I would try a couple of Tic-Tac mints or one cough drop. Even 1/2 of a glucose tab might do it. Your experiment, your choice.
I don’t see any problem with long periods 65-70. If you’re going to drive or exercise or perhaps do something that might preclude closer than normal monitoring, then bumping it up gives you a larger buffer between you and a hypo.
I have used SmartieBeans (Smarties and Starburst Jelly beans…) for a while. I’m not partial to the green ones but MrsAcidRock and junior like them so I take them out and mix them up in a tub. for 65, I might have like 2-3, depending on what’s going on, and that will usually push me up to the 75-80 range for a little more space without getting carried away. A full bag is like 30-35g of carbs so a bag lasts a while and is very portable. 
I often use skittles, which for me are about as fast as glucose tablets (and I like them better than jelly beans). One skittle is approximately 1 gram of carbs, which in my case results in +5 points, fairly consistently. 1 gram resolution is also nice for fine tuning hypo corrections. I keep them in a plastic tube container leftover from glucose tablets, which fits about 30 skittles, i.e. about 30g - more than enough to carry around.
Curious, how often do you guys test basal rates and other pump settings? I posted before that I felt like my blood sugar was becoming more volatile, though I’d finally managed a six-hour flatline. I’m thinking I need to start from scratch and recallibrate my basal rates and ratios… No flatline to speak of since then, unless you count a three-hour high or low as a flatline…
In the past two weeks my blood sugar has been crazy. Constant up and down arrows, lows and highs, pump settings seem to be completely off even though I’ve been adjusting them constantly trying to get on top of things. Has this happened to anyone else? I’ve been travelling for part of that period, but that shouldn’t affect much because I bring all my own food due to food allergies and the things I do while travelling are not dissimilar to the things I do on regular work days.
I just downloaded my data and my 14-day average is 8.8 mmol/L (158 mg/dl) and standard deviation is 3.4 mmol/L (61 mg/dl) with only 38% of readings in range. This is worse than my statistics have ever been since starting the Dexcom, but I believe it based on how I’ve been constantly treating highs and lows over the past few weeks, day and night.
This is my first fall/winter with the Dexcom, and so I’m thinking that maybe something really shifts between sping/summer and fall/winter that I have to adjust for.
I no longer use the more formal protocol specified by people like Scheiner or Walsh. But my changes are usually made as slight tweaks. Like if my trends indicate my blood glucose is rising overnight, I’ll bump the appropriate basal rate by perhaps 0.1 unit/hour. I’ll do the same when I find myself increasing post meal temp basal rates to cover trending highs. I change my basal several times per month. My I:C ratio and insulin sensitivity factor might change once or twice a year.
For your case, however, where your BGs have deviated so much from past trends, I’d be tempted to run through the full basal rate test protocol. Other people have reported insulin needs changing with the seasons. You’re at a more northerly latitude. The angle of the sun could very well produce effects hard wired into our DNA over the millennia. It makes sense. Humans do respond to environmental cues. For example dawn phenomena responds to the rising sun.
Good luck! Do the experiment - it usually leads to better control. Diabetes is relentless.
Sometimes traveling can cause some stress and activity outside your “normal” routine - if you have one, LOL!
I am in the same boat as @Terry4. I will do tweaks here and there when I see a new pattern developing, but I haven’t done formal basal testing in … well … ever. My initial basal rates recommended by my pump prescribing endo were pretty spot on.
[quote=“Jen, post:310, topic:22716”]
No flatline to speak of since then, unless you count a three-hour high or low as a flatline…
[/quote] Well, yes, you might be able count them as a flatline where your bolus DIA has ended/reached a peak and your basal is holding you steady.
Since starting Dexcom, about a year ago, I quickly realized my basal rates were off and I made more significant adjustments in the first couple of months of using CGM. Since then, I have only occasionally made small tweaks in my basal rates, mainly focusing on night time. I have to admit I have not read any books about formal basal adjustment protocols - without or with CGM I have always made my own adjustments based on observed bg data.I have used temporary basal rates to deal with transient basal changes due to illness, travel or aftereffects of unusually high levels of exercise. My I:C ratio has been 1:10 for very long time. With CGM, I realized I should change my morning ratio only (which is 1:8.5 now), and I have not made any further I:C adjustments since. In general,
In general, I would not rush to make I:C or basal rate changes based on daily events. I simply correct for those with extra boluses or carb nudges as needed, and only reexamine and readjust pump settings if some new patterns emerge over longer periods of time. I have not noticed changes related to weather or season. In your case, it may indeed be a good idea to reexamine basal rates and I:C ratios. But, as always, be aware of variability due to site rotations, set issues, bubbles, bad insulin, possibly delayed effects of protein/fat, any changes in food patterns or habits, illness, etc, any of which individually or in combination can produce erratic bg outcomes.
Wow. You all adjust basal rates much less than I do. I “tweak” basal rates (and ratios to some extent) maybe once or twice a week, but I make major changes at least every two weeks or so due to hormonal shifts. Without those changes, I end up skyrocketing (as in going from spending 90% TIR to 15% TIR for a range of say 4-10) even with constant corrections, or going the opposite way and crashing for hours on end even with treatment. When I started the Dexcom I did some basal testing and changed my basal rates significantly. Since then, I’ve raised/lowered my basal rates (and ratios) every two weeks or so as above, and made some minor “tweaks” to individual segments or changed the timing of a segment, but haven’t done any additional testing.
The problem I’m having now is that I’m having significant highs and lows every day, despite having not changed anything and trying to make tweaks every day to work on it. I’m not in as good control as some here, so I have highs and lows every day as it is, but lately I’ve been having multiple lows in the 2s and spiking to the teens a couple times every day. Many of these rises and falls take place while I’m not even doing anything, like during sleep or between meals, and the changes have been extremely rapid so that even trying to pre-empt them as soon as I notice is unsuccessful.
The worst part is that having such swings is exhausting and having them continue for weeks on end is burning me out, which makes it all that much harder to deal with. The other day I actually had to turn all the alerts on my Dexcom off for about 24 hours, because between high, low, rising, and falling my Dexcom had been alarming every 30 minutes or more for the past two days, non-stop even overnight, and I just couldn’t take it.
I think I’ll have an early dinner tonight and start with trying to start getting things sorted out now that I’m back home. Being able to stay between the lines and get a good sleep would probably help me a lot in sorting the rest of the day out.
Hi @Jen, such swings can indeed be so frustrating and exhausting, especially when it is not easy to figure out what exactly may need to be adjusted or corrected. From what you are describing I think you may be trying to adjust your pump settings too often. You may also reduce carbs some, to make it easier to work through this period. I think your plan to start with looking at overnight basal rates is good.
However, before making any adjustments in pump settings, it is always good to think about some other possible root causes of the erratic bg swings: (1) is your insulin fresh, refrigerated, never frozen; (2) site rotations: I’ve had cases when an area that I thought was just fine simply no longer worked well (with erratic bg as a result) and I had to let it ‘rest’ for a longer period and move the set to other sites; (3) set type: even if you have been successfully using a particular set type for long time, the subcutaneous tissue changes over time and a different set may work better. Your doctor or pump supplier should be able to provide samples to try.
I know you have lots of experience - but I thought it would not hurt to run through some of these reminders. Hope you get all this sorted out soon
I’ve found that fasting, even missing one meal can start to quiet the volatility. I hope you catch a break soon.
Thanks for all the suggestions! I use pen cartridges as vials (and a pen as a backup), so they get rotated every few days. The swings have crossed over a change in boxes of pen cartrdiges, so I don’t think it’s that. I try to rotate my sites as much as possible between stomach, hips, arms, and legs, and the current difficulties have been while using sites in arms, stomach, and legs, so I’m also not sure it could be that, although I’ve wondered how much different absorption at different sites (irrespective of scar tissue) might affect things.
A few years ago I had major problems caused by developing allergies to the plastic cannulas in infusion sets (not the tape, the actual cannula that is inserted under the skin). I almost gave up pumping because of it. I tried several different kinds of cannula sets before switching to metal sets and finding that they worked much better with no reaction. I’ve noticed over the past few months that my body seems to be reacting more to the metal sets, especially on days I forget to take an antihistamine (which I take every day year-round due to environmental allergies). I’ve sort of been in denial and have tried to just ignore it and change sets more often (every 12-24 hours, which is what I was doing with the plastic sets before switching), but I’ve noticed the metal sets still manage to fail, regardless of which area they are in. For example, I had a set today that I’d put in yesterday stop working (it had bled, I discovered when I removed it, and I suspect insulin was leaking out in hindsight because a couple hours earlier I’d noticed a wet spot on my clothes but hadn’t clued in) which caused me to spike to 19.4 mmol/L (349 mg/dl). If I do have to switch infusion set, I’m not sure what I’d move to given my issues with plastic sets, although I’m tempted to try those again and see if my body is still reactive to them. I’m going to call Animas on Monday and talk to them about it (my endocrinologist knows, but he didn’t have many suggestions beyond trying different sets). I may try going back to MDI to see how that works, although I already know that one flat basal rate does not work for me, so I’m not sure how MDI would be.
I agree with you that the amount of carbohydrates I eat is probably part of the reason I don’t achieve as tight control as some here (though there are some here, like acidrock, who would disagree!). But that is hard because I’m allergic to about a dozen foods, which makes eating difficult even at the best of times (especially when travelling and packing lunches). Milk (including cheese) and coconut (along with some other legumes and seeds and other protein sources) are among my allergens, and I find it very hard to find recipes that don’t include one of those two things as staple ingredients. One of these days maybe I will have the time and energy to try to adapt the recipes, but I’m not an experienced cook to begin with, so after failed attempts at making a few things I gave up for the time being. I try to limit meals to about 30-45 grams of carbohydrates right now, trying to stick to foods low or moderate on the glycemic index, and try to always pre-bolus for meals. Even though I’m not eating a low carbohydrate diet, the diet I do eat is nearly identical from day to day in terms of the types of foods (since it’s so hard to find things that I actually can eat, especially packaged food) that at least that factor is held somewhat consistent.
I’m curious, are you dealing with monthly hormones (I’m sorry, I can’t tell what gender/age you are from your profile!)? From other women around my age I’ve talked to, the changes I make seem pretty consistent with the changes that they make. (I should note, I change all the basal segments up/down the same amount, so my basal profile doesn’t change, only the amount of basal insulin I’m getting. I do the same for ratios, changing them all by the same amount.) If I just let things be without ramping up my basal and other settings, which is what I used to do until I got the Dexcom, I end up running high non-stop for about two weeks out of every month, and another half a week eating non-stop to avoid lows. Adjusting my pump settings that often isn’t ideal (I find things are not exactly the same from month to month, so I can’t just have one set strategy), but at least when things were stable it helped drastically increase the amount of time I stayed in range. I feel like this response to hormonal shift, rather than anything else I’ve done since starting the Dexcom, is the reason my A1c dropped as much as it did.
Anyway, whew, didn’t mean for this to be a complain-y post (I feel like it has been). If I can find ways to adjust my pump setting less and/or eat fewer carbohydrates, I’ll definitely try to incorporate those. I find I need to “ration” the energy I put into diabetes with the energy I put into my other health conditions so that I don’t get totally burned out overall. Hopefully the basal test tonight will be a good start. My low alert just went off, so I’ll treat that, but then I have no insulin on board and no food on board from 6:30 PM onwards.
Don’t apologize for complaining,that’s what we’re all about! Well, not really but it can help you feel better and sometimes when we write rants, it sort of lays things out in such a manner that it helps clarify what’s going on, see the forest instead of the trees or whatever?
If you’re adjusting all the time, maybe it’s hard to pin down what’s going on? I do a lot of temp basals instead of corrections, or sometimes demi-corrections coupled with temp basals but I haven’t changed basals too much lately. I got out of Sugar Surfing that “straight people” are programmed with one basal rate, at least scientifically from which I interpreted that perhaps I’d used basal boosts to cover behaviors, like food, “I need more basal at lunch…” = I need to adjust my lunch ratio but I’m lazy sometimes.
The downside of that is that my programming inevitably ends up skewed towards the 5 day workweek and weekends then have these anomalies programmed in which can be interesting but cutting them out seems to have generally been helpful. I find it easier to manage ratio adjustments by simply using varied carb counting. If a sandwich “eyeballs” that it might come out a bit “heavier”, I toss in 5-10 extra G of carbs and keep an eye on it. At least in my experience, that’s not as disruptive as changing a ratio, with which I’d then be stuck? I have no clue if this is applicable to you or not but maybe dialing back the number of changes could help you find areas that need to be adjusted more accurately, smooth things out and, of course, get ready for the holidays! urp
No need to feel bad about complaining - that’s what an online forum like this is for! In fact, thanks for sharing more details - that’s how we can learn from each other.
I am male, and I have not had allergies, so I have no personal experiences I could share related to those issues. Regarding pump settings and sugar surfing, I would in general concur with the comments by @acidrock23 and @Terry4. Best luck!
Thought this was a pretty good day:
But then, look at this 2-week trend - almost 90% in-range! Just gotta nails down those outliers now…
Nice line, @Thas. The 14-day graph is even more impressive! Good work.
What outliers? I don’t see any outliers here! Great job @Thas!!
@Jen: Just on the hormonal fluctuations within each monthly cycle (for women with diabetes): definitely my experience too.
For most of my life with T1, I used contraceptive pills which actually helped me figure out a very precise set of basal profiles for three distinct phases of each cycle. During menstruation I’d need slightly less basal than my defaults; the two weeks after, I’d use the defaults; and the week right before the next period, I’d need slightly more. Worked like clockwork because the pills introduced pretty uniform levels of estrogen and progestin into my body on a predictable sliding scale over the course of 28 days.
After I got married in the middle of this year, I stopped taking the pills. My natural periods are not nearly as uniform, though I am slowly learning to get the hang of them. Since we’ve been trying to conceive, I have been learning a lot more about the natural fluctuation of the suite of reproductive hormones, which has given me some idea of how to calibrate the basal rates again. Studying your CGM records with the pattern of your cycles in mind can be quite helpful.
I never see a flat line for more than 3 to 6 hours, and I think this is the first time ever I´ve managed to stay between the lines for 24 hours. Tresholds are 3.9-7.8 mmol/L (70-140 mg/dl). This one I think is due to allergy medicin. I don´t know what I´m allergic to, but my doc gave me something to take on a daily basis and my BG-levels have never been this smooth for the last 34 years. And this is what smooth looks like to me:
Woo Hoo! Congrats!
For a long time, I wasn’t sure that I could participate in the Flat-Liners, but with the help of my CGM AND seeing the success of others here, I have increased my TIR and produced my lowest A1C ever.
Since T1 diabetes is an autoimmune disease, it makes sense that an allergy medication could help with blood glucose levels. There’s another thread active here about a study that shows identical food given to different people produces very different post-food blood sugar curves. It talks about the microbiome (our gut bacterial ecosystem). I understand that the gut microbiome determines to a large extent our immune system.
It’s wonderful that your doc prescribed this allergy med for you. Do you think s/he thought it would also help blood sugar levels?
A flatline is actually a misnomer here. We view flatlines in a more elastic way. Your line is indeed smooth! And a classic flatline. Way to go!
