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


#1029

@Thas, that is great! A 100% in range on an exercise day is especially impressive. Can’t say I’ve ever been able to do that!

My last two weeks have been great eating low-carb (<50 grams total per day) and using Fiasp. I’ve had an average of 6.6 mmol/L (119 mg/dl), standard deviation of 2.2 mmol/L (40 mg/dl), and time in range of 71%. The time in range, in particular, has improved a lot for me. I’ve recently set my Dexcom alerts to be 0.5 mmol/L away from my true range, so that I get 0.5 mmol/L warning before going high or low and can correct it, and I think that’s mostly what accounts for the increased time in range. Before, even eating low-carb, I was stuck with 50-65% in range no matter what I did. My one-month values are only slightly worse than my two-week values (and the average is the same) which is very exciting!

My highest and lowest BG during the past month still tops out my Dexcom limits—22.3 mmol/L (400 mg/dl) and 2.2 mmol/L (40 mg/dl), so my next goal will be to try to eliminate those extremes as much as possible. They are mostly caused by me deciding to “cheat” and eat carbs (though I’ve discovered that if I want to do that, I can do so relatively successfully by doubling my bolus and basal rates) and from me deciding to ignore the low alert, which I should have learned by now means I just stay low for hours and hours (my body seems to have no counterregulartory response at all).


#1030

It’s good to read that your low-carb approach combined with Fiasp has helped with your numbers. Improvement with your time in range number is impressive. It’s also nice to see your trend start to make itself felt in your longer 30-day numbers.

Are you getting two days out of your Fiasp infusion sites?


#1031

Yes, I am. :grinning: It seems that the volume of Fiasp I infuse is related to how long sites last. The few times I’ve had higher-carb foods, and therefore infused more insulin, sites get itchy/painful almost immediately and I inevitably end up changing them within 24 hours. Blood sugar control seems worse in the 24 hours after I eat something higher in carbs, too. I’m not sure if this same would be true of other insulins or not, but I don’t remember it being the case (I also didn’t eat as low-carb as I am now for such an extended time before). Interestingly, Fiasp injections seem to be more “powerful” than Fiasp through the pump, too.


#1032

I’ve observed this same thing. I’ve also noticed what I call the “24-hour echo” when I tend towards a 24-hours later repeat of a significant high or low. It’s like the initial event is stored in a short-term circadian metabolic clock.


#1033

Like @Jen I have been doing low carb and Fiasp, but I have just started this in the last couple of days. I decided to go full Bernstein but with Fiasp I decided I can eat small amounts of the so called no-no foods without too much effort so I have been keeping them in and use a max of 10-20-20 for carbs. I think I was inspired to try this by seeing some of Jen’s earlie posts about going low carb.

My big change lately has been to more carefully monitor my protien intake and do extended boluses for the protien. Fiasp really works well for this and I was not having the same success with extended boluses with Humalog. I think I getting a hang of it right now. I am also getting more exercise which is also good as everyone know :slight_smile:

I find that all of a sudden control has become so much easier and I not making many corrections.

Here is this morning, which for me is fantastic. Breakfast even featured one slice of toast (10g carb) with my eggs and lunch was a low carb wrap (which are pretty awesome) and some low carb cocolate cheesecake (even the kids love it).

Here is my 7 day average which keeps getting better.


#1034

Wow, that is incredible, @AE13! It sounds like you are doing things similar to me. I aim to keep breakfast at as close to zero carbs as I can get, and lunch and dinner at around 15 grams, plus a few 5-10 gram snacks in there. I do still eat some “high carb” fruits and veggies like berries, small apples, and carrots. I think I need to start looking into bolusing for protein, because I’ve been finding myself going high for “no reason” at times. I’m re-reading Dr. Bernstein’s book as well (read it about ten years ago and couldn’t stand it, but I’m finding it much better now that I’m open to his suggestions!).

Highs and lows continue to be a daily struggle. I just had a weird spike to 10 this afternoon despite not eating anything today except eggs about eight hours ago. Many of my highs and lows remain “mysteries” like that, that I just have to respond to as promptly as possible. I’ve started counting any commute except my morning commute as “activity” and using temporary basal rates to compensate, and also using a lot of Sugar Surfing techniques. In my opinion, the combination of low-carb/Bernstein, Sugar Surfing, testing and adjusting pump settings and figuring out what strategies work for activity (Think Like a Pancreas/Pumping Insulin), advice from Adam Brown’s book (e.g., keep meals simple rather than feeling compelled to cook a gourmet meal), and Fiasp have come together so that I have better control with this combination—and sustained control—than I ever have before. I’m very excited to see what my next A1c will be (in July), because I think it will be good, maybe even breaking into the 5s for the first time in my life.


#1035

I have, but not for that period. Here’s what’s there:


#1036

I get that, too, generally (even with Novolog and Apidra) – my weekend sites tend to need to be changed out quicker than weekday/lower-carb-day sites. This weekend was the first time I got more than 2 days from a ‘weekend site’ – but that’s only because the site was inserted on Thursday morning.


#1037

I’ve mentioned Dr. Bernstein’s book to lots of people lately - including my PCP on Friday! - yet, I neither own a copy, nor have read it. Perhaps it’s time I consider changing those two ‘conditions’ – after all, I am following a low-carb approach most of the time (though, as recommended by Dr. Brian Mowll, and Franziska Spriztler). Hm… :wink:


#1038

Good to see another xdrip and night scout user!


#1039

Good luck with breaking the 5 barrier. I am excited for my next A1C, which will be in a couple of weeks. My best ever has been a 6.0 which happened about 3 months ago. I am hoping on a high 5ish one just to prove I can do it.

When I found this site last August my A1C was 7.0 and I was at my wits end to figure out how to break into the 6’s. Up to that time I had been following all the advice I had got from the medical community I was following the “rules” and didn’t seem to be getting the recommended A1C numbers.

I got a lot of good ideas from this site and have tried them out with a lot of success as you can see
This thread was a good one because I tried to figure out what all these people were doing to get the good results and tried to pick up a few pointers from them.


#1040

Exact same boat! My best-ever A1c was 6.0 in the summer of 2015. I was hoping to break into the 5s at that point, but then other health stuff happened that threw me off-track. I’d also like to hit the 5s just to prove that I can do it, but I’d be happy with anything in the low 6s that’s maintainable. What’s really motivated me to go low-carb is that I’ll be doing an internship in the fall where I will need to be on my toes 110% of the time, and since safety is a factor, I absolutely do not want to be dealing with going low in the middle of doing somewhere that needs my full attention.


#1041

Medical professionals definitely have an important role to play. My experience has taught me, however, that advice about day to day management is not their strong suit. I know that some individual practitioners can be useful but my overall impression has been pretty dim in this area.

I’m happy to read you’ve been helped by your diabetes peers. There is no substitute for the hard-won wisdom of someone living with diabetes all day every day.


#1042

My AGP for the last 2 weeks. I am always amazed. I think I am doing not as well, then I upload my data and let Diasend do the math… and then I see things like this. I realize I’m doing okay.

Without an insulin pump I could not eliminate dawn phenomenon. Without a pump and a cgm I could not get this level of management. I have no support from friends nor family, nor much from the health care community. I don’t do what their precious guidelines suggest. I went rogue. I am self taught… and in my case, I am doing what is right for me. I’m glad places like this exist. Noone else can empathize with the work involved in achieving results like this, and the accompanying frustration. :blush:

Edit: spelling booboo


#1043

I agree with the last several comments re this group. I did exactly what @AE13 did, read the tips here and tried to apply them to myself. Before joining I had no idea a T1 could really achieve such great numbers and graphs. Course, it is a never ending job but at least now I know how to take action rather than just drift and go with the main stream.


#1044

I’m always happy to read comments like this. For someone who enjoys decent blood glucose control it’s a fine line between documenting successful techniques in a way that educates and inspires rather than discourages readers.


#1045

Plus, you write so well, too!:wink: Perfect for the of task of educating and inspiring! We all know how so easy it is to get discouraged with diabetes, too:(


#1046

So anyways… I have been having a couple of good-for-me weeks with diabetes and thought it may be interesting to compare my current 2 week performance to past performance from a random 2 week period in the past.

2 week period November 2016 - MDI Humalog + Levemir 2x per day

Last two weeks - June/July 2017 - Pump (Omnipod) + Fiasp
(with a 5 to 10 minute pre-bolus for carbs + extended bolus for 50% protein)

Red Line is 4.0 mmol/l (72 mg/dl) and Yellow line is 8 mmol/l (144 mg/dl).

I am probably eating the same amount of carbs now as I was in November (somewhere between 50g to 80g meal-carbs a day + exercise and correction carbs), but the big differences in “treatment” since November is a switch from MDI to a pump, using Fiasp, and doing an extended bolus for protein, which was made possible by now having a pump.

Changing from Levemir to the pump basal allowed me to “flatline” with my basals. With levemir there was always a time when I had either too much basal (always late afternoon) or not enough (between breakfast and lunch and after dinner). With the the adjustable basal rates on the pump I now can pretty much remain flat when I am not eating. Having good basal profile to build on help made everything else (all those ratios) easier to get in the right place.

Overall with my current practices, I seem to have gotten a much flatter line during the day and I find there are not very many corrections anymore during the day. My current problem is the evening “highs” (I use that term to mean anything over 8 mmol/l (144mg/dl) which is more of a personal goal) which have either been caused by exercise (either over correcting for lows, cutting back the basal too much), site problems, omnipod change weirdness (highs after a pod change), bad carb counting, or just life.

I had really be dithering over whether to switch to a pump, but the results show that adjustable basal rates and extend boluses for protein have been a bit help. Should have switched sooner :slight_smile:


#1047

You have some fantastic control, @AE13. Even your MDI profile looks better than my pump + Fiasp + low-carb profile! :slight_smile: I’m glad the pump was able to help you get even tighter control.


#1048

Your last 2 week AGP report, the second one, is quite an improvement over the comparison period last fall. Virtually no lows and high % TIR (time in range) 4-8 mmol/L (72-144). Time in range is king; the A1c can conceal too much – it’s not the best measure of good glycemia.

Omnipod + Fiasp looks like a winner!

Extended boluses are great for high fat meals, too. It’s a great technique, very effective and relatively easy to calibrate.