-----Flatliners Club-----


#1

Taken from the main page of the group...

A club to share your successful and not so successful trends graphs (all graphs time wise are welcome, 1hr to 24hr) from your CGM or Glucose Meters....

"Post your trends, don't be bashful. There's not many things better in a diabetics life than discussing glucose trends (good or bad) with other diabetics. Remember, the bottom line is, this group is for support, not in anyway a competition."

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Flatlining
#2

Good !!!!


#3

No way man, that's totally impossible...



#5

Not everyone can achieve this though, some of us fluctuate a lot. I also wonder since normal bg fluctuating in people without D is not a flatline why do we need to do that? Clearly most people do fluctuate between prolly in the 60-120 range throughout the day and higher for some after a lot of carbs coming back to a normal at 80-90 2 hours after eating. So I have to ask why would we want to flatline? I found it very stressful to try to always stay at 80-90. On mdi it is not possible for me and I don't want to be on a pump for many reasons. I do have periods of "flatlining" though.


#6

I'd also like to mention that even though I don't use a CGM I was welcomed warmly even with my 6-8 times a day tests. The point is to demonstrate achievements (or failures) in attaining tight control of variations. Thanks to Danny for starting this and reinvigorating the efforts.


#7

I've seen the term "no-hitter", as in you don't hit your "lines" or targets. That can be much more realistic and there are plenty of those in the annals of the FLC. The amount of data we have can be oppressive and I've always felt that this was a good way to turn that feeling around for about as much fun as you can have with diabetes!


#9

My biggest problem is that, even though I "low carb" (relative to the rest of the non-D population, <100g/day), I'm not willing to eat the way *I* have to to get there.

For me, it impacts quality of life too much.


#10

Well, I've had a few of those days (I'm being a bit more loose with the idea and allowing for minor dipping below the 70 line).

That's a far more achievable goal for me, and in fact basically my normal operating procedure. My G4's set at 70/140.

Maybe we need a "no hitters" group? Or change the name to "Flatliners and No Hitters"?


#11

How about the "No hitting Flatliners Club"??!?!??! Haha. Too late to change the club name, I deleted my "Danny" account years ago.


#12

I have pretty strong feelings on this topic, and have to admit that despite the "smiles" I kind of winced at the "walk around like zombies with 250 mg blood sugars and moan oh poor me all day". While there are certainly people who fit that profile, there are also many many people on here who work very hard on their management and still don't get anything like the stability you're talking about. There is currently a post from someone in that category in another thread. I think there are two things at play: As Dave mentions here, we all make choices in our D management that impact our quality of life and with those choices come trade-offs we willingly make.I'll give my own example: I generally eat around 60 carbs a day, sometimes I get down to the 30s, sometimes up near 100. I know my numbers would be better if I kept it lower. But I am a vegetarian and a foodie and those things are important to me. People's choices relate to all the known variables like using pumps and cgms,(financial considerations) exercise, diet and carb intake, etc. But I have long believed there is something else which I call "the luck of the draw" that makes it harder for some people and near impossible for others to have anything like non-D stability. Perhaps it's related to some as yet unknown variables like metabolism, or perhaps it's truly random. We all seem to come in somewhere on the continuum from those who fairly easily achieve incredible stability (I too think of "flatlining" as dying). Then there are those who work their butts off and still have unpredictable variations (what we used to call brittle). Most of us (like me) are somewhere in between.

I admire those of you with such stability and what you do to get there. But I want to speak for the many of us who either unable to do this, or choose not to do so. To hear that anyone can do it and have it implied we are zombies and slackers, can make people feel that, despite doing the hard work of managing Type 1 24/7, they are failures. This can be very disheartening, painful and discouraging.


#13

A few years back I stumbled on the flatliner group. I lurked with equal parts fascination and disbelief. I could not believe that PWD can actually "flatline." A literal flatline is probably not found in the non-diabetic population but the "normal" line probably gently fluctuates in a relatively tight range.

I read on one peer-reviewed scientific study that the standard deviation (a measure of BG variability) of a gluco-normal person was 15. That number says that about 2/3 of the BGs stay within +/- 15 of the average.

Once I realized that actual PWD could exert that level of control over their BGs, a level I previously did not think possible, my immediate next questions to myself were, "How do they do that?" and "How can I do that?" Knowing something is possible spurs my motivation to figure out how to make it happen! Low carb and TAGging made it happen for me.

I'm active in this group and like the environment. Praise and encouragement are freely given as we all know that we're in this boat together. We all realize that BG control in diabetes is hard! That's what makes the victories sweeter.

This group is not for everyone but it has made the biggest contribution to my day to day quality of life since I started using the CGM 5 years ago. Maybe you should stop in and take a look.


#15

Dave, Have you ever tried or considered insulin dosing for protein and fat as well as carbs? That,in addition to low carbs (for me, 50-75 grams/day) took a lot, but not all, BG variability out of my day.


#16

Terry, thank you.


#17

Hi Terry!

I already TAG protein. Don't seem to need to for fat. Unfortunately the type of bolus I really need isn't supported by the pod -- basically, a 3-part bolus: Spike, flat extended, spike. I can only do spike followed by flat. So I spike the carbs, and square bolus the protein over 3 hours.

That produces the best possible results I can get, short of having to bookmark in my head to do another bolus about 2.5-3.5 hours later to catch the protein spike. I just don't have the patience to add one more thing to remember and act on for this disease.

All that said, I speculate that insulin resistance makes TAG'ing harder to maybe even impossible with the current pharmacodynamics of fast-acting insulins. I find that carbs act very fast -- true to the literature, they seem to be fully digested and peaking within about an hour. The proportional insulin taken to cover the sugar takes pretty much the full 3.5 hours of action to get it back down.

In other words, there just doesn't seem to be any way to directly counter carbs mg/dl for mg/dl because of the timing issue. All I have been able to do to really "handle" carbs well is play the pre-bolus timing game, drive my BG down to 70-80 before I start eating, then eat. I still get a significant rise, but it's relative... a 50pt rise starting at 80 is 130, rather than 160 having started at 110.

I eat a burger for lunch with 40g carb (and nothing else) and no matter how I manage insulin dosing I'm going to see 50-60 mg/dl rise. The only way I can avoid this is to eat NO CARBS.

As Dana Carvey as George Bush I would say, "Naht gunna dew it"!


#18

"It wouldn't be prudent!"

Have you tried eating 20 grams of carbs? If you've done that, is the rise proportional or the same? In other words, does a 20 gram CHO meal rise 25-30 points, or double the 40 gram CHO meal?

Have you ever experimented with using old fashioned Regular to inject for meals? I haven't used it in years but it's action profile is longer and peak delayed when compared to the rapid acting analogs. Just a thought.

One thing I've done a few times when my BG was rising a few hours after my meal and I was only about half way through my extended protein/fat bolus. I cancelled the bolus and delivered the missed amount all at once, similar to your spike, flat, spike needed profile.


#19

I'll give that a shot. Just so happens I'm having a 24g carb lunch today, which is right on the target you suggested trying an experiment with.

If the extended bolus doesn't go as well as I'd like (which is likely), I'll give the cancel/one shot approach a try when the BG starts to definitely rise.

Another thing I may try this weekend is just doing a deliberate double-shot... one for the carbs, and another for the protein 2-3 hours later. My family gave me this cool smartwatch thingy that I can just say, "set timer, 2 hours" and voila! Timer set and running. That will help with making that second bolus happen.

As far as the TAG insulin quantities, I seem to have that pretty dialed in. The standard bolus for 50% protein weight as equivalent carbs reliably lands me right back where I started before eating... It just takes 3-4 hours to finally settle, and I have a significant spike (more like a hump) in my BG profile in between.


#20

Great points, Zoe, and very well made . I agree 100%.


#21

I agree you're correct Zoe, I also think that people get used to BG@ 250 that may not be healthy and may very well feel fine. I don't but that's likely because I hang out where I'm used to. I have wondered about the luck of the draw issue but how many people are there who are able to "go for it" with all the tools and equipment that I have? I am very fortunate to have access to a pump and insulin and test strips but, without those, it would be more challenging. Or at least I'd be less active. I run up and down too though, so I wouldn't refer to my lines as "a trend" as much as "cherry-picked"!

The one on my Tu page is a hot mess but is special to me since it's from the 2012 Chicago Marathon and features some pretty elevated numbers. And then big plateau from eating Popeye's Fried Chicken later...heh heh heh...



#22



#23

Nice job Clare! Right on the money!

One other thing about working to achieve more normalized BG is that I find I can be really flexible and pretty much eat, drink and all of that whenever I want to!