Fine-tuning, or maybe completely revamping, settings

Could you post a pic of what you're talking about here? I don't seem to see anything like that in the patterns/trends data.


is what I look at (Medtronic) this is a couple years old, I couldn't find newer ones and looks a bit crazy, tons of lows, but the SD is only 19 w/ average of 84 so, to me, I was probably doing pretty well but probably turned things down a bit. Still, the report shows how you can see that maybe evening---> sleeping would be good to smooth out. A lot of times, when I do that, the next few time chunks fall into place too?

Thanks Acidrock! those do look really, really good, except for the lows of course, lol.. do you have less lows now? Here is the more recent pic, I uploaded one so far at my page. Sleeping/evening? I'm not sure where that is there, I often get quite confused by too much info in one graph/page when it's not clearly explained, to me anyway, what is what.

... ok, now I see that area that says sleeping... yes you were going low then, which happens to me a lot too, unless I go up instead which is happening a lot lately. I noticed from the daily graphs at diasend that the days I teach are the worst it seems, lots of fluctuations... looks like I will have to quit my job, lol.

This is an example of my past week, and the type of thing that is driving me crazy. I do NOT understand why somet days I am fighting lows all day, some days I am perfect (for me), and some days I am having huge spikes after meals that, the very previous day, I had no major spike for. This morning I ate breakfast and then I crasehd to 2.5/45, treated with about 30 grams of carbs, crashed back down to 2.9/50 an hour later, ate another 30 grams of crabs, and then spiked after lunch - maybe from eating so many carbs to treat the lows, although they were all fast-acting carbs, and the spike did not begin until after I ate lunch. I also don't understand why, when I go low overnight, I've only been eating one glucose tablet, and sometimes that works perfectly while other times I end up going high. I am not after ultra-tight control, I would just like to get rid of these extreme highs and lows and feeling like I have no idea what my blood sugar might do next.

My meals are usually identical from one day to the next - because I have so many food allergies, I always eat my own food even when the office is having a potluck or something. My meals are usually at the same time each day. My exercise varies a bit only because I commute on public tranist and by walking, and it's not always possible to know ahead of time how much commuting/walking I'll be doing that day (especially if I'm running an errend via a bus route I've never taken before). My work hours and bedtime and waketime are identical each day, even on weekends. So overall my schedule is as consistent as I can get it.

Also, the little green blips are only showing carbs I ate without taking a bolus (i.e., mostly glucose tablets or other fast-acting carbs). Also, I will be bolusing less at breakfast because that seems too high, but last week I was spiking high after breakfast, so I have no idea how long it will work before it changes, or whether I'll end up spiking high tomorrow...


Those are excellent results because they are very consistent, even though the lines are going up and down a bit.

To take a stab at it, if your lows are after meals e.g. "ate breakfast and crashed" followed by post-crash highs, I'd say there's two things I'd try. Depending on how busy I was, maybe simultaneously. I agree with you that I'd 1)try turning my bolus ratio up (carbs/ insulin...) from like 7.3 to 7.4, so there'd be a shade less insulin going in on the front end and see if that cuts down on post meal crashing. As an added safety margin, I would probably do less carbs, like 1/2 sandwich (15G/ slice of bread)instead of a whole one (although I guess bread is out, but 1/2 of whatever, maybe add in some extra protein to help avoid getting hungry, keep energy going, etc.). This could help take some of the steepness of the crashing out.

I would also look at the low treatment plan. 60G of carbs is a ton and, as you say "maybe from eating so many carbs to treat the lows" is followed by a spike. I think you're correct. I use more like 5-10G of carbs and wait 20 minutes as a lot of times, I'll get some rise at 15 and, even if it's not normal, I've interpreted that as that it's still going up and it will read still higher 10-15 minutes later. If it spikes, it might only spike to like 110-120, which is higher than I'd like to be but not as much of a hassle to get rid of as a 15/ 270. It can be *very* hard to wait, as I get those hypo munchies but I usually use the kitchen timer if I'm at home. An iphone timer would probably work at work. Obviously, you should be ***extremely*** careful doing anything like this but I think you might find the results surprising. A lot of times, small changes will make enough of a difference to avoid the lows that cause the spikes and things can fall into place, just in time for Spring!!

I would agree with AR. There are some reasonably clear patterns there. My day-to-day traces aren't actually any more consistent than yours. One of the lessons from 24/7 CGM is however good you THINK you control is, compared to someone with a working set of beta cells, it's completely pants. Even seasoned health professionals can fall into this trap. I sometimes get flak from my clinic where my DSN has claimed that with a pump, your BG should never be outside the range of 4 to 8. I suspect that was because she hardly ever sees anyone using CGM 24/7 and most of her pumpers only show her pre-meal fingerstick readings.

1. There's a clear drop from around 0800 to around 12.00 - you can see the drop even on Tues and Wed when you didn't have any hypos. It could be from your breakfast bolus. I always find breakfast is "difficult" and it's my lowest carb meal. Are you pre-bolussing? For breakfast I typically bolus as soon as I get out of bed and do a fingerstick. It can be another 20+ minutes before I eat. That seems to cut down the spike. It might be worthwhile skipping breakfast and looking at your SG traces in the morning. (Be aware that for me at least due to DP skipping breakfast does bad things to my insulin sensitivity - you may be the same. If so, eating a small low carb breakfast might be more informative)

2. There's a consistent rise overnight between midnight to 04.00 every day except Tuesday (which seems like a great day actually). You might want to up your basal from around 11.00 to 02.00 (you seem to be levelling off around 04.00).

Good luck -
Joel

Well, 60g of carbs was only for that one, huge crashing low, and also I ate quite a few carbs for the series of lows on that first day. Yesterday when I was low I was at a big meeting where a ton of people were trying to talk to me and I was feeling lightheaded (I think from dropping so rapidly rather than the low itself) and had 4u of insulin on board (about half my breakfast bolus left). Usually I am only using one glucose tablet to treat lows if I have little to no IOB and it's not a complete crashing low. I'll use 8g if it's crashing or I have IOB or am walking or something and think that 4g won't be enough. Any more than that and I seem to go too high. But even with a low like yesterdays, I treat with 15g and wait 15-20 minutes, then treat again, then wait, then treat...so I didn't take 60g in one go, it was spread out over perhaps an hour. The 60g was definitely an exception in trating lows (hence why I commented on it), and not the norm at all. I'm not totally convinced the spike is related to the 60g, though - it was 60g of glucose tablets and juice, and I don't understand how that would cause a spike happening 3-4 hours later, particularly when lunch (which caused a spike the previous day) happened an hour before the spike started.

I usually eat 20-25g of carbs for breakfast, so not too far off 15g. I aim for 30-35g for other meals. I know this isn't low carb, but it seems to be what I am comfortable with. I do weigh/measure all of my food so I'm almost never guestimating on the carb count.

So in terms of basal rate, I look at the above four days and see that on three of the four days my overnight blood sugar goes up about 5 mmol/L from midnight until 6:00 AM (when I wake up). So, based on patterns, I would want to raise my overnight basal rate. However, there is one night in there that I stayed almost perfectly flat. And, for the sake of experimentation I also did not correct my blood sugar last night because I wanted to see what would happen, and even though I was high I stayed almost perfectly flat overnight. So...would I raise the basal rates or not??? If I raise them, then the three nights I might not go up, but the two other nights I might end up going low... Also, after I woke up today I suddenly dropped 2 mmol/L without doing anything. That's the sort of drop that, if I were at 5 mmol/L, would send me low. Yet, the previous four days I did not drop after I woke up (other than days I did a correction).


Also, it seems like my breakfast carb ratio is suddenly too high while my lunch and dinner carb ratios are suddenly two low, based on the past three days, so I will probably change those for now. But, again, I don't know when I will suddenly have to change them again. Do most people find they are having to change not only basals but also ratios every few days? Maybe some of it is that I'm currently in the middle of my hormonal cycle, but in a sense I am *always* at some point in that cycle, and I feel like it's part of the reason things just "change" for no reason.

That's a nice flat line!! I think that it's a good idea to change one meal at a time as I always get these "ripple effects" where fixing breakfast will cause changes all morning and sometimes even into or past lunch? When one meal is fixed (ha ha about fixing breakfast...), then I move onto the next one...

I agree- you are going up at 2-4am and down at 8-10am. I have some similar patterns too but they also vary like you so so far I'm just doing temp rates and corrections although I'm going to do a .1 increase at night as per cde advice to the basal.

Last night I was high all night, I couldn't get myself down with multiple corrections and temp rates, then I went to sleep with one and woke up high, did another correction and temp rate, big one, and went back to sleep and I finally dropped to normal range.

I do similar low corrections as you do Jen, 1/2- 1 tab for a mild low, 1-2 for worse and more for fast dropping, usually with liquid for bad ones. I had one last night that was bad but I treated it with only 8g and it stabilized which is unusual for me, Then I went to 120 and then 130, I didn't want to correct it so I ate with a higher bg and later spiked after eating after dropping a bit at first, so I wonder if the earlier low played any role in keeping me high most of the night. I know this was a bad low from my symptoms and how I felt, lots of neurological stuff, sound/ringing ears and the feeling I had etc.

(bg was only 70 though when it came on)

Here are my results from using a higher breakfast ratio (1:7 instead of 1:6) and lower lunch and dinner ratio (1:7 as well, instead of 1:8). I went high after lunch and ended up doing a correction at around 11:00. Lunch (which was a bit later than usual, around 1:00) seemed fine but ended up having a low around 5:00 (did not exercise). Dinner I went high, but maybe that's a low rebound. All last night I kept going low and ended up eating about 20g in the form of glucose tablets every 30 minutes or every time the low alert went off. Haven't changed anything about my basal rates yet.


Does your pump have .1 G/U settings? I have found that those adjustments are easier to manage? I think the Medtronic might have a switch, the first time my pump blew up and I got a new one, it took me a while to track it down to get it set again.

My pump allows you to bolus in 0.01 unit increments when manually entering a unit bolus or adjusting units recommended by the pump. But when using the ezCarb feature, it only has steps of 1:8, 1:7, 1:6 and so on. The Cozmo used to have steps of 1:7.5 when below 1:10. I've never heard of a pump that has any smaller steps than that...

Should say I went high after breakfast, not after lunch.

The Animas Ping insulin to carb, I:C, ratio only adjusts carbs in whole unit numbers. For most meals I calculate carbs in tenth of a carb units and then round up or down.

My breakfast insulin to carb ratio is 1:4; tenths of carbs are a significant portion of the total. I calculate most home meals using a spreadsheet and then force the pump to over or under deliver the exact amount of insulin I want. In other words I over-ride the bolus carb calculator, one of the key features I bought the pump for.

All pump companies should allow this! At least as a user-selected option. If I can reduce my total daily insulin by a few tenths of a unit each day, then that's certainly worth it. I'm impressed that Medtronic does this.

I'm confused, by "units" are we talking about carbs or units of insulin? I also use the Ping and it allows me to override the bolus in 0.05 unit increments (though I thought it could do down to 0.01, I can't find where to chagne that setting for anything other than the Audio Bolus). When I calculate carbs I usually end up with a 0.X number and round up or down depending on if it's above or below 0.5.

I do wish the Ping allowed me to do a 1:7.5 ratio. Based on my experience so far, it seems like 1:7 is too much but 1:8 is too little. I still have my Cozmo and some cartridges as a backup, but I can't see the screen on that pump at all.

I was talking about units of carbs in the insulin to carb ratio setting.

The workaround, as I mentioned, is to do the "rough" dose calculation using the carb bolus wizard and then to adjust the actual insulin delivered to the exact amount you want. So if 1:7 directs you to dose 4 units and 1:8 figures 3 units, then you can choose to deliver 3.5 units and over-ride the wizard.

But to do this, wouldn't you have to do the math yourself, anyway? Why use the carb bolus suggestion at all? If you eat 15 grams of carbs, then the pump would suggest either 2.15 or 2.85 units. I, at least, wouldn't be able to tell that I had to add 0.35 units to get the half-way point by only seeing one of those numbers... Math is definitely not a strength for me! I thought you were talking about bolusing for, say, 10.5 grams of carbs instead of rounding up to 11 grams, which would require even more calculating.

Yes. You’d have to do the math yourself or do two consectutive pump carb calculations and split the difference. I agree that this is a nuisance! Animas should change the design to relieve the burden on all of us, not just those who enjoy high insulin to carb ratios like 1:10 or greater.

The main reason I use the carb bolus is to be able to keep track of all meal carbs so that Diasend can track.

Oh, yeah, I forgot about that. Though you could also enter them in Dexcom and they get tracked (but I also would think it would be helpful to have ezCarb vs. ezBG boluses in Diasend to see how often you are correcting...).

hi jen, i've been reading your post. i have the same issue(s), can't find patterns, but often I do. sometimes just a few jelly beans can spike me high after a low. sometimes I can eat a lot of glucose from a low and it works great or it's not enough. this is type 1 diabetes, it's just simply so hard to figure out so we do the best we can. Some days I have DP so bad, just rise and rise. other times not so much, but I too prebolus big time in the morning and typically only eat an egg or two. It seems just waking up can spike me. Some days, no. So, this too is why I'm so ambivalent about a pump. you're just changing stuff all the time, no? It sounds so confusing to me..ugh!