sure your correction factor (i.e. "sensitivity") is set correctly. Mine was set too low for a long time, but my new endo helped me find the right factor. My concern is with your last statement...why would she "dump you" as a patient? If she's actively working with you, that tells me she wants to help, so I would think the last thing she'd want to do is mess with your pump/CGM usage. You are obviously taking responsibility and trying to fine-tune your settings, which we all need to do from time to time.
Wow, you all make me thankful about my DP. It doesn't start until I wake up. I don't how you would deal with DP that started while you were sleeping. Why, on earth, does it start then? I always thought the DP was the result of waking up - producing a bunch of adrenaline or changes in metabolism that occur from waking.
LOL. No good in Cheyenne, but maybe in Estes Park....http://www.mayoclinic.org/drugs-supplements/marijuana/interactions/...I've heard some speculation, from the mountain towns, that this may lower bg.
I think you mean to say you have 34 segments in your basal program? Or do you actually have 34 different basal programs you switch around between?
I've got a half dozen or so different basal programs (each is a 24h profile with different segments at different levels at different times). My main program that I am on most of the time. I have a three different "sick" basal programs, and two "party" programs.
Once again I'll plug for Holger's Glucosurfer app... handles everything a pump does in terms of calculating doses and doing IOB accounting (including different ICs and ISF values at different times of the day).
Indispensable for anyone doing MDI. Can be used with a pump too, when combining the pump and MDI (for example, when giving an IM correction bolus to speed up the action).
See, this is one of the things that drives me absolutely nuts about the profession: the one-size-fits-all mentality. Each case of diabetes is different. We know this. Why don't they?
My A1c is in the mid fives and has been for quite some time. I have very few worrisome lows. Very few. I'll trade those for living in the 150-160 range without hesitation. As someone said earlier -- I think it was Brian -- time in range is coming to be seen more and more as a key indicator. "In range" is not a synonym for "not too low" -- it also means "not too high". "In range" means . . . . IN RANGE. It doesn't mean anything else.
And I don't even have a pump.
IMHOP your endo is possessed of an incomplete education, an attitude problem, laziness, lawsuit paranoia, or some combination of the above.
Agreed, I've been struck by how poorly informed not only many GPs, but also some endos, are. They latch onto rules of thumb like "50/50" and "below 7 A1cs," but they don't seem to be able to put those heuristics in context.
Amen
I'm not sure what to make of the medical professionals who pursue a career to "help diabetics." I started out by elevating them onto a pedestal not fit for any helper.
Then I had that Toto-pulling-the-curtain-back-Wizard-of-Oz moment when I realized that they certainly did not know as much as me about controlling BGs and sometimes their advice was downright harmful. I was angry with them.
I let go of the anger since I know it's corrosive and I now just think that I must take full responsibility for my medical path. Doctors can/may help but I now look at them and their capacities with a pragmatic realism.
Separately, last year I adopted time in range or TIR as my ultimate measure of blood glucose control. I see it as the king of all BG metrics. It outclasses A1c and average BG due to distortions hidden in any average. It also subsumes the doctor favorite, minimizing time spent hypo. Finally when you spend over 80% TIR, it implies low variability. TIR is the perfect all-in-one BG measure!